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The Circuit EHR Presentation


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

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The Circuit EHR Presentation

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