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“The Medical Advantage ”                 TM



                                                A HEALTH CARE TECHNOLOGY AND TRAINING COMPANY




The Medical Advantage, Inc. formerly a certified Allscripts Reseller
EMR: Why Wait - The Time is Now!




                                   2
There is an Urgent Need


    US Healthcare Market Large And Troubled


            $2.2 Trillion Spent in Healthcare

                 $700 Billion in Waste

               1000’s of Medical Errors




3
The Opportunity

Inefficiencies: Information and Practice
   Management
•   Our healthcare system is largely a paper driven industry (similar to the way
    financial services used to be)

•   Inefficient use of staff and physician time means less profitability. practice
    management automation can help with improvements that can result in an
    increased number of patient visits and office profitability

•   Claims processing is an inefficient and manual process for many physicians
    leading to delayed payments and high cost (a measurable revenue
    enhancement opportunity resulting from more complete and automated
    information)

•   Lack of integration across physicians, hospitals, clinics, labs, pharmacies,
    and patients leads to errors and waste

•   Estimates of 20-35 million additional people will likely be in the healthcare
    system as a result of healthcare reform which makes achieving greater
    efficiency more critical
     01/15/13                              Confidential Property of The Medical Advantage and Gregory French   4
Growing pressure on reimbursements,
            you need to be more cost efficient
Physicians Working Harder




      Source: Modern Medicine




  5
Funding- HITECH Act

 $19 billion in incentives require proof of "meaningful" use
   – Allow patients to access their health records in a timely manner;
   – Develop capabilities to exchange health information where possible;
   – Implement at least one clinical decision support rule for a specialty or clinical
     priority;
   – Provide patients with electronic copies of discharge instructions and
     procedures;
   – Submit insurance claims electronically; and
   – Verify insurance eligibility electronically when possible

 Those that adopt first will benefit the most (declining
  incentives)
    Physicians can earn between $44,000 to $64,000 over five
     years from Medicare / Medicaid if they are utilizing an EHR in
   6
     2011
What You Need To Do:
     General Program Details

HITECH - The Approach




                                     Stage 3
                      Stage 2
           Stage 1


                          2013            2015
          2011
                     Exchange of        Improved
        Capture &
                     clinical data      Outcomes
        Share Data
                      (Advancement
                     of processes)
Medicaid Incentive Program




8
Who is eligible?


›   Medicare                      › Medicaid
    1. Doctor of medicine or        1. Physicians (MDs and DOs)
      osteopathy                    2. Dentists
    2. Doctor of dental surgery or 3. Certified nurse-midwives
      medicine                      4. Nurse practitioners
    3. Doctor of podiatric          5. Physician assistants
      medicine                        practicing in an FQHC or RHC
    4. Doctor of optometry            that is so led by a physician
    5. Chiropractor                   assistant

      9
“MEANINGFUL USE”

In order to qualify for the incentive payments physicians
have to demonstrate “meaningful use” of an EHR by
Proving three things:

   – Use of an EHR with ePrescribing capability that meets
     current HHS standards

   – Connectivity to other providers to improve access to the
     authorized patient health history

   – Ability to report on their use of the technology to HHS
  10
Meaningful Use
                             Stage 1 Meaningful Use Objectives
Core Objective                                                                Menu Set (Pick 5, 1 must be Pop Health)
Computerized Provider Order Entry (CPOE) for medication orders directly       Implement drug-formulary checks
entered by any licensed healthcare professional who can enter orders into
the medical record per state, local and professional guidelines

Implement drug-drug and drug-allergy checks                                   Lab results

Maintain an up-to-date problem list of current and active diagnoses           Generate lists of patient based on specific conditions to use for quality
                                                                              improvement, reduction of disparities, research or outreach.

Generate and transmit permissible prescriptions electronically (eRx)          Send reminders to patients based on patient preferences and selected by
                                                                              specific criteria

Maintain active medication list                                               Provide patients with timely electronic access to their health information
                                                                              (including lab results, problem list, medication lists, medication allergies)
                                                                              within 4 business days of the information being available to the EP

Maintain active medication allergy list                                       Provide access to patient-specific education resources upon request

Record the following demographics: preferred language, gender, race and       The EP who receives a patient from another setting of care or provider of care
ethnicity, and date of birth                                                  or believes an encounter is relevant should perform medication reconciliation

Record and chart vital signs                                                  Provide summary care record for each transition of care

Record smoking status for patients 13 and over                                Capability to submit electronic data to immunization registries

Report ambulatory clinical quality measures to CMS (or, for EPs seeking the   Capability to submit electronic syndromic surveillance data to public health
Medicaid incentive payment, the states)                                       agencies

Implement one clinical decision support rule relevant to specialty or high
clinical priority along with the ability to track compliance with that rule

Provide patients with an electronic copy of their health information

Clinical summaries provided to patients for all office visits

Capability to exchange key clinical information among providers of care and
patient authorized entities electronically

Protect Health Information
How will I submit proof & required
       reports?
     › First opportunity to actually file for the incentives
       will be April 2011
     › New web-based portal is being developed
       through which all required reports will be
       submitted
     › Note: Must keep records of all qualification &
       reports for six years following each Reporting
       Year (similar to HIPAA)




12
How will Meaningful Use be measured?

     › Two required components under HITECH statute
        ›   EHR Functional (operational) metrics
        ›   Clinical Quality Metrics

     › Can opt out of some metrics if they are irrelevant
       for your practice / patients
     › No longer any manual chart review required
       to determine if you’ve met the thresholds –
       everything can now be reported out of the
       EHR




13
What are the EHR Functional Metrics?

     › 15 Core measures
        › Required of everyone

     › 10 Menu Set measures
        › You choose five that best fit within your practice

     › Can attest that almost any of the metrics are
       irrelevant to your practice to remove it from the
       list and reduce the number of metrics you must
       report on




14
Measures of EHR Use




* See Allscripts web site for entire list
 15
Measures of EHR Use




* See Allscripts web site for entire list
 16
Measures of EHR Use




* See Allscripts web site for entire list
 17
Measures of EHR Use




* See Allscripts web site for entire list
 18
Measures of EHR Use




* See Allscripts web site for entire list
 19
Why You Should Not Wait! 

     • Too much change for your practice at
       once….more change coming 2011-2015!

        – EMR Certification and implementation
        – Continued “Meaningful Use”
          requirements
        – ANSI 5010 – This covers certain electronic 
          health care administrative transactions 
          (claims, remittances, eligibility, claim status 
          request and response).
        – ICD 10 coding enhancements are coming
        – Regulatory health care changes

20
The Path is Clear…


            “We're investing in electronic medical
            records and other technologies that can
            drive down healthcare costs.”
            - President Barack Obama



                “Cost savings from a mandatory
                requirement that Medicare providers
                adopt and use HIT as a condition of
                participating in the Medicare
                program…savings total $34 billion
                over 10 years from physicians and
                hospitals.”
            - CBO

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The Medical Advantage, Inc. - EMR & Meaningful Use

  • 1. “The Medical Advantage ” TM A HEALTH CARE TECHNOLOGY AND TRAINING COMPANY The Medical Advantage, Inc. formerly a certified Allscripts Reseller
  • 2. EMR: Why Wait - The Time is Now! 2
  • 3. There is an Urgent Need US Healthcare Market Large And Troubled $2.2 Trillion Spent in Healthcare $700 Billion in Waste 1000’s of Medical Errors 3
  • 4. The Opportunity Inefficiencies: Information and Practice Management • Our healthcare system is largely a paper driven industry (similar to the way financial services used to be) • Inefficient use of staff and physician time means less profitability. practice management automation can help with improvements that can result in an increased number of patient visits and office profitability • Claims processing is an inefficient and manual process for many physicians leading to delayed payments and high cost (a measurable revenue enhancement opportunity resulting from more complete and automated information) • Lack of integration across physicians, hospitals, clinics, labs, pharmacies, and patients leads to errors and waste • Estimates of 20-35 million additional people will likely be in the healthcare system as a result of healthcare reform which makes achieving greater efficiency more critical 01/15/13 Confidential Property of The Medical Advantage and Gregory French 4
  • 5. Growing pressure on reimbursements, you need to be more cost efficient Physicians Working Harder Source: Modern Medicine 5
  • 6. Funding- HITECH Act  $19 billion in incentives require proof of "meaningful" use – Allow patients to access their health records in a timely manner; – Develop capabilities to exchange health information where possible; – Implement at least one clinical decision support rule for a specialty or clinical priority; – Provide patients with electronic copies of discharge instructions and procedures; – Submit insurance claims electronically; and – Verify insurance eligibility electronically when possible  Those that adopt first will benefit the most (declining incentives)  Physicians can earn between $44,000 to $64,000 over five years from Medicare / Medicaid if they are utilizing an EHR in 6 2011
  • 7. What You Need To Do: General Program Details HITECH - The Approach Stage 3 Stage 2 Stage 1 2013 2015 2011 Exchange of Improved Capture & clinical data Outcomes Share Data (Advancement of processes)
  • 9. Who is eligible? › Medicare › Medicaid 1. Doctor of medicine or 1. Physicians (MDs and DOs) osteopathy 2. Dentists 2. Doctor of dental surgery or 3. Certified nurse-midwives medicine 4. Nurse practitioners 3. Doctor of podiatric 5. Physician assistants medicine practicing in an FQHC or RHC 4. Doctor of optometry that is so led by a physician 5. Chiropractor assistant 9
  • 10. “MEANINGFUL USE” In order to qualify for the incentive payments physicians have to demonstrate “meaningful use” of an EHR by Proving three things: – Use of an EHR with ePrescribing capability that meets current HHS standards – Connectivity to other providers to improve access to the authorized patient health history – Ability to report on their use of the technology to HHS 10
  • 11. Meaningful Use Stage 1 Meaningful Use Objectives Core Objective Menu Set (Pick 5, 1 must be Pop Health) Computerized Provider Order Entry (CPOE) for medication orders directly Implement drug-formulary checks entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines Implement drug-drug and drug-allergy checks Lab results Maintain an up-to-date problem list of current and active diagnoses Generate lists of patient based on specific conditions to use for quality improvement, reduction of disparities, research or outreach. Generate and transmit permissible prescriptions electronically (eRx) Send reminders to patients based on patient preferences and selected by specific criteria Maintain active medication list Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within 4 business days of the information being available to the EP Maintain active medication allergy list Provide access to patient-specific education resources upon request Record the following demographics: preferred language, gender, race and The EP who receives a patient from another setting of care or provider of care ethnicity, and date of birth or believes an encounter is relevant should perform medication reconciliation Record and chart vital signs Provide summary care record for each transition of care Record smoking status for patients 13 and over Capability to submit electronic data to immunization registries Report ambulatory clinical quality measures to CMS (or, for EPs seeking the Capability to submit electronic syndromic surveillance data to public health Medicaid incentive payment, the states) agencies Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule Provide patients with an electronic copy of their health information Clinical summaries provided to patients for all office visits Capability to exchange key clinical information among providers of care and patient authorized entities electronically Protect Health Information
  • 12. How will I submit proof & required reports? › First opportunity to actually file for the incentives will be April 2011 › New web-based portal is being developed through which all required reports will be submitted › Note: Must keep records of all qualification & reports for six years following each Reporting Year (similar to HIPAA) 12
  • 13. How will Meaningful Use be measured? › Two required components under HITECH statute › EHR Functional (operational) metrics › Clinical Quality Metrics › Can opt out of some metrics if they are irrelevant for your practice / patients › No longer any manual chart review required to determine if you’ve met the thresholds – everything can now be reported out of the EHR 13
  • 14. What are the EHR Functional Metrics? › 15 Core measures › Required of everyone › 10 Menu Set measures › You choose five that best fit within your practice › Can attest that almost any of the metrics are irrelevant to your practice to remove it from the list and reduce the number of metrics you must report on 14
  • 15. Measures of EHR Use * See Allscripts web site for entire list 15
  • 16. Measures of EHR Use * See Allscripts web site for entire list 16
  • 17. Measures of EHR Use * See Allscripts web site for entire list 17
  • 18. Measures of EHR Use * See Allscripts web site for entire list 18
  • 19. Measures of EHR Use * See Allscripts web site for entire list 19
  • 20. Why You Should Not Wait!  • Too much change for your practice at once….more change coming 2011-2015! – EMR Certification and implementation – Continued “Meaningful Use” requirements – ANSI 5010 – This covers certain electronic  health care administrative transactions  (claims, remittances, eligibility, claim status  request and response). – ICD 10 coding enhancements are coming – Regulatory health care changes 20
  • 21. The Path is Clear… “We're investing in electronic medical records and other technologies that can drive down healthcare costs.” - President Barack Obama “Cost savings from a mandatory requirement that Medicare providers adopt and use HIT as a condition of participating in the Medicare program…savings total $34 billion over 10 years from physicians and hospitals.” - CBO

Editor's Notes

  1. Funding is front-loaded: It decreases significantly every year thereafter. Meaningful Use: Steps include: evaluate your workflows, develop your selection criteria, select a vendor, develop your implementation plan, install your EHR, connect to other providers and have your physicians fully functional. A lot to do in a short period of time. Funding is Time Stamped: Penalties begin in 2015 .
  2. Two required components under HITECH statute EHR Functional (operational) metrics Clinical Quality Metrics Can opt out of some metrics if they are irrelevant for your practice / patients No longer any manual chart review required to determine if you ’ve met the thresholds – everything can now be reported out of the EHR 15 Core measures Required of everyone 10 Menu Set measures You choose five that best fit within your practice Can attest that almost any of the metrics are irrelevant to your practice to remove it from the list and reduce the number of metrics you must report on
  3. KLAS Consistent Leader 6 to 25 Physicians 100% of Clients Would Recommend Allscripts to a Friend/Colleague