CareTech Solutions

The American Recovery &

Reinvestment Act of 2009

Health Care Perspective

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What is it?

$790 billion total

Approximately $30 billion allocated towards the improvement of healthcare

Health ITTraining for more

primary care physicians and

nurses

Chronic Diseases Research

Community Health Centers

Renovation

“Comparative Effectiveness”

research

HITECH includes $19 billion for health

information technology

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$19 Billion Break Down

$17

Billion

$2 Billion

$19 Billio

n

Hospital & Physician Incentive Bonuses from Medicare/Medicaid

HHS Discretionary Funds :

Standards, Grants , HIE Infrastructure, Loans to the States for EHR, Regional HIT Resource Centers, Telemedicine, Efficacy Studies

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HITECH Act: Overview

Results: 90% of Doctors and 70% of Hospitals using comprehensive EHR

by 2020

Strengthen Privacy

and Security

Laws

Save Government $12 billion

Establish CCHIT

Standards by 2010

HIT infrastructure

for interoperability

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HITECH Act: Physician Incentives

• $17 billion• Starting FY11.

• Decreasing sliding scale over time.• Penalties for non-compliance FY15

“Meaningful” use of certified product that is connected

and compiles with submission of clinical

quality measures

• Choose one program• $44 – 66 K from over 5 years if utilizing by 2011

• Fee Reductions for non-EHR users• Penalties Start 2015 for noncompliance• Site of Service defined as not in hospital

Medicare/caid Reimbursements:

Physician EHR adoption benefits

• Up to $2 million plus discharge bonuses (estimated $10 million+ per

hospital)

Hospitals payout

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HITECH Act: HHS Discretionary Funds

• $2 billion• 90 day window started

04.30.09

Secretary HHS has 90 days to

develop spending plan

• Standards requirements due by 12.31.09• HIE Infrastructure & National Health Information Network

(NHIN)• Regional Health IT Resource Centers

• Federal grants through AHRQ, HRSA, CMS• Grants to the states in 2010 for HIT and EHR Loans• Promote advanced EHR – disease mgmt., quality care

measures

Areas of focus

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HITECH Act: Standards & Privacy

• Focused on rapidly increasing interoperability capabilities, EHR privacy protections and

regional HIE efforts• Standards to harmonization organization and a

health IT certification organization (CCHIT)

Standards

• Define breach actions• Impose restrictions on certain disclosures, sales, & marketing

of protected health information• Require an accounting of disclosures to a patient upon

request• Authorize increased civil monetary penalties for HIPAA

violations• Grant authority to state attorneys general to enforce HIPAA

Privacy – Expand HIPAA for EHR

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Additional Funding

• $1 billionPrevention & Wellness

• $1.5 billionCommunity Health Centers

• $200 millionPrimary Care Provider Training

• $415 million ($85 million for IT)Indian Health Services

• $10 billionNIH Research & Facilities

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EHR - Big Goal!

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Fact:• There are over 800,000 clinicians in the US.

• 17% * have EHRs today. • This leaves 664,000 who need EHRs. • Over the next 5 years the early to mid-adopters will work hard to gain

the full stimulus incentive amounts available in 2011-2012. • Late adopters will gain the reduced stimulus available in 2013-2014.• Resistors will begin receiving penalties in 2015.

* The Wall Street Journal reports that only 9% of Clinicians utilize a Comprehensive EHR (03.26.09)

Source: Certification Commission for Healthcare Information Technology (CCHIT)

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EMR Adoption Model

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HIMSS Analytics Cumulative Capabilities

% of U.S. Hospitals

2007 (Final)

% of U.S. Hospitals

2008 (Final)

Stage 7Medical record fully electronic;

Organization able to contribute to Electronic Health Record (EHR) as byproduct of EMR

0.0% 0.3%

Stage 6 Physician documentation (structured templates),full CDSS (variance and compliance), full PACS 0.3% 0.5%

Stage 5 Closed loop medication administration 1.9% 2.5%Stage 4 CPOE, CDSS (clinical protocols) 2.2% 2.5%

Stage 3 Clinical documentation (flow sheets), CDSS(error checking), PACS available outside Radiology 25.1% 34.7%

Stage 2 Clinical Data Repository, Controlled Medical Vocabulary, Clinical Decision Support System (CDSS) Capability 37.2 31.4%

Stage 1 Ancillaries - Lab, Radiology, Pharmacy 14.0% 11.5%Stage 0 All three ancillaries not installed 19.3% 15.6%

Total Hospitals N=5,703 N=5,166

It is believed that a hospital rated stage 4 or higher on the HIMSS EMR Adoption Model will meet “Meaningful Use” criteria as defined in ARRA.

310 of the 5,166 surveyed meet

level 4 requirements

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Key Questions

• Incentive Payments Begin in FY 2011 (October 1, 2010), however The Secretary needs to determine if the payment will be installments or lump sum.

• No restrictions on how you may spend the money.• “Hospital based” physicians are not eligible; ie Pathologists, ER Physicians, Anesthesiologists. (Site of Service)

• “Meaningful Use” must be defined by December 31, 2009.• CCHIT will most likely be named as the EHR system certification committee.

Yr of Adoption 2011 2012 2013 2014 2015 2016 2017

Payment for adopting in FY 2011 or prior

100% 75% 50% 25%

First Adoption 2012 100% 75% 50% 25%

First Adoption 2013 100% 75% 50% 25%

First Adoption 2014 75% 50% 50%

First Adoption 2015 50% 25%

Penalties if not adopted by 2015. three-quarters of the market basket update is reduced by:

33% 66% 100%

• How does the Hospital Medicare

“sliding scale” for adoption work?

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Next Steps

• The time to start is now• Update/ Create a Strategic Plan for IT Tied to Hospital

Business Drivers• Evaluate Current Process & Procedures• Launch/ Optimize Current Procedures to Meet EHR

Requirements• Demonstrate “Meaningful Use” of certified EHR

product with e Prescribing capability• Connect Physician Offices & Other Providers for

Improved Access to Patient Records• Insure Ability to Report Technology Use to HHS• Review Training Programs for Primary Care Providers