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MSMA HIT 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 ...
HITECH Act – Health Information Technology for Economic and Clinical Health  <ul><ul><li>Part ($2B) of the American Recove...
Most  of the $20 Billion is for incentives for physicians
New programs <ul><li>Regional Centers  $673 M </li></ul><ul><li>HI exchange - states $564 M </li></ul><ul><li>Workforce tr...
New Regulations –  open for comment! <ul><li>Meaningful use  </li></ul><ul><li>Certification </li></ul>
Background Information <ul><li>CMS released notice of proposed rulemaking on “meaningful use” of certified electronic heal...
“ Meaningful Use”  <ul><li>Using EHR technology in a meaningful manner. </li></ul><ul><li>Requires meaningful use measures...
Proposed Stages of Meaningful Use By Payment Year Source: Association of American Medical Colleges First Payment Year for ...
Medicare and Medicaid Rules <ul><li>EPs (eligible professionals) choose between Medicare & Medicaid (must be 30% of pts. e...
Incentives for Eligible Professionals <ul><ul><li>Medicare payments are available for EPs that are paid under the physicia...
Source: Manatt Health Solutions  Adoption Year Maximum Payment PFS Penalty 2011 2012 2013 2014 2015 2016 Total 2011 $18,00...
3 Stages of Objectives <ul><li>Stage 1: (details in this proposed rule) </li></ul><ul><ul><li>Using information to track k...
Stage 2 :(Proposed by end of 2011) <ul><ul><li>Expand stage 1 criteria to encourage using health IT for quality improvemen...
Stage 3:  (Proposed by end of 2013) <ul><ul><li>Promote improvements in quality, safety, and efficiency </li></ul></ul><ul...
Stage 1 Highlights <ul><li>25 measures corresponding to Stage 1 objectives for EPs </li></ul><ul><li>Must meet all 25 meas...
Baseline Requirement 50% or more of patent encounters during the reporting period at practice(s)/location(s) equipped with...
Examples of Yes/No Measures <ul><li>Implement drug-drug, drug-allergy, drug-formulary checks </li></ul><ul><li>Generated a...
Examples of Yes/No Measures <ul><li>One test of electronic data submission to immunization registry </li></ul><ul><li>One ...
<ul><li>Measures requiring a numerator and denominator </li></ul><ul><ul><li>Higher % for criteria based on capability </l...
Stage 1 Highlights <ul><li>25 measures corresponding to Stage 1 objectives for EPs </li></ul><ul><li>Must meet all 25 meas...
Examples of Measures Requiring a Numerator and Denominator <ul><li>75% of all permissible prescriptions transmitted electr...
Examples of Measures Requiring a Numerator and Denominator <ul><li>80% of all unique patients over age 12 have smoking sta...
Medicare Meaningful Use Reporting <ul><li>How to report? Attestation through secure mechanism </li></ul><ul><li>90 Day Rep...
Incentive Payments <ul><li>Rolling payments-90 days first year; full calendar year thereafter </li></ul><ul><li>Fee schedu...
Source: Association of American Medical Colleges Medicare Medicaid Eligible professional Physician, (medicine or osteopath...
This is a very fluid process Your voice matters!
Missouri State Wide Health Information Exchange
State activity so far……….  <ul><li>Establish MO-HITECH </li></ul><ul><li>Establish Advisory Board </li></ul><ul><li>Conven...
Current state activity and plan <ul><li>Convene Advisory Board & Workgroups </li></ul><ul><li>Publish Draft Operational Pl...
MO-HITECH Advisory Board <ul><li>Co-Chairs – Ronald Levy, Director DSS & HIT Coordinator and Barrett Toan </li></ul><ul><l...
Physician members of the Advisory Board <ul><li>Karen Edison, MD, Center for Health Policy </li></ul><ul><li>Tracy Godfrey...
Workgroups <ul><li>Governance </li></ul><ul><li>Finance </li></ul><ul><li>Technical Infrastructure </li></ul><ul><li>Busin...
Key decisions are being made NOW!
Missouri Health Information Technology (HIT) Assistance Center
Core Applicant Team <ul><li>University of Missouri’s </li></ul><ul><ul><li>Health Management and Informatics (HMI) Departm...
Key Partners <ul><li>Primaris (Missouri’s Quality Improvement Organization) </li></ul><ul><li>Missouri Primary Care Associ...
Mission <ul><li>To help primary care providers and others to </li></ul><ul><ul><li>Choose an EHR </li></ul></ul><ul><ul><l...
“ 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 HI...
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MSMA Health Information Technology - PowerPoint Presentation

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MSMA Health Information Technology - PowerPoint Presentation

  1. 1. MSMA HIT for the Physician January 30, 2010 Karen Edison, MD Center for Health Policy University of Missouri, Columbia
  2. 3. “ 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.
  3. 4. HITECH Act – Health Information Technology for Economic and Clinical Health <ul><ul><li>Part ($2B) of the American Recovery and Reinvestment Act of 2009 aka “ARRA” or the “Stimulus Bill” </li></ul></ul>
  4. 5. Most of the $20 Billion is for incentives for physicians
  5. 6. New programs <ul><li>Regional Centers $673 M </li></ul><ul><li>HI exchange - states $564 M </li></ul><ul><li>Workforce training $118 M </li></ul><ul><li>Beacon communities $235 M </li></ul><ul><li>HIT research (SHARP) $60 M </li></ul><ul><li>NHIN (National HI network) & </li></ul><ul><li>Standards and certification $64 M </li></ul>
  6. 7. New Regulations – open for comment! <ul><li>Meaningful use </li></ul><ul><li>Certification </li></ul>
  7. 8. Background Information <ul><li>CMS released notice of proposed rulemaking on “meaningful use” of certified electronic health records on Dec. 30, 2009 </li></ul><ul><li>The Office of the National Coordinator for Health Information Technology (ONC) released its complementary certification standards </li></ul><ul><ul><li>Both rules published in Federal Register January 13, 2010. </li></ul></ul><ul><li>ONC: interim final rule; effective date February 12, 2010, but changes are still possible. </li></ul><ul><li>Comments are strongly encouraged: Deadline March 15, 2010. </li></ul>Source: Association of American Medical Colleges & Manatt Health Solutions
  8. 9. “ Meaningful Use” <ul><li>Using EHR technology in a meaningful manner. </li></ul><ul><li>Requires meaningful use measures to become more stringent over time. </li></ul>Source: Association of American Medical Colleges
  9. 10. Proposed Stages of Meaningful Use By Payment Year Source: Association of American Medical Colleges First 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
  10. 11. Medicare and Medicaid Rules <ul><li>EPs (eligible professionals) choose between Medicare & Medicaid (must be 30% of pts. except for peds who need 20%) </li></ul><ul><li>Medicare and Medicaid rules: mostly consistent </li></ul><ul><li>One-time switch no later than 2014 </li></ul>Source: Association of American Medical Colleges
  11. 12. Incentives for Eligible Professionals <ul><ul><li>Medicare payments are available for EPs that are paid under the physician fee schedule (PFS) </li></ul></ul><ul><ul><li>Medicare payments will be determined on an individual-practitioner basis </li></ul></ul><ul><ul><li>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. </li></ul></ul><ul><ul><li>The payment limit for the first year depends on when the EP begins “meaningful use” of an EHR system. </li></ul></ul>Source: Manatt Health Solutions
  12. 13. Source: Manatt Health Solutions Adoption Year Maximum Payment PFS Penalty 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%
  13. 14. 3 Stages of Objectives <ul><li>Stage 1: (details in this proposed rule) </li></ul><ul><ul><li>Using information to track key clinical conditions and communicating that information for care coordination </li></ul></ul><ul><ul><li>Implementing clinical decision support tools </li></ul></ul><ul><ul><li>Reporting clinical quality measures and public health information </li></ul></ul>Source: Association of American Medical Colleges
  14. 15. Stage 2 :(Proposed by end of 2011) <ul><ul><li>Expand stage 1 criteria to encourage using health IT for quality improvement </li></ul></ul><ul><ul><li>Exchange of information in most structured format possible </li></ul></ul>Source: Association of American Medical Colleges
  15. 16. Stage 3: (Proposed by end of 2013) <ul><ul><li>Promote improvements in quality, safety, and efficiency </li></ul></ul><ul><ul><li>Decision support for national high priority conditions </li></ul></ul><ul><ul><li>Patient access to self-management tools </li></ul></ul><ul><ul><li>Access to comprehensive patient data </li></ul></ul><ul><ul><li>Improving population health </li></ul></ul>
  16. 17. Stage 1 Highlights <ul><li>25 measures corresponding to Stage 1 objectives for EPs </li></ul><ul><li>Must meet all 25 measures </li></ul><ul><li>Yes/No Measures </li></ul>Source: Association of American Medical Colleges
  17. 18. 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
  18. 19. Examples of Yes/No Measures <ul><li>Implement drug-drug, drug-allergy, drug-formulary checks </li></ul><ul><li>Generated at least 1 report of patients with specific condition </li></ul><ul><li>Implement 5 clinical decision support rules </li></ul><ul><li>One test of electronic exchange of key clinical information </li></ul>Source: Association of American Medical Colleges
  19. 20. Examples of Yes/No Measures <ul><li>One test of electronic data submission to immunization registry </li></ul><ul><li>One test of electronic syndromic surveillance data to public health agency </li></ul><ul><li>Conduct or review security risk analysis and implement security updates </li></ul>Source: Association of American Medical Colleges
  20. 21. <ul><li>Measures requiring a numerator and denominator </li></ul><ul><ul><li>Higher % for criteria based on capability </li></ul></ul><ul><ul><li>Lower % if electronic exchange of information </li></ul></ul>
  21. 22. Stage 1 Highlights <ul><li>25 measures corresponding to Stage 1 objectives for EPs </li></ul><ul><li>Must meet all 25 measures </li></ul><ul><li>Yes/No Measures </li></ul>Source: Association of American Medical Colleges
  22. 23. Examples of Measures Requiring a Numerator and Denominator <ul><li>75% of all permissible prescriptions transmitted electronically </li></ul><ul><li>10% of all unique patients provided timely electronic access to their health information </li></ul><ul><li>80% of all unique patients have at least one medication entry (or an indication of “none”) recorded as structured data </li></ul>Source: Association of American Medical Colleges & Manatt Health Solutions
  23. 24. Examples of Measures Requiring a Numerator and Denominator <ul><li>80% of all unique patients over age 12 have smoking status recorded </li></ul><ul><li>Reminder sent to 50% of all unique patients that are age 50 or older </li></ul><ul><li>50% of clinical lab test ordered are incorporated in EHR technology </li></ul>Source: Manatt Health Solutions
  24. 25. Medicare Meaningful Use Reporting <ul><li>How to report? Attestation through secure mechanism </li></ul><ul><li>90 Day Reporting Periods for EPs </li></ul><ul><ul><li>Earliest: Jan. 1, 2011-Apr. 1, 2011 </li></ul></ul><ul><ul><li>Latest: Oct. 1, 2011-Dec. 31, 2011 </li></ul></ul><ul><li>Quality Reporting </li></ul><ul><ul><li>2011: Calculate and attest to results </li></ul></ul><ul><ul><li>2012: Submit data through EHR </li></ul></ul>Source: Association of American Medical Colleges
  25. 26. Incentive Payments <ul><li>Rolling payments-90 days first year; full calendar year thereafter </li></ul><ul><li>Fee schedule reductions for EPs who do not achieve meaningful use: </li></ul><ul><ul><li>2015: 1% </li></ul></ul><ul><ul><li>2016: 2% </li></ul></ul><ul><ul><li>2017 and after: 3% </li></ul></ul><ul><ul><li>Exceptions for hardship on case-by-case basis for EPs practicing in rural areas with insufficient internet access and for hospital-based EPs </li></ul></ul>Source: Association of American Medical Colleges
  26. 27. 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
  27. 28. This is a very fluid process Your voice matters!
  28. 29. Missouri State Wide Health Information Exchange
  29. 30. State activity so far………. <ul><li>Establish MO-HITECH </li></ul><ul><li>Establish Advisory Board </li></ul><ul><li>Convene Workgroups </li></ul><ul><li>Publish Draft Strategic Plan for Review </li></ul><ul><li>Engage and educate stakeholders </li></ul>
  30. 31. Current state activity and plan <ul><li>Convene Advisory Board & Workgroups </li></ul><ul><li>Publish Draft Operational Plan for Review – mid March </li></ul><ul><li>Engage and educate stakeholders </li></ul><ul><li>Submit Operational Plan – late April </li></ul>
  31. 32. MO-HITECH Advisory Board <ul><li>Co-Chairs – Ronald Levy, Director DSS & HIT Coordinator and Barrett Toan </li></ul><ul><li>Staff – George Oestreich, Charlotte Krebs & Manatt Team: Bill Bernstein, Melinda Dutton, Tim Andrews, Kier Wallis </li></ul><ul><li>Membership – 18 people from public and private sector </li></ul>
  32. 33. Physician members of the Advisory Board <ul><li>Karen Edison, MD, Center for Health Policy </li></ul><ul><li>Tracy Godfrey, MD, Family Physician, Joplin </li></ul><ul><li>Ian McCaslin, MD, MO HealthNet Director </li></ul><ul><li>Tom Hale, MD, PhD, Sisters of Mercy, St. Louis </li></ul>
  33. 34. Workgroups <ul><li>Governance </li></ul><ul><li>Finance </li></ul><ul><li>Technical Infrastructure </li></ul><ul><li>Business and Technical Operations </li></ul><ul><li>Legal/Policy </li></ul><ul><li>Consumer Engagement </li></ul>
  34. 35. Key decisions are being made NOW!
  35. 36. Missouri Health Information Technology (HIT) Assistance Center
  36. 37. Core Applicant Team <ul><li>University of Missouri’s </li></ul><ul><ul><li>Health Management and Informatics (HMI) Department </li></ul></ul><ul><ul><li>Center for Health Policy (CHP) </li></ul></ul><ul><ul><li>Missouri Telehealth Network (MTN) </li></ul></ul><ul><ul><li>Family and Community Medicine (FCM) Department </li></ul></ul>
  37. 38. Key Partners <ul><li>Primaris (Missouri’s Quality Improvement Organization) </li></ul><ul><li>Missouri Primary Care Association (MPCA) </li></ul><ul><li>Kansas City Quality Improvement Collaborative (KCQIC) </li></ul>
  38. 39. Mission <ul><li>To help primary care providers and others to </li></ul><ul><ul><li>Choose an EHR </li></ul></ul><ul><ul><li>Re-engineer office workflow </li></ul></ul><ul><ul><li>Implement an EHR and deal with vendors </li></ul></ul><ul><ul><li>Achieve “meaningful use” </li></ul></ul><ul><ul><li>Pull down incentives </li></ul></ul>
  39. 40. “ Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe
  40. 42. 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 [email_address]

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