improving patient care through meaningful use of an electronic health record: an introduction ehr...
TRANSCRIPT
Improving Patient Care Through Meaningful Use of an
Electronic Health Record: An Introduction
EHR CAC Basic Training (OP)October 18, 2010
IHS Office of Information Technology
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Today’s Session
This training will introduce the following topics:1.American Reinvestment and Recovery Act
(ARRA) and Health Information Technology for Economic and Clinical Health (HITECH)
2.Centers for Medicare & Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Programs
3.Regional Extension Centers (RECs)4.Meaningful Use (MU) and Indian Health Service
(IHS) 5.Contacts and Resources
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ARRA and HITECH
1. CMS EHR Financial Incentives – Offers incentive payments to eligible health care providers who achieve meaningful use of an EHR
2. Regional Extension Centers (REC) – Assist health care providers seeking to achieve meaningful use of an EHR
3. Beacon Communities – funding to build and strengthen health IT infrastructure and exchange capabilities
4. HIT educational grants – certificate through university level
The American Recovery and Reinvestment Act of 2009 (ARRA) included the HITECH act which “seeks to improve American health care delivery and patient care through an unprecedented investment in health information technology” through:
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CMS EHR Financial Incentive Programs
Two CMS EHR Financial Incentive Programs were established under ARRA HITECH
Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
•Both programs are voluntary however eligible providers must choose which program they will participate in•Both programs require use of certified EHR technology •Medicare program requires demonstration of meaningful use during first year of participation•Medicaid provides for payment of financial incentives to EPs who meet patient volume requirements and adopt/upgrade/implement during their first year of participation
1. Medicare- administered by CMS2. Medicaid – joint administration by CMS and
state
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Medicare and Medicaid Incentive Programs
Medicare Medicaid
Federal Government will implement starting in January 2011
Voluntary for States to implement - Most are expected to start by late summer 2011
Payment reductions begin in 2015 for providers that do not demonstrate Meaningful Use
No Medicaid payment reductions
Must demonstrate MU in Year 1 A/I/U option for 1st participation year
Maximum incentive is $44,000 for EPs (bonus for EPs in HPSAs)
Maximum incentive is $63,750 for EPs
MU definition is common for Medicare States can adopt certain additional requirements for MU
Last year a provider may initiate program is 2014; Last year to register is 2016; Payment adjustments begin in 2015
Last year a provider may register for and initiate program is 2016; Last payment year is 2021
Only physicians, subsection (d) hospitals and CAHs
5 types of EPs, acute care hospitals (including CAHs) and children’s hospitals
Slide content provided by CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
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Definitions
Adopt/Implement/Upgrade• Adopt - Acquire and Install• Implement – Begin to Use• Upgrade – EHR certification or addition of new
functionality
Meaningful use refers to using certified EHR technology to:
1.Improve quality, safety, efficiency, and reduce health disparities
2.Engage patients and families in their health care3.Improve care coordination4.Improve population and public health5.Maintain privacy and securitySlide content provided by CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
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Meaningful Use Basic Requirements
1. Use of certified EHR in a meaningful manner (e.g., e-prescribing)
2. Use of certified EHR technology for electronic exchange of health information to improve quality of health care
3. Use of certified EHR technology to submit clinical quality measures (CQM)
Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
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Certification vs Meaningful Use
• Certification is an official stamp of approval indicating that the EHR is fully functional. The EHR vendor is responsible for obtaining certification. IHS OIT performs this function for the RPMS EHR.
• Meaningful Use is how the EHR is used. This is the responsibility of providers with assistance from local, area, and national staff
Health program staff are responsible for knowing the MU requirements and using the EHR to meet MU requirements
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Real Life Exampleof MU
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Medicare Incentives
Amount of Payment Each Year if Continues Meeting Requirements
1st Calendar Year EP Receives a Payment
CY 2011 CY 2012 CY 2013 CY2014CY 2015 and later
CY 2011 $18,000
CY 2012 $12,000 $18,000
CY 2013 $8,000 $12,000 $15,000
CY 2014 $4,000 $8,000 $12,000 $12,000
CY 2015 $2,000 $4,000 $8,000 $8,000 $0
CY 2016 $2,000 $4,000 $4,000 $0
TOTAL $44,000 $44,000 $39,000 $24,000 $0
Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
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Medicare Penalties
• An Eligible Professional (who accepts Medicare) but does NOT demonstrate meaningful use by 2015 will be subject to payment reductions in Medicare reimbursements
• These reductions apply to all providers who accept Medicare even if the provider only participates in the Medicaid EHR Financial Incentive program
Medicaid-only EPs who are not eligible for the Medicare incentive are not subject to the Medicare payment reductions
Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
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Medicaid Incentives
Amount of Bonus Each Year if Continues Meeting Requirements
1st Calendar Year EP Receives a Payment
CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016
CY 2011 $21,250
CY 2012 $8,500 $21,250
CY 2013 $8,500 $8,500 $21,250
CY 2014 $8,500 $8,500 $8,500 $21,250
CY 2015 $8,500 $8,500 $8,500 $8,500 $21,250
CY 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250
CY 2017 $8,500 $8,500 $8,500 $8,500 $8,500
CY 2018 $8,500 $8,500 $8,500 $8,500
CY 2019 $8,500 $8,500 $8,500
CY 2020 $8,500 $8,500
CY 2021 $8,500
TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
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CMS Financial Incentives Summary
MEDICARE MEDICAIDIncentives
StartCY 2011 CY 2011
IncentivesEnd
CY 2016(max. 5 years)
2021(max. 6 years, must start by
2016)
Incentive Amount
Up to $44,000 total per provider; based on %
Medicare claims (bonus for EPs in HPSAs)
Up to $63,750 total per provider; based on 85% of EHR
costs
Patient Volume
Requirements
None
30% Medicaid* (20% for pediatricians)30% needy individuals (FQHC or RHC)
Reimbursement Reduced
CY 2015 No penalties
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Stages of Meaningful Use
Stage 12011-2012
Stage 22013-2014
Stage 32015+
Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
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Stage 1Reporting
Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
15 core objectivesMost require achievement of performance targets
5 objectives out of 10 from menu setMost require achievement of performance targets
Some MU objectives will not apply to every provider (i.e. dentists who do not perform immunizations) and the eligible provider will not be required to meet the measure. Exclusions do NOT count against the 5 deferred measures.
States can request CMS approval for inclusion of 4 additional objectives as core measures for state Medicaid providers.
6 total Clinical Quality Measures do not have performance targets - 3 core or alternate core - 3 out of 38 from menu set
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Eligible Professionals
Medicare• Doctors of medicine or osteopathy• Doctors of dental surgery or dental medicine• Doctors of podiatric medicine• Doctors of optometry• Chiropractors
Medicaid• Physicians• Nurse practitioners• Certified nurse-midwives• Dentists• Physicians assistants** working in a Federally Qualified Health Center (FQHC) or rural health clinic
(RHC) led by a physician’s assistant
Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
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Eligible Provider Registration
Eligible providers can register on the CMS EHR Incentive Program website beginning January 2011
http://www.cms.gov/EHRIncentivePrograms
All Eligible Providers must:1. Participate in Medicaid or Medicare program2. Have a National Provider Identifier (NPI)
3. Medicare providers must be enrolled in PECOS
NOTE: CMS EHR Incentive Program website will interface with state(s) registration website. States will ask providers to provide and/or attest to additional information (patient volume, licensure, certified EHR) in order to make accurate and timely payments.
Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
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EHR Certification
Certified EHR Technology is required in order to achieve meaningful use
• Standards and certification criteria were announced on July 13, 2010
• IHS OIT is currently preparing to submit the RPMS EHR for certification under the new criteria
• Information about certification bodies and certified EHRs available at http://healthit.hhs.gov/certification
Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
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Indian Health Service andMeaningful Use
IHS is ahead of the curve with some of the Meaningful Use requirements
• RPMS EHR deployment is consistent with the Meaningful Use goal of increasing EHR adoption across the U.S.
• Public Health surveillance – IHS has reported information on H1N1 since 2009
• Electronic clinical quality reporting - IHS has reported clinical quality measures with the Clinical Reporting System (CRS) since 2002
• IHS has ongoing relationship with Office of the National Coordinator (ONC) and Center for Medicare and Medicaid Services (CMS)
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Meaningful Use Contacts
• Theresa Cullen, RADM, MD, MS IHS Chief Information Officer (301) 443-9848 [email protected]
• Stephanie Klepacki, Meaningful Use Project Lead, IHS (505) 821-4480 [email protected]
• MB Leaf, Meaningful Use Project Manager, Contractor (505) 798-1448 [email protected]
• Tom Kauley, Director AI/AN National REC(202) 507-4078
Area Meaningful Use Coordinators
Area MU Coordinator Contact Information
Aberdeen CAPT Scott Anderson [email protected] ; (605) 335-2504
Alaska
Richard HallKimi GosneyErika Wolter [email protected]; [email protected]; 90
[email protected]; 907-729-3907ABQ Vacant
Bemidji Jason Douglas Alan Fogarty
[email protected]; (218) 444-0550 [email protected] ; (218) 444-0538
Billings CAPT James Sabatinos [email protected]; (406) 247-7125
California Marilyn Freeman [email protected]; (916) 930-3981, ext. 362
Nashville Robin Bartlett [email protected] ; (615) 467-1577
Navajo LCDR Andrea Scott [email protected]; (928) 292-0201
Oklahoma Amy Rubin [email protected]; (405) 951-3732
Phoenix CAPT Lee Stern [email protected]; (602) 364-5287
Portland CAPT Leslie Dye Donnie Lee, MD
[email protected]; (503) 326-3288 [email protected]; (503) 326-2017
Tucson Scott Hamstra, MD [email protected]; (520) 295-2532
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Regional ExtensionCenters (RECs)A nationwide system of Regional Extension Centers (RECs)
has been established to support and serve health care providers to help them quickly become adept and meaningful users of electronic health records (EHRs)
• There are currently 62 RECs. All but one of the RECs are state or area specific
• The AI/AN National Indian Health Board (NIHB) National REC was formed to support health care providers in Indian Country
RECs will:• Provide training and support services to assist eligible
providers in adopting EHRs and achieving meaningful use• Offer information and guidance to help with EHR
implementation • Give technical assistance as needed
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Resources
• IHS Meaningful Use Websitehttp://www.ihs.gov/recovery/index.cfm?
module=dsp_arra_meaningful_use
• AI/AN National RECwww.nihb.org
• CMS EHR Financial Incentive Programswww.cms.gov/EHRIncentivePrograms
• EHR certification (and other ONC programs designed to support providers in the transition to EHR)http://healthit.hhs.gov
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Learn More…
• Contact your site, area, and/or or national MU representative(s)
• Contact your Regional Extension Center
• Sign up for the IHS Meaningful Use listserv (see instructions at the top of the Meaningful Use website)
• Read material available and training sessions offered by IHS , CMS, and RECs
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It’s time to…