MSMAHIT for the Physician

January 30, 2010

Karen Edison, MD

Center for Health Policy

University of Missouri, Columbia

“Information is the lifeblood of modern medicine. Health information technology (HIT) is destined to be its circulatory system.”

David Blumenthal, M.D., M.P.P.

HITECH Act – Health Information Technology for Economic and Clinical Health

Part ($2B) of the American Recovery and Reinvestment

Act of 2009 aka “ARRA” or the “Stimulus Bill”

Most of the $20 Billion is for incentives for physicians

New programs

Regional Centers $673 M HI exchange - states $564 M Workforce training $118 M Beacon communities $235 M HIT research (SHARP) $60 M NHIN (National HI network) & Standards and certification $64 M

New Regulations – open for comment!

Meaningful use

Certification

Background Information CMS released notice of proposed rulemaking on

“meaningful use” of certified electronic health records on Dec. 30, 2009

The Office of the National Coordinator for Health Information Technology (ONC) released its complementary certification standards Both rules published in Federal Register January 13, 2010.

ONC: interim final rule; effective date February 12, 2010, but changes are still possible.

Comments are strongly encouraged: Deadline March 15, 2010.

Source: Association of American Medical Colleges & Manatt Health Solutions

“Meaningful Use”

Using EHR technology in a meaningful manner.

Requires meaningful use measures to become more stringent over time.

Source: Association of American Medical Colleges

Proposed Stages of Meaningful Use By Payment YearFirst Payment Year for EP

Payment Year

2011 2012 2013 2014 2015+

2011 Stage 1 Stage 1 Stage 2 Stage 2 Stage 3

2012 Stage 1 Stage 1 Stage 2 Stage 3

2013 Stage 1 Stage 2 Stage 3

2014 Stage 1 Stage 3

2015 Stage 3

Source: Association of American Medical Colleges

Medicare and Medicaid Rules

EPs (eligible professionals) choose between Medicare & Medicaid (must be 30% of pts. except for peds who need 20%)

Medicare and Medicaid rules: mostly consistent

One-time switch no later than 2014

Source: Association of American Medical Colleges

Incentives for Eligible Professionals Medicare payments are available for EPs that are

paid under the physician fee schedule (PFS)

Medicare payments will be determined on an individual-practitioner basis

Each year under the EHR Incentive Program, an EP will receive 75 percent of the EP’s total “allowed charges” during the Payment Year, subject to a cap.

The payment limit for the first year depends on when the EP begins “meaningful use” of an EHR system.

Source: Manatt Health Solutions

Adoption Year

Maximum Payment

PFSPenalty

2011 2012 2013 2014 2015 2016 Total

2011 $18,000 $12,00 $8,000 $4,000 $2,000 $0 $44,000

2012 $18,000 $12,000

$8,000 $4,000 $2,000 $44,000

2013 $15,000

$12,000

$8,000 $4,000 $39,000

2014 $12,00 $8,000 $4,000 $24,000

2015 $0 1%

2016 $0 2%

2017+$0 3%

Source: Manatt Health Solutions

3 Stages of Objectives Stage 1: (details in this proposed rule)

Using information to track key clinical conditions and communicating that information for care coordination

Implementing clinical decision support tools

Reporting clinical quality measures and public health information

Source: Association of American Medical Colleges

Stage 2:(Proposed by end of 2011)

Expand stage 1 criteria to encourage using health IT for quality improvement

Exchange of information in most structured format possible

Source: Association of American Medical Colleges

Stage 3: (Proposed by end of 2013)

Promote improvements in quality, safety, and efficiency

Decision support for national high priority conditions

Patient access to self-management tools

Access to comprehensive patient data

Improving population health

Stage 1 Highlights

25 measures corresponding to Stage 1

objectives for EPs

Must meet all 25 measures

Yes/No Measures

Source: Association of American Medical Colleges

Baseline Requirement

50% or more of patent encounters during the reporting period at

practice(s)/location(s) equipped with certified EHR technology

Source: Association of American Medical Colleges

Examples of Yes/No Measures

Implement drug-drug, drug-allergy, drug-formulary checks

Generated at least 1 report of patients with specific condition

Implement 5 clinical decision support rules One test of electronic exchange of key

clinical information

Source: Association of American Medical Colleges

Examples of Yes/No Measures

One test of electronic data submission to immunization registry

One test of electronic syndromic surveillance data to public health agency

Conduct or review security risk analysis and implement security updates

Source: Association of American Medical Colleges

Measures requiring a numerator and

denominator Higher % for criteria based on capability Lower % if electronic exchange of information

Stage 1 Highlights

25 measures corresponding to Stage 1

objectives for EPs

Must meet all 25 measures

Yes/No Measures

Source: Association of American Medical Colleges

Examples of Measures Requiring a Numerator and Denominator

75% of all permissible prescriptions transmitted electronically

10% of all unique patients provided timely electronic access to their health information

80% of all unique patients have at least one medication entry (or an indication of “none”) recorded as structured data

Source: Association of American Medical Colleges & Manatt Health Solutions

Examples of Measures Requiring a Numerator and Denominator

80% of all unique patients over age 12 have smoking status recorded

Reminder sent to 50% of all unique patients that are age 50 or older

50% of clinical lab test ordered are incorporated in EHR technology

Source: Manatt Health Solutions

Medicare Meaningful Use Reporting How to report? Attestation through secure

mechanism 90 Day Reporting Periods for EPs

Earliest: Jan. 1, 2011-Apr. 1, 2011 Latest: Oct. 1, 2011-Dec. 31, 2011

Quality Reporting 2011: Calculate and attest to results 2012: Submit data through EHR

Source: Association of American Medical Colleges

Incentive Payments

Rolling payments-90 days first year; full calendar year thereafter

Fee schedule reductions for EPs who do not achieve meaningful use: 2015: 1% 2016: 2% 2017 and after: 3% Exceptions for hardship on case-by-case basis for

EPs practicing in rural areas with insufficient internet access and for hospital-based EPs

Source: Association of American Medical Colleges

Medicare Medicaid

Eligible professional Physician, (medicine or osteopathy), dentist, podiatrist, optometrists, chiropractor

Physician, dentist, certified nurse, mid-wife, nurse practitioner, physician assistant in RHC or FQHC

Max incentive amount $44,000 $63,750

Maximum amount first payment year

$18,000 (2011-2012)$15,000 (2013)$12,000 (2014)

$21,250 (2011-2016)

To earn incentive for first payment year

Must meet all meaningful use criteria

Adopt, implement, or upgrade

Year penalties begin 2015 No penalties

Maximum number of years can receive payment

5 6

Source: Association of American Medical Colleges

This is a very fluid process

Your voice matters!

29

Missouri State Wide Health Information Exchange

State activity so far……….

•Establish MO-HITECH

•Establish Advisory Board

•Convene Workgroups

•Publish Draft Strategic Plan for Review

•Engage and educate stakeholders

Current state activity and plan

•Convene Advisory Board & Workgroups

•Publish Draft Operational Plan for Review – mid March

•Engage and educate stakeholders

•Submit Operational Plan – late April

MO-HITECH Advisory Board

Co-Chairs – Ronald Levy, Director DSS & HIT Coordinator and Barrett Toan

Staff – George Oestreich, Charlotte Krebs & Manatt Team: Bill Bernstein, Melinda Dutton, Tim Andrews, Kier Wallis

Membership – 18 people from public and private sector

Physician members of the Advisory Board

Karen Edison, MD, Center for Health Policy

Tracy Godfrey, MD, Family Physician, Joplin

Ian McCaslin, MD, MO HealthNet Director

Tom Hale, MD, PhD, Sisters of Mercy, St. Louis

Workgroups

Governance Finance Technical Infrastructure Business and Technical Operations Legal/Policy Consumer Engagement

Key decisions are being made NOW!

Missouri Health Information Technology (HIT) Assistance

Center

Core Applicant Team

University of Missouri’s Health Management and Informatics

(HMI) Department Center for Health Policy (CHP) Missouri Telehealth Network (MTN) Family and Community Medicine (FCM)

Department

Key Partners

Primaris (Missouri’s Quality Improvement Organization)

Missouri Primary Care Association (MPCA)

Kansas City Quality Improvement Collaborative (KCQIC)

Mission

To help primary care providers and others to

Choose an EHR Re-engineer office workflow Implement an EHR and deal with vendors Achieve “meaningful use” Pull down incentives

“Knowing is not enough; we must apply.Willing is not enough; we must do.”—Goethe

If you are interested in the State HIE process

www.dss.mo.gov/hie

If you are interested in the services of the Missouri HIT Assistance Center

Hoytav@health.Missouri.edu