American Recovery and Reinvestment Act of 2009 HIT

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American Recovery and Reinvestment Act of 2009 Summary

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American Recovery and Reinvestment Act of 2009 HIT

  1. 1. American Recovery and Reinvestment Act of 2009 (ARRA) As of: March 13, 2009
  2. 2. Why is ARRA Important? <ul><li>It is now the Law. </li></ul><ul><li>It Will be a Major Source of HIT Funding. </li></ul><ul><li>THE Source of Major Funding for EHRs. </li></ul><ul><li>It Will Determine Who Gets What. </li></ul><ul><li>It Will Determine EHR Standards. </li></ul>
  3. 3. How Does ARRA Relate to Health Care? <ul><li>Promote Health Information Technology. </li></ul><ul><li>Improve Health Care Quality, Safety, Efficiency. </li></ul><ul><li>Improve the Quality of HIT. </li></ul><ul><li>Provide Standards: Development & Adoption of HIT. </li></ul>
  4. 4. ARRA Organization & Funding of HIT ARRA Funding: $787 Billion HIT Related Funding (~ $22 Billion?) Medicare/Medicaid $17.7 Billion (2019?) National Coordinator for HIT $2.0 Billion Regional/State Health Exchanges Mandated $300 Million Infrastructure Grants Implement/Improvements National Institute of Standards/Technology $20 Million Policy Committee Standards Committee Chief Privacy Officer. IHS: ~$85 Million HHS: ~ $2-3 Billion CHC: $1+ Billion Agriculture: 2.5 Billion Medicare Providers: Enterprise: DC-Based MDs: ~$40K Medicaid Providers: Enterprise: DC ~ $2 M Providers: ~$75K
  5. 5. Overall Funding Definitions <ul><li>Provides Medicare and Medicaid incentive payments for Critical Access Hospitals, Federally qualified health centers, rural health clinics and children’s hospitals. </li></ul>• Phases in Medicare payment penalties beginning in FY 2015 for physicians and hospitals not using EHRs. <ul><li>Heavily emphasizes EHR Integrity, Interoperability, Security, Confidentiality, Patient Notification. </li></ul><ul><li>Provides temporary bonus payments up to $6 million for individual hospitals that “meaningfully” use EHRs. Physicians are eligible for payments as well. </li></ul>
  6. 6. Salient Financial Points <ul><li>Medicaid: $ Dispersed by States, ~ $70K Incentive for Non-Hospital Based Physicians. </li></ul><ul><li>All incentives are based on meeting goals of HIT use, time related, an incorporate penalties with time. </li></ul><ul><li>Medicare: Incentives to Hospitals (2-6 Million), ~$40K to Physicians. </li></ul><ul><li>Grants/Loans for EHRs are competitive, grants for Infrastructure would be immediate. </li></ul><ul><li>Broad emphasis on funding for Underserved. </li></ul>
  7. 7. HIT Definitions <ul><li>Certified EHR Technology: Ambulatory or Hospital. </li></ul><ul><li>Enterprise Integration: “ Interoperability ” </li></ul><ul><li>Health Care Provider: Enterprise, Groups, Providers operated by or under IHS. </li></ul><ul><li>HIT: Hardware, Software, Integrated Technologies, etc. </li></ul>
  8. 8. EHR Definitions “ Qualified Electronic Health Record” <ul><li>Patient Demographics. </li></ul><ul><li>Clinical Health Information: History, Problems. </li></ul><ul><li>Has the Capacity to: </li></ul>i. Provide Clinical Decision Support. ii. Support Physician Order Entry. iii. Capture/Query Information Relevant to Health Care Quality. iv. Exchange/Integrate Information from Other Sources.
  9. 9. Office of National Coordinator of HIT <ul><li>Improve Patient Care, Safety, Security, Privacy. </li></ul><ul><li>Reducing Costs by Reducing Med Errors, Duplicate and Unnecessary Care. </li></ul><ul><li>Uses HIT to Achieve these Goals. </li></ul><ul><li>Standardizing Care Across the Health Care Continuum. </li></ul><ul><li>Producing, Testing, Deploying and Monitoring Standards as They Apply to HIT. </li></ul><ul><li>Reporting to Congress & the Public on the Progress of this Effort. </li></ul>
  10. 10. HIT Policy Committee <ul><li>Recommend Policies for HIT Plan and Infrastructure. </li></ul><ul><li>Update Policies as Required or Necessary. </li></ul><ul><li>Develop Policies that Support Developed Standards. </li></ul><ul><li>Recommend Technologies for Security, Privacy, Interoperability, Demographics, Children’s Needs. </li></ul><ul><li>Bio Surveillance, Public Health, Research, Drug Safety, Telemedicine, Home Health, Health Care Continuity. </li></ul><ul><li>“ What to Do!” </li></ul>
  11. 11. HIT Standards Committee <ul><li>Recommend Standards, Implementation Specifications, & Certification Criteria for HIT. </li></ul><ul><li>“ Harmonize” These Standards to Produce Uniformity. </li></ul><ul><li>Update and Make New Recommendations as Appropriate. </li></ul><ul><li>Pilot Testing of Standards and Implementation Specifics. </li></ul><ul><li>Serve as a Forum for Input from a Variety of Sources. </li></ul><ul><li>“ How to Do It!” </li></ul>
  12. 12. Areas Highlighted For Funding <ul><li>Immediate Funding to Strengthen HIT Infrastructure. </li></ul><ul><li>HIT Implementation Assistance: Forums, Regional Extension Centers. </li></ul><ul><li>State Grants for Planning and Implementation. </li></ul><ul><li>Competitive Grants to States and Indian Tribes for Loans. </li></ul><ul><li>Demonstration Programs to Integrate HIT into Clinical Education. </li></ul><ul><li>Information Technology Professionals in Health Care. </li></ul>
  13. 13. Medicare Incentives and Penalties: <ul><li>User Class: Year 1 Year 2 Year 3 Year 4 Year 5 </li></ul><ul><li>Physicians: $18K/$15K $12K $8K $4K $2K </li></ul><ul><li>Non User </li></ul><ul><li>Physicians: 2015:1% Dec 2016: 2% Dec 2017: 3% Dec 2017 on: 3% Dec </li></ul><ul><li>Hospital-Based Physicians are NOT included in this incentive program. </li></ul><ul><li>Hospitals: Full Incentive 25% Dec 50% Dec 75% Dec 100% Dec </li></ul><ul><li>Non User </li></ul><ul><li>Hospitals: 2015: 33% Dec 2016: 67% Dec 2017: 100% Dec </li></ul><ul><li>These decreases are in the “Market Basket Adjustments in Medicare” or in the Inflation Adjustments.. </li></ul>
  14. 14. Preliminary Calculation of ARRA Medicare Benefits <ul><li>If a hospital (>25 Beds) has the “Meaningful Use” of a “Qualified EHR” which is capable of the “Exchange of Health Care Information”, the following yearly calculation may apply: </li></ul><ul><li>($2million Incentive + Discharge Incentive) * X </li></ul><ul><li>( Part A Days + Part C Days) </li></ul><ul><li>((Total Eligible Charges/Est Total Charges) x Total Bed Days.) </li></ul><ul><li>* Incentive = $200/Discharge from 1,150 to 23,000 Hospital Discharges/Year. </li></ul><ul><li>Note: The Total incentive payments decrease by 25% in year 2, by 50% year 3, by 75% year 4, and no incentive thereafter. </li></ul>
  15. 15. Preliminary Calculation of ARRA Medicaid Benefits <ul><li>Medicaid Providers: $25,000 in year 1 for purchase and implementation of an EHR by 2016, up to $10,000/year for 5 years for maintenance. </li></ul><ul><li>Hospitals (10% Medicaid patients): Incentives similar to that of Medicare (Incentive + Discharge premium), actual payment may not exceed 50% of that amount in1year or 90% of that amount for 2 years. </li></ul><ul><li>There are no duplicate payments for certified EHR technology under Medicare and Medicaid. </li></ul>
  16. 16. Precautions: <ul><li>Too Much, Too Soon, Too Little Detail?? </li></ul><ul><li>Will No Standards Cause a Pause in the Market? </li></ul><ul><li>Will ANY of the Current EHRs Actually Qualify? </li></ul><ul><li>The Money Looks Good: Spread Over Years, with Hooks, Penalties, Time Limits, Matching Funds. </li></ul><ul><li>Is Everyone Using a “Certified EHR” by 2014 Even Possible? </li></ul><ul><li>Is Spending Money “Quickly” and “Wisely” an Oxymoron? </li></ul>
  17. 17. Recommendations: <ul><li>Be Ready for Unintended Consequences. Nimble! </li></ul><ul><li>Key Words: “Interoperability” & “Security”: Use them! </li></ul><ul><li>Stress Our “Affordability” Especially in Rural and Underserved Areas. </li></ul><ul><li>Mayhem!!! Be Secure, Confident, Competent, & Informed. Provide Shelter for our Partners. </li></ul><ul><li>Quantify Outcomes: Midland will be Key! Wyoming? </li></ul><ul><li>Broaden Our Academia Position. </li></ul><ul><li>We Should ALL Be Involved. All Can Contribute! </li></ul>

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