Meaningful Use and Financial Incentives Michele Madison

Meaningful Use and Certification Requirements Infrastructure and Federal Standards Funding Eligible Professionals Medicare/Medicaid Incentives Medicaid Program Meaningful Use Next Steps

Health Information Technology for Economic and Clinical Health Act $2 Billion Dollars Allocated to the Office of National Coordinator $20 Million to National Institute of Standards and Technology for continued work on advancing health care information enterprise integration through activities such as technical standards analysis and establishment of conformance testing infrastructure $300 Million to Regional and Sub-national Efforts for Health Information Exchange

Establishing and Governing the National Health Information Network National Coordinator to develop a nationwide health information technology infrastructure for the electronic exchange of health information to:  ensure that each patient's health information is secure and protected  improve health care quality, reduce costs and medical errors  endorse standard and certification for electronic exchange and use of health information

Office of National Coordinator HIT Policy Committee: evaluates and recommends: Technologies that protect the privacy of health information and promote security in a qualified electronic health record A nationwide health information technology infrastructure that allows for the electronic use and accurate exchange of health information Any other technology that the HIT Policy Committee finds to be among the technologies with the greatest potential to improve the quality and efficiency of health care HIT Standards Committee Recommend to the National Coordinator Standards, Implementation Specifications, and Certification Criteria for the Electronic Exchange of Health Information Harmonization of standards in order to achieve uniform and consistent implementation Pilot Testing of Standards and Implementation Specifications Serve as a Forum for Broad Stakeholder Input with Specific Expertise in the development, harmonization, and recognition of standards, implementation specifications, and certification criteria

Governmental Incentives Medicare and Medicaid EHR Programs are estimated to provide incentives in the amount of: $9.7Billion to $27.4 Billion

GENERAL RULE “Eligible Professionals” who adopt and “meaningfully use” “certified” electronic health records are eligible for Medicare and Medicaid Financial Incentives

Who is Eligible? Eligible Professionals A qualifying EP is one who successfully demonstrates meaningful use for the EHR reporting period. The Final Rule finalizes that hospital based eligible professionals to exclude physicians that provide 90% or more of their services in either an inpatient or emergency department. Hospitals –Acute Care Hospitals that are paid on PPS Critical Access Hospitals –The Final Rule Includes Critical Access Hospitals in the definition of eligible hospital for Medicaid incentives.

Eligible Professionals Medicare A physician as defined in section 1861(r) of the Social Security Act*, which includes the following five types of professionals:  Doctor of medicine or osteopathy  Doctor of dental surgery or medicine  Doctor of podiatric medicine  Doctor of optometry  Chiropractor

Medicaid Program Medicaid Eligible Professionals (30% population) Physicians Pediatricians (20% population) Dentists Certified nurse-midwives Nurse practitioners Physician assistants who are practicing in Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs) led by a physician assistant. Hospitals -10% Medicaid Patient Volume Childrens Hospitals (cannot include CHIP patients in Medicaid Volume)

Registration Eligible Providers may Register with CMS starting on January 3, EPs may only participate in one program. The EPs may change programs one time prior to Hospitals may participate in both Medicare and Medicaid Programs.

Payment Calculation For Medicare, the Eligible Professionals may receive payments equal to 75 percent of Medicare allowable charges for covered professional services furnished by the EP in a payment year, subject to maximum payments. The Annual Payments for Eligible Professionals are the maximum amounts to be paid per year. There is a total maximum of $44,000 for Medicare For HPSA there is a 10% Bonus = $48,400 for Medicare

Medicare Incentives Incentives for Adoption and Meaningful Use of Certified EHR Paid to the Eligible Professional or Facility or Employer No payments after 2016 No incentive if first adopting after 2014 Payment is single consolidated payment

Medicare Incentives by Adoption Year 15 Meaningful User Total Incentive 2011$ 18,000 $ 12,000 $ 8,000 $ 4,000$ 2,000 $ 44, ,000 $ 12,000 $ 8,000$ 4,000$ 2,000 $ 44, ,000 $ 12,000$ 8,000$ 4,000 $39, ,000 $ 8,000$ 4,000 $ 24, $ Penalties

Medicaid Payments Maximum incentive is $63,750 Must begin by 2016 No bonus for HPSA Incentives available through 2021 Paid Once per Year

HOSPITAL PAYMENTS Acute Care Hospitals Critical Access Hospitals Children's Hospitals (Medicaid)

Hospital Payments Hospital Specific Calculation:  [$2Million + (0 x ( discharges) +(200 x (23, discharges) + [Medicare Share] x [Transition Factor].  If the adoption is after 2013 the payment will reduce based upon modified Transition Factor  Critical Access Hospital:  (Reasonable costs incurred for the purchase of certified EHR technology) times (Medicare share percentage).  The Medicare share percentage equals the lesser of (1) 100 percent; or (2) the sum of the Medicare share fraction for the CAH and 20 percentage points.  Paid through prompt interim payment– cost reporting period  No payment after 2015 and no payments for more than 4 consecutive years

(Overall EHR Amount) * (Medicaid Share) or Overall EHR Amount Equals {Sum over 4 year of [(Base Amount Plus Discharge Related Amount Applicable for Each Year) * Transition Factor Applicable for Each Year]} * Medicaid Share Equals {(Medicaid inpatient-bed-days + Medicaid managed care inpatient-bed-days) divided by [(total inpatient-bed days) times (estimated total charges minus charity care charges) divided by (estimated total charges)]} Medicaid Hospital Calculation

Key Dates for Eligible Professionals January 1, 2011 – Reporting year begins for eligible professionals. January 3, 2011 – Registration for the Medicare EHR Incentive Program begins. January 3, 2011 – For Medicaid providers, states may launch their programs if they so choose. April 2011 – Attestation for the Medicare EHR Incentive Program begins.  May 2011 – EHR Incentive Payments expected to begin. October 1, 2011 – Last day for eligible professionals to begin their 90-day reporting period for calendar year 2011 for the Medicare EHR Incentive Program. December 31, 2011 – Reporting year ends for eligible professionals. February 29, 2012 – Last day for eligible professionals to register and attest to receive an Incentive Payment for calendar year (CY) 2011.

Key Dates for Hospitals October 1, 2010 – Reporting year begins for eligible hospitals and CAHs. January 3, 2011 – Registration for the Medicare EHR Incentive Program begins. January 3, 2011 – For Medicaid providers, states may launch their programs if they so choose. April 2011 – Attestation for the Medicare EHR Incentive Program begins. May 2011 – EHR Incentive Payments expected to begin. July 3, 2011 – Last day for eligible hospitals to begin their 90-day reporting period to demonstrate meaningful use for the Medicare EHR Incentive Program. September 30, 2011 – Last day of the federal fiscal year. Reporting year ends for eligible hospitals and CAHs. November 30, 2011 – Last day for eligible hospitals and critical access hospitals to register and attest to receive an Incentive Payment for Federal fiscal year (FY) 2011

Meaningful Use

Development of Meaningful Use ARRA –February 17, 2009 Meaningful Use Proposed Definition  Health IT Policy Committee-Provided a Matrix to Define Terms Final Matrix Approved August 14, 2009 Proposed Rule Published January 13, 2010 Final Rule Published July 28, 2010

Ultimate Goal The ultimate goal of meaningful use of an Electronic Health Record is to enable significant and measurable improvements in population health through a transformed health care delivery system. The ultimate vision is one in which all patients are fully engaged in their healthcare, providers have real-time access to all medical information and tools to help ensure the quality and safety of the care provided while also affording improved access and elimination of health care disparities.

Health Outcome Policy Priorities Improve Quality, Safety, Efficiencies and Reduce Health Disparities Engage Patients and Families Improve Care Coordination Improve Population and Public Health Ensure Adequate Privacy and Security Protections for Personal Health Information

Meaningful User --Medicare Eligible Professional/Eligible Hospital is a meaningful user during the payment year if: 1. Demonstrates use of a certified EHR technology in a meaningful manner; 2. Demonstrates to the satisfaction of the Secretary that certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of health care such as promoting care coordination, in accordance with all laws and standards applicable to the exchange of information; and 3. Using certified EHR technology to submit to DHHS in a manner the clinical quality measures specified by DHHS

Meaningful User--Medicaid EP or Eligible Hospital may demonstrate that they have engaged in efforts to adopt implement or upgrade certified EHR technology Must demonstrate meaningful use of certified EHR technology through a means approved by the State and acceptable to the Secretary that may be based upon the federal methodologies for Medicare programs For Hospitals, if the hospital is a meaningful user under Medicare then it is a meaningful user for Medicaid One uniform definition of Meaningful Use is the minimum standard for both Medicare and Medicaid.

Meaningful Use Requirements January 13, 2010July 22, Measures for Providers 23 Measures for Hospitals Core Elements Menu Elements Administrative TasksRemoved Administrative Transactions Measures required high thresholdsMeasures require lower end of percentage thresholds Denominator calculation of each chart No Denominator calculation on each chart Patient Education RequiredPatient education only for Hospitals

Final Rule Stage 1: Electronically capturing health information in a coded format Track key clinical conditions and communicating that information for Care Coordination Purposes Implement Clinical Decision Support tools to facilitate disease and medication management; reporting clinical quality measures; and public health information

Stages Stage 2 Encourage the use of Health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible, such as the electronic transmission of orders entered using CPOE and the electronic transmission of diagnostic test results. Stage 3 Focus on promoting improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to comprehensive patient data and improving population health

Demonstration of Meaningful Use During the First Year Eligible Professionals and Hospitals shall file an attestation statement that they are in compliance with the meaningful use measures. Reporting Period is 90 days During the Second Year, Eligible Professionals and Hospitals shall electronically report the information. Reporting Period is Full Year

Medicaid Payments First participation year only for Medicaid providers Adopted –Acquired and Installed: Evidence of installation prior to incentive Implemented –Commenced Utilization of: Staff training, data entry of patient demographic information into EHR Upgraded –Expanded Upgraded to certified EHR technology or added new functionality to meet the definition of certified EHR technology (CMS Presentation July 20, 2010)

Medicaid and State Public Policy For Stage 1, the States may add additional public health objectives for Medicaid Incentives: 1. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach 1. Generate one report listing patients with a specific conditions 2. Submit electronic immunization information 1. Perform at least one test to submit immunization registry information

Medicaid State Public Policy 3. Submit electronic data on reportable lab results to public health agencies Perform at least one test of capacity to submit data on lab results to public health agencies 4. Submit electronic surveillance data to public health agencies Perform one test to submit data to public health agencies Hospitals do not have to satisfy extra requirements if “deemed” a meaningful user under Medicare

MU Elements Eligible Professionals have 15 Core Elements Hospitals have 14 Core Elements Menu Sets offer flexibility, but at least one Menu set must address a public objective 5 objectives out of 10 from the Menu Set 6 Total Clinical Quality measures If an element is not applicable and the provider does not have any eligible patients then the measure may be excluded

Criteria for HIT Stimulus Funding: Meaningful Use and Certification Requirement s May 4, 2010 Certification A Required Element

Standards, Implementation Specifications and Certification Criteria for Electronic Health Record Certification criteria specify the capabilities and related standards that certified EHR technology must include to support the meaningful use Stage 1 requirements Adopted standards are consistent with current industry practices – no surprise Adopted standards based on standards for interoperability of health information technologies Future rules will have increased details and requirements regarding interoperability

Certification Process Temporary Certification Program Certification Commission for Health Information Technology (CCHIT) - Chicago, Ill. Date of authorization: September 3, Scope of authorization: Complete EHR and EHR Modules. Certification Commission for Health Information Technology Drummond Group, Inc. (DGI) - Austin, Texas. Date of authorization: September 3, Scope of authorization: Complete EHR and EHR Modules. Drummond Group, Inc. InfoGard Laboratories, Inc. – San Luis Obispo, CA Date of authorization: September 24, Scope of authorization: Complete EHR and EHR Modules. InfoGard Laboratories, Inc. Temporary program sunsets on January 1, 2012

Permanent Certification Commencing on January 1, 2012 the Permanent Certification Program commences The National Institute of Standards and Technology (NIST) through its National Voluntary Laboratory Accreditation Program (NVLAP) will be responsible for accrediting organizations to test health information technology (particularly EHR technology) under the permanent certification program. One accreditation organization will be approved through a competitive process to accredit certification bodies.

What Should I Do? Registration Planning and Implementation Medicare or Medicaid?

Thank you Michele Madison Partner, Healthcare This presentation is provided as a general informational service to clients and friends of Morris, Manning & Martin LLP. It should not be construed as, and does not constitute, legal advice on any specific matter, nor does this message create an attorney-client relationship. These materials may be considered Attorney Advertising in some states. Please note, prior results discussed in the material do not guarantee similar outcomes.