The Circuit EHR Presentation
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Transcript of The Circuit EHR Presentation
Electronic Health Electronic Health Records Records InitiativeInitiative
Understanding the Understanding the
American Recovery and American Recovery and Reinvestment ActReinvestment Act
and it’s Impactand it’s Impact
OverviewOverview The ARRA recently signed into law in February The ARRA recently signed into law in February
2009 includes incentives for physician practices 2009 includes incentives for physician practices and hospitals to implement and demonstrate and hospitals to implement and demonstrate ““meaningful usemeaningful use” of a ” of a qualifiedqualified electronic health electronic health records system (EHR).records system (EHR).
ARRA provides for significant incentives for those ARRA provides for significant incentives for those physicians and hospitals that are meaningful EHR physicians and hospitals that are meaningful EHR users .users .
There are significant penalties for those physicians There are significant penalties for those physicians and hospitals that do not implement EHR prior to and hospitals that do not implement EHR prior to 2015.2015.
Practices and hospitals that already have EHR Practices and hospitals that already have EHR qualify for the incentives as long as the system qualify for the incentives as long as the system meets the “qualified” criteria and they can meets the “qualified” criteria and they can demonstrate “meaningful use”.demonstrate “meaningful use”.
AgendaAgenda Health IT Economic & Clinical Health Act Health IT Economic & Clinical Health Act
(HITECH) provision of the American (HITECH) provision of the American Recovery and Reinvestment Act (ARRA)Recovery and Reinvestment Act (ARRA)
Qualified EHRQualified EHR Meaningful UseMeaningful Use Health Information Exchange (HIE)Health Information Exchange (HIE) EHR Meaningful Use Incentive ProgramsEHR Meaningful Use Incentive Programs OpportunitiesOpportunities HIT Extension CentersHIT Extension Centers Q & AQ & A
ARRA and HITECHARRA and HITECHTitle XIIITitle XIII
Financial Impact of ARRAFinancial Impact of ARRA $47 billion for Health Information Technology
Expectation is that $45B will be paid to eligible professionals and hospitals in incentives
$2 billion allocated to the Office of the National Coordinator (ONC) for administration
$300,000,000 to support regional efforts toward national health information exchange (HIE) and the Regional Health Information Organizations (RHIO)
Title IV HITECH Title IV HITECH Medicare and Medicaid Health Medicare and Medicaid Health
Information TechnologyInformation Technology Incentives are available for implementation and
“meaningful” use of qualified EHR systems. Qualified Electronic Health Record — The term
‘qualified electronic health record’ means an electronic record of health-related information on an individual includes patient demographic and clinical health
information, such as medical history and problem lists
has the capacity— to provide clinical decision support to support computerized physician order entry to capture and query information relevant to health care
quality to exchange electronic health information with, and
integrate such information from other sources
Office of the National Office of the National Coordinator Coordinator (ONC)(ONC)
Formed under the provisions of Formed under the provisions of ARRA to further define key policies ARRA to further define key policies and regulations of the HITECH Act.and regulations of the HITECH Act. Define certification process of EHR’sDefine certification process of EHR’s Establish Meaningful Use objectives Establish Meaningful Use objectives
and measuresand measures Define incentive payment plansDefine incentive payment plans Administer HITECH ActAdminister HITECH Act
Qualified EHRQualified EHR
Qualified EHR Qualified EHR ApplicationApplication
Certification body and standardsCertification body and standards ONC will certify organization to qualify EHR systemsONC will certify organization to qualify EHR systems Stated goal is to have more than one certified Stated goal is to have more than one certified
organizationorganization Most recognized EHR certification body today is Most recognized EHR certification body today is
Certification Commission on Health Information Certification Commission on Health Information Technology (CCHIT)Technology (CCHIT) Established in 2004, certifying EHR systems since Established in 2004, certifying EHR systems since
20062006 Comprehensive certification processComprehensive certification process Published certification standardsPublished certification standards Endorsed by AMA and many other professional Endorsed by AMA and many other professional
organizationsorganizations
CCHIT Certification CCHIT Certification OverviewOverview
CCHIT CCHIT Comprehensive Comprehensive CertificationCertification
CCHIT ARRA CCHIT ARRA CertificationCertification
System supports all System supports all functionality deemed functionality deemed to be necessary by to be necessary by CCHIT work groupCCHIT work group CCHIT work groups CCHIT work groups staffed by volunteer staffed by volunteer professionals from professionals from providers, vendors, providers, vendors, and industry expertsand industry experts criteria available at criteria available at www.cchit.orgwww.cchit.org
Systems meets specific Systems meets specific requirements to support requirements to support specific components of specific components of the ARRA Meaningful Use the ARRA Meaningful Use criteria.criteria. Modular certification Modular certification allows vendors to allows vendors to integrate best-of-breed integrate best-of-breed solutions to achieve a solutions to achieve a “meaningful use” “meaningful use” qualifying environment.qualifying environment. Draft criteria to be Draft criteria to be published in Oct. 2009. published in Oct. 2009. Final in April 2010Final in April 2010
CCHIT EHR Certification CCHIT EHR Certification CategoriesCategories
AreasAreas AmbulatoryAmbulatory Emergency Emergency
DepartmentDepartment In-PatientIn-Patient Long Term and Post Long Term and Post
Acute CareAcute Care Clinical ResearchClinical Research
Behavioral HealthBehavioral Health CardiovascularCardiovascular Children’s HealthChildren’s Health DermatologyDermatology
Overall Overall FunctionalityFunctionality
Clinical Decision Clinical Decision SupportSupport
InteroperabilityInteroperability QualityQuality SecuritySecurity PrivacyPrivacy ePrescribingePrescribing Health Information Health Information
ExchangeExchange Personal Health Personal Health
RecordRecord
Qualified EHR Qualified EHR ApplicationsApplications
Number of CCHIT Certified EHR Applications Number of CCHIT Certified EHR Applications (Comprehensive Certification)(Comprehensive Certification)
20072007CriteriaCriteria
20082008CriteriaCriteria
AmbulatoryAmbulatory 5555 2020
InpatientInpatient 1313 33
ED (new in 08)ED (new in 08) 88
Additional certifications for Cardiovascular Medicine and Children’s HealthAdditional certifications for Cardiovascular Medicine and Children’s Health Approximately 50 certification applications are currently pending.Approximately 50 certification applications are currently pending. Additional certification criteria evolving continuouslyAdditional certification criteria evolving continuously
Meaningful UseMeaningful Use
ARRA “Meaningful” Use?ARRA “Meaningful” Use? shall include the use of electronic prescribing
electronic exchange of health information
clinical quality measures and such other measures
Secretary shall provide preference to clinical quality measures that have been endorsed the Secretary
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
Measures will evolve, with initial measures for 2011, and expanded measures in each of 2013 and 2015
ONC Meaningful UseONC Meaningful UseObjectives and MeasuresObjectives and Measures
Can be found at healthit.hhs.gov
““Meaningful Use” Meaningful Use” Ascension PathAscension Path
““Meaningful Use” criteria are the minimum standardsMeaningful Use” criteria are the minimum standards Without reporting of meaningful use measures, Without reporting of meaningful use measures,
providers can not qualify for incentive payments.providers can not qualify for incentive payments.
Meaningful Use Ascension Path
Health IT ExchangeHealth IT ExchangeNational Coordinator shall establish a
program to facilitate and expand electronic movement and use of health information among organization according to nationally recognized standards
EHR information available regionally/nationally Electronic Ordering and Results Radiology images Patient Transfers ePrescribing Public and Population Health Reporting
HL7 based transaction set likely
IncentivesIncentives
Subtitle A – Medicare IncentivesSubtitle A – Medicare Incentives
Incentives for Ambulatory Care Incentives for Ambulatory Care FacilitiesFacilities
Incentives for implementation and “meaningful” use of EHR 1st year: $18,000
If the first payment year is 2013 or later, payment will be $15,000
Must be implemented and in use before 2015 2nd year: $12,000 3rd year: $8,000 4th year: $4,000 5th year: $2,000
Those engaged in Physician Quality Reporting Initiative (PQRI) and electronic prescribing can earn an additional $6,000 - $8,000 per year beginning immediately
Maximum payout limited to 75% of an eligible professionals Medicare billings
Subtitle A – Medicare IncentivesSubtitle A – Medicare IncentivesAmbulatory FacilityAmbulatory Facility
EHR Implementation IncentivesEHR Implementation IncentivesPayment per "Eligible Professional"Payment per "Eligible Professional"
Final Payment methods and timelines not yet final• Hospitals cannot receive first payment prior to November 2010• Eligible Professionals cannot receive first payment prior to January 2011
Subtitle A – Medicare IncentivesSubtitle A – Medicare Incentives
Penalties for Non-Penalties for Non-ComplianceCompliance
Beginning in 2015, any eligible professional who is not a meaningful user of EHR, the Medicare reimbursement for covered services will be reduced:
YearYear Reimbursement Reimbursement
20152015 99%99%
20162016 98%98%
20172017 97% 97%
2018 2018 (75% rule)(75% rule) 96%96%
20192019 (75% rule) (75% rule) 95%95%
Subtitle A – Medicare IncentivesSubtitle A – Medicare Incentives
Incentives for Acute Care Facilities Annual Payment =
Initial Amount * Medicare Share * Transition Factor
Initial Amount $2,000,000 plus $200 per discharge for each
discharge over 1,149 and up to 23,000. Initial Amount range of $2,000,000 to $6,370,200
Medicare Share(Medicare Part A Bed Days + Medicare Advantage Bed Days)
(Total Bed Days * % Non-Charity Care Charges)
Transition FactorYear : 1 Factor :
12 ¾3 ½4 ¼5 and beyond 0
Subtitle A – Medicare IncentivesSubtitle A – Medicare IncentivesAcute Care FacilityAcute Care Facility
EHR Implementation IncentivesEHR Implementation Incentives
•A 300 bed hospital with 40% Medicare population and 4% Charity Care.
Subtitle A – Medicare IncentivesSubtitle A – Medicare Incentives
Other Applicable ConditionsOther Applicable Conditions Eligible professional who predominantly furnish
services in a health professional shortage area, the amount shall be increased by 10%.
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.
No incentive payment may be made in the case of a hospital-based eligible professional.
the Secretary shall establish rules to coordinate the incentive payments for eligible professionals furnishing covered services in more than one practice.
Special conditions apply to Critical Access Hospitals and Medicare Advantage (MA) hospitals.
Subtitle B – Medicaid Subtitle B – Medicaid IncentivesIncentives
The term ‘Medicaid provider’ means Eligible professional who has at least 30% Medicaid
patient volume Pediatrician who has at least 20% Medicaid patient
volume Eligible professional who practices predominantly in
a Federally qualified health center or rural health clinic and has at least 30% “needy individuals” patient volume
Acute-care hospital that has at least 10% Medicaid patient volume
An eligible professional cannot qualify for both Medicare and Medicaid incentives.
A hospital can qualify for both Medicare and Medicaid incentives.
Subtitle B – Medicaid IncentivesSubtitle B – Medicaid Incentives
Incentives for Eligible Incentives for Eligible ProfessionalsProfessionals
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
Net average allowable costs per eligible Medicaid provider not to exceed $25,000 for first year’s implementation services $10,000 per subsequent year, up to 5, for
maintenance and support Total incentive per eligible Medicaid
professional is not to exceed $63,750 $50,000 for pediatricians with 20% Medicaid volume
Subtitle B – Medicaid IncentivesSubtitle B – Medicaid Incentives
Incentives for Acute-Care Incentives for Acute-Care HospitalsHospitals
Payments to a Medicaid hospital shall not exceed: the product of the overall amount
expended for the EHR and the Medicaid share for that provider
in any year, incentive payment shall not exceed 50% of the EHR product
In any 2 year period, payments shall not exceed 90% of the costs of the EHR
OpportunityOpportunity
EHR Market PenetrationEHR Market PenetrationEligible ProfessionalsEligible Professionals
DesRoches CM et al., N Engl J Med 2008;359:50-60.
Market Penetration of EHRMarket Penetration of EHRHospitalsHospitals
Approximately 50% have Approximately 50% have implemented, but fewer than 10% implemented, but fewer than 10% have qualified EHR and can have qualified EHR and can demonstrate meaningful use.demonstrate meaningful use.
1.5% have comprehensive system across all 1.5% have comprehensive system across all departmentsdepartments
10.9% have basic system10.9% have basic system
Barriers to SuccessBarriers to Success Barriers to implementation Barriers to implementation
costcost physician resistance physician resistance lack of confidence in HITECH provisionslack of confidence in HITECH provisions system selectionsystem selection availability of qualified implementation staffavailability of qualified implementation staff the complexities of the ARRA law the complexities of the ARRA law
Barriers to demonstration of meaningful useBarriers to demonstration of meaningful use interoperability requirementsinteroperability requirements availability of qualified implementation staffavailability of qualified implementation staff acceptance and use by all staffacceptance and use by all staff annual reporting requirementannual reporting requirement
Conclusion Conclusion
ConsultantsConsultants establish expertiseestablish expertise maintain product maintain product
independenceindependence provide selection, provide selection,
implementation, and implementation, and training support, but training support, but focus on meaningful usefocus on meaningful use
EHR VendorsEHR Vendors get certifiedget certified clearly identify your clearly identify your
strengths and stick to strengths and stick to themthem
commit to maintaining commit to maintaining compliance with compliance with meaningful use criteriameaningful use criteria
partner with others to fill partner with others to fill gapsgaps
support interoperabilitysupport interoperability
HospitalsHospitals proceed soon, but proceed soon, but
cautiouslycautiously evaluate solutions evaluate solutions
and plan and plan implementationsimplementations
dedicate resources dedicate resources or hirer consultantsor hirer consultants
Eligible ProfessionalsEligible Professionals don’t go it alone or don’t go it alone or
rely exclusively on a rely exclusively on a vendor for directionvendor for direction
consider vendor consider vendor commitment to their commitment to their product and ease of product and ease of integrationintegration
Commit the time and Commit the time and effort to do it righteffort to do it right
Physician AttitudesPhysician Attitudes
Massachusetts study of physicians Massachusetts study of physicians attitudes after EHR implementationattitudes after EHR implementation
GoodGood NeutralNeutral BadBad Ability to Ability to prevent errorsprevent errors
Control of Control of practicepractice
Increased Increased earnings earnings potentialpotential
Improved Improved productivityproductivity
Cost of Cost of implementatiimplementationon
HIT Extension CentersHIT Extension Centers The HITECH Act authorizes resources to facilitate the adoption and The HITECH Act authorizes resources to facilitate the adoption and
use of EHRs by providing technical assistance and the capacity to use of EHRs by providing technical assistance and the capacity to exchange health information.exchange health information.
Regional Centers offer providers within their geographic service Regional Centers offer providers within their geographic service areas technical assistance in the selection, acquisition, areas technical assistance in the selection, acquisition, implementation, and meaningful use of EHRs—including health implementation, and meaningful use of EHRs—including health information exchange (HIE).information exchange (HIE).
Implementation and Project Management: Support end-to-end Implementation and Project Management: Support end-to-end project management over the entire EHR implementation process, project management over the entire EHR implementation process, including individualized and on-site coaching, consultation, including individualized and on-site coaching, consultation, troubleshooting.troubleshooting.
Progress Towards Meaningful Use: Participate in program training Progress Towards Meaningful Use: Participate in program training and be able to provide effective assistance in attaining meaningful and be able to provide effective assistance in attaining meaningful use.use.
Funding of Extension Centers begins 11 Dec 2009.Funding of Extension Centers begins 11 Dec 2009.