Grec Program Overview

Dominic H. Mack MD, MBA Project Director, GREC Deputy Director, National Center for Primary Care Morehouse School of Medicine [email_address] 404-756-8960 www.primarycareforall .org Georgia Regional Extension Center (GREC)

HITECH Act
Re-Establish ONC for HIT to develop rules by 2010
Savings -quality, care coordination & error reduction
Strengthening Federal privacy and security law
$20 billion
Health information technology infrastructure
60-70 Regional Extension Centers
32 centers have been awarded
Medicare and Medicaid incentives

Meaningful Use Definition & Rules
The Recovery Act specifies the following 3 components of Meaningful Use:
Use of certified EHR in a meaningful manner (ex: e-prescribing)
Use of certified EHR technology for electronic exchange of health information to improve quality of health care
Use of certified EHR technology to submit clinical quality and other measures
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Stage 1- Health Outcome Initiatives
Improving quality, safety, efficiency, and reducing health disparities
• Engage patients and families in their health care
• Improve care coordination
• Improve population and public health
• Ensure adequate privacy and security protections for personal health information

GREC Mission
GREC’s mission is to furnish assistance to help Georgia’s providers select, successfully implement, and meaningfully use certified EHR technology to improve clinical outcomes and the quality of care provided to their patients.
Vision: GREC will work collaboratively with valued partners to assure the adoption of certified EHR technology to improve the quality of health for the community while eliminating the disparate gap of healthcare throughout Georgia.

GREC Goals and Services
To use a community oriented approach to provide outreach and education to facilitate the adoption and meaningful use of EHR.
To work collaboratively with statewide partners across the 18 public health districts of GA to develop and implement programs to meet GREC objectives.
To select HIT products that meet provider’s needs and helps them to meet patient centered medical home standards .
To provide equitable group purchasing agreements for Georgia’s priority primary care providers.
To build up competent technical teams to obtain meaningful use of EHR throughout the state and grow Georgia’s HIT workforce.
To work collaboratively with State HIE (GA. DCH) to meet all meaningful use criteria.
To provide excellent quality service to our customers in order to build a national reputation as a reliable HIT resource for providers.

The following organizations, serving over 9,000 PCPs, submitted letters of partnership AmeriChoice Andrew Young School of Policy Studies GA Academy of Family Physicians GA Association for Primary Health Care GA Hospital Association GA Institute of Technology GA Chapter of the of Pediatrics GA Department of Community Health (DCH) GA DCH Office of Health Information Technology and Transparency GA State Medical Association GA State Office of Rural Health GA State Policy Institute GMCF (QIO) Greenway Medical Technologies Hispanic Health Coalition of GA Governor’s Office of Workforce Investment Kibbe Group, Founding Director of the Center for HIT for the of Family Physicians Morehouse School of Medicine Office of Sponsored Research Administration Kids Health First Pediatric , Independent Practice Association Statewide Area Health Education Centers Network The Center for Pan Asian Community Services, inc. Medical College of GA N.W. GA Healthcare Partnership Technical College System of GA (TCSG) University System of GA WellCare of GA Macon State College

Key Statewide Statistics
Map of Georgia
PCP: 15,563
Priority PCP: 8040
Total Number Served:
1608 (Yr 1) 5225 (Yr 5)
Georgia Population:
9,965,744
Total patients served (projected) : 2.8 million

Georgia Healthcare Coverage Kaiser Family State Health Facts 2007-2008 Medicaid 12.2% 1,150,800 Medicare 10.1% 958,200 Employer 54.8% 5,185,900 Individual 3.4% 325,400 Other Public 1.7% 164,300 Uninsured 17.8% 1,682,400 Total 9,467,100

Organization Chart

Statewide Organization

Pyramid of Providers

Meaningful Use Summary
EPs
25 Objectives and Measures
8 Measures require ‘Yes’ or ‘No’ as structured data
17 Measures require numerator and denominator
Eligible Hospitals and CAHs
23 Objectives and Measures
10 Measures require ‘Yes’ or ‘No’ as structured data
13 Measures require numerator and denominator
Reporting Period –90 days for first year; one year subsequently

Examples of Meaningful Use EHR criteria
Use CPOE
Implement drug-drug, drug-allergy, drug-formulary checks
Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT®
Check Insurance eligibility & submit claims electronically
Maintain active medication allergy list
Record demographics
Record and chart changes in vital signs
Record smoking status for 13 and old
Provide electronic syndromic surveillance data

Eligible Providers
Medicare FFS
Eligible professionals (EPs)
Eligible hospitals and critical access hospitals (CAHs)
Medicare Advantage
(MA)MA EPs
MA-affiliated eligible hospital
Medicaid
EPs
Eligible hospitals
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Medicaid Eligible Providers
Eligible Professionals (EPs)
Physicians (Peds have special eligibility & payment rules)
Nurse Practitioners (NPs)
Certified Nurse-Midwives (CNMs)
Dentists
Physician Assistants (FQHC or RHC that is directed by a PA)
Eligible Hospitals
Acute Care Hospitals
Children’s Hospitals

Medicare Eligible Providers
Eligible Professionals (EPs)
Doctor of Medicine or Osteopathy
Doctor of Dental Surgery or Dental Medicine
Doctor of Podiatric Medicine
Doctor of Optometry
Chiropractor
Eligible Hospitals
Acute Care Hospitals
Critical Access Hospitals (CAHs)

Hospital-based Eligible Providers
Hospital-based EPs do not qualify for Medicare EHR incentive payments
Most hospital-based EPs will not qualify for Medicaid EHR incentive payments (FQHCs will qualify)
Defined as an EP who furnishes 90% or more of their services in a hospital setting (inpatient, outpatient, or emergency room)

Eligible Providers in Medicare Advantage
MA Eligible Professionals (EPs)
Must furnish, on average, at least 20 hours/week of patient-care services and be employed by the qualifying MA organization -or-
Must be employed by, or be a partner of, an entity that through contract with the qualifying MA organization furnishes at least 80 percent of the entity’s Medicare patient care services to enrollees of the qualifying MA organization
Qualifying MA-Affiliated Eligible Hospitals
Will be paid under the Medicare Fee-for-service EHR incentive program

Minimum Medicaid pt volume threshold
30%-Physicians, Dentist, CNMs, NPs, Pas
20%-Pediatricians
10%Acute care hospitals
0%-Children’s hospitals
Or the Medicaid EP practices predominantly in an FQHC or RHC—30% needy individual patient volume threshold

Medicare Providers-Meaningful Use
Meet requirements in 2011 or 2012
$15,000 - $18,000 payments yr 1, $44,000 total by yr4
Declining payments through year 5
The later you meet requirements, the less you get
No incentives after 2016 or for first adopters after 2014
Provider payments increase 10% in HPSA
Payment reduction if not adopted by 2015
Excludes hospital based “eligible professionals”
Special rules for Medicare Advantage

Medicare First Calendar Year in which the EP receives an Incentive Payment Calendar Year 2011 2012 2013 2014 2015 & later 2011 $18,000 2012 $12,000 $18,000 2013 $8,000 $12,000 $15,000 2014 $4,000 $8,000 $12,000 $12,000 2015 $2,000 $4,000 $8,000 8,000 $0 2016 $2000 $4,000 $4,000 $0 Total $44,000 $44,000 $39,000 $24,000 $0

Medicaid Providers-Meaningful Use
The Medicaid EHR Incentive Program starts in 2011 and ends in 2021
 The latest that a Medicaid provider can initiate the program is 2016
 A Medicaid provider can initiate the program under the Adopt, Implement and Upgrade bar but in their 2ndand subsequent years, they must meet MU at the stage that is in place, per rule-making (Stage 3 by 2015).

Medicaid First Calendar Year in which the EP receives an Incentive Payment Calendar Year 2011 2012 2013 2014 2015 2016 2011 $21,250 2012 $8,500 $21,250 2013 $8,500 $8,500 $21,500 2014 $8,500 $8,500 $8,500 $21,500 2015 $8,500 $8,500 $8,500 $8,500 $21,500 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,000 2017 $8,500 $8,500 $8,500 $8,500 $8,500 2018 $8,500 $8,500 $8,500 $8,500 2019 $8,500 $8,500 $8,500 2020 $8,500 $8,500 2021 $8,500 Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750

Medicare Hospitals-Meaningful Use
“ Eligible hospitals” meet requirements in 2011
$2,000,000 base + discharge related payment
Payments reduced over 4 year period
Non-adopters received reduced payments in 2015
Critical access hospital have more generous formula

Medicaid Hospitals-Meaningful Use
Eligible hospitals, unlike EPs, may receive incentives from Medicare and Medicaid Subsection(d) hospitals, also acute care
Hospitals meeting Medicare MU requirements may be deemed for Medicaid , even if the State has an expanded (approved) definition of meaningful use
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Workforce development
Insufficient Technical Workforce
Not much education capacity around HIT
Education budget cut $1 billion
GA Economy – 10% unemployment rate
Low broadband access in rural areas
Challenges

Scaling capabilities of education system
HIT is a growing industry in GA
HIT intellectual capital in Atlanta
Large lab space
Enthusiasm of the state
Workforce development Strengths

Workforce Development
Cost of Education and training is rising
Decreasing funds for education programs
Education level in underserved communities

Threats

Workforce Development
Low technical capabilities leaves room for growth
Development of new partnerships
GA Board or Regents
Technical college System of GA (TCSG)
GAFP
GA Partnership for TeleHealth
New certification programs in education system
Growth of degreed programs
Opportunities

What is the importance of meaningful use to the primary provider?

Thank You

Grec Program Overview

by Lloyd Sirmons on Mar 14, 2011

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