presentation to chinese american association of southern ... presentation 1-31-2011.… · wilbert...

A project of L.A. Care Health PlanA project of L.A. Care Health Plan

Presentation toChinese American Association of

Southern California

Health Information Technology Extension Centerfor Los Angeles

1/31/11

This presentation is incomplete without supporting oral commentary

A project of L.A. Care Health Plan

Federal HITECH Act

“To improve the quality of our health care while lowering its costs, we

will make immediate investments necessary to ensure that, within five

years, all of America’s medical records are computerized. This will cut

waste, eliminate red tape and reduce the need to repeat expensive

tests… But it just won’t save billions of dollars and thousands of jobs;

it will save lives by reducing the deadly but preventable medical errors

that pervade our health care system.”

President Obama

January 2009


HITECH Program

• Medicare and MedicaidIncentives & Penalties

• State Grants for HIE• Standards &

Certification Framework• Privacy & Security

Framework

$60B HITECH Program: How the Pieces Fit Together

Improved Individual & Population Health

Outcomes

Increased Transparency &

Efficiency

Improved Ability to Study & Improve Care

Delivery

ADOPTION

MEANINGFUL USE

EXCHANGE

Health IT Practice Research

• Regional Extension Centers

• Workforce Training

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Regional Extension Centers

• Not-for-profit organizations established to provide training, support, and technical assistance to help primary care providers select, implement, and use EHRs in a meaningful way

• Selection, purchase, and implementation of EHR

• Workflow redesign

• Connection to health information exchange

• Attainment of meaningful use

• Compliance with privacy and security

• Goal is for 100,000 priority primary care providers to become meaningful users of EHRs within four years

• Four years are 90% subsidized by the federal government


Why Did L.A. Care Pursue the REC Program?

• Mission Alignment:Focus on small and solo practices, community clinics, and public hospitals aligns with core mission to support safety net providers. The REC program leverages past and future investments with additional federal dollars.

• Quality Alignment:Meaningful use of HIT is an important component of quality healthcare. Providers using EHRs and exchanging health information will improve quality of care for members.

• Business Alignment:Two-thirds of Los Angeles County primary care providers are in L.A. Care network. The REC is an opportunity to strengthen relationships with these providers, develop relationships with new providers, and increase exchange of clinical data.

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Who We Are

• April 2010 – L.A. Care awarded a federally

funded grant to serve 3,000 providers in Los

Angeles County

• HITEC-LA formed as a separate division of L.A.

Care

• Experienced 12-person core team; over 100

with Service Partners/EHR vendors

• We are not vendors; we are a neutral party

advised by providers


Our team plus:

• A set of hand-selected Service Partners who will assess, project manage, help you achieve meaningful use, and train

• Certified EHR vendors who will install, implement, train, and support

• Hardware vendors who will install, implement, and support

150 of us working together with you!

Meet the TeamWe’re ready to help you from start to finish


Members

• 1400 providers have enrolled to-date including:

Aids HealthCare Foundation

Denise A. Albury, MD

AltaMed Health Systems

American Indian Healing Center

Ali Awada MD

Asian Pacific Health Care Venture

Lily Balette, MD

Clinica Msr Oscar Romero

Compton Central Health

Lina C. Dela Cruz, MD

Eisner Pediatric and Family Medical

Center

El Proyecto del Barrio

Family Health Care Center of L.A.

Santosh Garg MD

Harbor Community Clinic

Mona Iskander MD

Wilbert Jordan MD

Vigen Khojayan MD

Gia D. Le

Los Angeles Christian Centers

Manuel F. Mendoza, MD

Willy Murtidjaja, MD

Narinder Nat, MD

Oscar Perez, MD

QueensCare Family Clinics

Alagia Rangarajan, MD

Ruben M Ruiz, III MD

Saban Free Clinic

South Central Family Health Center

St. John's Well Child & Family

Center

Darren Takeuchi MD

Terence TZ Tan MD

T.H.E. Clinic Inc.

UMMA Community Clinic

URDC Human Services

Venice Family Clinic

Z. Joseph Wanski, MD

Watts Healthcare Corporation

Kong-Tay Wu, MD

Raquel M. Ynchausti, MD


Available Monies

• Contracted,

eligible

providers can

receive $5,000

from HIT

incentive

programs

• Additional grant

money is

available

• Utilize REC’s

Service Partners

• On-site

technical

assistance from

readiness

through MU

Stage I, paid for

by HITEC-LA

program

• Medicare/

Medicaid

incentive

program

• Medicare:

up to $44,000

• Medicaid:

up to $63,750

L.A. Care HITEC-LA CMS


Provider Eligibility CrosswalkProvider Type/License Eligible for subsidized REC

ServicesEligible for Medi-Cal Incentives1 Eligible for Medicare Incentives

Medical Doctor (MD) YES2 YES3 YES3

Doctor of Osteopathy (DO) YES2 YES3 YES3

Psychiatrists (MD) NO4 YES3 YES3

Dentist (DDS, DMD) NO4 YES YES

Nurse Practitioner (NP) YES2 YES3 NO

Certified Nurse Midwife (CNM) YES2 YES3 NO

Chiropractor (DC) NO4 NO YES

Physician Assistant (PA) YES2 YES5 NO

Psychologists NO4 NO NO

Optometrists (OD) NO4 YES YES

Podiatrists (DPM) NO4 NO YES

Residents NO YES3 YES3

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1Must meet Medi-Cal Patient volume criteria

• Minimum 30% Medicaid patient volume

• Minimum 20% Medicaid patient volume and is a pediatrician

• Practice predominantly in a Federally Qualified Health Center or Rural Health Clinic and have a minimum 30% patient volume of needy individuals2Non-Hospital based, certified in Internal Medicine, Family Practice, Pediatrics, Adolescent Medicine, OB/GYN, or Family Practice practicing in one of the following settings:

• Physician Practices of 10 providers or less

• Community health centers, primary care clinics and rural health clinics

• Ambulatory care clinics associated with public hospitals, critical access hospitals, or rural hospitals

• Other medically underserved settings3Non-Hospital based: if more than 90% or the provider’s services are performed in a hospital in-patient or emergency room setting, that provider is Hospital-Based and not eligible for the EHR incentive program4May be eligible for REC services on a Fee for Service basis5Physician Assistants are only eligible if practicing in FQHC or RCH that is “Physician Assistant-led”

A project of L.A. Care Health Plan11

First Calendar Year in Which Eligible Provider Receives a Medicaid Incentive Payment

Calendar Year 2011 2012 2013 2014 2015 2016

2011 $21,250

2012 $8,500 $21,250

2013 $8,500 $8,500 $21,250

2014 $8,500 $8,500 $8,500 $21,250

2015 $8,500 $8,500 $8,500 $8,500 $21,250

2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250

2017 $8,500 $8,500 $8,500 $8,500 $8,500

2018 $8,500 $8,500 $8,500 $8,500

2019 $8,500 $8,500 $8,500

2020 $8,500 $8,500

2021 $8,500

Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750

• Eligible Providers are those that see 30% Medicaid, Medicaid HMO or uninsured patients over any 90-day period during the year

• Pediatricians must see 20% Medicaid, Medicaid HMO or uninsured patients

• To qualify for the first payment, an EP must implement, upgrade or acquire an EHR

• Payout occurs over 6 years with the last payment year being 2021

• EPs must show $25,000 in expenses in Year 1 and $10,000 in subsequent years for maximum incentive

Medicaid Incentives

A project of L.A. Care Health Plan12

First Calendar Year in Which Eligible Provider Receives a Medicare Incentive Payment

Calendar Year 2011 2012 2013 2014 2015 +

2011 $18,000

2012 $12,000 $18,000

2013 $8,000 $12,000 $15,000

2014 $4,000 $8,000 $12,000 $12,000

2015 $2,000 $4,000 $8,000 $8,000 $0

2016 $2,000 $4,000 $4,000 $0

Total $44,000 $44,000 $39,000 $24,000 $0

• Incentive payments are equal to 75% of Medicare Allowable amount up to the maximum listed in the table below.

• During 2011, EPs only have to demonstrate meaningful use for 90 days.

• During 2012+, EPs must demonstrate meaningful use for entire year.

Medicare Incentives


Why Enroll Now?

• The program serves the first 3,000 provider

members

• We can help make it easier to pick your EHR

• We can get you money and free service

• Enrolling helps other Los Angeles County

providers get free assistance

• The program ends in 2014


Serving Our Members• Every practice receives a telephone practice assessment to

determine readiness:

– 741 assessments completed so far; 84% of our providers are ready

• Next, a Service Partner is assigned, meets with practice, and scopes out the work to help onsite from start to finish:

– Currently helping 100 providers with vendor selection, infrastructure selection, upgrades to certified EHRs, workflow redesign, and meaningful use achievement

• We are also providing legal advice, answering MU questions, and processing incentives

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Phases of EHR Implementation

Planning

EHR Selection

ImplementationIntegration

Post-Implementation Meaningful Use

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Service Partners

• Six Service Partners have been selected; they

provide on-site, local technical assistance to:– Select an EHR

– Determine readiness

– Design workflow

– Determine hardware and connectivity needs

– Manage the vendors

– Do additional training

– Achieve meaningful use

– Develop interfaces

• Highly subsidized assistance for 3,000 members


Group Purchasing of EHRs

• Eight EHR vendors with standard contracts, statewide pricing, and full-featured solutions including HIE and MU:

– Allscripts

– eClinicalWorks

– GE (Practice and Advanced Systems)

– Greenway

– NextGen

– athenahealth

– McKesson Practice Partner

– e-MDs


Vendor’s Implementation Gap

• Lack of practice-focused preparation

• Inadequate training

• Lack of support during implementation

• Poor go-live strategy

• Unclear costs and fees

• Lack of training on achieving meaningful use

• Lack of practice-focused HIE connectivity

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Service Partner Technical Services

Readiness Assessment

Vendor Selection Implementation Training Go Live Meaningful Use

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• On-site Assessment

• Gap Report• Boot Camp• Education

• Assist with EHR Selection

• Arrange Demo

• Coordinates HW/SW Install

• Oversee/Test Equipment

• Hand-Holding• Customizing

Templates

• Onsite Support• Workflow

Redesign

• Rx Connection• Lab Connection• Monitoring MU

Reports

•Vendor Demo•Price Quote•Sign Contract

Installation:•Internet•Hardware•EHR

•EHR Training•Template Design

•Conversion


EHR Products Selection

• ONC-ATCB Certification (3 certifying bodies)

• HIPAA privacy & security compliant

• Meaningful use reporting

• Ability to generate county, state and federal reports

• Support HL7 messaging standard

• Support Secure Sockets Layer (SSL) digital certificate

• Report writing tool (e.g. Crystal report)

• Audit trail capabilities

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Basic EHR Criteria


Prioritize your Requirements

• ASP/SaaS hosted or client/server on-premise

• Data access and ownership

• List the capabilities you want in an ideal EHR system

• Prioritize the list into “must haves” and “nice-to-haves”

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Step 1 – Decision Point


EHR Selection Tips

• Determine which EHR system meets your high-level requirements

• Identify ways that EHR software will make your office more efficient

• Determine which EHR system falls within your budget

• Rank the vendors based on perceived ease-of-use

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Step 2 – EHR Demonstration


EHR Selection Tips

• Ask for two or three references that share your specialty

• Ask each reference what they don’t like about the system

• Ask references how the vendor responded to any problems

• Assess the vendor’s financial and strategic viability

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Step 3 – Reference Check


The Hidden Costs

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1. Interfaces (device, lab, imaging, portal, HIE, PM )

2. Third party software

3. Claims processing

4. Web portal

5. Template customization

6. Report customization

Avoiding Surprises


EHR Implementation

• Takes planning and time to make an implementation successful

• Need to be willing to commit the necessary time and resources

• Need to have buy in from all office staff members

• Create a plan to transition your practice from paper to electronic records

• Identify a champion or “super-user” to help train and assist other staff

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Keys to Success


EHR Implementation

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• Plan and prepare for implementation

• Create a tailored project plan for your practice

• Define measurable goals and milestones (scheduling, EHR and PM go live) and share it with staff

• Use the change as an opportunity to improve processes in both patient care and administrative areas

• Focus on meaningful use from the outset of the implementation

Keys to Success


TestimonialsHere is just a sample of what members are saying about HITEC-LA:

“It is good that we have someone well informed and knowledgeable to help us through implementation of EHR.”

Joseph DianchianAdministrator, Helen Rostalmoo MD

“The help we received from the REC was invaluable to us. HITEC-LA found us a great service provider team who worked side by side with us and brought the

knowledge and skill we needed to get the job done!”Tracy Robinson, MD

Chief Medical Officer, T.H.E. Clinic, Inc.

“We were impressed with their rapid response to our request for assessment....We are very pleased with HITEC-LA and plan to call on them further as we move forward to achieve meaningful use of our EHR. Thank you HITEC-LA!”

Paula WilsonPresident and Chief Executive Officer, Valley Community Clinic

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www.hitecla.org

1 (888) 524-4832

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http://www.hitecla.org/

presentation to chinese american association of southern ... presentation 1-31-2011.… · wilbert...

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