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MSMAHIT for the Physician
January 30, 2010
Karen Edison, MD
Center for Health Policy
University of Missouri, Columbia
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“Information is the lifeblood of modern medicine. Health information technology (HIT) is destined to be its circulatory system.”
David Blumenthal, M.D., M.P.P.
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HITECH Act – Health Information Technology for Economic and Clinical Health
Part ($2B) of the American Recovery and Reinvestment
Act of 2009 aka “ARRA” or the “Stimulus Bill”
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Most of the $20 Billion is for incentives for physicians
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New programs
Regional Centers $673 M HI exchange - states $564 M Workforce training $118 M Beacon communities $235 M HIT research (SHARP) $60 M NHIN (National HI network) & Standards and certification $64 M
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New Regulations – open for comment!
Meaningful use
Certification
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Background Information CMS released notice of proposed rulemaking on
“meaningful use” of certified electronic health records on Dec. 30, 2009
The Office of the National Coordinator for Health Information Technology (ONC) released its complementary certification standards Both rules published in Federal Register January 13, 2010.
ONC: interim final rule; effective date February 12, 2010, but changes are still possible.
Comments are strongly encouraged: Deadline March 15, 2010.
Source: Association of American Medical Colleges & Manatt Health Solutions
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“Meaningful Use”
Using EHR technology in a meaningful manner.
Requires meaningful use measures to become more stringent over time.
Source: Association of American Medical Colleges
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Proposed Stages of Meaningful Use By Payment YearFirst Payment Year for EP
Payment Year
2011 2012 2013 2014 2015+
2011 Stage 1 Stage 1 Stage 2 Stage 2 Stage 3
2012 Stage 1 Stage 1 Stage 2 Stage 3
2013 Stage 1 Stage 2 Stage 3
2014 Stage 1 Stage 3
2015 Stage 3
Source: Association of American Medical Colleges
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Medicare and Medicaid Rules
EPs (eligible professionals) choose between Medicare & Medicaid (must be 30% of pts. except for peds who need 20%)
Medicare and Medicaid rules: mostly consistent
One-time switch no later than 2014
Source: Association of American Medical Colleges
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Incentives for Eligible Professionals Medicare payments are available for EPs that are
paid under the physician fee schedule (PFS)
Medicare payments will be determined on an individual-practitioner basis
Each year under the EHR Incentive Program, an EP will receive 75 percent of the EP’s total “allowed charges” during the Payment Year, subject to a cap.
The payment limit for the first year depends on when the EP begins “meaningful use” of an EHR system.
Source: Manatt Health Solutions
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Adoption Year
Maximum Payment
PFSPenalty
2011 2012 2013 2014 2015 2016 Total
2011 $18,000 $12,00 $8,000 $4,000 $2,000 $0 $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 $12,00 $8,000 $4,000 $24,000
2015 $0 1%
2016 $0 2%
2017+$0 3%
Source: Manatt Health Solutions
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3 Stages of Objectives Stage 1: (details in this proposed rule)
Using information to track key clinical conditions and communicating that information for care coordination
Implementing clinical decision support tools
Reporting clinical quality measures and public health information
Source: Association of American Medical Colleges
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Stage 2:(Proposed by end of 2011)
Expand stage 1 criteria to encourage using health IT for quality improvement
Exchange of information in most structured format possible
Source: Association of American Medical Colleges
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Stage 3: (Proposed by end of 2013)
Promote improvements in quality, safety, and efficiency
Decision support for national high priority conditions
Patient access to self-management tools
Access to comprehensive patient data
Improving population health
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Stage 1 Highlights
25 measures corresponding to Stage 1
objectives for EPs
Must meet all 25 measures
Yes/No Measures
Source: Association of American Medical Colleges
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Baseline Requirement
50% or more of patent encounters during the reporting period at
practice(s)/location(s) equipped with certified EHR technology
Source: Association of American Medical Colleges
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Examples of Yes/No Measures
Implement drug-drug, drug-allergy, drug-formulary checks
Generated at least 1 report of patients with specific condition
Implement 5 clinical decision support rules One test of electronic exchange of key
clinical information
Source: Association of American Medical Colleges
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Examples of Yes/No Measures
One test of electronic data submission to immunization registry
One test of electronic syndromic surveillance data to public health agency
Conduct or review security risk analysis and implement security updates
Source: Association of American Medical Colleges
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Measures requiring a numerator and
denominator Higher % for criteria based on capability Lower % if electronic exchange of information
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Stage 1 Highlights
25 measures corresponding to Stage 1
objectives for EPs
Must meet all 25 measures
Yes/No Measures
Source: Association of American Medical Colleges
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Examples of Measures Requiring a Numerator and Denominator
75% of all permissible prescriptions transmitted electronically
10% of all unique patients provided timely electronic access to their health information
80% of all unique patients have at least one medication entry (or an indication of “none”) recorded as structured data
Source: Association of American Medical Colleges & Manatt Health Solutions
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Examples of Measures Requiring a Numerator and Denominator
80% of all unique patients over age 12 have smoking status recorded
Reminder sent to 50% of all unique patients that are age 50 or older
50% of clinical lab test ordered are incorporated in EHR technology
Source: Manatt Health Solutions
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Medicare Meaningful Use Reporting How to report? Attestation through secure
mechanism 90 Day Reporting Periods for EPs
Earliest: Jan. 1, 2011-Apr. 1, 2011 Latest: Oct. 1, 2011-Dec. 31, 2011
Quality Reporting 2011: Calculate and attest to results 2012: Submit data through EHR
Source: Association of American Medical Colleges
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Incentive Payments
Rolling payments-90 days first year; full calendar year thereafter
Fee schedule reductions for EPs who do not achieve meaningful use: 2015: 1% 2016: 2% 2017 and after: 3% Exceptions for hardship on case-by-case basis for
EPs practicing in rural areas with insufficient internet access and for hospital-based EPs
Source: Association of American Medical Colleges
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Medicare Medicaid
Eligible professional Physician, (medicine or osteopathy), dentist, podiatrist, optometrists, chiropractor
Physician, dentist, certified nurse, mid-wife, nurse practitioner, physician assistant in RHC or FQHC
Max incentive amount $44,000 $63,750
Maximum amount first payment year
$18,000 (2011-2012)$15,000 (2013)$12,000 (2014)
$21,250 (2011-2016)
To earn incentive for first payment year
Must meet all meaningful use criteria
Adopt, implement, or upgrade
Year penalties begin 2015 No penalties
Maximum number of years can receive payment
5 6
Source: Association of American Medical Colleges
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This is a very fluid process
Your voice matters!
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29
Missouri State Wide Health Information Exchange
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State activity so far……….
•Establish MO-HITECH
•Establish Advisory Board
•Convene Workgroups
•Publish Draft Strategic Plan for Review
•Engage and educate stakeholders
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Current state activity and plan
•Convene Advisory Board & Workgroups
•Publish Draft Operational Plan for Review – mid March
•Engage and educate stakeholders
•Submit Operational Plan – late April
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MO-HITECH Advisory Board
Co-Chairs – Ronald Levy, Director DSS & HIT Coordinator and Barrett Toan
Staff – George Oestreich, Charlotte Krebs & Manatt Team: Bill Bernstein, Melinda Dutton, Tim Andrews, Kier Wallis
Membership – 18 people from public and private sector
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Physician members of the Advisory Board
Karen Edison, MD, Center for Health Policy
Tracy Godfrey, MD, Family Physician, Joplin
Ian McCaslin, MD, MO HealthNet Director
Tom Hale, MD, PhD, Sisters of Mercy, St. Louis
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Workgroups
Governance Finance Technical Infrastructure Business and Technical Operations Legal/Policy Consumer Engagement
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Key decisions are being made NOW!
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Missouri Health Information Technology (HIT) Assistance
Center
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Core Applicant Team
University of Missouri’s Health Management and Informatics
(HMI) Department Center for Health Policy (CHP) Missouri Telehealth Network (MTN) Family and Community Medicine (FCM)
Department
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Key Partners
Primaris (Missouri’s Quality Improvement Organization)
Missouri Primary Care Association (MPCA)
Kansas City Quality Improvement Collaborative (KCQIC)
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Mission
To help primary care providers and others to
Choose an EHR Re-engineer office workflow Implement an EHR and deal with vendors Achieve “meaningful use” Pull down incentives
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“Knowing is not enough; we must apply.Willing is not enough; we must do.”—Goethe
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If you are interested in the State HIE process
www.dss.mo.gov/hie
If you are interested in the services of the Missouri HIT Assistance Center