American Recovery and Reinvestment Act (ARRA) of 2009

Health IT Provisions Overview

Spring 2009

HIT Programs & FundingGeneral Summary

• HHS to lead standards development for nationwide exchange and use of health information to improve quality and coordination of care.

• Over $30B of direct adoption incentives for “meaningful use” of certified EHRs. Specifically, $17.7B in Medicare incentives and $12.4 in Medicaid incentives. Over $2B for infrastructure, health information exchange (HIE) and clinical research funding.

• Conservative CBO estimates show that ARRA funding will save over $15B in government spending throughout the health sector through improved quality and care coordination, reductions in medical errors and duplicative care.

• Strengthens HIPAA to protect identifiable health information from misuse as use of HIT increases.

Federal HIT Leadership• Office of the National Coordinator

– Codifies ONC, to be headed by the National Coordinator appointed by the Secretary of HHS

– Primary purpose is to develop a nationwide health information technology infrastructure that allows for the electronic use and exchange of information

• HIT Policy Committee– Make recommendations on national HIT infrastructure and

implementation of the ONC Strategic Plan– Prioritize focus for interoperability and certification– Federal Advisory Committee Act (FACA)

• HIT Standards Committee– Recommend standards, implementation specs, and certification criteria

in accordance with the policies developed by the HIT Policy Committee– HITSP role is to be determined

Office of the National Coordinator

• Purpose– Develop a nationwide health information technology infrastructure

that allows for the electronic use and exchange of information

• Duties– Review and endorse standards, implementation specs and

certification criteria recommended by the HIT Standards Committee– Initial set of standards to be defined by 12/31/2009

• Those adopted previously may be applied toward meeting this requirement

– Coordinates HIT investments and programs of Federal agencies– In consultation with NIST, keep or recognize a program for the

voluntary certification of HIT (CCHIT)– Establish a governance mechanism for the nationwide health

information network– Appoint a Chief Privacy Officer

HIT Policy Committee

• Purpose– Make policy recommendations to the National Coordinator relating to

implementation of a nationwide health information technology infrastructure including implementation of the Federal HIT Strategic Plan

• Duties– Recommend a policy framework for the development and adoption of

a nationwide health information technology infrastructure– Prioritize areas in which standards, implementation specs and

certification criteria are needed

• Membership– Members appointed by government and to include at least one

information technology vendor

HIT Standards Committee• Purpose

– Recommend standards, implementation specs and certification criteria in accordance with the policies developed by the HIT Policy Committee

• Duties– Recommend standards, implementation specs and certification criteria

that have been developed, harmonized or recognized by the HIT Standards Committee

– Recognize harmonized or updated standards from an entity or entities– As appropriate, provide for the pilot testing of standards and specs by

NIST– With NIST, establish conformance testing infrastructure which may

include a program to accredit independent labs to perform testing • Membership

– Members are appointed and include a broad range of stakeholders (providers, ancillary healthcare works, consumers, purchasers, health plans, technology vendors, researchers, Federal agencies, and individuals with relevant expertise)

– Allows for open public comment

• Incentives begin in CY11 (1/1/2011)• For maximum bonus, must be a “meaningful” user of certified

EHR in CY11 or CY12• Bonus amounts decrease starting in CY13• If not a “meaningful” user by CY15, no bonus payments and

penalties will be applied• Physicians receive a reduction in fee schedule

– 2015 - 99%– 2016 - 98%– 2017 - 97%– 2018 - HHS Secretary has authority to increase penalties if

percentage of physicians who are “meaningful” users is less than 75%

– Maximum reduction is 95% of fee schedule

Medicare Physician Incentives

Medicare Physician Incentives• “Meaningful” use

– Using certified EHR technology, which includes e-prescribing– Demonstrates EHR is connected to provide electronic exchange of

health information to improve quality and promote care coordination– Reports on clinical quality measures selected by the Secretary– HHS Secretary to decide on further definitions which may change over

time• Incentive amount is calculated as 75% of allowable Part B charges

for the payment year• Maximum incentive payments are as follows

– Year 1 - $18,000 (If year 1 is 2011 or 2012, otherwise $15,000) – Year 2 - $12,000 – Year 3 - $8,000 – Year 4 - $4,000 – Year 5 - $2,000 – Year 6 - $0

• Physicians in health professional shortage areas receive a 10% increase

Medicare Physician Payout Schedule

Performance Year -> Starting

Year

CY11 CY12 CY13 CY14 CY15 CY16 Total

CY11 $18K $12K $8K $4K $2K 0 $44K

CY12 $18K $12K $8K $4K $2K $44K

CY13 $15K $12K $8K $4K $39K

CY14 $12K $8K $4K $24K

CY15 $0 $0 $0K

CY16 $0 $0

Medicaid Incentives forPhysicians & Hospitals

• Eligible Providers– Non-hospital-based professionals with ≥ 30% patient volume attributable to

individuals receiving medical assistance– Non-hospital-based pediatricians with ≥ 20% of patient volume attributable

to individuals receiving medical assistance– Eligible professionals who practice predominately in a Federally-qualified

health center or rural health clinic with ≥ 30% patient volume attributable to needy individuals

– Children’s hospitals or acute care hospitals that have ≥ 10% patient volume attributable to individuals receiving medical assistance

• Incentives– Professionals

• Must choose either Medicare or Medicaid• States authorized to make payments totaling no more than 85% of the

net average allowable costs for acquiring, upgrading, implementing and ongoing “meaningful” use of certified EHRs and associated services

• Maximum is $63,750.for physicians– Hospitals

• Maximum Medicare and Medicaid bonus is projected to be $11M

Medicare Incentives for Hospitals

• Requirements for incentives begin in FY11 (10/1/2010)

• For maximum bonus, must be a “meaningful” user of a certified EHR in FY11, FY12 or FY13

• Bonus amounts decrease beginning in FY14 with further reductions in FY15

• If not a “meaningful” user by FY15, there are penalties– Reduction in market basket increase

Medicare Hospital Incentives• “Meaningful” use

– Use of a certified EHR technology in a “meaningful” manner– Demonstrates EHR is connected to provide electronic exchange of

health information to improve quality and care coordination– Able to report clinical quality measures as specified by HHS

Secretary– HHS Secretary to decide on further definitions which may change

over time

$2M Base+ Discharge Amount* x Medicare Share** x Transition Factor ***Year x Payout Amount

*Discharge Amounts calculated as discharge amount = For the 1150th – 23,000th discharge - $200 per discharge – regardless of payer**Medicare Share calculated as Medicare Inpatient bed days + Medicare Advantage inpatient bed days (Number of inpatient bed days * (Total charges – charges for charity care) /Total Charges*** Transition Factor – see next slide

• Year 1 Incentive Calculation

Medicare Hospital Payout Example

Performance Yr ->

Starting Yr

FY11 FY12 FY13 FY14 FY15 FY16 Total

FY11 $1,256K $942K $628K $314K 0 0 $3,141K

FY12 $1,256K $942K $628K $314K 0 $3,141K

FY13 $1,256K $942K $628K $314K $3,141K

FY14 $942K $628K $314K $1,885K

FY15 $628K $314K $942K

FY16 $0 $0

Hospital with 10,000 discharges, 25% Medicare share, 25% charity care

Base Amount: $2,000,000 Discharge Amount + $1,770,200

$3,770,200Factor (Medicare & Charity) x .3333Year 1 Payout Amt $1,256,730

Grants and Loans$2B in Funding

• Health Information Technology Implementation Assistance– Establish Health IT Research Center

• Provide technical assistance and develop best practices to accelerate efforts to implement and utilize HIT that allows for electronic exchange and use of information

– Provide assistance for the creation of HIT Regional Extension Centers (details to be published in Federal Register within 90 days of enactment)

• Provide technical assistance and disseminate best practices and other information learned from the Center

• Regional Centers can be affiliated with any US-based non-profit organization– State grants to promote HIT

• Grants issued to states or qualified state-designated entities to facilitate and expand electronic movement and use of health information among organizations

• States required to match funds increasing over time• States can spend funds on certified EHRs

Grants and Loans • Competitive grants to states and Indian tribes for loan programs

– Development of loan programs to providers to facilitate the widespread adoption of certified EHRs

– Awards can begin in 2010– Matching funds required

• Demonstration programs to integrate certified HIT into clinical education– Develop academic curricula integrating certified EHRs into clinical

education– Matching funds required– Funds cannot be used to purchase hardware, software or services

• Information technology professionals in health care– Assist institutions to establish or expand medical and health informatics

education programs for health care and information technology– Preference to short-term existing programs

Privacy & Security• Notification of breach

– Defines breach– Individuals must be notified of unauthorized disclosure of their health

information• Accounting for disclosures

– Gives patients the right to request an accounting of disclosures of their health information made through an electronic record

– Requires HHS Secretary to promulgate regulations regarding what information must be included in the accounting of disclosures

• Restrictions on certain disclosures– Permits individuals to request that their PHI regarding a specific item or

service not be disclosed by a covered entity to a health plan for purposes of payment or healthcare operations if the individual has paid out-of-pocket for the item or service

Privacy & Security• Requirements for Business Associates (BAs)

– BAs now subject to same HIPAA privacy and security provisions and penalties that apply to Covered Entities (CEs)

• Sales/Marketing of protected health information (PHI)– Provides new restrictions on marketing use of PHI and on the

circumstances under which any entity can receive remuneration for PHI• New HIPAA Business Associate categories

– New entities not contemplated when HIPAA was written (such as PHR vendors, RHIOs, HIEs, etc.) are subject to same privacy and security rules as providers and health insurers by requiring BA contracts and treating the entities as BAs under HIPAA

• Enforcement allowed through states’ attorneys general

HHS Reports & Studies • Report on actions taken to facilitate adoption, barriers to achieve adoption and

further recommendations• Examine methods to create reimbursement incentives for improving health

care quality for Federally-qualified health centers, rural health clinics and free clinics

• Potential use of technology to assist seniors, individuals with disabilities and their caregivers

• Various reports on privacy and security• Report on open source technology (by 10/1/2010)

– HHS Secretary, Veterans’ Health Administration, Secretary of Defense, AHRQ and Federal Communications Commission

– Current availability of open source health IT systems to Federal safety net providers

– Total cost of ownership of such systems in comparison to the cost of proprietary commercial products available

– Ability of such systems to respond to the needs of, and be applied to, various populations (including children and disabled individuals)

– Capacity of such systems to facilitate interoperability

Research Programs• NIST and the National Science Foundation to issue competitive

grants to institutions of higher education (or consortia)– Generate innovative approaches to enterprise integration by

conducting cutting-edge, multidisciplinary research on the systems challenges to healthcare delivery

– Development and use of health information technologies and other complementary fields

– Research areas may include:• Interfaces between human information and communications technology• Software that improves interoperability among health information systems• Software dependability• Health information enterprise management• HIT security and integrity• Relevant HIT to reduce medical errors

Greenway - Moving Forward • Ongoing planning, monitoring and education

• There will be ongoing issues that require education and influence. Greenway will prioritize these issues based on:– Legislative movements– Regulatory interpretations and movements– Impact (+/-) on care provider and stakeholder communities

• For key issues– Determine positioning– Determine monitoring and education process– Educate/ engage Congress and Administration for specific or broad actions

• Staying informed– Greenway web site - http://www.greenwaymedical.com– Blog ~ http://healthitforthe21stcentury.blogspot.com/

Additional Resources

• Greenway’s Economic Stimulus Page on the Stimulus Package– http://www.greenwaymedical.com/news/stimulus/– Stimulus Package Overview of Health IT Funding and Incentives

• Government & HHS Stimulus Sites – www.recovery.gov– http://www.hhs.gov/recovery/

• Link to Final Congressional Language– http://fdsys.gpo.gov/fdsys/pkg/BILLS-111hr1ENR/pdf/BILLS-

111hr1ENR.pdf

Greenway Educational Materials and Positioning

• National Health IT Leadership– http://www.greenwaymedical.com/news/leadership/

• Government Affairs Testimonies & Leadership– http://www.greenwaymedical.com/company/government/

• Privacy & Security– EHR Association Privacy Position Statement

Greenway Medical Technologies, Inc.Corporate Headquarters121 Greenway BoulevardCarrollton, Georgia 30117

Phone: 770-836-3100 Toll-free: 866-242-3805Fax: 770-836-3200

www.greenwaymedcial.com