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HCIT and the Stimulus The American Recovery & Reinvestment Act of 2009 Corporate Public Affairs MBA Intern Candidates February 28, 2008 Tammy Eden VP of.

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Presentation on theme: "HCIT and the Stimulus The American Recovery & Reinvestment Act of 2009 Corporate Public Affairs MBA Intern Candidates February 28, 2008 Tammy Eden VP of."— Presentation transcript:

1 HCIT and the Stimulus The American Recovery & Reinvestment Act of 2009 Corporate Public Affairs MBA Intern Candidates February 28, 2008 Tammy Eden VP of Sales McKesson Physician Practice Solutions April 8, 2010

2 2 44 McKesson’s EHR Solutions 11 Stimulus Plan Overview 33 Eligible Provider Programs 22 HITECH Act Specifics HCIT and the Stimulus Agenda 55 Next Steps and Discussion

3 3 January 25, 2009 H.R. 1 introduced in the House Appropriations Committee January 28, 2009 House votes 244 – 188 for the bill estimated at $819 B February 10, 2009 Senate votes 61 – 37 for their bill estimated at $837 B February 11, 2009 Conference Committee reaches compromise with a bill estimated at $787 B February 13, 2009 House passes 246 – 183 Senate passes 60 – 38 February 17, 2009 President Obama signs The American Recovery & Reinvestment Act of 2009  The American Recovery & Reinvestment Act of 2009 (H.R. 1) ─ One of the largest single pieces of legislation in U.S. history ─ Signed 23 days after official introduction (28 days after inauguration) Stimulus Plan Overview Where are we and how did we get here? Scale = 1 day

4 4  $787 billion in total net impact on the federal deficit  $154 billion in total net spending for healthcare  $19 billion for health information technology Stimulus Plan Overview What is in the stimulus plan for healthcare? Source: Congressional Budget Office Summary of Estimated Cost of the Conference Agreement for H.R., The American Recovery and Reinvestment Act of 2009; figures are rounded “HITECH” Act Medicaid $90B Health Insurance $25B Incentives $19B ONCHIT $2B NIH $10B HHS $10B Increased match to State Medicaid COBRA extension Research grants Various initiatives Adoption incentives Infrastructure and budget

5 5 22 HITECH Act Specifics 33 Eligible Provider Programs 11 Stimulus Plan Overview HCIT and the Stimulus Agenda 44 McKesson’s EHR Solutions 55 Next Steps and Discussion

6 6  Certification ─ Qualified EHR ─ Meets specifications ─ HIT Standards, NIST, etc. HITECH Act Specifics Incentives require both certified systems and “meaningful use”  “Meaningful Use” ─ Electronic Prescriptions ─ Interoperability ─ Quality reporting “The eligible [provider] demonstrates…that during such period the [provider] is using certified EHR technology in a meaningful manner”

7 7 Vision for Meaningful Use Health IT and Transformed Health Care  Enable significant and measurable improvements in population health through a transformed health care delivery system.  Key goals*: ─ Improve quality, safety, & efficiency ─ Engage patients & their families ─ Improve care coordination ─ Improve population and public health; reduce disparities ─ Ensure privacy and security protections Source: HIT Policy Committee, Meaningful Use Workgroup Presentation June 23, 2009

8 8 Estimated EHR Adoption with Stimulus Source: Congressional Budget Office; Thomas Weisel Partners; Raymond James; MTS analysis “Carrot” and “stick”  Incentives begin in 2011  Penalties begin in 2015 Physician Adoption  70% of physicians by 2014  90% of physicians by 2019 PhysicianHospital HITECH Act Impact Incentives and penalties expected to drive adoption of EHRs Incentives (~$36B) Penalties (~$17B)

9 9 October 1, 2010 Medicare / Medicaid incentive program for hospitals begins January 1, 2011 Medicare / Medicaid incentive program for physicians begins July 31, 2009 Formal recommendation to ONC on Meaningful Use from HIT Policy April 3, 2009 HIT Policy Committee appointed July 21, 2009 Preliminary approach to Certification from HIT Standards June 16,2009 Preliminary draft on “Meaningful Use from HIT Policy May 8, 2009 HIT Standards Committee appointed December 30, 2009 Initial rule publication on Meaningful Use (NPRM) The Road Toward “Meaningful Use” Estimated timeline for key events to finalize regulations Scale = 1 month June 2010 (Late Spring/Early Summer estimate) Final Rule on Meaningful Use and Temporary Certification December 30, 2009 HHS publication of interim final on Certification criteria (IFR) February 17, 2009 President Obama signs ARRA March 2, 2010 Initial rule publication on Establishment of Certification Programs (NPRM)

10 10 The Road Toward “Meaningful Use” CMS & ONC Publications  CMS Notice of Proposed Rule Making for Meaningful Use (NPRM) ─ Defines the provisions for incentive payments to eligible professionals and hospitals participating in Medicare and Medicaid programs that adopt and meaningfully use certified EHRs. Deadline for Public Comments... March 15, 2010 Final Rule Released................... Late Spring, takes effective 60 days later  ONC Interim Final Rule (IFR) with Comment on Standards and Certification Criteria ─ Proposes initial set of standards, implementation specifications, and certification criteria to “enhance the interoperability, functionality, utility, and security of health IT and to support its meaningful use.” Deadline for Public Comments... March 15, 2010 Final Rule Released................... Late Spring  ONC Rule on Certification Process (NPRM) ─ Proposes the establishment of two certification programs for the purposes of testing and certifying health IT, one temporary and one permanent Deadline for Public Comments Temporary Program…Mid-April w/final rule Late Spring Deadline for Public Comments Permanent Program…Mid-May w/final rule Fall 2010

11 1133 Eligible Provider Programs 22 HITECH Act Specifics 11 Stimulus Plan Overview HCIT and the Stimulus Agenda 44 McKesson’s EHR Solutions 55 Next Steps and Discussion

12 12 Eligible Provider Program Providers must choose a program  General ─ Must be office-based physicians ─ Eligible professional must prove meaningful use of a certified EHR  Medicare Incentive ─ Pays 75% of the all Part B claims submitted up to an annual maximum ─ Potential incentives up to $44,000 over a 5-year period beginning 2011 ─ Administered through CMS  Medicaid Incentive ─ Pays 85% of the “Net Average Allowable Cost” up to an annual maximum ─ Requires 30% Medicaid patient volume or 20% for pediatricians ─ Administered through the State  No Double Dipping ─ Providers may receive incentive payments from only one program, even if they qualify for both  Election Change ─ Permitted to change election once during the life of the EHR incentive programs prior to 2014 ─ EP would continue in the next program at whichever payment year he or she would have attained had the EP not chosen to switch ─ Payout can not exceed $63,750

13 13 Eligible Provider Program Medicare Provision  Eligible Professional is a physician as defined in the Social Security Act section 1861: ─ a doctor of medicine or osteopathy ─ a doctor of dental surgery or of dental medicine ─ a doctor of podiatric medicine ─ a doctor of optometry ─ a chiropractor

14 14 Eligible Provider Program Medicaid Provision  The Medicaid HIT Incentive program expands the definition of “eligible professionals” to include: ─ certified nurse mid-wife ─ nurse practitioner ─ physician assistant practicing in an FQHC or RHC that is so led by a physician assistant

15 15 Eligible Provider Program Hospital-based Provider  Hospital-based EPs are not eligible  Defined as: Provide “substantially all” of their services as hospital based practitioners furnishing at least 90% of services in an inpatient or outpatient hospital setting  Determination made using place of services (POS) codes on claims ─ 21 (inpatient hospital) ─ 22 (outpatient hospital) ─ 23 (emergency room, hospital)  Services provided in a provider-based outpatient department would count toward the 90 percent threshold

16 16 Eligible Provider Program Medicare incentive program uses a part B claims method Up to $44k per physician Potential PayoutBonusPart B Claims Req’d  Pays 75% of “allowed charges” based on claims submitted to Medicare up to max ─ “allowed charges” the lesser of the actual charge or the Medicare physician fee schedule amount  $3,000 bonus to qualify by 2012  Up to $44k per physician over 5 years  10% bonus if 50%+ of Medicare covered professional services furnished in a geographic Health Physician Shortage Area (HPSA)  Must qualify by 2012 to receive max ─ Reduced incentives for 2013 – 2015  No payments to providers after 2016  Penalties begin in 2015 ─ 2015 – 1% cut in Medicare payment ─ 2016 – 2% cut ─ 2017 and beyond – 3% to 5% cut pending overall market adoption rate  Medicare Advantage (MA) providers qualify for the Medicare incentives using MA claims instead of part B claims

17 17 Maximum Incentive Payments Eligible Provider Program Medicare Reimbursement Schedule Now- 2011 201220132014 2011 $18k--- 2012 $12k$18k-- 2013 $8k$12k$15k- 2014 $4k$8k$12k 2015 $2k$4k$8k 2016 -$2k$4k Total $44K $39K$24K Shortage Area $48.4K $42.9K$26.4K Source: MTS Primary Research Survey Adoption Year Payment Year Part B Annual Charges Maximum Payment $24,000$18,000 $16,000$12,000 $10,667$8,000 $5,334$4,000 $2,667$2,000

18 18 Eligible Provider Program Medicaid incentive program uses a cost based method  Requires 30% Medicaid patient volume ─ 20% for pediatricians, but receive only 66% of net allowable costs ─ 30 percent of all patient encounters attributable to Medicaid (or “needy individuals” in an FQHC or RHC) over any continuous 90-day period within the most recent calendar year prior to reporting  Pays 85% of the “net allowable costs” ─ Payments are not direct reimbursement for the purchase and acquisition of the EHR ─ Intended to serve as incentives for EPs to adopt and meaningfully use certified EHR technology ─ Net average allowable cost determined based on a study conducted by HHS  Requires “meaningful use” by Year 2, Year 1 can be for adoption only  Meaningful Users in Year 1 would also be eligible for the full payment  Must qualify by 2016 to receive max with no payments after 2021 Up to $63,750 per physician Potential PayoutNet Allowable Costs

19 19 Maximum Incentive Payments Eligible Provider Program Medicaid Reimbursement Schedule Source: MTS Primary Research Survey Adoption Year Payment Year Allowable Costs Max Pmt For 30% provider (85% of allowable cost) Max Pmt For Pediatrician (20% to 29%) Allowable Cost*2/3*85%) $25,000 (year 1 only) $21,250$14,167 $10,000$8,500$5,667 30% Provider 2011 – 2016 20% Pediatrician 2011 – 2016 Year 1 $21,250$14,167 Year 2 $8,500$5,667 Year 3 $8,500$5,667 Year 4 $8,500$5,667 Year 5 $8,500$5,666 Year 6 (up to 2021) $8,500$5,666 TOTAL$63,750$42,500

20 20 Eligible Provider Program Meaningful Use “Reporting Period”  For the First Year Incentive Qualification ─ 90 day reporting period to prove meaningful use through required measures ─ First opportunity to start reporting is January 1, 2011 For example, EP has until Oct 1, 2011 to begin meaningful use of their certified HER technology & receive incentive for payment year 2011 (EP must begin by Oct 1, 2012 to receive maximum incentive payments) ─ Attestation methodology proposed for 2011 ─ Electronic reporting starting in 2012  Subsequent years reporting period ─ Entire 12 months (calendar year for EP) in the respective year 20

21 21 Meaningful Use Regulatory Definition The Act provides that an eligible provider (EP) shall be considered a meaningful EHR user for an EHR reporting period for a payment year if they meet the following three requirements: 1. use of certified EHR technology in a meaningful manner (e.g. e- Prescribing); 2. that the certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of care; and 3. that, in using certified EHR technology, the provider submits to the Secretary information on clinical quality measures and such other measures selected by the Secretary.

22 22 Meaningful Use Update HITECH Program Stages  Stage 1 defined in Notice of Proposed Rule Making  Criteria of meaningful use will be updated through future rulemaking ─ Stage 2 criteria proposed by the end of 2011 ─ Stage 3 criteria proposed by the end of 2013. StageGoal Stage 1 (formerly 2011) Electronic Capture of Patient Data Stage 2 (formerly 2013) Improved Clinical Processes Stage 3 (formerly 2015) Quality Measurement & Improvement

23 23 Meaningful Use Update Respective Criteria per Payment Year First Payment Year Payment Year 20112012201320142015+ 2011Stage 1 Stage 2 Stage 3 2012Stage 1 Stage 2Stage 3 2013Stage 1Stage 2Stage 3 2014Stage 1Stage 3 2015+Stage 3

24 24 Meaningful Use Criteria Objectives and Measures  Grouped into two categories ─ Health IT functionality measures Rely solely on capabilities included as part of Certified EHR Technology ─ Clinical quality measures Use certified EHR technology to submit information “on such clinical quality measures and such other measures” as the CMS shall select 24

25 25 Meaningful Use Health IT Functionality Measures  25 Health IT functionality measures matched to the objectives for Meaningful Use  IT functionality measures are fully defined in the NPRM and must be reported in the first payment year via attestation  The format and mechanism for attestation are not yet defined

26 26 Meaningful Use Update Health IT Functionality Measures 1 – 9 ObjectiveMeasure 1Use CPOECPOE is used for at least 80 percent of all orders 2Implement drug-drug, drug-allergy, drug- formulary checks The EP has enabled this functionality 3Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT® At least 80 percent of all unique patients seen by the EP have at least one entry or an indication of none recorded as structured data. 4Generate and transmit permissible prescriptions electronically (eRx). At least 75 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology. 5Maintain active medication list.At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient is not currently prescribed any medication) recorded as structured data. 6Maintain active medication allergy list.At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient has no medication allergies) recorded as structured data. 7Record demographics.At least 80 percent of all unique patients seen by the EP or admitted to the eligible hospital have demographics recorded as structured data 8Record and chart changes in vital signs. For at least 80 percent of all unique patients age 2 and over seen by the EP, record blood pressure and BMI; additionally, plot growth chart for children age 2 to 20. 9Record smoking status for patients 13 years old or older At least 80 percent of all unique patients 13 years old or older seen by the EP “smoking status” recorded

27 27 Meaningful Use Update Health IT Functionality Measures 10 – 15 ObjectiveMeasure 10Incorporate clinical lab-test results into EHR as structured data. At least 50 percent of all clinical lab tests results ordered by the EP or by an authorized provider of the eligible hospital during the EHR reporting period whose results are in either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data. 11Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach. Generate at least one report listing patients of the EP with a specific condition. 12Report ambulatory quality measures to CMS or the States. For 2011, an EP would provide the aggregate numerator and denominator through attestation as discussed in section II.A.3 of this proposed rule. For 2012, an EP would electronically submit the measures discussed in section II.A.3. of this proposed rule. 13Send reminders to patients per patient preference for preventive/ follow-up care. Reminder sent to at least 50 percent of all unique patients seen by the EP that are 50 and over 14Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules. Implement five clinical decision support rules relevant to the clinical quality metrics the EP is responsible for as described further in section II.A.3. 15Check insurance eligibility electronically from public and private payers. Insurance eligibility checked electronically for at least 80 percent of all unique patients seen by the EP

28 28 Meaningful Use Update Health IT Functionality Measures 17 – 22 ObjectiveMeasure 17Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and allergies) upon request At least 80 percent of all patients who request an electronic copy of their health information are provided it within 48 hours. 18Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies) At least 10 percent of all unique patients seen by the EP are provided timely electronic access to their health information 19Provide clinical summaries to patients for each office visit Clinical summaries provided to patients for at least 80 percent of all office visits. 20Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically. Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information. 21Perform medication reconciliation at relevant encounters and each transition of care. Perform medication reconciliation for at least 80 percent of relevant encounters and transitions of care. 22Provide summary care record for each transition of care and referral. Provide summary of care record for at least 80 percent of transitions of care and referrals.

29 29 Meaningful Use Update Health IT Functionality Measures 23 – 25 ObjectiveMeasure 23Capability to submit electronic data to immunization registries and actual submission where required and accepted. Performed at least one test of certified EHR technology's capacity to submit electronic data to immunization registries. 24Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice. Performed at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies (unless none of the public health agencies to which an EP or eligible hospital submits such information have the capacity to receive the information electronically). 25Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities. Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308 (a)(1) and implement security updates as necessary. www.mckesson.com/doctors Stimulus 101 Meaningful Use

30 30 Meaningful Use Update Clinical Quality Measures  Clinical quality measures are specific to setting and specialty ─ 3 core measures to be reported by all EPs tobacco use, blood pressure, and drugs to be avoided in the elderly ─ 15 sets of specialty measures, with each EP expected to report one of these sets  Specifications for the measures have not been published with a target to do so in April 2010  CMS has asked for comments on whether quality measure reporting should be deferred until 2012  Medicaid EPs will report Clinical Quality Measures to the State

31 31 EHR Certification Update Certification Criteria  Requirements for EHR certification will be more stringent than the requirements for demonstrating meaningful use  At this time, there is no recognized certification process available for vendors and there is no certification body formally recognized by HHS  In the past CCHIT was the certification agency for EHRs but at this point there has been no ruling on who will be the final certifying entity 31

32 32 Certification Update Certified EHR Technology  Two Types of Certification of EHR Technology 1. Complete EHR EHR must certify all requirements to certify as Complete EHR 2. Certified EHR Module “..any service, component, or combination thereof that can meet the requirements of at least one certification criterion adopted by the Secretary.” 32

33 33 Certification Update Certification Process/Bodies  Certification process NPRM issued on March 2 nd  Was placed in the Federal Register (FR) on March 10 th -  Proposes two different process – temporary and permanent ─ Temporary Process Accreditation of bodies will be governed by ONC ONC will take application of bodies applying for accreditation prior to the rule being final Expected timeframe for first bodies being accredited is May-June 2010 Comment period will be 30 days after publication placed in the FR No recertification of temporary certification bodies expected; temporary processes will only apply to Stage 1 meaningful use certification ─ Permanent Process Accreditation of bodies expected to be completed through private entities with guidance from National Institute of Standards and Technology (NIST) Expected timeframe for first bodies under permanent program to accredited January 2012 Comment period will be 60 days after publication in FR

34 3433 Eligible Provider Programs 44 McKesson’s EHR Solutions 22 HITECH Act Specifics 11 Stimulus Plan Overview HCIT and the Stimulus Agenda 55 Next Steps and Discussion

35 35 McKesson’s EHR for Independent Practices Practice Partner, Medisoft Clinical, Lytec MD  Certification Track Record ─ Practice Partner 9.3, Medisoft v15 and Lytec 2009 are CCHIT Certified® products for CCHIT Ambulatory EHR 2008 and Child Health  Surescripts Solution Provider ─ Certified for all three message types – Benefit, History and Routing  Backed by an Industry Leader ─ McKesson Corporation, currently ranked 15th on the FORTUNE 500, is the longest-operating company in healthcare Industry Certifications & Recognition

36 36 Traditional Barriers to EMR Adoption Cost and Disruption Barriers for EMR Adoption (# of Respondents w/o EMR) n = 107 Respondents Source: MTS Primary Research Survey  Cost has been the top barrier for physicians adopting an EMR  Disruption second highest barrier to adoption

37 37 Addressing the Cost Barrier OFFEHR Special Promotion  Applies to Practice Partner, Medisoft Clinical and Lytec MD  $1000 Cash Rebate for the first provider, $500 each additional provider  For more information go to www.offehr.com www.offehr.com

38 38 4/28/201538 A dynamic processing technology that enables physicians to utilize their preferred charting style to capture information in a single note. With one touch, data is instantly synchronized across the complete chart. Searchable patient data is then automatically generated so providers can quickly access meaningful clinical care reporting. Addressing the Disruption Barrier Bright Note Technology TM Inside

39 39 33 Eligible Provider Programs 55 Next Steps and Discussion 22 HITECH Act Specifics 11 Stimulus Plan Overview HCIT and the Stimulus Agenda 44 McKesson’s EHR Solutions

40 40  What is the provider application process for the incentives?  What are the specifications for CMS quality reporting measures? (due in April)  What is the vendor certification process?  Who are the certifying bodies?  Will Practice Management systems need to be certified? Next Steps and Discussion Several key questions remain to be answered

41 41 Next Steps and Discussion Q & A


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