HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

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Are you having trouble navigating through the murky waters of health care legislation? Fear not! We have broken down the complexities of the HIPAAMIPPATRHCAARRAPPACA Era, provided an illustration of each initiative in action, and explained what your IT vendor should be doing to help you comply with today's health care legislation.

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HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

  1. 1. HIPAAMIPPATRHCAARRAPPACA EraConnecting the Health Care Legislation Dots
  2. 2. Wait… What?
  3. 3. A Legislation Smorgasbord• HIPAA – Health Insurance Portability & Accountability Act• MIPAA – Medicare Improvements for Patients & Providers Act• TRHCA – Tax Relief & Health Care Act• ARRA – American Recovery & Reinvestment Act• PPACA – Patient Protection & Affordable Care Act
  4. 4. HIPAA• 1996• In short, electronic transactions: 5010/ICD-10• The “5010 Rules” requiring the changeover from 4010 to 5010 transactions and from ICD- 9 to ICD-10, fall under the administrative simplification portion of HIPAA
  5. 5. MIPPA• 2008• In short, Medicare ePrescribing Program• Established the Medicare ePrescribing program that requires eligible professionals with prescriptive privileges to eRx permissible medications for Medicare Part B fee-for- service patients or suffer a payment adjustment
  6. 6. TRHCA• 2006• In short, Physician Quality Reporting System (PQRS)• Established the Physician Quality Reporting Initiative (now known as PQRS) to collect clinical data so that the government could define value and purchase value
  7. 7. ARRA• 2009• In short, Meaningful Use of certified EHRs• HITECH, which is 60 pages of ARRA, establishes the MU programs to accelerate and reward adoption of interoperable certified electronic health record technology
  8. 8. PPACA• 2010• In short, defining and purchasing value for affordable care• Seeks to reduce the number of uninsured Americans and make care affordable by defining value and purchasing value
  9. 9. What do they have in common?• All of these pieces of legislation have an increased focus on process and technology• The two major laws enacted under our current administration (ARRA and PPACA) accelerate transformation through the use of health IT
  10. 10. Is it time to retire?• Providers are utterly overwhelmed trying to figure out what systems are impacted, how to align disparate dates of compliance, design roadmaps, or even figuring out how close to retirement they are• It is nearly impossible to put all the pieces together and translate them into usable health IT workflows without a strong technology partner
  11. 11. HIPAAMIPPATRHCAARRAPPACA in Action
  12. 12. Health & HumanServicesFactory
  13. 13. Status Quo Pay-for-Service Data Provider CEHRTHealth & HumanServicesFactory
  14. 14. Status Quo Pay-for-Service Provider CEHRT DataHealth & HumanServicesFactory
  15. 15. Status Quo Pay-for-Service Provider CEHRT DataHealth & HumanServicesFactory Comparative Effectiveness Research
  16. 16. Status Quo Pay-for-Service Provider CEHRT DataHealth & HumanServicesFactory Comparative Effectiveness Guidelines Research
  17. 17. Status Quo Pay-for-Service Provider CEHRT DataHealth & HumanServicesFactory Comparative Effectiveness Guidelines Research
  18. 18. Status Quo Pay-for-Service Provider CEHRT Data Educate MeasuresHealth & Guidelines HumanServicesFactory Comparative Effectiveness Research
  19. 19. Status Quo Pay-for-Service Provider CEHRT Data Clinical Decision Educate Measures SupportHealth & Guidelines HumanServicesFactory Comparative Effectiveness Research
  20. 20. Status Quo Pay-for-Service Performance Provider CEHRT Data Provider CEHRT Data Clinical Decision Educate Measures SupportHealth & Guidelines HumanServicesFactory Comparative Effectiveness Research
  21. 21. New Status Quo Pay-for-Value Status Quo Pay-for-Service Performance Provider CEHRT Data Provider CEHRT Data Clinical Decision Educate Measures SupportHealth & Guidelines HumanServicesFactory Comparative Effectiveness Research
  22. 22. All together now! New Status Quo Pay-for-Value Status Quo Pay-for-Service Performance Provider CEHRT Data Provider CEHRT Data Clinical Decision Educate Measures SupportHealth & Guidelines HumanServicesFactory Comparative Effectiveness Research
  23. 23. New Status Quo Pay-for-Value Status Quo Pay-for-Service MIPPA - eRx Provider CEHRT Performance Data Provider CEHRT Data Clinical Decision Educate Measures SupportHealth & Guidelines HumanServicesFactory Comparative Effectiveness Research
  24. 24. New Status Quo Pay-for-Value Status Quo ARRA – Meaningful Use Pay-for-Service MIPPA - eRx Provider CEHRT Performance Data Provider CEHRT Data Clinical Decision Educate Measures SupportHealth & Guidelines HumanServicesFactory Comparative Effectiveness Research
  25. 25. New Status Quo Pay-for-Value Status Quo ARRA – Meaningful Use Pay-for-Service MIPPA - eRx Provider CEHRT Performance Data Provider CEHRT TRHCA – PQRS Data Clinical Decision Educate Measures SupportHealth & Guidelines HumanServicesFactory Comparative Effectiveness Research
  26. 26. New Status Quo Pay-for-Value Status Quo ARRA – Meaningful Use Pay-for-Service MIPPA - eRx Provider CEHRT Performance Data Provider CEHRT TRHCA – PQRS Data Clinical Decision Educate Measures SupportHealth & Guidelines HumanServicesFactory PPACA – Define “Value” Comparative Effectiveness Research
  27. 27. PPACA QuoVBM New Status – Pay-for-Value Status Quo ARRA – Meaningful Use Pay-for-Service MIPPA - eRx Provider CEHRT Performance Data Provider CEHRT TRHCA – PQRS Data Clinical Decision Educate Measures SupportHealth & Guidelines HumanServicesFactory PPACA – Define “Value” Comparative Effectiveness Research
  28. 28. PPACA QuoVBM New Status – Pay-for-Value Status Quo ARRA – Meaningful Use Pay-for-Service MIPPA - eRx Provider CEHRT Performance Data Provider CEHRT TRHCA HIPAA – ICD-10 – PQRS Data Educate Measures Clinical Decision SupportHealth & Guidelines HumanServicesFactory PPACA – Define “Value” Comparative Effectiveness Research
  29. 29. What can my IT vendor do to help?
  30. 30. How your IT Vendor Should Help• Meaningful Use and other Dashboards – MU and PQRS metrics with analytics on each provider – Facilitates quick numerators / denominators for Meaningful Use attestation – Analytics on your practice with drill-through details
  31. 31. How your IT Vendor Should Help• Patient Portal Inherent with System – If your vendor outsources its Patient Portal, you could be paying additional license or support fees – If your vendor is not equipped with a Patient Portal, you could face an additional Portal vendor and all the integration considerations that go with it
  32. 32. How your IT Vendor Should Help• Single database solution – Always use a certified, complete EHR, meaning the practice management and electronic health record are part of the same solution – A certified, quality vendor can seamlessly provide both
  33. 33. How your IT Vendor Should Help• EHR Direct PQRS – Must be certified to do EHR Direct PQRS, not beta testing
  34. 34. How your IT Vendor Should Help• Support that’s more than just a phone call (and two continents) away – Initiative toolkits for Meaningful Use, PCMH, PQRS, etc. – Consulting support with domain experts – U.S.-based staff that is well-trained, friendly and considerate of your time and needs
  35. 35. How your IT Vendor Should Help• Ongoing Client Educational Offerings – Provides free educational webinars – Offers a wealth of articles, white papers, case studies, tips and tricks to help you become more knowledgeable about the industry and your specialty – Provides CEU-approved opportunities – Consistently communicates about new features
  36. 36. How your IT Vendor Should Help• Quality Improvement Organization Alignment
  37. 37. Are you getting enough from your vendor during thisHIPAAMIPPATRHCAARRAPPACA Era of Health Care?

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