Federal Health IT PolicyLarry Wolf

Health IT Strategist, Kindred HealthcareJanuary 13, 2015

© 2015 Kindred Healthcare, Inc.

Change Happened

AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009

Health Information Technology for Economic and Clinical Health Act (HITECH)

ELECTRONIC HEALTH RECORDS

• Almost all hospitals now use EHRs

• Over half of outpatient physicians now use EHRs

HITECH

February 2009

TECHNICAL VISION

• Electronic Health Records are the norm

• Information follows the patient & available as needed

• Quality measures derived from EHR

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Strategic Themes

POST-ACUTE CARE

• Partnerships are essential

• Transitions are high risk

• Value must be proven

→ Share information with partners

→ Good communication reduces risk

→ Quality measures becoming eQuality Measures

→ Communication and data standards are key enablers

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PERSON-CENTERED

• Get Home (live your life)

• Stay Home (avoid hospitalization/re-hospitalization)

FEDERAL POLICY AND HEALTH INFORMATION TECHNOLOGY

• Triple Aim: Best Care for every individual + Best Health for the nation + Best Total Cost

• Align programs and payment

• Health IT is a means, not an end

• All providers and community partners need to be electronically enabled and connected

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Post-Acute Care• Diagnosis

• Intervention

• Recovery

• Rehabilitation

• Healing

• Wellness

• Prevention

• Long-term Management

TRANSITION OF CARE OBJECTIVE FOR HITECH MEANINGFUL USE STAGE 2

Electronic Care Summary for 10% of STAC hospital discharges

Standards:

• Direct – Secure Medical eMail

• Consolidated Clinical Document Architecture (C-CDA)

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* Source: RTI, 2009: Examining Post Acute Care Relationships in an Integrated Hospital System

35% of Medicare beneficiaries discharged from a short-term acute hospital receive post-acute services*

Physician payment for

• Care coordination

• Telehealth

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IMPACT Act of 2014 (Pubic Law 113-185)

STANDARDIZED ASSESSMENT DATA FOR POST-ACUTE CARE

GOALS• Comparison across LTPAC• Improved quality – care and outcomes• Improved communication and interoperability• Recommendations on payment reformMETHODS• Selectively standardize assessment data, data

for QMs, and data on resource use• Replace some elements of current

assessments (OASIS , MDS, IRF-PAI, LTCH)• Assess at admission and discharge

Improving Medicare Post-Acute Care Transformation Act of 2014

https://www.congress.gov/bill/113th-congress/house-bill/4994

http://www.gpo.gov/fdsys/pkg/PLAW-113publ185/pdf/PLAW-113publ185.pdf

FY 2015 FY 2017 FY 2018 FY 2019

Today

Use of quality data to inform discharge planning

FY 2016 FY 2020 FY 2021 FY 2022

Standardized quality and resource use measure reporting

Standardized assessment data (no later than)

CMS and MedPACreports on PAC prospective payment

Study on hospital assessment data

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QUALITY MEASURES – to include change in status

• Functional status (such as: mobility, self-care)

• Cognitive function (such as: ability to express ideas)

• Skin integrity

• Medication reconciliation

• Incidence of major falls

• Communicating health information and care preferences

ADDITIONAL DATA CATEGORIES – to include

• Medical conditions and co-morbidities

• Mental status (such as: depression, dementia)

• Impairments (such as: incontinence, impaired ability to see,

hear or swallow)

• Special services, treatments, and interventions

RESOURCE USE MEASURES – Domains include

• Estimated Medicare spending per beneficiary,

• Discharge to community,

• All-condition risk-adjusted potentially-preventable hospital

readmission rates

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Federal Health IT Strategic Plan: 2015-2020

DRAFT HEALTH IT STRATEGIC PLAN – OPEN FOR COMMENTS UNTIL FEBRUARY 6, 2015

http://www.healthit.gov/policy-researchers-implementers/health-it-strategic-planning

Collect

Share

Use

• Expand Adoption of Health IT

• Advance Secure and Interoperable Health Information

• Strengthen Health Care Delivery

• Advance the Health and Well-Being of Individuals and Communities

• Advance Research, Scientific Knowledge, and Innovation

RECOMMENDATIONS: FEDERAL HIT POLICY COMMITTEE ON LTPAC AND BEHAVIORAL HEALTH (June 2014)

• Interoperability especially for assessments• Privacy and Security

• Align Federal programs on data and standards• Consistent HIT certification program

http://healthit.gov/facas/sites/faca/files/HITPC_CAWG_VoluntaryCert_Update_2014-06-10.pdf

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CONNECT WITH PARTNERS

• Electronic Health Record (EHR) vendor

• Acute care providers – hospitals and physician groups

• Local Health Information Organization/Exchange (HIO/HIE)

• Free-standing Direct email provider/Health Internet Service Provider (HISP)

In early 2015

• Interoperability Roadmap

• Proposed Rule for MU Stage 3 and HIT 2015 Certification

© 2015 Kindred Healthcare, Inc.

Thank YouCONTACT INFORMATION

Larry Wolf

Health IT Strategist, Kindred Healthcare

Co-chair, Implementation, Usability and Safety Workgroup, Federal Health IT Policy Committee

Member, LTPAC Health IT Collaborative

Larry.Wolf@Kindred.com

@larrywolf51

Office of the National Coordinator for Health IThttp://www.healthit.gov/

Long-Term and Post-Acute Care Health IT Collaborative

http://www.ltpachealthit.org/

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