The Affordable Care Act and its Impact on Health IT

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How does the Affordable Care Act impact the healthcare industry? What role does technology play in this controversial piece of legislation? Find out in this brief presentation on the health care transformation happening now in the U.S.

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The Affordable Care Act and its Impact on Health IT

  1. 1. The Affordable Care Act and its Impact on Health IT
  2. 2. 3 Health IT Themes in ACA• Enhance Quality Reporting and Measurement • Expand quality reporting (PQRS, ACO performance measures, etc.) • Improve quality of care (evidence-based guidelines, CDS) • Encourage quality through reimbursement modeling (CMMI) • Needed for reimbursement reform
  3. 3. 3 Health IT Themes in ACA• Establish Uniform Operating Rules and Standards• Promote Health IT Workforce Development Remember: The ACA ruling may impact certain funding provisions.
  4. 4. ACA and Health IT - Data• §2717 – Establishment of quality reporting for insurers o CMS is an insurer (Medicare and Medicaid), extends to private insurers o Priority given to:  Health care outcomes  Management across episodes of care / transitions of care  Use of health IT  Informed treatment decisions and shared decision- making
  5. 5. ACA and Health IT - Datao If upheld, “Preference for Clinical Care” must be defined by HHS  Use of CDS to guide “preference-sensitive” treatment choices  Drives reimbursement  Controversial for government – “My doctor should decide, not my government.”
  6. 6. ACA and Health IT - Data• §3004 and 3005 – Submission of quality measures to HHS o Affects LTC, Hospitals, Inpatient Rehab, Hospice and Cancer Hospitals• §3013 – Grant awards for purposes of developing Health IT Quality Measures o Focus on where no measures exist o Seeks to create standards for measuring population improvement o Quality Reporting becomes a broad federal initiative
  7. 7. ACA and Health IT - Data• §4302 – Federal data collection at the smallest level possible o HHS/ONC to develop national standards for data collection, interoperability and security for data management o Includes federally conducted/supported health care programs or surveys
  8. 8. ACA and Health IT - Educate• §6301 → Communication and Knowledge Transfer (ARHQ) o RFP issued for preferred vendors for Knowledge Transfer o $150M in Grant awards earmarked• §10332 → Medicare A, B, and D Claims Data o Probabilistic Matching between unrelated databases → Leveraged with ACOs o Impact Physician Compare rating website o Patient Privacy issues? → Challenged in other courts (Patient de-identified, Provider Identity intact)
  9. 9. ACA and Health IT - Educate• §10333 → Grants for Community-based Collaborative Care Networks • Example: Tele-health services• §10109 → HHS to receive input • Input from NCVHS, HIT Policy Committee, HIT Standards Committee, Standards Orgs and Stakeholders will be considered• §4103 → Annual Wellness Visit for each Medicare Patient o Increase Self-Management through use of Health IT
  10. 10. ACA and Health IT - Educate• §5405 → Primary Care Extension Programs o Education / Technical Assistance in Evidence- based Practices o HHS to consults with agencies experienced in health care / prevention, including ONC• §934 → Technical Assistance Grants o Provide education / technical assistance to health care providers o Must coordinate with RECs regarding quality improvement, reform and best practices
  11. 11. ACA and Health IT - Educate• §5604 → Grants to Community Mental Health Programs o Includes for provisions of Health IT• §6701 → Grants for LTC Facilitates for Certified EHR Technology
  12. 12. ACA and Health IT - Measure• §10305 → Public Reporting of Performance Data o Requires alignment with other Health IT efforts• §1322 → Consumer Operated and Oriented Plan (CO-OP) o Non-profit health insurance companies o CO-OP Organizations Collective Purchasing for items and services, including HIT
  13. 13. ACA and Health IT - Measure• §1323 → Community Health Insurance, or Exchanges o Use Health IT for real-time data for investigation of fraud/abuse• §2401 → Home/Community-based services and support o To help eligible patients with care such as daily living o Includes back-up systems for Continuity-of-Care
  14. 14. ACA and Health IT - Measure• §2703 → Chronic Condition Consumers receive payments o Provision for home health services o Includes use of Health IT for care management
  15. 15. ACA and Health IT – Pay-for-Value• §10410 → Grants to establish National Centers of Excellence for Depression o Includes use of EHR and Tele-Health technologies• §1311 → Reformed Provider Reimbursement – Ind. & SBA o Increased pay for best practices, evidence-based medicine and use of Health IT
  16. 16. ACA and Health IT – Pay-for-Value• §2706 → Pediatric ACO Demonstration – Incentives for Quality• §3002 → PQRS integration with MU CQMs o Establishes informal review process• §3021 → CMMI Created ($10B in funding) o Innovative payment and service delivery models o Includes ACOs and Health IT enabled networks
  17. 17. Learn more!Our website hosts a wealth of freeresources, including white papers,case studies, an industry blog, anewsletter covering current events inhealth care, tips and tricks for yourpractice, and other informative articles. www.successehs.com

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