Missouri hospital association technical assistance presentation


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Missouri hospital association technical assistance presentation

  1. 1. Rural Health Information Technology Conference May 2010 Theresa Rogers Senior Vice President
  2. 2. HITECH Components <ul><li>Incentives/penalties related to Meaningful EHR Use </li></ul><ul><li>Certification and Standards </li></ul><ul><li>Regional Extension Centers </li></ul><ul><li>State Medicaid support including HIT </li></ul><ul><li>Comparative Effectiveness Research </li></ul><ul><li>Broadband Expansion and Innovation </li></ul><ul><li>Privacy and Security beyond HIPAA </li></ul><ul><li>State designated entity HIE support </li></ul>
  3. 3. CMS Proposed Rule on “Meaningful Use” <ul><li>“ Meaningful Use” Rule </li></ul><ul><li>Proposed rule published January 13, 2010 </li></ul><ul><li>Final comments received March 15, 2010 </li></ul><ul><li>Expect final rule sometime in June 2010 </li></ul><ul><li>Outlines provisions governing EHR incentive programs </li></ul><ul><li>Defines “meaningful use” </li></ul><ul><ul><li>Requires use of “certified” EHR </li></ul></ul><ul><ul><li>Requires functional measures </li></ul></ul><ul><ul><li>Requires clinical quality measures to be reported from EHR </li></ul></ul>
  4. 4. “ Meaningful Use” Vision for 2015 <ul><li>Prevention, and management, of chronic diseases </li></ul><ul><ul><li>A million heart attacks and strokes prevented </li></ul></ul><ul><ul><li>Heart disease no longer the leading cause of death in the US </li></ul></ul><ul><li>Medical errors </li></ul><ul><ul><li>50% fewer preventable medication errors </li></ul></ul><ul><li>Health disparities </li></ul><ul><ul><li>The racial/ethnic gap in diabetes control halved </li></ul></ul><ul><li>Care Coordination </li></ul><ul><ul><li>Preventable hospitalizations and re-admissions cut by 50% </li></ul></ul><ul><li>Patients and families </li></ul><ul><ul><li>All patients have access to their own health information </li></ul></ul><ul><ul><li>Patient preferences for end of life care are followed more often </li></ul></ul><ul><li>Public health </li></ul><ul><ul><li>All health departments have real-time situational awareness of outbreaks </li></ul></ul>
  5. 5. MHA Comments to CMS “Meaningful Use” <ul><li>Timeline is too aggressive and unrealistic </li></ul><ul><li>Need a glide path to achievable “meaningful use” </li></ul><ul><li>Delay automated quality reporting until EHR quality measures have been tested and validated for EHR reporting </li></ul><ul><li>As proposed wrongfully excludes too many physicians as “hospital-based” </li></ul>
  6. 6. Meaningful Use for 2011 <ul><li>For EPs </li></ul><ul><ul><li>25 Objectives and Measures </li></ul></ul><ul><ul><li>8 yes/no; 17 numerator/denominator </li></ul></ul><ul><ul><li>Clinical reporting </li></ul></ul><ul><li>Hospitals </li></ul><ul><ul><li>23 Objectives and Measures </li></ul></ul><ul><ul><li>10 yes/no; 13 numerator/denominator </li></ul></ul><ul><ul><li>Clinical reporting </li></ul></ul>
  7. 7. MHA Comments to CMS “Meaningful Use” <ul><li>Unfairly excludes critical access hospitals as “eligible” for Medicaid incentives </li></ul><ul><li>Too restrictive in what qualifies as “reasonable costs” for CAHs </li></ul><ul><li>As a plus, deems those who are “meaningful users” under Medicare to have met “meaningful use” requirements for Medicaid </li></ul><ul><li>Agree with CMS that “meaningful use” is not the appropriate tool to ensure HIPAA privacy and security compliance </li></ul>
  8. 8. Consumer Reaction to “Meaningful Use” <ul><li>Proposed rules don’t include sufficient patient privacy protections </li></ul><ul><li>Rules should ensure that consumers have control over their personal health information </li></ul>
  9. 9. Potential Incentive Dollars* – Missouri Hospitals <ul><li>Medicare </li></ul><ul><li>$369 million </li></ul><ul><li>Medicaid </li></ul><ul><li>$17 million </li></ul>*Estimated by BKD; data from Medicare cost report and HIDI 2008 data; must meet &quot;meaningful use&quot; criteria using a certified EHR to qualify for incentives; hospitals must have 10% Medicaid utilization to qualify for Medicaid incentive
  10. 10. Funding and Incentives <ul><li>Medicare Hospital Incentives Timeline </li></ul>
  11. 11. Incentive Eligibility: Medicare <ul><li>Subsection (d) hospitals </li></ul><ul><li>Critical Access Hospitals (CAH) </li></ul><ul><li>Non Hospital-based Physicians </li></ul><ul><ul><li>Doctor of Medicine, Osteopathy, Doctors of dental surgery or dental medicine, podiatry, optometry or a chiropractor </li></ul></ul>
  12. 12. PPS Hospital Incentives: Medicare <ul><li>Formula as stated in legislation </li></ul><ul><ul><li>“ Medicare Share” of “Initial Amount” multiplied by “Transition Factor” adjusted for “Charity Care” </li></ul></ul><ul><li>Based on CMC Certification Number (CCN) not TIN </li></ul><ul><li>Discharges: </li></ul><ul><ul><li>Taken from hospital FY ending prior to FY serving as payment year for preliminary payment; final payment determined using cost report for FY ending during the payment year using discharges from that reporting period </li></ul></ul>
  13. 13. CAH Incentives: Medicare <ul><li>Excluded from Medicaid payments </li></ul><ul><li>Up to four years of Medicare incentives </li></ul><ul><ul><li>“ Reasonable acquisition costs, excluding depreciation and interest expenses” for computers and associated hardware and software </li></ul></ul><ul><ul><li>“ Medicare Share” of “Reasonable Costs” and may depreciate in first year </li></ul></ul><ul><ul><li>Medicare Share bumped 20 percentage points from calculation </li></ul></ul><ul><ul><li>Subject to adjustments if not “meaningful user” by 2015 (exemptions up to 5 years) </li></ul></ul>
  14. 14. Incentive Eligibility: Medicaid <ul><li>Acute care hospitals </li></ul><ul><ul><li>Average stay < 25 days and Medicare CCN within range of 0001-0879 </li></ul></ul><ul><ul><li>10 percent Medicaid </li></ul></ul><ul><li>Children’s hospitals </li></ul><ul><li>Physicians, nurse midwives, nurse practitioners, physician assistants, dentists </li></ul>
  15. 15. Medicaid Incentives <ul><li>Needn’t demonstrate MU in first year </li></ul><ul><li>CAHs don’t qualify under proposed rule </li></ul><ul><li>EPs cannot take both incentives * </li></ul><ul><li>EP payments higher </li></ul><ul><li>Formulas very similar </li></ul><ul><li>States paid 100% providers, 90% admin cost </li></ul>* EPs and Hospitals are allowed a one time “switch” between Medicare and Medicaid programs
  16. 16. Medicare / Medicaid Differences Medicare Medicaid Implemented at federal level Voluntary State implementation MBU reductions in 2015 No fee reductions Must achieve MU in Year 1 May adopt, implement or upgrade Year 1 Up to $44,000 for EPs Up to $63,750 for EPs Common MU definition States may add requirements Last year EP may start is 2014; Last payment 2016; Penalties start 2015 Last year EP may start is 2016; Last payments in 2021 Physicians, CAHs, subsection (d) hospitals Additional EP types and three hospital types
  17. 17. MHA Outreach/Advocacy <ul><li>Issue brief(s) on rules </li></ul><ul><li>Regular MHA board agenda items </li></ul><ul><li>Newsletter updates on HIT and HIE </li></ul><ul><li>MHA HIT Advisory Committee </li></ul><ul><li>Multi-stakeholder/provider task forces </li></ul><ul><li>Educational programming/Webinars </li></ul><ul><li>Full participation in MO-HITECH work groups </li></ul><ul><li>Seat on Mo-HITECH Advisory Board </li></ul><ul><li>Seat on KCBHIE Board </li></ul><ul><li>Ongoing discussions with bordering states </li></ul>
  18. 18. Missouri HIT Assistance Center <ul><li>University of Missouri Columbia awarded REC grant for Missouri </li></ul><ul><li>Core Support - outreach and educational activities, grants and program mgmt., local workforce support, best practices </li></ul><ul><li>Direct Assistance Support - providing direct onsite technical assistance to providers </li></ul>
  19. 19. REC Priority Providers <ul><li>Individual and small group (10 or fewer prescribers) primarily focused on primary care </li></ul><ul><li>Small rural and Critical Access Hospitals </li></ul><ul><li>Community Health Centers and Rural Health Clinics; and </li></ul><ul><li>Other settings that predominantly serve uninsured, underinsured and medically underserved populations. </li></ul>
  20. 20. REC Supplemental Expansion Grant <ul><li>Two-year expansion supplement to original REC grant awards </li></ul><ul><li>Intended to ensure the provision of services to CAHs and rural hospitals </li></ul><ul><li>HIDI will be the REC partner to provide and coordinate REC services to hospitals </li></ul>
  21. 21. Potential REC Services for Small Rural and CAHs <ul><li>Outreach and Education </li></ul><ul><li>HIT Web site </li></ul><ul><li>Newsletter updates </li></ul><ul><li>Meaningful Use Summit </li></ul><ul><li>HIT Web Resources Toolkit </li></ul><ul><li>Fee-based Services through Group Purchasing Organization (GPO) </li></ul>
  22. 22. Meaningful Use Symposium August 11 – 12, 2010 <ul><li>2-day summit with concurrent sessions </li></ul><ul><ul><li>Understanding “meaningful use” basics </li></ul></ul><ul><ul><li>EHR functional requirements </li></ul></ul><ul><ul><li>Clinical reporting requirements </li></ul></ul><ul><ul><li>Incentive calculations </li></ul></ul><ul><ul><li>Understanding the vendor certification process </li></ul></ul><ul><ul><li>Working sessions with vendors and customer peers </li></ul></ul><ul><ul><li>Developing a project plan to meet “meaningful use” </li></ul></ul><ul><ul><li>Rural Assistance Center introduction </li></ul></ul><ul><ul><li>Missouri statewide HIE update </li></ul></ul>
  23. 23. H IT Web Resources Toolkit <ul><li>EHR readiness assessment – tool to learn where you are in the EHR implementation cycle </li></ul><ul><li>EHR Connector – tool to connect you to other customers using your EHR platform </li></ul><ul><li>EHR Selection basics – step-by-step guide to selection of an EHR </li></ul><ul><li>EHR evaluation tool – electronic template organizer to match EHR requirements against vendor capabilities </li></ul>
  24. 24. H IT Web Resources Toolkit <ul><li>Implementation tutorials including </li></ul><ul><ul><li>Project management – timeline, milestones, risk assessment </li></ul></ul><ul><ul><li>Stakeholder engagement </li></ul></ul><ul><ul><li>Communication plan </li></ul></ul><ul><ul><li>How to manage your vendor </li></ul></ul><ul><ul><li>Workflow redesign basics </li></ul></ul><ul><ul><li>Parallel testing </li></ul></ul><ul><ul><li>“ Go live” day management </li></ul></ul>
  25. 25. H IT Web Resources Toolkit <ul><li>Physician engagement – how to engage and secure physician buy-in </li></ul><ul><li>Security basics </li></ul><ul><li>Technical support requirements outline </li></ul>
  26. 26. Optional Discounted Fee-based Services through GPO <ul><li>Technical Assistance for </li></ul><ul><li>Vendor Selection </li></ul><ul><li>Project Management </li></ul><ul><li>Shoulder to Shoulder Implementation Management </li></ul><ul><li>Practice Workflow Redesign </li></ul><ul><li>Assistance with Interoperability and HIE </li></ul><ul><li>Implementation of Privacy & Security Best Practices </li></ul><ul><li>Technical Infrastructure Support </li></ul><ul><li>Data Center Hosting </li></ul>
  27. 27. Ready, Set, Go! <ul><li>Implement technology for the right reasons </li></ul><ul><li>Steer the organization toward that vision </li></ul><ul><li>Stay educated and be mindful of “meaningful use” requirements – develop a “meaningful use” roadmap </li></ul><ul><li>Plan for change </li></ul>
  28. 28. <ul><li>Thank you! </li></ul><ul><li>[email_address] </li></ul>