Impact of the Healthcare IT Stimulus Package Presented by Mark R. Anderson, FHIMSS, CPHIMS CEO, AC...

Impact of the Impact of the Healthcare IT Healthcare IT

Stimulus PackageStimulus Package

Presented byPresented by

Mark R. Anderson, FHIMSS, CPHIMSMark R. Anderson, FHIMSS, CPHIMSCEO, AC Group, Inc. CEO, AC Group, Inc.

Mark Anderson, FHIMSS, CPHIMSSMark Anderson, FHIMSS, CPHIMSSHealthcare IT FuturistHealthcare IT Futurist

CEO of AC GroupCEO of AC Group

– Conducted > 300 Technology Software Searches for Conducted > 300 Technology Software Searches for Hospital and Physician OrganizationsHospital and Physician Organizations

– National Speaker on EHR > 380 sessions since 2001National Speaker on EHR > 380 sessions since 2001

– Semi annual report on Vendor product functionality Semi annual report on Vendor product functionality and company viabilityand company viability

36+ Years In Healthcare IT36+ Years In Healthcare IT

– CIO Position at Three Multi Facility Regional IDN’sCIO Position at Three Multi Facility Regional IDN’s

– Installed over $1B in technologies since 1972Installed over $1B in technologies since 1972

– Former CIO of a 2,300+ physician (500+ Practices) Former CIO of a 2,300+ physician (500+ Practices) IPAIPA

Http://www.acgroup.orgHttp://www.acgroup.org Page No: Page No: 22

DisclosureDisclosure

Speaking at numerous professional associations Speaking at numerous professional associations and at vendor meetings and at vendor meetings (over 100/Year)(over 100/Year)

White Papers on the use of technologyWhite Papers on the use of technology

Serve on numerous conference boardsServe on numerous conference boards

EHR Search and Selections EHR Search and Selections (> 100 Practices)(> 100 Practices)

DOQ-IT and CMS EHR Selection ToolDOQ-IT and CMS EHR Selection Tool

NONO Revenue from any vendor based on any Revenue from any vendor based on any Sales or increase in RevenuesSales or increase in Revenues

The GenesisThe Genesis

EHR adoption needs a financial incentive

May, 2008May, 200866

© SFT, 2008© SFT, 2008

Health Care Drivers Health Care Drivers

US health care expenditures now exceed $2 US health care expenditures now exceed $2 trillion annually trillion annually

$6,697 per capita annually (2006)$6,697 per capita annually (2006)

47 million uninsured and growing47 million uninsured and growing

World Health Organization ranked USA World Health Organization ranked USA healthcare system at 37healthcare system at 37thth in world (2000) in world (2000)

May, 2008May, 2008 77© SFT, 2008© SFT, 2008

US Health Care CostsUS Health Care Costs Comparison Comparison

© SFT, 2008

May, 2008May, 200888

© SFT, 2008© SFT, 2008

Burden of Chronic DiseasesBurden of Chronic DiseasesHealthcare costs not evenly distributedHealthcare costs not evenly distributed– 15% of Americans have no costs annually15% of Americans have no costs annually– 10% account for 70% of costs10% account for 70% of costs– 5% account for 60% of costs5% account for 60% of costs– 1% account for 35% of costs1% account for 35% of costs

75% of total costs are from chronic diseases75% of total costs are from chronic diseases

70% of chronic disease costs are from70% of chronic disease costs are from – Diabetes mellitusDiabetes mellitus– Congestive heart failureCongestive heart failure– Coronary artery diseaseCoronary artery disease– AsthmaAsthma– DepressionDepression

May, 2008May, 2008 99© SFT, 2008© SFT, 2008

What about Quality? What about Quality? Medicare costs versus qualityMedicare costs versus quality

Hospital EMR Adoption ModelHospital EMR Adoption Model

Stage Functionality 2007 2008

Stage 7Full e-chart, Creation of CCD record, Data warehousing, outcomes reporting

0.0% 0.3%

Stage 6Physician Documentation using templates, CDSS (variance and compliance, full PACS 0.3% 0.5%

Stage 5 Closed Loop Medication 1.9% 2.5%

Stage 4 CPOE, CDSS with Clinicals protocols 2.2% 2.5%

Stage 3Clinical Documentation, Flow sheets, CDSS error checking

25.1% 35.7%

Stage 2CDR, Controlled Clinical Vocabulary, CDS, DIM

37.2% 31.4%

Stage 1 Lab, Radiology and Pharmacy Installed 14.0% 11.5%

Stage 0 Lab, Radiology and Pharmacy not Installed 19.3% 15.6%

Estimated EHR Penetration in Estimated EHR Penetration in Physician OfficesPhysician Offices

Source: AC Group Annual Survey, February 2009

Why are Practices not using what Why are Practices not using what they Purchased?they Purchased?

Source: AC Group Annual Survey of buying patternsNew England Journal of Medicine

Page No: Page No: 1414

EHR Failure rate EHR Failure rate

Through 2007, the EHR failure rate continues Through 2007, the EHR failure rate continues to increase.to increase.

When asked, “1 year of EHR installation, are When asked, “1 year of EHR installation, are you seeing 80% of your patients using the EHR you seeing 80% of your patients using the EHR for charting, ROS, HPI, Evaluation, coding, for charting, ROS, HPI, Evaluation, coding, orders and results reporting”.orders and results reporting”.

– 73% of the physicians (3,245) indicated that no, they 73% of the physicians (3,245) indicated that no, they were NOT using the EHR for 80% of their patients.were NOT using the EHR for 80% of their patients.

– Why, are 73% of the physicians NOT fully utilizing Why, are 73% of the physicians NOT fully utilizing the EHR after 1 year?the EHR after 1 year?

Stimulus ActStimulus Act

On February 17, 2009, President Barack Obama signed into law the On February 17, 2009, President Barack Obama signed into law the American Recovery & Reinvestment Act to American Recovery & Reinvestment Act to stimulatestimulate the lagging the lagging U.S. economy. U.S. economy.

Total funds allocated = Total funds allocated = $29.6B$29.6B

The health IT component of the Bill is called the Health Information The health IT component of the Bill is called the Health Information Technology for Economic and Clinical Health (HITECH) Act Technology for Economic and Clinical Health (HITECH) Act

– $19.2 $19.2 billion dollars allocated between 2009 and 2016billion dollars allocated between 2009 and 2016

– Encourage healthcare organizations to adopt and effectively Encourage healthcare organizations to adopt and effectively utilize Electronic Health Records (EHR)utilize Electronic Health Records (EHR)

– Establish health information exchange networks at a regional Establish health information exchange networks at a regional level, all while ensuring that the systems deployed protect and level, all while ensuring that the systems deployed protect and safeguard the critical patient data at the core of the system. safeguard the critical patient data at the core of the system.

HITECH FinancesHITECH Finances$2B$2B for HIT infrastructure, especially HIE for HIT infrastructure, especially HIE

$17.2B$17.2B Medicare/Medicaid incentives to doctors and hospitals Medicare/Medicaid incentives to doctors and hospitals for “meaningful” use of for “meaningful” use of certified certified HIT (net after government HIT (net after government projected savings)projected savings)

$4.7B$4.7B for the National Telecommunications and Information for the National Telecommunications and Information Administration's Broadband Technology Opportunities ProgramAdministration's Broadband Technology Opportunities Program

$2.5B$2.5B for the U.S. Department of Agriculture's Distance for the U.S. Department of Agriculture's Distance Learning, Telemedicine, and Broadband ProgramLearning, Telemedicine, and Broadband Program

$1.1B $1.1B for comparative effectiveness grants from AHRQ, NIH, for comparative effectiveness grants from AHRQ, NIH, and HHS- does automation improve careand HHS- does automation improve care

HITECH FinancesHITECH Finances

$1.5B$1.5B for the community health centers through the Health Resources and Services for the community health centers through the Health Resources and Services Administration; Administration;

$500M$500M for the Social Security Administration; for the Social Security Administration;

$85M $85M for the Indian Health Service; and for the Indian Health Service; and

$50M$50M for the Veterans Benefits Administration for the Veterans Benefits Administration

Assorted “pockets” of HIT funding in state and community funding allotments.Assorted “pockets” of HIT funding in state and community funding allotments.

$29.6B IN TOTAL (not counting local funding)$29.6B IN TOTAL (not counting local funding)

NoteNote

There is actually another $20B for Medicare IncentivesThere is actually another $20B for Medicare Incentives

The real total for Health IT is about $50 BThe real total for Health IT is about $50 B

High Level Allocation of FundsHigh Level Allocation of Funds

HITECH includes $19.2B in FundingHITECH includes $19.2B in Funding

– $2 billion $2 billion immediately to the Department of Health & immediately to the Department of Health & Human Services (HHS) Human Services (HHS)

The Office of the National Coordinator for Health IT (ONC)The Office of the National Coordinator for Health IT (ONC)

Directs creation of standards and policy committeesDirects creation of standards and policy committees

– $17.2 billion $17.2 billion that will eventually be paid to healthcare that will eventually be paid to healthcare providers who can demonstrate their use of Electronic providers who can demonstrate their use of Electronic Health Records. Health Records.

High Level Allocation of FundsHigh Level Allocation of Funds

Incentives actually total ~$34BIncentives actually total ~$34B

CBO calculationCBO calculation

The $17.2 B figure is the net expenditure The $17.2 B figure is the net expenditure after including expected savings in health after including expected savings in health care costscare costs

The Office of the National Coordinator for Health

Information Technology (ONC)

Office of National CoordinatorOffice of National Coordinator

$2 billion $2 billion immediately to the Department of Health & Human Services (HHS) immediately to the Department of Health & Human Services (HHS)

David Blumenthal, MD will head ONCDavid Blumenthal, MD will head ONC

Charged with developing a nationwide HIT infrastructure to improve quality, Charged with developing a nationwide HIT infrastructure to improve quality, reduce costs, and protect privacyreduce costs, and protect privacy

Chief Privacy Officer to be appointed by ONC within 12 monthsChief Privacy Officer to be appointed by ONC within 12 months

Federal Health IT Strategic Plan to be updated on published on a website. Federal Health IT Strategic Plan to be updated on published on a website.

Must include a plan for implementation of EHRs Must include a plan for implementation of EHRs for every patient for every patient in the US in the US by 2014by 2014

Privacy and Interoperatability standards to be set by 12/2009Privacy and Interoperatability standards to be set by 12/2009

$2 billion to HHS / ONC$2 billion to HHS / ONC

$300 million to establish more health information $300 million to establish more health information exchange exchange (HIE) (HIE) initiatives in regions and towns across initiatives in regions and towns across the country, as well as helping existing HIEs to progress the country, as well as helping existing HIEs to progress in connecting providers. in connecting providers.

$20 million allocated to ensure that $20 million allocated to ensure that standardsstandards are are consistent across products and care settings. consistent across products and care settings.

Beyond those guidelines, the Bill does not assign Beyond those guidelines, the Bill does not assign specific dollar amounts to specific programs. specific dollar amounts to specific programs.

The incoming Secretary will announce how the The incoming Secretary will announce how the remaining funds will be allocated by November 2009. remaining funds will be allocated by November 2009.

$2 billion to HHS / ONC$2 billion to HHS / ONC

Areas called out for investment include:Areas called out for investment include:

– clarifying and further developing clarifying and further developing standardsstandards related to interoperability related to interoperability

and privacy and privacy

– building infrastructure for the advances of building infrastructure for the advances of telemedicine telemedicine

– expanding health IT in expanding health IT in public health public health departments departments

– establishing a establishing a Health IT Research Center Health IT Research Center and regional Health IT and regional Health IT Extension Centers to provide information to healthcare providers on Extension Centers to provide information to healthcare providers on best practices, vendor selection, implementation, training, etc. best practices, vendor selection, implementation, training, etc.

– Funding through Funding through Federal grants Federal grants via AHRQ, HRSA, CMS and the via AHRQ, HRSA, CMS and the CDC, as well as grants to states and state-designees to be passed CDC, as well as grants to states and state-designees to be passed on to healthcare organizations needing assistance with upfront on to healthcare organizations needing assistance with upfront funding for EHRs funding for EHRs

Standards and Certification Standards and Certification

Qualified EHR technology means:Qualified EHR technology means:– EHR is certified to meet standards and EHR is certified to meet standards and

includes:includes:patient demographic and clinical health information, patient demographic and clinical health information,

medical history and problem lists, medical history and problem lists,

provides decision support for physician order entry, provides decision support for physician order entry,

capture and query healthcare quality information, capture and query healthcare quality information,

exchange electronic health information with other exchange electronic health information with other sources.sources.


The Secretary of HHS is required by the BillThe Secretary of HHS is required by the Bill

– Review all existing standards, Review all existing standards,

– Determine the initial set of standards Determine the initial set of standards

– Define “Meaningful Use” criteria Define “Meaningful Use” criteria

– Establish implementation specifications. Establish implementation specifications.

– All of this must be completed by the HIT Policy All of this must be completed by the HIT Policy Committee and HIT Standards Committee before the Committee and HIT Standards Committee before the end of 2009. end of 2009.


Adopt initial set of standards by December 31, 2009 Adopt initial set of standards by December 31, 2009

Does this mean CCHIT 2009 Certification?Does this mean CCHIT 2009 Certification?

Does not specifically state CCHITDoes not specifically state CCHIT

National Coordinator may recognize an entity – but which National Coordinator may recognize an entity – but which one?one?

NIST shall support the establishment of conformance NIST shall support the establishment of conformance testing infrastructure, in collaboration with the Certification testing infrastructure, in collaboration with the Certification program and coordination with HIT Standards Committeeprogram and coordination with HIT Standards Committee

Will CCHIT Survive?Will CCHIT Survive?CCHIT has been Federally recognized since 2006CCHIT has been Federally recognized since 2006

The organization met all contractual goals, on time/on The organization met all contractual goals, on time/on budgetbudget

Operationally successful and sustainable with high levels Operationally successful and sustainable with high levels of market acceptance – large number of EHR products of market acceptance – large number of EHR products currently certified and ‘adoption-ready’currently certified and ‘adoption-ready’

It is not practical to design, bid, and develop a credible It is not practical to design, bid, and develop a credible new certification body in 20 monthsnew certification body in 20 months

ONC has many other challenging new programs to ONC has many other challenging new programs to developdevelop

0

20

40

60

80

100

2006 2007 2008 2009 2010

Renew

New Vendors

Pass 2008

Pass 2007

Pass 2006

Page No: Page No: 3030

CCHIT Certified EHR VendorsCCHIT Certified EHR VendorsCertification is good for 3 years – but!!!!!Certification is good for 3 years – but!!!!!

As of March 20, 2009 only 50 products have passed the 2007 CCHITand 24 have passed the 2008 CCHIT Requirements

Many Vendors Pretend to be part of the Many Vendors Pretend to be part of the Marketplace Marketplace

Privacy Expansion

DefiningDefining which actions constitute a breach (including which actions constitute a breach (including some inadvertent disclosures) by some inadvertent disclosures) by 12/0912/09

Imposing Imposing restrictionsrestrictions on certain disclosures, sales, and on certain disclosures, sales, and marketing of protected health information marketing of protected health information

Requiring an accounting of disclosures to a patient upon Requiring an accounting of disclosures to a patient upon request request

Authorizing increased Authorizing increased civilcivil monetary monetary penaltiespenalties for HIPAA for HIPAA violations violations

Granting authority to Granting authority to state attorneys state attorneys general to enforce general to enforce HIPAA HIPAA

Breach NotificationBreach Notification

Establishes a federal security Establishes a federal security breach notification breach notification requirement for breach of protected health informationrequirement for breach of protected health information

Requires Requires each individual each individual be notified if their “unsecured” be notified if their “unsecured” PHI is accessed, acquired or disclosed as a result of the PHI is accessed, acquired or disclosed as a result of the breachbreach

Requires notification to Sec HHS and prominent media Requires notification to Sec HHS and prominent media outlets if more than outlets if more than 500 individuals 500 individuals impactedimpacted

Applies to PHR vendorsApplies to PHR vendors

Accounting of DisclosuresAccounting of Disclosures

Gives patients the Gives patients the right to request right to request an accounting of an accounting of disclosures of their health information made through an disclosures of their health information made through an EHREHR

– Does not state how the EHR will provide informationDoes not state how the EHR will provide information

Secretary of HHS to promulgate regulations that take Secretary of HHS to promulgate regulations that take into account the “interests of individuals” in learninginto account the “interests of individuals” in learning

– when and to whom their information is disclosed, when and to whom their information is disclosed,

– the “usefulness” of the information to the individual, andthe “usefulness” of the information to the individual, and

– the “cost burden” for such accountingthe “cost burden” for such accounting

Business AssociatesBusiness Associates

Ensures that new entities that were not contemplated Ensures that new entities that were not contemplated when HIPAA was written when HIPAA was written

– PHR vendors, PHR vendors,

– RHIOs, RHIOs,

– HIEs, etc.HIEs, etc.

Requires Business Associate contracts, and treating Requires Business Associate contracts, and treating these entities as Business Associates under HIPAAthese entities as Business Associates under HIPAA

Marketing and Sale of PHIMarketing and Sale of PHI

Provides Provides new restrictions new restrictions on marketing using PHI on marketing using PHI

Marketing Communications are not Health Care Marketing Communications are not Health Care OperationsOperations

Provides new Provides new restrictions on payment restrictions on payment for PHIfor PHI

Prohibits a CE/BA from receiving remuneration in Prohibits a CE/BA from receiving remuneration in exchange for any PHI exchange for any PHI without a valid authorization without a valid authorization from from the individual.the individual.

Enforcement/PenaltiesEnforcement/Penalties

Allows Allows criminal penalties criminal penalties to apply to individualsto apply to individuals

Provides new system of civil monetary penaltiesProvides new system of civil monetary penalties

Modifies distribution of certain civil monetary penalties Modifies distribution of certain civil monetary penalties collected collected

Requires the Secretary to provide for periodic audits of Requires the Secretary to provide for periodic audits of covered entities and business associates covered entities and business associates

Allows State Attorneys General to bring a civil action in Allows State Attorneys General to bring a civil action in federal court on behalf of the residents of their statefederal court on behalf of the residents of their state

Additional ItemsAdditional Items

Development and Routine Updating of a Development and Routine Updating of a Qualified EHR Technology Qualified EHR Technology

Study Concerning Open Source Study Concerning Open Source TechnologyTechnology

$17.2 billion in incentive payments $17.2 billion in incentive payments to physicians and hospitals to physicians and hospitals

The government is focused on two primary goals in this legislation:The government is focused on two primary goals in this legislation:

– moving moving physiciansphysicians who have been slow to adopt Electronic Health Records to a who have been slow to adopt Electronic Health Records to a computerized environment, and computerized environment, and

– ensuring that patient data ensuring that patient data no longer sits in silos no longer sits in silos within individual provider within individual provider organizations but instead of actively exchanged between healthcare organizations but instead of actively exchanged between healthcare professionals to ensure that patients are receiving informed care. professionals to ensure that patients are receiving informed care.

Therefore, the vast majority of the funds within the HITECH Act are Therefore, the vast majority of the funds within the HITECH Act are assigned to payments that will assigned to payments that will reward physicians and hospitals reward physicians and hospitals for for effectively using a robust, effectively using a robust, connected connected EHR system. EHR system.

There is a program designed for those that see large volumes of There is a program designed for those that see large volumes of Medicaid patients, and another for those that accept MedicareMedicaid patients, and another for those that accept Medicare

$17.2 B to Physicians and Hospitals $17.2 B to Physicians and Hospitals

In order to qualify for the incentive payments, In order to qualify for the incentive payments, both physicians and hospitals have to prove both physicians and hospitals have to prove three things: three things:

– 1. Use of a 1. Use of a certified certified EHR product with EHR product with ePrescribingePrescribing capability capability that meets current HHS standards. that meets current HHS standards.

– 2. 2. ConnectivityConnectivity to other providers to improve access to the full to other providers to improve access to the full view of a patient’s health history. view of a patient’s health history.

– 3. Ability to 3. Ability to reportreport on their use of the technology to HHS. on their use of the technology to HHS.

Http://www.acgroup.orgHttp://www.acgroup.org Page No: Page No: 4343

Connecting PhysiciansConnecting PhysiciansDelivers the Connected CommunityDelivers the Connected Community

In-patient Clinicals & Physician Portal

Physician Office Solutions

Broad CommunityConnectivity

PatientsPatients Payers & PBMsPayers & PBMs

Retail Retail PharmacyPharmacy

HomecareHomecareProvidersProviders

EmployersEmployers PhysiciansPhysicians

HospitalsHospitals Ancillary Ancillary DepartmentsDepartments

Providers are best positioned to lead the way to a connected care community

Connecting the CommunityConnecting the Community

Security and Access Control

Enterprise Master Patient Index

Patient Event InformationPatient Demographics, Social & Family, Clinical InformationMedication Details, Laboratory Results, Insurance Details

Pharmacy

Radiology

Hospital

Laboratory

Patient

Access Consent

Providers

Health Care Insurer

Scanned Documents Specialist Transcription

Physician Physician MedicaidMedicaid Incentives Incentives

Physicians who see more than 30% of patients Physicians who see more than 30% of patients paying with paying with MedicaidMedicaid (20% for pediatricians) are (20% for pediatricians) are eligible for payments of up to $64,000 over five eligible for payments of up to $64,000 over five years. years.

The incentives will be calculated through a The incentives will be calculated through a formula that factors in the exact Medicaid mix formula that factors in the exact Medicaid mix seen by the provider.seen by the provider.

Up to 85% of certain costs for certified EHR Up to 85% of certain costs for certified EHR technology, subject to capstechnology, subject to caps


1st year of payment capped at 1st year of payment capped at $25,000$25,000

Costs for purchase and implementation or upgrade of EHR Costs for purchase and implementation or upgrade of EHR technology and support and training services,technology and support and training services,

Engaging in efforts to adopt, implement or upgrade a certified EHR Engaging in efforts to adopt, implement or upgrade a certified EHR technology, ortechnology, or

Investment was made prior to beginning of funding period with Investment was made prior to beginning of funding period with demonstration of “meaningful use” of certified EHR technologydemonstration of “meaningful use” of certified EHR technology

Subsequent years of payment, capped at $10,000 per year, for Subsequent years of payment, capped at $10,000 per year, for costs relating to the operation, maintenance and use of certified costs relating to the operation, maintenance and use of certified EHR technologyEHR technology


First year costs must not be later than 2016First year costs must not be later than 2016

No payments made after 2021 or for more than No payments made after 2021 or for more than 5 years (Maximum incentive will be $65,000)5 years (Maximum incentive will be $65,000)

Medicaid Pediatricians are eligible for 2/3 the Medicaid Pediatricians are eligible for 2/3 the amount otherwise specifiedamount otherwise specified

Physician Physician MedicareMedicare Incentives Incentives

Physicians who do not have a large Medicaid Physicians who do not have a large Medicaid volume but do volume but do accept Medicare accept Medicare can receive up can receive up to $44,000 over the five years. to $44,000 over the five years.

Additionally, physicians operating in a "provider Additionally, physicians operating in a "provider shortage areashortage area" will be eligible for an incremental " will be eligible for an incremental increase of 10%,increase of 10%,

and those delivering care entirely in a hospital and those delivering care entirely in a hospital environment, such as anesthesiologists, environment, such as anesthesiologists, pathologists and ED physicians, are pathologists and ED physicians, are ineligible. ineligible.

Medicare Incentives for PhysiciansMedicare Incentives for Physicians

Money is available commencing in Money is available commencing in 2011 2011

Compensate “meaningful EHR users” in an amount equal to an Compensate “meaningful EHR users” in an amount equal to an additional 75% of the allowed charge for professional services additional 75% of the allowed charge for professional services furnished by physiciansfurnished by physicians

Incentives are for Incentives are for 5 years5 years, with a decreasing schedule each year, with a decreasing schedule each year

Phase down for physicians adopting after 2013Phase down for physicians adopting after 2013

Physicians whose first payment year is after Physicians whose first payment year is after 20142014 receive no receive no incentivesincentives

No incentives after 2016No incentives after 2016

Beginning 2015, reduction in Medicare reimbursements by 1 to 3 Beginning 2015, reduction in Medicare reimbursements by 1 to 3 percent each year for physicians who are percent each year for physicians who are not meaningful EHR usersnot meaningful EHR users

Medicare Incentives in $1,000’sMedicare Incentives in $1,000’s

YR c11 c12 c13 c14 c15 c16 Tot

1-4 $18 $12 $8 $4 $2 $0 $44

1-4 $18 $12 $8 $4 $2 $44

1-4 $15 $12 $8 $4 $42

2-4 $12 $8 $4 $24

No Pay

$0 $0 $0

No Pay

$0 $0

Medicare PenaltiesMedicare Penalties

1% of your Medicare fee schedule - 20151% of your Medicare fee schedule - 2015

2% of your Medicare fee schedule - 20162% of your Medicare fee schedule - 2016

3% of your Medicare fee schedule – 20173% of your Medicare fee schedule – 2017

For 2018 and beyond, if proportion of eligible For 2018 and beyond, if proportion of eligible professionals who are professionals who are meaningful users is less meaningful users is less than 75%, percentage shall increase by 1% from than 75%, percentage shall increase by 1% from percent in previous year but not be greater than 5%percent in previous year but not be greater than 5%

Meaningful Use of Certified EHR Meaningful Use of Certified EHR Technology for PhysiciansTechnology for Physicians

That the CCHIT-certified EHR should have That the CCHIT-certified EHR should have robust functionality; robust functionality;

The EHR enables the physician to The EHR enables the physician to electronically electronically exchangeexchange standardized patient summary data standardized patient summary data with clinical & administrative stakeholders; and, with clinical & administrative stakeholders; and,

The EHR equips the physician to quantify and The EHR equips the physician to quantify and report improved report improved patient safety, quality outcomes, patient safety, quality outcomes, and cost reductions. and cost reductions.

Meaningful Use of Certified EHR Meaningful Use of Certified EHR Technology for PhysiciansTechnology for Physicians

Must include a clinical data repository and CPOE supported by Must include a clinical data repository and CPOE supported by CDS. CDS.

ePrescribing technology to electronically transmit prescriptions to ePrescribing technology to electronically transmit prescriptions to pharmacies. pharmacies.

Exchange health information electronically with external entities. Exchange health information electronically with external entities.

E-submission of claims complying with HIPAA Claims Attachment E-submission of claims complying with HIPAA Claims Attachment regulationsregulations

Quality reporting metrics. Quality reporting metrics.

Meaningful Use of Certified EHR Meaningful Use of Certified EHR Quality Reporting Metrics Quality Reporting Metrics

Baseline reporting of percentage of medical orders entered Baseline reporting of percentage of medical orders entered electronically into the EHR by physicianselectronically into the EHR by physicians

Baseline electronic reporting of Joint Commission core measures Baseline electronic reporting of Joint Commission core measures

Baseline reporting of AHRQ quality outcomes Baseline reporting of AHRQ quality outcomes

Baseline reporting of National Priorities Partnership goals, convened Baseline reporting of National Priorities Partnership goals, convened by National Quality Forumby National Quality Forum

Baseline reporting of all adverse (drug) eventsBaseline reporting of all adverse (drug) events

Baseline reporting of percentage of prescriptions sent to the Baseline reporting of percentage of prescriptions sent to the pharmacy electronically upon a patient’s visit pharmacy electronically upon a patient’s visit

HospitalHospital Medicaid Medicaid IncentivesIncentives:

Category Eligibility Criteria

Non-hospitals based pediatricians (“Medicaid Pediatricians”)

At least 20% of patient volume is attributable to individuals receiving medical assistance

Other non-hospital based providers At least 30% of patient volume is attributable to individuals receiving medical assistance

Non-hospital based providers that practice predominantly in federally qualified health center or rural health clinic

At least 30% of patient volume is attributable to needy individuals (medical assistance, SCHIP assistance, uncompensated care and those charged based on a sliding scale per ability to pay)

Children’s hospitals No requirement

Acute-Care hospitals At least 10% of patient volume attributable to individuals receiving medical assistance

HospitalHospital Medicaid Medicaid IncentivesIncentives

Start of incentive payments not specified in legislative language; Start of incentive payments not specified in legislative language; probably 2011probably 2011

Must demonstrate “meaningful use” of certified EHR technology in Must demonstrate “meaningful use” of certified EHR technology in second and subsequent years of incentives. second and subsequent years of incentives.

– But standards are not set yetBut standards are not set yet

Must be established by a means Must be established by a means approved by the state approved by the state and and acceptable to HHSacceptable to HHS

Consistent with the definition used for Consistent with the definition used for Medicare incentivesMedicare incentives

No reductions No reductions in Medicaid payments for failure to demonstrate in Medicaid payments for failure to demonstrate “meaningful use”“meaningful use”

HospitalHospital Medicaid Medicaid IncentivesIncentives

Hospitals that adopt in 2017 or later are not eligible for Hospitals that adopt in 2017 or later are not eligible for any incentives any incentives

Incentives limited to 6 yearsIncentives limited to 6 years

Incentives equal the product of the overall Hospital EHR Incentives equal the product of the overall Hospital EHR Amount and the Medicaid Share for such provider Amount and the Medicaid Share for such provider (“Medicaid Incentive”)(“Medicaid Incentive”)

– What in the world does that mean?What in the world does that mean?

In any year, the total amount shall not exceed 50% of the In any year, the total amount shall not exceed 50% of the Medicaid Incentive and in any 2 year period, the total Medicaid Incentive and in any 2 year period, the total amount shall not exceed 90% of the Medicaid Incentiveamount shall not exceed 90% of the Medicaid Incentive

HospitalHospital Medicare Medicare IncentivesIncentives

Hospitals stand to make up to $11 million from incentiveHospitals stand to make up to $11 million from incentive

$2 million base payment, plus$2 million base payment, plus

$0 for first 1,149 discharges and $0 for each discharge after 23,000$0 for first 1,149 discharges and $0 for each discharge after 23,000

$200 for each discharge between the 1,150th and the 23,000th $200 for each discharge between the 1,150th and the 23,000th discharge annuallydischarge annually

Note that Note that Critical Care Hospitals Critical Care Hospitals are not eligible for the incentives are not eligible for the incentives described above; described above;

instead, they will be allowed to expense the acquisition cost of instead, they will be allowed to expense the acquisition cost of health IT in a single year up to health IT in a single year up to $1.5 million$1.5 million. .

Hospital IncentivesHospital Incentives

Fee Reductions: Fee Reductions:

– Eligible hospitals Eligible hospitals not not demonstrating meaningful EHR use by demonstrating meaningful EHR use by 20152015

– Fee schedules will Fee schedules will not increased not increased as planned as planned

– Fee schedules will be adjusted increasingly to the Fee schedules will be adjusted increasingly to the disadvantagedisadvantage of the hospital. of the hospital.

– This reduction only applies to the individual fiscal year; This reduction only applies to the individual fiscal year;

– if the hospital begins demonstrating use of an EHR the following if the hospital begins demonstrating use of an EHR the following year, their fee schedule increase will normalize. year, their fee schedule increase will normalize.


Medicare Share is a fraction:Medicare Share is a fraction:

– Numerator equals: Inpatient-bed days attributable to Part A Numerator equals: Inpatient-bed days attributable to Part A plus plus inpatient-bed days attributable to Part Cinpatient-bed days attributable to Part C

– Denominator equals: Total number of inpatient-bed days Denominator equals: Total number of inpatient-bed days times times ((a) non-charity care charges divided by (b) total amount of ((a) non-charity care charges divided by (b) total amount of charges)charges)

Critical Access Hospitals increase the Medicare Share Critical Access Hospitals increase the Medicare Share by 20 percentage points, as long as Medicare Share by 20 percentage points, as long as Medicare Share does not exceed 100%.does not exceed 100%.


““Meaningful EHR users” Meaningful EHR users”

– Hospitals that demonstrate to HHS that they are using Hospitals that demonstrate to HHS that they are using certified EHR technology in a meaningful mannercertified EHR technology in a meaningful manner

– Certified EHR technology is connected in a manner that Certified EHR technology is connected in a manner that provides for electronic exchange of health information to provides for electronic exchange of health information to improve quality of health careimprove quality of health care

– Submit information to HHS on clinical quality measuresSubmit information to HHS on clinical quality measures

– No e-prescribing requirementNo e-prescribing requirement

– CCHIT for Inpatient Systems? Which year?CCHIT for Inpatient Systems? Which year?

The Problem!!The Problem!!

Which vendor sells a hospital EMR product?Which vendor sells a hospital EMR product?– Cerner Corporation - CPSI Cerner Corporation - CPSI – Epic Systems Corporation - GE Healthcare, Epic Systems Corporation - GE Healthcare, – McKesson - MEDITECHMcKesson - MEDITECH– Siemens Medical SolutionsSiemens Medical Solutions

But no one list an EMR productBut no one list an EMR product

They list CIS, Nursing Documentation, CPOE, Lab, They list CIS, Nursing Documentation, CPOE, Lab, Pharmacy, Surgery, Radiology, etc.Pharmacy, Surgery, Radiology, etc.


FY 11 FY 12 FY 13 FY 14 FY 15 FY 16

FY 11 1.00

FY 12 0.75 1.00

FY 13 0.50 0.75 1.00

FY 14 0.25 0.50 0.75 0.75

FY 15 0.00 0.25 0.50 0.50 0.50

FY 16 0.00 0.00 0.25 0.25 0.25 0.00

FY 17 0.00 0.00 0.00 0.00 0.00 0.00

Meaningful Use of Certified EHR Meaningful Use of Certified EHR Technology forTechnology for Hospitals Hospitals

That the CCHIT-certified EHR should have That the CCHIT-certified EHR should have robust functionality; robust functionality;

The EHR enables the physician to The EHR enables the physician to electronically electronically exchangeexchange standardized patient summary data standardized patient summary data with clinical & administrative stakeholders; and, with clinical & administrative stakeholders; and,

The EHR equips the hospital to quantify and The EHR equips the hospital to quantify and report improved report improved patient safety, quality outcomes, patient safety, quality outcomes, and cost reductions. and cost reductions.

Meaningful Use of Certified EHR Meaningful Use of Certified EHR Technology for Technology for HospitalsHospitals

A hospital’s EMR infrastructure ought to include the major A hospital’s EMR infrastructure ought to include the major ancillary department information systemsancillary department information systems

– lab, pharmacy, radiology, as well as a clinical data lab, pharmacy, radiology, as well as a clinical data repository. repository.

Clinical documentation by Clinical documentation by nursesnurses and other clinicians and other clinicians such as pharmacists, but such as pharmacists, but optional for physiciansoptional for physicians. .

Such documentation is a prerequisite for effective Such documentation is a prerequisite for effective computerized practitioner order entry (CPOE). computerized practitioner order entry (CPOE).

– For example, to make effective patient care decisions, For example, to make effective patient care decisions, clinicians must have a patient’s allergies, problem list, clinicians must have a patient’s allergies, problem list, vital signs, I&Os, flow sheets, and medication list. vital signs, I&Os, flow sheets, and medication list.


A A majority of physicians majority of physicians electronically entering orders, followed in another electronically entering orders, followed in another two years by requiring all physicians to enter orders and provide clinical two years by requiring all physicians to enter orders and provide clinical documentation electronically.documentation electronically.

ePrescribing ePrescribing beyond the bounds beyond the bounds of the hospital.of the hospital.

Hospitals electronically Hospitals electronically exchanging patient summary (CCD) exchanging patient summary (CCD) information with information with external entities such as, but not limited to, other hospitals, payers, external entities such as, but not limited to, other hospitals, payers, transitional/long-term care, physician practices, patients’ personal health transitional/long-term care, physician practices, patients’ personal health record, and health information exchanges. record, and health information exchanges.

Such summary information should include demographics, allergies, Such summary information should include demographics, allergies, medication summaries, problem list, reporting of diagnostic tests, the medication summaries, problem list, reporting of diagnostic tests, the patient’s primary spoken language, race, and ethnicity. patient’s primary spoken language, race, and ethnicity.

Grant the hospital the latitude to electronically exchange information as Grant the hospital the latitude to electronically exchange information as discrete data elements or in a text document.discrete data elements or in a text document.


Demonstration of a hospital’s active process of Demonstration of a hospital’s active process of implementing EMR applications, working implementing EMR applications, working towards true interoperability. towards true interoperability. – Note that this requires no actual operational, external exchange Note that this requires no actual operational, external exchange

of health information with another entity.of health information with another entity.

E-submission of claims complying with HIPAA E-submission of claims complying with HIPAA Claims Attachment regulations.Claims Attachment regulations.

Quality reporting metricsQuality reporting metrics. .


Baseline reporting of percentage of Baseline reporting of percentage of medical orders medical orders entered electronically entered electronically into the EMR by physiciansinto the EMR by physicians

Baseline electronic reporting of Baseline electronic reporting of Joint Commission core measures Joint Commission core measures

Baseline reporting of Baseline reporting of AHRQ quality outcomes AHRQ quality outcomes

Baseline reporting of rBaseline reporting of re-admissions e-admissions within 24 hours of dischargewithin 24 hours of discharge

Baseline reporting of Baseline reporting of duplicate diagnostic duplicate diagnostic test orderstest orders

Baseline reporting of present-on-admission Baseline reporting of present-on-admission tests compliance tests compliance (i.e. MRSA, (i.e. MRSA, pneumonia)pneumonia)

Baseline reporting of Baseline reporting of medication errors medication errors

Baseline reporting of percentage of diagnostic test results and Baseline reporting of percentage of diagnostic test results and medical medical imagesimages that are electronically available to clinician’s via CDR access that are electronically available to clinician’s via CDR access

Hospital EMR Adoption ModelHospital EMR Adoption Model

Stage Functionality 2007 2008

Stage 7Full e-chart, Creation of CCD record, Data warehousing, outcomes reporting

0.0% 0.3%

Stage 6Physician Documentation using templates, CDSS (variance and compliance, full PACS 0.3% 0.5%

Stage 5 Closed Loop Medication 1.9% 2.5%

Stage 4 CPOE, CDSS with Clinicals protocols 2.2% 2.5%

Stage 3Clinical Documentation, Flow sheets, CDSS error checking

25.1% 35.7%

Stage 2CDR, Controlled Clinical Vocabulary, CDS, DIM

37.2% 31.4%

Stage 1 Lab, Radiology and Pharmacy Installed 14.0% 11.5%

Stage 0 Lab, Radiology and Pharmacy not Installed 19.3% 15.6%

Community Health Community Health Center ProgramsCenter Programs

$1.5 billion to be distributed by HRSA$1.5 billion to be distributed by HRSA

Plan is to be ready by May 2009Plan is to be ready by May 2009

Only Federally Qualified Health Centers or groups of these Only Federally Qualified Health Centers or groups of these centers are eligiblecenters are eligible

Primary Care Associations cannot apply for the money but Primary Care Associations cannot apply for the money but Health Center Controlled Networks (HCCN's) are beneficial Health Center Controlled Networks (HCCN's) are beneficial recipientsrecipients

FQHC providers- identified as physicians, physician assistants, FQHC providers- identified as physicians, physician assistants, nurse midwives, nurse practitioners and dentists- are eligible nurse midwives, nurse practitioners and dentists- are eligible for the Medicaid incentives outlined in previous slides as long for the Medicaid incentives outlined in previous slides as long that they are treating a that they are treating a minimum 30% Medicaid minimum 30% Medicaid base.base.

When Is The Right Time To Start When Is The Right Time To Start Your HIT Planning?Your HIT Planning?

NOW! NOW!

It will take you It will take you 12-18 months 12-18 months to prepare to prepare appropriatelyappropriately

If you don’t have a “certified” EHR, you need to get If you don’t have a “certified” EHR, you need to get one.one.

If you have no EHR, conduct your site analysis and If you have no EHR, conduct your site analysis and start your solution searchstart your solution search

Review 2008 certified products ~24 and the Review 2008 certified products ~24 and the 20072007 Inpatient CCHIT productsInpatient CCHIT products

Will the Stimulus Package Help?Will the Stimulus Package Help?PhysiciansPhysicians

As of August 2008, only 4% of providers are using full EHR As of August 2008, only 4% of providers are using full EHR

An additional 13% are using a partial EHR product.An additional 13% are using a partial EHR product.

Traditional EHRs require 7X more time to capture informationTraditional EHRs require 7X more time to capture information

Requires provider to change the way they provide careRequires provider to change the way they provide care

Allows documentation of 1,000’s of data elements, although less Allows documentation of 1,000’s of data elements, although less than 30 are used today.than 30 are used today.

Does not reduce duplicate data entry – Silos of InfoDoes not reduce duplicate data entry – Silos of Info

Will the Stimulus Package Help?Will the Stimulus Package Help?HospitalsHospitals

As of August 2008, As of August 2008, only 1%only 1% of hospitals are using full Inpatient of hospitals are using full Inpatient EMRs EMRs

An additional An additional 34%34% are using a are using a partial EMR partial EMR product.product.

Traditional EMRs require 7X more time to capture informationTraditional EMRs require 7X more time to capture information

Requires Physicians to change the way they provide careRequires Physicians to change the way they provide care

Allows documentation of 1,000’s of data elements, although less Allows documentation of 1,000’s of data elements, although less than 30 are used today.than 30 are used today.

Does not reduce duplicate data entry – Silos of InfoDoes not reduce duplicate data entry – Silos of Info

Need direct interface with Physicians EHR’sNeed direct interface with Physicians EHR’s

Need fully functional HIE communitiesNeed fully functional HIE communities

Take Home MessageTake Home Message

There is NO Stimulus in the Stimulus planThere is NO Stimulus in the Stimulus plan

Hospitals and Physicians have not seen the benefits or Hospitals and Physicians have not seen the benefits or “value” in changing“value” in changing

Clinical studies have show no outcomes improve by using Clinical studies have show no outcomes improve by using EHRsEHRs

EHRs Can Improve Patient Service and Provide Financial EHRs Can Improve Patient Service and Provide Financial Benefits.Benefits.

EHR Products Are Available in 5 Types. Each Type Can EHR Products Are Available in 5 Types. Each Type Can Impact What the Product Will Do for Your Organization.Impact What the Product Will Do for Your Organization.

EHR Implementation is a “Bet the Organization” Proposition EHR Implementation is a “Bet the Organization” Proposition That Requires Adequate Resources and Investments to That Requires Adequate Resources and Investments to Achieve Success. Achieve Success.

Impact of the Healthcare IT Stimulus Package Presented by Mark R. Anderson, FHIMSS, CPHIMS CEO, AC...

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