Health Information Technology

EHR Meaningful Use

Milestones for HIT Funding

Michele Madison

mmadison@mmmlaw.com

Presentation Overview

Purpose and Function of Stimulus Package

Provider Financial Incentives

Meaningful Use

Certification Standards

Governmental Incentives

American Recovery and Reinvestment Act of 2009 (ARRA)

Medicare Incentives for Eligible Professionals

Medicaid Incentives for Eligible Professionals

Direct Provider Funding

WHO: DHHS – CMS

WHEN: 2011 ----

HOW: Financial Incentive Payments

TO WHOM: Eligible Professional and Hospitals

GENERAL RULE

“Eligible Professionals” who adopt and “meaningfully use”

“certified” electronic health records

are eligible for Medicare and Medicaid Financial Incentives

Eligible Professionals

Medicare Incentives may be paid to “Eligible Professionals”

– Physicians

– Does not Apply to Hospital Based Physicians

• Emergency Room

• Anesthesia

• Pathologists

• (Determined based upon Site of Service)

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

Physicians

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.

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 either single consolidated payment or periodic installment payments

Meaningful Use Incentives by Adoption Year

9

Meaningful User 2009 2010 2011 2012 2013 2014 2015 2016 Total Incentive

2011 $ 18,000 $ 12,000 $ 8,000 $ 4,000 $ 2,000 $ 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 12,000 $ 8,000 $ 4,000 $ 24,000

2015 + $ Penalties

Medicare Dis-Incentive

Failure to Meaningfully Use Certified EHR

Starting in 2015 reduce reimbursement to 99%

– 2016 – 98%. . .

– 2017-- 97%. . .

– 2018 -- 96% . . .

– Not less than 95%

Unless Significant Hardship applies (5 year Limitation)

Hospital Payments

Hospital Specific Calculation:

[$2Million + (0 x (1149-1 discharges) +(200 x (23,000-1150 discharges) + (>23000 x 0)] x [Medicare Share] x [Transition Factor].

If the adoption is after 2013 the payment will reduce based upon modified Transition Factor

Critical Access Hospital:

Paid through prompt interim payment– cost reporting period

No payment after 2015 and no payments for more than 4 consecutive years

Development of Meaningful Use

ARRA –February 17, 2009

Meaningful Use Proposed Definition

– Health IT Policy Committee

– June 16, 2009

– Provided a Matrix to Define Terms

– Comments received until June 26, 2009

Meaningful Use under ARRA

Use of E-prescribing

Use Certified EHR to report on clinical quality measures selected by DHHS

DHHS may set alternative requirements for a group practice

DHHS shall seek to improve the use of electronic health records and health care quality over time by requiring more stringent measures of meaningful use

Information exchange - ARRA

EHR technology is connected in a manner that provides, in accordance with law and standards applicable to the exchange of information, for the electronic exchange of health information to improve the quality of health care, such as promoting care coordination.

Meaningful Use

Meaningful Use Criteria must be selected and approved by DHHS

The Measures must be published for public comment

Must be measures that DHHS can accept for reporting

Demonstration of Meaningful Use

Demonstrate Use

(1) attestation;

(2) submit claims;

(3) survey; or

(4) reporting

Meaningful Users will be identified on CMS website

HIT Policy Committee Recommendations

Established “Health Outcome Policy Priorities”

Care Goals

2011, 2013 and 2015 Objectives

2011, 2013 and 2015 Measures

Ultimate Goal of HIT Policy Committee

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

HIT Policy Committee

July 16, 2009 Revised Meaningful Use Objectives and Measures

August 14, 2009—Final Meaningful Use Objectives and Measures

Final Matrix for Review

http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_888532_0_0_18/FINAL%20MU%20RECOMMENDATIONS%20TABLE.pdf

HIT Standards Committee

August 20, 2009

Meaningful Use Measures and Data Grid

Clinical Operations Workgroup

Privacy and Security Workgroup

Meaningful Use WorkgroupStandards Committee

Standard Categories

Quality Data Types

HITEP Definitions

Data Elements

Standards

http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_880493_0_0_18/MU%20Grid%20Data%20Element%20Standards_08202009.pdf

Measure Process Workflow

Clinical Operations

Subject Area

Recommended for 2011 and 2013 Implementation

Recommended Directional Statement for 2013 and 2015

http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_880490_0_0_18/Ferguson_Clinical%20Operations%20WG%20Recommendations%20Revised%20Summary.pdf

Privacy and Security Standards

Source

Standards

Services Supported

Recommended Implementation Time Frame

http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_880497_0_0_18/PRIVACY%20AND%20SECURITY%20STANDARDS%20APPLICABLE%20TO%20ARRA%20REQUIREMENTS.pdf

Certification Process

• Once a certification process is proposed, HHS in consultation with other relevant federal agencies, will review the recommendations and propose adoption of the standards, implementation specifications and certification criteria and jointly determine adoption

• Adoption pursuant to the formal rulemaking process

• Refusal to adopt requires notice to ONC and the Standards Committee with rationale

• Voluntary use of standards and implementation specifications by private entities

• Certification of private technologies will be voluntary.

• Federal agencies will require by contract that healthcare providers, health plans or health insurance issuers upgrade to IT Systems that meet the standards – catalyst to adopt.

Certification Process

• ONC will keep or recognize programs to certify technology that is in compliance with applicable certification criteria.

• Certification criteria means criteria to establish the technology meets with the standards and implementation specifications.

• The National Coordinator will consult with the Director of the National Institute of Standards and Technology in creating the certification programs.

• Implications of certification standards that do not support or require “interoperable” health network

Providers

Focus on Certification and Standards Foundation:

Functionality - ensuring that the systems can support the activities and perform the functions for which they are intended;

Security - ensuring that systems can protect and maintain the confidentiality of data entrusted to them; and

Interoperability - ensuring that systems implement the recognized standards and can exchange information and work with other systems.

Providers

Evaluate current Technology

Determine if the Technology is being programmed to address

Objectives 2011

Measures 2011

Focus on Interoperability, Functionality and Security

Evaluate Current Operations

Evaluate New Technology

Take Pro-active Steps

Monitor Objectives and Measures

Monitor Technology Compliance

Evaluate Disparate Programs

Take steps to ensure compliance with measures

Reporting mechanisms

Thank you

Michele MadisonPartner, Healthcare Practice

404.504.7621mmadison@mmmlaw.com

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