Electronic Health Records/Meaningful Use –

Current Status

Presented by Patricia Holladay, Ph.D.

American Recovery and Reinvestment Act of 2009 and HITECH Act

• ARRA provides substantial financial incentives ($19 billion over a specified five-year period) that will help physicians purchase and implement Healthcare IT systems.

• Medicare and Medicaid EHR Incentive Program begins October 1, 2010 for hospitals and January 1, 2011 for eligible professionals.

• However, physicians cannot take advantage of the incentive payment programs under both the Medicare and Medicaid programs.

• Source: Centers for Medicare and Medicaid Services

Even with incentive payments, EHRs are expensive…

• Centers for Medicare and Medicaid Services (CMS) estimates that the average cost for an eligible professional to adopt/implement/upgrade a certified EHR technology is $54,000 per physician FTE (full-time equivalent).

• Further, CMS estimates that annual maintenance costs average $10,000 per physician FTE per year.

• For eligible hospitals, CMS estimates the range to be between $1 million and $5 million for installation and $1 million annually for maintenance, upgrades, and training.

• Source: Centers for Medicare and Medicaid Services

American Recovery and Reinvestment Act of 2009 and HITECH Act

• Eligible providers and hospitals must select and implement an:

Electronic Health Record (EHR) which is certified by an Authorized Testing and Certification Body (currently CCHIT and the Drummond Group), demonstrate Meaningful Use (MU) in a phased in process with a few criteria to accomplish within a 90-day period in 2011 and full calendar year use starting in 2012.

• Interoperability and communication to the Health Information Exchange program will be significant challenges to all healthcare organizations.

ARRA provides financial incentives through the Medicare Part B Total = $44k

First Payment Year First Payment Year First Payment Year Amount,and Subsequent PaymentAmounts in Following YearsReduction in Fee Schedule forNon-Adoption/Use

Reduction in Fee Schedule forNon-Adoption/Use

2011 $18k, $12k, $8k, $4k, & $2k $0

2012 $18k, $12k, $8k, $4k, & $2k $0

2013 $15k, $12k, $8k, and $4k $0

2014 $12k ,$8k, and $4k $0

2015 $0 -1% of Medicare fee schedule

2016 $0 -2% of Medicare fee schedule

2017 and thereafter $0 -3% of Medicare fee schedule

Incentives under the Medicaid program

• Incentives under the Medicaid program are available for:– physicians, – hospitals, – federally-qualified health centers,– rural health clinics, – and other providers.

• Physicians (non-hospital based), with at least 30% Medicaid patient volume, could receive up to $63,750 and eligible pediatricians (non-hospital based), with at least 20% Medicaid patient volume, could receive up to $42,500 over a six-year period.

• First payment is $21,250• Must begin by 2018 to receive a payment

Electronic Health Record Incentive Program: Meaningful Use

• Purpose of Meaningful Use

1. Improve quality, safety, efficiency and reduce

health disparities

2. Engage patients and families

3. Improve care coordination

4. Ensure adequate privacy and security

protections for personal health information

5. Improve population and public health

Source: HIMSS Webinar conducted August 11, 2010 by Fred Rachman, M.D.

and Mary Griskewicz, MS, FHIMSS

CMS Vision for StagesRequirements Scaling Up Over

Stage 1 Stage 2 Stage 3

1. Capturing healthinformation in acoded format2. Using the informationto track key clinicalconditions3. Communicatingcaptured informationfor care coordinationpurposes4. Reporting of clinicalquality measures andpublic healthinformation

1. Disease management,clinical decisionsupport2. Medicationmanagement3. Support for patientaccess to their healthinformation4. Transitions in care5. Quality measurement6. Research7. Bi-directionalcommunication withpublic health agencies

1. Achievingimprovements inquality, safety andefficiency2. Focusing on decisionsupport for nationalhigh priorityconditions3. Patient access to self-managementtools4. Access tocomprehensivepatient data5. Improving populationhealth outcomes

For Stage 2, CMS may also consider applying the criteria more broadly to both the inpatient and outpatient hospitalsettings. CMS expects to propose Stage 2 criteria by the end of 2011.CMS expects to propose Stage 3 criteria by the end of 2013.

Source: www.physiciansfoundation.org

MU Objectives for Eligible Providers (EP)

• All objectives are published in the final rule

• A total of 20 objectives are required

• Reporting period is 90 days for the first year and 1

year subsequently

• 15 Core Objectives with measures required for EPs

• Five Menu Objectives with measures required for EPs

– EPs may select from 10 potential objectives based on

current EHR Stage 1 criteria

Source: HIMSS Webinar conducted August 11, 2010 by Fred Rachman M.D. and Mary Griskewicz, MS, FHIMSS

Eligible Provider MU Stage 1: Menu Objectives

• Menu Objective (Choose Five) Measure

1. Implement drug formulary checks. Drug formulary check system is implemented and has

access to at least one internal or external drug

formulary for the entire reporting period.

2. Incorporate clinical laboratory test results More than 40% of clinical laboratory test results

into EHRs as structured data. whose results are in positive/negative or numerical format

are incorporated into EHRs as structured data.

3. Generate lists of patients by specific Generate at least one listing of patients with a specific

conditions for quality improvement, condition.

reduction of disparities, research, or outreach.

4. Use EHR technology to identify More than 10% of patients are provided patient-specific

patient‐specific education resources and educational resources.

provide those to the patient as appropriate.

5. Perform medication reconciliation between Medication reconciliation is performed for more than

care settings. 50% of transitions of care

Source: HIMSS Webinar conducted August 11, 2010 by Fred Rachman M.D. and Mary Griskewicz, MS, FHIMSS

Eligible Provider MU Stage 1: Menu Objectives

6. Provide summary of care records for patient’s Summary of care record is provided for more than 50%

referred or transitioned to another provider or of patient transitions or referrals.

setting.

7. Submit electronic immunization data to Perform at least one test of data submission and follow up

immunization registries or immunization submission and follow up submission (where registries

information systems. can accept electronic submissions).

8. Submit electronic syndromic surveillance Perform at least one test of data submission and follow-

data to public health agencies. up submission (where agencies can accept electronic

submissions).

9. Provide patients with timely electronic access More than 10% of all unique patients seen by the EP

to their health information within four business are provided timely electronic access to their health

days of the information being available to the EP. information subject to the EP’s discretion to withhold

certain information.

10. Send reminders to patient per patient preference More than 20% of all unique patients 65 years or older, or

for preventive or follow up care five years old or younger, were sent an appropriate re-

minder during the HER reporting period.

Source: HIMSS Webinar conducted August 11, 2010 by Fred Rachman M.D. and Mary Griskewicz, MS, FHIMSS

CQM: Eligible Professionals

• Core, alternate core, and additional CQM sets for EPs

• EPs must report on three required core CQMs, and if the denominator of one or more of the required core measures is zero, then EPs are required to report results for up to three alternate core measures.

• EPs also must select three additional CQM from a set of 44 CQM (other than the core or alternate core measures)

• In sum, EPs must report on six total measures: three required core measures (substituting alternate core measures where necessary) and three additional measures.