Beyond Meaningful Use MS-HIN Introduction April 24, 2015

Beyond Meaningful Use

MS-HIN IntroductionApril 24, 2015

Who is the Mississippi Health Information Network (MS-HIN)?

Who is MS-HIN

MS-HIN is a state agency that serves two functions:

The statewide Health Information Exchange organization for Mississippi.

The statewide public health reporting gateway. (including Meaningful Use reporting)

Meaningful Use

What is Health Information Exchange

The term “health information exchange” (HIE) includes two related concepts:

• Verb: The electronic sharing of health related information among organizations and providers.

• Noun: An organization that provides services to enable the electronic sharing of health information.

Aftermath of Katrina

The vision is to continue building a healthcare “Community” with patients at the center. This community shares data that helps create information. The information helps improve decision making.

Dispersed Health Care Information

Collaboration Among Providers

Why is this Important

With limited time and a heavy patient load, providers face a daunting task trying to identify a patient's multiple needs during a single office visit.

“By collecting and analyzing data that present a more comprehensive, detailed medical picture of entire patient populations, physician practices can monitor their patient panels more efficiently -- often without scheduling additional office visits” (AAFP, 2014, para. 2).

Why is the Important

“patients seeing nurse practitioners were also found to have higher levels of satisfaction with their care” Health Affairs - (Cassidy, 2013).

“The patient-centered nature of nurse practitioner training, which often includes care coordination and sensitivity to the impact on health of social and cultural factors, such as environment and family situation, makes nurse practitioners particularly well prepared for and interested in providing primary care” Health Affairs - (Cassidy, 2013).

Why is this Important - Readmissions

Consider a patient with a high potential for readmission (who) is discharged from the hospital on Wednesday. You might want to see (the patient) that Friday to make sure (he or she is) on the right track. The data we have suggest that we don't do that well. Providers are often not involved at that point.

Dr. David Bates, chief of the Division of General Medicine at Brigham and Women's Hospital in Boston

Who Has Access?MS-HIN makes its Health Information Exchange available to Providers, Hospitals and its Authorized Users only for the Permissible Purposes authorized and approved by the MS-HIN:

You may only use or download patient information contained on the system according to the HIPAA minimum necessary standard, for the following purposes, and only to the extent permissible under all applicable laws regarding the privacy of patient information: (i) for treatment of those patients under your care; (ii) to collect payment for the services you provide to your patients; (iii) to conduct your business operations; and (iv) to comply with the laws that govern health care.

All patient information viewed through the system is strictly confidential and is subject to the protection of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the privacy and security regulations promulgated pursuant to HIPAA, including, but not limited to, 45 C.F.R. Parts 160 and 164 Subparts C and E, as may be amended from time to time.

CURRENT MS-HIN PARTNERS

Current Numbers

Unique Patients: 900,000+ Participating Hospitals: 12 Participating Clinics / FQHCs: 150+ Hospitals in Active Onboarding: 41 Total HL7 messages sent to the CHR:

1,739,620 (JAN 2015)

Chart Views: 4,986 (JAN 2015)

MS-HIN TECHNOLOGY

MS-HIN Technology

COMMUNITY (Consolidated Community Health Record)

– COLLABORATE (Electronic Referrals)

– COMMUNICATE (Secure Email)

AWARE (Encounter-Based Patient Notifications)

COMMUNITY(Consolidated Community Health Record)

Web based platform. (nothing to install) Longitudinal/Consolidated Patient Record. Results Inbox. (result notification tool) HealtheWay Certified System. Filled Medication History Lookup. Embedded COMMUNICATE Platform. Embedded COLLOBORATE Platform.

COMMUNITY(Consolidated Community Health Record)

Do you spend a lot of time searching for clinical data?

Can the Community Health Record improve this process?

COLLABORATE(Electronic Referrals)

Web based platform. (nothing to install) Link from the Community Health Record. An EHR is not required to send or receive

referrals. Eliminates the need for faxing, phone tag,

and waiting for status updates on preliminary information, appointment verification, and results.

COLLABORATE(Electronic Referrals)

Are you currently using a referral system?– Electronic– EHR Based– Paper/Phone

COMMUNICATE(Secure Email)

Web based platform. (nothing to install) Direct Trust Accreted. An EHR is not required to send or receive

secure emails.

COMMUNICATE(Secure Email)

1. Mail folders and nested folders2. Link to return to the messages

screen3. Check for new mail4. Move selected message(s) to a

different folder5. Deleted selected message(s)

6. Link to return to the Contacts list7. Reply to the message

8. Forward the message9. Print the Message

10. Save the Message

11. Link to the settings panel12. Manage Folders

13. List of messages in the currently-displayed folder14. Message Text

AWARE(Patient Based Event Alerts)

Hospital visit triggers notification

Notifications configured by each user

Can be secure (with PHI) or unsecure (no PHI)

Available Fall 2015

AWARE (Patient Based Event Alerts)

Subscription Wizard– User can choose to have

notifications sent immediately when the event happens or aggregated and sent at specified time intervals

– Filter subscriptions on ADT criteria (e.g. diagnosis code, admissions, and discharge events

– Identify modality (text, email, secure email)

AWARE (Direct) Notification

Is there value in knowing external patient events (timely)?

Will this help your care coordination and health outcomes?

FUTURE SERVICES / ROADMAP

MS-HIN Future Services

Images

Enhanced Reporting

Analytics

Care Coordination / Patient Engagement Solutions

Thank You

Contacts

www.ms-hin.ms.gov

Jeremy Hill, Acting Executive Director– jeremy.hill@ms-hin.ms.gov

30 Day Readmissions

Section 3025 of the Affordable Care Act added section 1886(q) to the Social Security Act establishing the Hospital Readmissions Reduction Program, which requires CMS to reduce payments to IPPS hospitals with excess readmissions, effective for discharges beginning on October 1, 2012. The regulations that implement this provision are in subpart I of 42 CFR part 412 (§412.150 through §412.154).

30 Day Readmissions (cont.)

CMS has posted the FY 2015 IPPS/LTCH PPS final rule. In the FY 2015 IPPS Final Rule, CMS has made refinements to the readmissions measures. CMS is finalizing to include two additional readmissions measures, COPD and THA/TKA in the calculation of a hospital’s readmissions payment adjustment factor.

30 Day Readmissions (cont.)In the FY 2012 IPPS final rule, CMS finalized the following policies with regard to the readmission measures under the Hospital Readmissions Reduction Program:

Defined readmission as an admission to a subsection(d) hospital within 30 days of a discharge from the same or another subsection(d) hospital;

Adopted readmission measures for the applicable conditions of Acute Myocardial Infarction (AMI), Heart Failure (HF) and Pneumonia (PN);

Established a methodology to calculate the excess readmission ratio for each applicable condition, which is used, in part, to calculate the readmission payment adjustment. . A hospital’s excess readmission ratio for AMI, HF and PN is a measure of a hospital’s readmission performance compared to the national average for the hospital’s set of patients with that applicable condition.

Established a policy of using the risk adjustment methodology endorsed by the National Quality Forum (NQF) for the readmissions measures for AMI, HF and PN to calculate the excess readmission ratios, which includes adjustment for factors that are clinically relevant including patient demographic characteristics, comorbidities, and patient frailty.

Established an applicable period of three years of discharge data and the use of a minimum of 25 cases to calculate a hospital’s excess readmission ratio of each applicable condition.

30 Day Readmissions (cont.)Formulas to Calculate the Readmission Adjustment Factor

Excess readmission ratio = risk-adjusted predicted readmissions/risk-adjusted expected readmissions

Aggregate payments for excess readmissions = [sum of base operating DRG payments for AMI x (excess readmission ratio for AMI-1)] + [sum of base operating DRG payments for HF x (excess readmission ratio for HF-1)] + [sum of base operating DRG payments for PN x (excess readmission ratio for PN-1)] + [sum of base operating DRG payments for COPD x (excess readmission ratio for COPD-1)] + [sum of base operating payments for THA/TKA x (excess readmission ratio for THA/TKA -1)]

*Note, if a hospital’s excess readmission ratio for a condition is less than/equal to 1, then there are no aggregate payments for excess readmissions for that condition included in this calculation.

Aggregate payments for all discharges = sum of base operating DRG payments for all discharges

Ratio = 1 - (Aggregate payments for excess readmissions/ Aggregate payments for all discharges)

Readmissions Adjustment Factor =

For FY 2013, the higher of the Ratio or 0.99 (1% reduction);For FY 2014, the higher of the Ratio or 0.98 (2% reduction).For FY 2015, the higher of the Ratio or 0.97 (3% reduction).

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