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The Circuit EHR Presentation
 

The Circuit EHR Presentation

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Dan Falke and Jeff Burke presented Electronic Health Records, hosted by Resovit

Dan Falke and Jeff Burke presented Electronic Health Records, hosted by Resovit

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    The Circuit EHR Presentation The Circuit EHR Presentation Presentation Transcript

    • Electronic Health Records Initiative Understanding the American Recovery and Reinvestment Act and it’s Impact
    • Overview
      • The ARRA recently signed into law in February 2009 includes incentives for physician practices and hospitals to implement and demonstrate “ meaningful use ” of a qualified electronic health records system (EHR).
      • ARRA provides for significant incentives for those physicians and hospitals that are meaningful EHR users .
      • There are significant penalties for those physicians and hospitals that do not implement EHR prior to 2015.
      • Practices and hospitals that already have EHR qualify for the incentives as long as the system meets the “qualified” criteria and they can demonstrate “meaningful use”.
    • Agenda
      • Health IT Economic & Clinical Health Act (HITECH) provision of the American Recovery and Reinvestment Act (ARRA)
      • Qualified EHR
      • Meaningful Use
      • Health Information Exchange (HIE)
      • EHR Meaningful Use Incentive Programs
      • Opportunities
      • HIT Extension Centers
      • Q & A
    • ARRA and HITECH Title XIII
      • Financial Impact of ARRA
        • $47 billion for Health Information Technology
          • Expectation is that $45B will be paid to eligible professionals and hospitals in incentives
        • $2 billion allocated to the Office of the National Coordinator (ONC) for administration
        • $300,000,000 to support regional efforts toward national health information exchange (HIE) and the Regional Health Information Organizations (RHIO)
    • Title IV HITECH Medicare and Medicaid Health Information Technology
      • Incentives are available for implementation and “meaningful” use of qualified EHR systems.
      • Qualified Electronic Health Record — The term ‘qualified electronic health record’ means an electronic record of health-related information on an individual
        • includes patient demographic and clinical health information , such as medical history and problem lists
        • has the capacity—
          • to provide clinical decision support
          • to support computerized physician order entry
          • to capture and query information relevant to health care quality
          • to exchange electronic health information with, and integrate such information from other sources
    • Office of the National Coordinator (ONC)
      • Formed under the provisions of ARRA to further define key policies and regulations of the HITECH Act.
        • Define certification process of EHR’s
        • Establish Meaningful Use objectives and measures
        • Define incentive payment plans
        • Administer HITECH Act
    • Qualified EHR
    • Qualified EHR Application
      • Certification body and standards
        • ONC will certify organization to qualify EHR systems
        • Stated goal is to have more than one certified organization
      • Most recognized EHR certification body today is Certification Commission on Health Information Technology (CCHIT)
        • Established in 2004, certifying EHR systems since 2006
        • Comprehensive certification process
        • Published certification standards
        • Endorsed by AMA and many other professional organizations
    • CCHIT Certification Overview
        • Systems meets specific requirements to support specific components of the ARRA Meaningful Use criteria.
        • Modular certification allows vendors to integrate best-of-breed solutions to achieve a “meaningful use” qualifying environment.
        • Draft criteria to be published in Oct. 2009. Final in April 2010
        • System supports all functionality deemed to be necessary by CCHIT work group
        • CCHIT work groups staffed by volunteer professionals from providers, vendors, and industry experts
        • criteria available at www.cchit.org
      CCHIT ARRA Certification CCHIT Comprehensive Certification
    • CCHIT EHR Certification Categories
      • Areas
      • Ambulatory
      • Emergency Department
      • In-Patient
      • Long Term and Post Acute Care
      • Clinical Research
      • Behavioral Health
      • Cardiovascular
      • Children’s Health
      • Dermatology
      • Overall Functionality
      • Clinical Decision Support
      • Interoperability
      • Quality
      • Security
      • Privacy
      • ePrescribing
      • Health Information Exchange
      • Personal Health Record
    • Qualified EHR Applications
      • Number of CCHIT Certified EHR Applications (Comprehensive Certification)
          • Additional certifications for Cardiovascular Medicine and Children’s Health
      • Approximately 50 certification applications are currently pending.
      • Additional certification criteria evolving continuously
      8 3 20 2008 Criteria ED (new in 08) 13 Inpatient 55 Ambulatory 2007 Criteria
    • Meaningful Use
    • ARRA “Meaningful” Use?
      • shall include the use of electronic prescribing
      • electronic exchange of health information
      • clinical quality measures and such other measures
          • Secretary shall provide preference to clinical quality measures that have been endorsed the Secretary
          • Prior to any measure being selected the Secretary shall publish in the Federal Register such measure and provide for a period of public comment on such measure
          • Measures will evolve, with initial measures for 2011, and expanded measures in each of 2013 and 2015
    • ONC Meaningful Use Objectives and Measures Can be found at healthit.hhs.gov
    • “ Meaningful Use” Ascension Path
      • “ Meaningful Use” criteria are the minimum standards
      • Without reporting of meaningful use measures, providers can not qualify for incentive payments.
      Meaningful Use Ascension Path
    • Health IT Exchange
      • National Coordinator shall establish a program to facilitate and expand electronic movement and use of health information among organization according to nationally recognized standards
          • EHR information available regionally/nationally
          • Electronic Ordering and Results
          • Radiology images
          • Patient Transfers
          • ePrescribing
          • Public and Population Health Reporting
        • HL7 based transaction set likely
    • Incentives
    • Subtitle A – Medicare Incentives Incentives for Ambulatory Care Facilities
      • Incentives for implementation and “meaningful” use of EHR
        • 1 st year: $18,000
            • If the first payment year is 2013 or later, payment will be $15,000
            • Must be implemented and in use before 2015
        • 2 nd year: $12,000
        • 3 rd year: $8,000
        • 4 th year: $4,000
        • 5 th year: $2,000
        • Those engaged in Physician Quality Reporting Initiative (PQRI) and electronic prescribing can earn an additional $6,000 - $8,000 per year beginning immediately
        • Maximum payout limited to 75% of an eligible professionals Medicare billings
    • Subtitle A – Medicare Incentives Ambulatory Facility EHR Implementation Incentives Payment per "Eligible Professional"
      • Final Payment methods and timelines not yet final
        • Hospitals cannot receive first payment prior to November 2010
        • Eligible Professionals cannot receive first payment prior to January 2011
    • Subtitle A – Medicare Incentives Penalties for Non-Compliance
      • Beginning in 2015, any eligible professional who is not a meaningful user of EHR, the Medicare reimbursement for covered services will be reduced:
      95% 2019 (75% rule) 96% 2018 (75% rule) 99% 2015 98% 2016 97% 2017 Reimbursement Year
    • Subtitle A – Medicare Incentives Incentives for Acute Care Facilities
      • Annual Payment =
      • Initial Amount * Medicare Share * Transition Factor
        • Initial Amount
              • $2,000,000 plus $200 per discharge for each discharge over 1,149 and up to 23,000.
              • Initial Amount range of $2,000,000 to $6,370,200
        • Medicare Share
        • (Medicare Part A Bed Days + Medicare Advantage Bed Days)
      • (Total Bed Days * % Non-Charity Care Charges)
        • Transition Factor
              • Year : 1 Factor : 1
              • 2 ¾
              • 3 ½
              • 4 ¼
              • 5 and beyond 0
    • Subtitle A – Medicare Incentives Acute Care Facility EHR Implementation Incentives
      • A 300 bed hospital with 40% Medicare population and 4% Charity Care.
    • Subtitle A – Medicare Incentives Other Applicable Conditions
      • Eligible professional who predominantly furnish services in a health professional shortage area, the amount shall be increased by 10%.
      • If the first payment year for an eligible professional is after 2014 then the applicable amount specified for such year and any subsequent year shall be $0.
      • No incentive payment may be made in the case of a hospital-based eligible professional.
      • the Secretary shall establish rules to coordinate the incentive payments for eligible professionals furnishing covered services in more than one practice.
      • Special conditions apply to Critical Access Hospitals and Medicare Advantage (MA) hospitals.
    • Subtitle B – Medicaid Incentives
      • The term ‘Medicaid provider’ means
        • Eligible professional who has at least 30% Medicaid patient volume
        • Pediatrician who has at least 20% Medicaid patient volume
        • Eligible professional who practices predominantly in a Federally qualified health center or rural health clinic and has at least 30% “needy individuals” patient volume
        • Acute-care hospital that has at least 10% Medicaid patient volume
      • An eligible professional cannot qualify for both Medicare and Medicaid incentives.
      • A hospital can qualify for both Medicare and Medicaid incentives.
    • Subtitle B – Medicaid Incentives Incentives for Eligible Professionals
      • For each Medicaid provider, incentives not in excess of 85% of net average allowable costs for certified EHR technology and support services including maintenance and training
      • Net average allowable costs per eligible Medicaid provider not to exceed
        • $25,000 for first year’s implementation services
        • $10,000 per subsequent year, up to 5, for maintenance and support
        • Total incentive per eligible Medicaid professional is not to exceed $63,750
          • $50,000 for pediatricians with 20% Medicaid volume
    • Subtitle B – Medicaid Incentives Incentives for Acute-Care Hospitals
      • Payments to a Medicaid hospital shall not exceed:
        • the product of the overall amount expended for the EHR and the Medicaid share for that provider
          • in any year, incentive payment shall not exceed 50% of the EHR product
          • In any 2 year period, payments shall not exceed 90% of the costs of the EHR
    • Opportunity
    • EHR Market Penetration Eligible Professionals DesRoches CM et al., N Engl J Med 2008;359:50-60.
    • Market Penetration of EHR Hospitals
      • Approximately 50% have implemented, but fewer than 10% have qualified EHR and can demonstrate meaningful use.
          • 1.5% have comprehensive system across all departments
          • 10.9% have basic system
    • Barriers to Success
      • Barriers to implementation
        • cost
        • physician resistance
        • lack of confidence in HITECH provisions
        • system selection
        • availability of qualified implementation staff
        • the complexities of the ARRA law
      • Barriers to demonstration of meaningful use
        • interoperability requirements
        • availability of qualified implementation staff
        • acceptance and use by all staff
        • annual reporting requirement
    • Conclusion
      • Consultants
        • establish expertise
        • maintain product independence
        • provide selection, implementation, and training support, but focus on meaningful use
      • EHR Vendors
        • get certified
        • clearly identify your strengths and stick to them
        • commit to maintaining compliance with meaningful use criteria
        • partner with others to fill gaps
        • support interoperability
      • Hospitals
        • proceed soon, but cautiously
        • evaluate solutions and plan implementations
        • dedicate resources or hirer consultants
      • Eligible Professionals
        • don’t go it alone or rely exclusively on a vendor for direction
        • consider vendor commitment to their product and ease of integration
        • Commit the time and effort to do it right
    • Physician Attitudes
      • Massachusetts study of physicians attitudes after EHR implementation
      • Cost of implementation
      • Increased earnings potential
      • Improved productivity
      • Ability to prevent errors
      • Control of practice
      Bad Neutral Good
    • HIT Extension Centers
      • The HITECH Act authorizes resources to facilitate the adoption and use of EHRs by providing technical assistance and the capacity to exchange health information.
      • Regional Centers offer providers within their geographic service areas technical assistance in the selection, acquisition, implementation, and meaningful use of EHRs—including health information exchange (HIE).
      • Implementation and Project Management: Support end-to-end project management over the entire EHR implementation process, including individualized and on-site coaching, consultation, troubleshooting.
      • Progress Towards Meaningful Use: Participate in program training and be able to provide effective assistance in attaining meaningful use.
      • Funding of Extension Centers begins 11 Dec 2009.
    • Q & A Dan Falke [email_address] (513) 227-2740 Jeff Burke [email_address] (513) 702-6846