Agenda HIT survey Health Information Technology Incentives HITREC- Health Information Technology...

Agenda

HIT surveyHealth Information Technology Incentives

HITREC- Health Information Technology Regional Extension Center

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BackgroundAmerican Recovery and Reinvestment Act (ARRA)

provides incentive payments to Medicaid-eligible professionals and hospitals for the meaningful use of certified Electronic Health Record (EHR) technology

For Medicaid-eligible professionals and hospitals to adopt and meaningfully use health information technology to improve health care quality, efficiency, and patient safety

Avoid excessive or unnecessary burdens on providers in helping them to achieve meaningful use

Ensure privacy and security of Personal Health Information (PHI)

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Division of ResponsibilityIowa Department of Public Health – e-Health

and statewide Health Information ExchangeKory Schnoor: 515.924.4636ehealth@idph.state.ia.us

IFMC – HIT Regional Extension Center (HITREC)Susan Harr 800.373.2964sharr@ifmc.org

Iowa Medicaid Enterprise – administration of incentive payment programKelly Peiper 515.974.3071imeincentives@dhs.state.ia.us

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Eligible Professional (EP)Non-hospital based Physicians

Hospital-based EP furnishes at least 90% of services in a hospital inpatient or ER setting**

PediatriciansNurse PractitionersCertified Nurse MidwivesDentistsPAs working in a FQHC/RHC when the

facility is so led by a PA

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Hospital Eligibility

One CMS Certification Number (CCN) = one hospital

Acute Care Average length of stay is less than or equal

to 25 days CCN range (0001-0879; 1300-1399) Includes cancer hospitals

Children’s Hospital 78 Children’s hospitals, CCN (3300-3399) Not children’s wings of larger hospitals

Critical Access Hospitals are eligible under Medicaid

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Patient Threshold EligibilityEntity Minimum

Medicaid patient volume

threshold

Or the Medicaid EP practices

predominately in an FQHC or

RHC – 30% needy

individual patient volume

threshold

Physicians 30% Pediatricians 20%

Dentists 30% CNMs 30% PAs when practicing at an FQHC/RHC that is so led by a PA

30%

NPs 30% Acute care hospitals

10% N/A

Children’s hospitals

No requirement

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Patient Threshold

EP is also eligible when “practicing predominately” in a FQHC/RHC providing care for “needy individuals”

“Practicing predominately” is when FQHC/RHC is the clinical location for over 50% of total encounters over a period of 6 months in the most recent calendar year for an eligible professional

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Patient Threshold, contNeedy individuals (for FQHC/RHC)are

defined as:Medicaid or the Children’s Health

Insurance ProgramReceiving uncompensated care by the

providerFurnished services at either no cost or

reduced cost based on a sliding scale determined by the individual’s ability to pay. 

Must annually meet patient volume thresholds,

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Patient Threshold, contFinal rule gives two options. Option One:

(Total (Medicaid) patient encounters in any 90-day period in the preceding calendar

year) Divided by

(Total patient encounters in that same 90-day period)

Multiplied by 100

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Patient Threshold, contOption Two:

(Total Medicaid patients assigned to the provider in any representative continuous 90-day period in the preceding calendar year with at least one encounter in the year preceding the start of the 90-day period) + (Unduplicated Medicaid encounters in that same 90-day period)

Divided By(Total patients assigned to the provider in the

same 90-day with at least one encounter in the year preceding the start of the 90-day period) + (All unduplicated encounters in that same 90-day period)

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Patient Encounter1 – Services rendered on any one day to an

individual where Medicaid or a Medicaid 1115 grant paid for part or all of the service

2 – Services rendered on any one day to an individual where Medicaid or a Medicaid 1115 grant paid all or part of their premiums, co-payments and/or cost sharing

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Incentive Payments to EPsCY Medicaid EPs who begin adoption, or MU certified EHR

technology in 2011 2012 2013 2014 2015 2016

2011 $21,250 2012 8,500 $21,250 2013 8,500 8,500 $21,250 2014 8,500 8,500 8,500 $21,250 2015 8,500 8,500 8,500 8,500 $21,250 2016 8,500 8,500 8,500 8,500 8,500 $21,250 2017 8,500 8,500 8,500 8,500 8,500 2018 8,500 8,500 8,500 8,500 2019 8,500 8,500 8,500 2020 8,500 8,500 2021 8,500 TOTAL 63,750 63,750 63,750 63,750 63,750 63,750

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Payments to HospitalsThe calculation is (overall EHR Amount) times (Medicaid Share)Where overall EHR Amount equals

{Sum over 4 year of {(Base Amount plus discharge related amount applicable for each year) times transition Factor applicable for each year}} times

Medicaid Share equals {(Medicaid inpatient-bed-days plus

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)]}

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Incentive Assignment

EP may assign payment to an employer or billing entity

EPs may assign payments to entities promoting EHR technology, as designated by the StateStates must establish verification procedures

that enable the latter assignment, to ensure it is voluntary and that the entity does not retain more than 5% of the payment for non-EHR activities

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Meaningful UseMeaningful Use

TimingMedicaid EHR incentive program starts

in 2011 and ends in 2021The latest that a Medicaid provider can

initiate is 2016A Medicaid provider can initiate the

program under the Adopt, Implement and Upgrade bar, but must meet Meaningful Use during subsequent years at the stage that is currently in place (Stage 3 by 2015)

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Adopt, Implement or UpgradeAdopt: Acquired and installed

E.g., Evidence of acquisition, installation, etc.

Implement: Commenced utilizationE.g., staff training, data entry of patient

demographic information into EHR, data use agreements

Upgrade: Version 2.0, expanded functionalityE.g., Office of National Coordinator (ONC)

EHR certification

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Meaningful UseA provider must demonstrate meaningful use

by:• Use of certified EHR technology in a meaningful manner, such as through e-prescribing, and

• 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

• In using this technology, the provider submits clinical quality measures to CMS and likely to the State

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Meaningful Use SummaryEligible Professionals 80% of patients must have records in the certified

EHR technology 20 of 25 Objectives and Measures 8 Measures require ‘Yes’ or ‘No’ answers 17 Measures require numerator and denominator

Eligible Hospitals 19 of 24 Objectives and Measures 10 Measures require ‘Yes’ or ‘No’ answers 14 Measures require numerator and denominator

Reporting Period – 90 days for first year; entire year subsequently

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Meaningful Use StagesMeaningful Use will be phased in over 3

stages through rulemaking: Stage 1 – 2011Stage 2 – 2013*

Stage 3 – 2015*

*Stages 2 and 3 will be defined in future CMS rulemaking.

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Verification2011 – Submit proof by attestation

Patient thresholdNot hospital-based

2012 – Electronically submit summary quality measure data

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Clinical Quality Measures for Eligible Hospitals

• Hospitals to report summary data on 15 clinical quality measures to CMS (first through attestation, then electronically) for each patient to whom the QM applies

• Hospitals only eligible for Medicaid will report directly to the States

• If the measures don’t apply, then option of selecting an alternative set of Medicaid clinical quality measures – including newborn measures, pediatric measures, and never-event measures

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Medicare vs. MedicaidMedicare vs. Medicaid

Medicare vs. Medicaid Criteria Medicare Medicaid

Feds will implement (will be an option nationally)

Fee schedule reductions begin in 2015 for providers that are not Meaningful Users

Must be a meaningful user in Year 1

Maximum incentive is $44,000 for EPs

MU definition will be common for Medicare

Voluntary for States to implement (may not be an option in every State)

No Medicaid fee schedule reductions

Adopt/Implement/Upgrade option for 1st participation year

Maximum incentive is $63,750 for EPs

States can adopt a more rigorous definition (based on common definition)

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Medicare vs. Medicaid Criteria Medicare Medicaid

Medicare Advantage EPs have special eligibility accommodations

Last year an EP may initiate program is 2014; Last payment in program is 2016.

Only physicians, subsection (d) hospitals and CAHs

Last year an EP may initiate program is 2016; Last payment in program is 2021

Medicaid managed care providers must meet regular eligibility requirements

5 types of EPs, 2 types of hospitals (including CAHs)

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Payments: Registration through the NLRTo prevent duplicate paymentsSupply Name, NPI, business address, phoneTINHospitals must provide CCNEPs select between Medicare or Medicaid

May switch once between programs before 2015

If Medicaid, must select one stateMay switch states annually

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Next StepsUnderstand your eligibility and

think about the measures that apply to you

Evaluate your workflows in relation to capturing the measures

Talk with your vendors about their plans to support meaningful use

Final rule http://www.ofr.gov/OFRUpload/OFRData/2010-17207_PI.pdf

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The HITRECFederally-funded Regional Extension CenterAssistance to providers in adopting,

implementing and achieving meaningful use of the of EHRs by:Vendor selectionGroup purchasingImplementationProject managementPractice workflow designInteroperabilityPrivacy and securityHIE

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The HITRECEligible providers:Individual and small primary care practices

(10 or fewer with prescriptive privileges)Public and critical access hospitalsCommunity Health Centers and Rural Health

ClinicsSettings that predominately serve the

uninsured, underinsured, and medically underserved

In the first two years, technical assistance is subsidized for priority primary care providers. Grant funds 90 percent, participating providers pay approximately 10 percent.

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Questions, comments?

Please complete the HIT surveyWhat are your barriers to

implementing an EHR?Likelihood of qualifying? Please send questions and

comments to imeincentives@dhs.state.ia.us

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