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MSMA Health Information Technology - PowerPoint Presentation
 

MSMA Health Information Technology - PowerPoint Presentation

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    MSMA Health Information Technology - PowerPoint Presentation MSMA Health Information Technology - PowerPoint Presentation Presentation Transcript

    • MSMA HIT for the Physician January 30, 2010 Karen Edison, MD Center for Health Policy University of Missouri, Columbia
    •  
    • “ Information is the lifeblood of modern medicine. Health information technology (HIT) is destined to be its circulatory system.” David Blumenthal, M.D., M.P.P.
    • HITECH Act – Health Information Technology for Economic and Clinical Health
        • Part ($2B) of the American Recovery and Reinvestment Act of 2009 aka “ARRA” or the “Stimulus Bill”
    • Most of the $20 Billion is for incentives for physicians
    • New programs
      • Regional Centers $673 M
      • HI exchange - states $564 M
      • Workforce training $118 M
      • Beacon communities $235 M
      • HIT research (SHARP) $60 M
      • NHIN (National HI network) &
      • Standards and certification $64 M
    • New Regulations – open for comment!
      • Meaningful use
      • Certification
    • Background Information
      • CMS released notice of proposed rulemaking on “meaningful use” of certified electronic health records on Dec. 30, 2009
      • The Office of the National Coordinator for Health Information Technology (ONC) released its complementary certification standards
        • Both rules published in Federal Register January 13, 2010.
      • ONC: interim final rule; effective date February 12, 2010, but changes are still possible.
      • Comments are strongly encouraged: Deadline March 15, 2010.
      Source: Association of American Medical Colleges & Manatt Health Solutions
    • “ Meaningful Use”
      • Using EHR technology in a meaningful manner.
      • Requires meaningful use measures to become more stringent over time.
      Source: Association of American Medical Colleges
    • Proposed Stages of Meaningful Use By Payment Year Source: Association of American Medical Colleges First Payment Year for EP Payment Year 2011 2012 2013 2014 2015+ 2011 Stage 1 Stage 1 Stage 2 Stage 2 Stage 3 2012 Stage 1 Stage 1 Stage 2 Stage 3 2013 Stage 1 Stage 2 Stage 3 2014 Stage 1 Stage 3 2015 Stage 3
    • Medicare and Medicaid Rules
      • EPs (eligible professionals) choose between Medicare & Medicaid (must be 30% of pts. except for peds who need 20%)
      • Medicare and Medicaid rules: mostly consistent
      • One-time switch no later than 2014
      Source: Association of American Medical Colleges
    • Incentives for Eligible Professionals
        • Medicare payments are available for EPs that are paid under the physician fee schedule (PFS)
        • Medicare payments will be determined on an individual-practitioner basis
        • Each year under the EHR Incentive Program, an EP will receive 75 percent of the EP’s total “allowed charges” during the Payment Year, subject to a cap.
        • The payment limit for the first year depends on when the EP begins “meaningful use” of an EHR system.
      Source: Manatt Health Solutions
    • Source: Manatt Health Solutions Adoption Year Maximum Payment PFS Penalty 2011 2012 2013 2014 2015 2016 Total 2011 $18,000 $12,00 $8,000 $4,000 $2,000 $0 $44,000 2012 $18,000 $12,000 $8,000 $4,000 $2,000 $44,000 2013 $15,000 $12,000 $8,000 $4,000 $39,000 2014 $12,00 $8,000 $4,000 $24,000 2015 $0 1% 2016 $0 2% 2017 + $0 3%
    • 3 Stages of Objectives
      • Stage 1: (details in this proposed rule)
        • Using information to track key clinical conditions and communicating that information for care coordination
        • Implementing clinical decision support tools
        • Reporting clinical quality measures and public health information
      Source: Association of American Medical Colleges
    • Stage 2 :(Proposed by end of 2011)
        • Expand stage 1 criteria to encourage using health IT for quality improvement
        • Exchange of information in most structured format possible
      Source: Association of American Medical Colleges
    • Stage 3: (Proposed by end of 2013)
        • Promote improvements in quality, safety, and efficiency
        • Decision support for national high priority conditions
        • Patient access to self-management tools
        • Access to comprehensive patient data
        • Improving population health
    • Stage 1 Highlights
      • 25 measures corresponding to Stage 1 objectives for EPs
      • Must meet all 25 measures
      • Yes/No Measures
      Source: Association of American Medical Colleges
    • Baseline Requirement 50% or more of patent encounters during the reporting period at practice(s)/location(s) equipped with certified EHR technology Source: Association of American Medical Colleges
    • Examples of Yes/No Measures
      • Implement drug-drug, drug-allergy, drug-formulary checks
      • Generated at least 1 report of patients with specific condition
      • Implement 5 clinical decision support rules
      • One test of electronic exchange of key clinical information
      Source: Association of American Medical Colleges
    • Examples of Yes/No Measures
      • One test of electronic data submission to immunization registry
      • One test of electronic syndromic surveillance data to public health agency
      • Conduct or review security risk analysis and implement security updates
      Source: Association of American Medical Colleges
      • Measures requiring a numerator and denominator
        • Higher % for criteria based on capability
        • Lower % if electronic exchange of information
    • Stage 1 Highlights
      • 25 measures corresponding to Stage 1 objectives for EPs
      • Must meet all 25 measures
      • Yes/No Measures
      Source: Association of American Medical Colleges
    • Examples of Measures Requiring a Numerator and Denominator
      • 75% of all permissible prescriptions transmitted electronically
      • 10% of all unique patients provided timely electronic access to their health information
      • 80% of all unique patients have at least one medication entry (or an indication of “none”) recorded as structured data
      Source: Association of American Medical Colleges & Manatt Health Solutions
    • Examples of Measures Requiring a Numerator and Denominator
      • 80% of all unique patients over age 12 have smoking status recorded
      • Reminder sent to 50% of all unique patients that are age 50 or older
      • 50% of clinical lab test ordered are incorporated in EHR technology
      Source: Manatt Health Solutions
    • Medicare Meaningful Use Reporting
      • How to report? Attestation through secure mechanism
      • 90 Day Reporting Periods for EPs
        • Earliest: Jan. 1, 2011-Apr. 1, 2011
        • Latest: Oct. 1, 2011-Dec. 31, 2011
      • Quality Reporting
        • 2011: Calculate and attest to results
        • 2012: Submit data through EHR
      Source: Association of American Medical Colleges
    • Incentive Payments
      • Rolling payments-90 days first year; full calendar year thereafter
      • Fee schedule reductions for EPs who do not achieve meaningful use:
        • 2015: 1%
        • 2016: 2%
        • 2017 and after: 3%
        • Exceptions for hardship on case-by-case basis for EPs practicing in rural areas with insufficient internet access and for hospital-based EPs
      Source: Association of American Medical Colleges
    • Source: Association of American Medical Colleges Medicare Medicaid Eligible professional Physician, (medicine or osteopathy), dentist, podiatrist, optometrists, chiropractor Physician, dentist, certified nurse, mid-wife, nurse practitioner, physician assistant in RHC or FQHC Max incentive amount $44,000 $63,750 Maximum amount first payment year $18,000 (2011-2012) $15,000 (2013) $12,000 (2014) $21,250 (2011-2016) To earn incentive for first payment year Must meet all meaningful use criteria Adopt, implement, or upgrade Year penalties begin 2015 No penalties Maximum number of years can receive payment 5 6
    • This is a very fluid process Your voice matters!
    • Missouri State Wide Health Information Exchange
    • State activity so far……….
      • Establish MO-HITECH
      • Establish Advisory Board
      • Convene Workgroups
      • Publish Draft Strategic Plan for Review
      • Engage and educate stakeholders
    • Current state activity and plan
      • Convene Advisory Board & Workgroups
      • Publish Draft Operational Plan for Review – mid March
      • Engage and educate stakeholders
      • Submit Operational Plan – late April
    • MO-HITECH Advisory Board
      • Co-Chairs – Ronald Levy, Director DSS & HIT Coordinator and Barrett Toan
      • Staff – George Oestreich, Charlotte Krebs & Manatt Team: Bill Bernstein, Melinda Dutton, Tim Andrews, Kier Wallis
      • Membership – 18 people from public and private sector
    • Physician members of the Advisory Board
      • Karen Edison, MD, Center for Health Policy
      • Tracy Godfrey, MD, Family Physician, Joplin
      • Ian McCaslin, MD, MO HealthNet Director
      • Tom Hale, MD, PhD, Sisters of Mercy, St. Louis
    • Workgroups
      • Governance
      • Finance
      • Technical Infrastructure
      • Business and Technical Operations
      • Legal/Policy
      • Consumer Engagement
    • Key decisions are being made NOW!
    • Missouri Health Information Technology (HIT) Assistance Center
    • Core Applicant Team
      • University of Missouri’s
        • Health Management and Informatics (HMI) Department
        • Center for Health Policy (CHP)
        • Missouri Telehealth Network (MTN)
        • Family and Community Medicine (FCM) Department
    • Key Partners
      • Primaris (Missouri’s Quality Improvement Organization)
      • Missouri Primary Care Association (MPCA)
      • Kansas City Quality Improvement Collaborative (KCQIC)
    • Mission
      • To help primary care providers and others to
        • Choose an EHR
        • Re-engineer office workflow
        • Implement an EHR and deal with vendors
        • Achieve “meaningful use”
        • Pull down incentives
    • “ Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe
    •  
    • If you are interested in the State HIE process www.dss.mo.gov/hie If you are interested in the services of the Missouri HIT Assistance Center [email_address]