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2. Overview of Health IT in the Stimulus Package Joel P. Hinzman Senior Director – Government Affairs

3. 3 Health IT Legislative Action in Stimulus bill Major Congressional Action 1/26/2009 Introduced in House 1/28/2009 Passed/agreed to in House: On passage Passed by the Yeas and Nays: 244 - 188 (Roll no. 46).Roll no. 46 2/10/2009 Passed by the Senate: On passage Passed by the Yeas and Nays: 61 – 37 2/13/2009 Conference report passed by both Houses of Congress 2/17/2009 Signed by the President, Public Law 111-5 3/20/2009 - David Blumenthal Named As National Coordinator for Health Information Technology Pending – Kathleen Sebelius confirmed as Secretary of HHS

4. 4 Overview of Stimulus Spending Funding is… temporary, intended to preserve and create jobs, and make investments in infrastructure, energy and science, unemployment assistance, and State and Local stabilization. Improved Oversight through Additional funds for the Inspectors General and GAO. A new Executive Branch-level board to oversee funding Requirements for Federal agencies to include expenditure plans prior to obligating funds. Additional reporting requirements to ensure greater accountability. Certification by State and local officials that the spending is an appropriate use of taxpayer funds. Key Funding Tenets $288 B $575 B $800+ B * Source: Public Law 111-5 (American Recovery and Reinvestment Act), Recovery.gov

5. 5 ARRA Health IT Summary ARRA provisions Codifies ONCHIT Creates HIT Policy and Standards Committees Health IT Certification program through NIST Financial Incentives through Medicare and Medicaid for Health IT Adoption Direct appropriations through HHS, SSA

6. 6 HIT Stimulus Implementation PhaseFunding FY2010-11Market Jumpstart o Standards and policy o Regional Health Information Extension Centers o National Health Exchange $2 Billion (HHS ONC) $1.6 – discretionary $0.3 – HIE $20M -- NIST FY2012-14EHR Incentives (CMS performance standards) $19-32 Billion (HHS CMS) FY2015 ->EHR PenaltiesProjected Savings (HHS CMS)

7. 7 PL 111-5 - American Recovery and Reinvestment Act of 2009 – Policy actions Codification: Office of the National Coordinator for Health Information Technology. The Bill would establish within HHS the Office of the National Coordinator for Health Information Technology (ONCHIT). The National Coordinator would be appointed by the Secretary and report directly to the Secretary. The purpose of ONCHIT would be to promote the development of a national health information technology infrastructure that allows the electronic use and exchange of information, in order to improve health care quality, reduce health care costs, improve public health, and facilitate research, among other things.

8. 8 HIT Policy Committee Creation of HIT Policy Committee. Make policy recommendations to the National Coordinator relating to the implementation of a nationwide health information technology infrastructure. The Committee would be required to provide recommendations in five areas: (1) technologies that protect the privacy and security of electronic health information; (2) a nationwide HIT infrastructure that enables electronic information exchange; (3) nationwide adoption of certified EHRs; (4) EHR technologies that allow for an accounting of disclosures; and (5) using EHRs to improve health care quality. The mark describes other areas that the committee might consider, including using HIT to reduce medical errors, and telemedicine

9. 9 HIT Policy Committee `(C) OTHER AREAS FOR CONSIDERATION- In making recommendations under subparagraph (A), the HIT Policy Committee may consider the following additional areas: `(i) The appropriate uses of a nationwide health information infrastructure, including for purposes of-- `(I) the collection of quality data and public reporting; `(II) biosurveillance and public health; `(III) medical and clinical research; and `(IV) drug safety.

10. 10 HIT Standards Committee HIT Standards Committee. The Bill would establish an HIT Standards Committee to recommend to the National Coordinator standards, implementation specifications, and certification criteria for the electronic exchange of health information. Duties of the HIT Standards Committee would include: The development and pilot testing of standards, Serving as a forum for the participation of a broad range of stakeholders to provide input on the development, harmonization, and recognition of standards. Not later than 90 days after enactment, the HIT Standards Committee would outline a schedule for assessing the policy recommendations developed by the HIT Policy Committee, and this schedule would be published in the Federal Register. The Secretary would be required to adopt, through rulemaking, an initial set of standards by December 31, 2009.

11. 11 Incentives for Adoption INCENTIVES FOR ELIGIBLE PROFESSIONALS `(I) For the first payment year for such professional, $15,000 (or, if the first payment year for such eligible professional is 2011 or 2012, $18,000). `(II) For the second payment year for such professional, $12,000. `(III) For the third payment year for such professional, $8,000. `(IV) For the fourth payment year for such professional, $4,000. `(V) For the fifth payment year for such professional, $2,000. `(VI) For any succeeding payment year for such professional, $0.

12. 12 INCENTIVES FOR HOSPITALS The applicable amount for an eligible hospital is based on a base amount, the discharge specifications for a 12 month period, Medicare Share, and Transition Factor BASE AMOUNT- The base amount specified is $2,000,000. `(C) DISCHARGE RELATED AMOUNT- The discharge related amount for a 12- month period selected by the Secretary shall be determined as the sum of the amount, based upon total discharges (regardless of any source of payment) for the period, for each discharge up to the 23,000th discharge as follows: `(i) For the 1,150th through the 9,200nd discharge, $200. `(ii) For the 9,201st through the 13,800th discharge, 50 percent of the amount specified in clause (i). `(iii) For the 13,801st through the 23,000th discharge, 30 percent of the amount specified in clause (i). Medicare Share is based on the number of inpatient-bed-days

13. 13 Funding Summary Direct Appropriations National Telecommunications and Information Administration’s Broadband Technology Opportunities Program $4.7 billion U.S. Department of Agriculture’s Distance Learning, Telemedicine, and Broadband Program $2.5 billion Office of the National Coordinator (ONC) $2 billion Health Resources and Services Administration (construction, renovation, and equipment for health centers)$1.5 billion Agency for Healthcare Research and Quality (AHRQ), National Institutes of Health (NIH), and the Department of Health and Human Services (HHS). comparative effectiveness research $1.1 billion Social Security Administration $500 million Indian Health Service: health IT, including telehealth $85 million Veterans Benefits Administration: information technology $50 million Medicare and Medicaid (2009 – 19)$31.0 Billion Medicare Improvement Fund$1.8 Billion Grants - TBD

14. 14 The HI-TECH Investment Over Time

15. 15 Health Care Reform and HIT Strategy Health Care Reform Payment Reform Care Delivery Transformation Health IT

16. 16 Health IT Market Re-alignment Technology Design Health Outcomes National Interoperability Local Data Exchange Private Sector- drive standards and certification Care-driven design/HHS Prioritization

17. 17 Healthcare Category / Amt IT = $ 31.0B Indirect = $ 1.2B * Assumes 1% of Total Current InvestmentsPipeline No Health in AU Siebel HHS / Insurance GBU – HTB, Analytics Middleware GBU AIA * Source: Oracle Govt Affairs, American Recovery and Reinvestment Act of 2009

18. 18 Grants State Grants to Promote Health Information Technology The Secretary, acting through the National Coordinator, shall establish a program to facilitate and expand electronic movement and use of health information among organizations according to nationally recognized standards. The Secretary may award a grant to a State or qualified State-designated entity. Beginning with FY11, the Secretary may not make a grant to a state unless that State agrees to make available non-federal contributions toward the costs of a grant: 1) FY11, not less than $1 for each $10 of federal funds provided under the grant; 2) FY12, not less than $1 for each $7 of federal funds provided under the grant, and 3) FY13 and each subsequent fiscal year, not less than $1 for each $3 of federal funds provided under the grant.

19. 19 Grants Competitive Grants to States and Indian Tribes for the Development of Loan Programs to Facilitate the Widespread Adoption of Certified EHR Technology: The National Coordinator may award competitive grants to eligible entities for the establishment of programs for loans to healthcare providers. Funding must be allocated for certified EHR technology. An eligible entity shall establish a certified EHR technology loan fund and specify the intent to use funds. Demonstration Program to Integrate Information Technology into Clinical Education: The Secretary may award grants to carry out demonstration projects to develop academic curricula integrating certified EHR technology in the clinical education of health professionals.

20. 20 Questions