Practitioner Database Project Advisory Committee Meeting

1. Practitioner Database ProjectAdvisory Committee Meeting HealtheConnections Health Planning (CNYHSA) Tuesday, January 14, 2014 Corning Tower, Room 1625Empire State Plaza, Albany, NY 12237

2. Welcome and Introductions • Caleb Wistar, Associate Director, Division of Workforce Development , Office of Primary Care & Health System Management New York State Dept of Health • Terry Richmond, Project Director HealtheConnections Health Planning (CNYHSA) • Sara Wall Bollinger, Executive Director HealtheConnections Health Planning (CNYHSA)

3. Agenda • Project Overview • Progress to Date • Relationship to other State Projects and Initiatives • Desired System Capabilities/Attributes • System Development Issues • Next Meeting

4. Project Objective:Develop Plan for a database that: • covers physicians, physicians’ assistants, midwives, and nurse practitioners (100,000-120,000 individuals) • integrates information from multiple sources • provides accurate, validated, geographically-based information on number of practitioners, associated practice group(s) and office locations; specialization and sub-specialization; professional education and advanced training; age, major professional activities, and other practice characteristics • meets the needs of a wide range of users

5. User Needs – Examples • accurate assessments of local resource capacity and need • improved understanding of practice trends (growth of large practices, proliferation of multiple practice locations, use of mid-levels, shift to specialty medicine, acceptance of PCMH principles, ACO participation) • estimate replacement needs of aging workforce • accommodate new demand due to Affordable Care Act and MRT reform • analyze facility staff development needs, target resources to high priority areas, respond to RFPs, or submit shortage area designations • Predict and track need for expanded training and medical education • Monitor implementation of EMRs • Prepare research and policy papers and develop criteria for comparing practice patterns and assessing needs

6. Project Activities • Assess User Needs and Requirements • Catalogue and Evaluate Potential Data Sources • Assess Potential Platform and other Design Issues • Recommend preferred strategy for implementation

7. Advisory Structures • Data Work Group • Advisory Committee • Platform Options Group • Subject Matter Advisors

8. Advisory Committee Role • accept recommendations from other work groups • address issues related to development, implementation, and operation of the proposed database on a long term basis • where should the system be housed • how should it be supported • how should it be related or connected to other data systems • should different classes of users or privilege levels be established • are legal and regulatory changes needed • review the project’s final report that will outline preferred strategy for plan implementation

9. Stakeholder Involvement • NYSDOH Offices (Primary Care, Health Insurance, Quality and Patient Safety, Public Health Practice, Information Technology Transformation) • NYSED Office of the Professions, Board of Regents, and professional boards • Center for Health Workforce Studies • Regional health planning agencies and quality improvement collaboratives • Economic development councils, county & regional planning agencies and development organizations • County health departments • Rural Health Networks/NYSARH • RHIOs/NYeC/HI-TECH/SHIN-NY • Entities with IT expertise • Area Health Education Centers • Health Advocates and disease associations (e.g. Cancer Society, Arthritis Foundation) • Hospitals, Health Centers, and other providers of health care • Provider and Insurer Associations • Foundations which support health related projects • Consultants and private sources of Information • Schools of Public Health, Medical Schools, and other institutions involved in provider training and research

10. Collaboration with Others • Coordinated with related DOH projects • Reached out to others who have done or are doing related projects • Consulted with Vendors and Other Experts • Made use of Center for Health Workforce Studies expertise • Consulted with HRSA/National Center for Health Workforce Analysis

11. Time Frame:July 2013 – March 2014 • Data Work Group September 2013 – January 2014 • Platform Options Group January – February 2014 • Advisory Committee January – March 2014 • Final Report: March 2014

12. Progress to Date • Data Set Documentation and Comparative Matrix completed • Contacts made with vendors, experts and other projects • National Standards Reviewed • Lessons learned • Preliminary Draft Recommendations from Data Work Group prepared

13. ASC X12 Provider Directory Standards(from Accredited Standards Committee Presentation by Don Bechtel, April 2011) The ASC X12 274 Provider Directory has several Implementation Specifications that can used 4050X185 Is an Inquiry and Response transaction for a Provider Directory Providers (and consumers) can request a list of providers from a specific geography, from a specific payer network, and by a specific specialty. Responses will provide a list of providers qualified by the request and can provide information about the providers practice. This transaction could be migrated to version 5010. If additional business requirements are identified by the this committee, we might be able to incorporate those in version 5010, provided the base standard supports the needed data elements. 4010X109 is the Provider Directory This Implementation Guide provides transaction specifications used to populate a Provider Directory; it has been published for several years. Plans are to bring version 5010X207 forward soon, but we are now waiting to see if additional requirements are needed from HIT Standards Committee.

14. ASC X12 Provider Directory StandardsImplementation Fields for X109 and X185 X109 – Provider Directory Available Information Affiliated Hospital Group Network Provider (i.e. doctor or facility) Site Name Identification Numbers Direct Contact Information Demographic Information Languages Spoken Work Schedule Location Logistics Healthcare Delivery Focus Healthcare Specialty Licensing/Accreditation/Certification Name of the affiliated entity Identification Numbers of the affiliated entity More… X185 – Provider Directory – Inquiry/Response Information Provider Name Geographic information Provider area of specialization Network Hospital Participation dates Provider Role Accepting new patients Provider Identification Number Geographic information Provider Age Provider gender Provider Language Site specific assistive aids State licensing information Site ID Provider site location Site location information Provider work schedule information More…

15. Council for Affordable Quality HealthcareCAQH Universal Provider Datasource (UPD) • Demographics, Licenses and Other Identifiers (including NPI) • Education, Training and Specialties • Practice Details – Sites of Service, Days and Hours, Contact Information • Billing Contact Information • Hospital Affiliations • Malpractice Liability Insurance • Work History and References • Disclosure Questions • Images of Supporting Documents

16. NYS Physician Profile (Art 2995-A) • criminal convictions • actions taken against the licensee and current license limitations • loss or involuntary restriction of hospital privileges or failure to renew • medical malpractice court judgments, awards, and settlements • medical schools attended and date of graduations; graduate medical education; • current specialty board certification and date of certification; • dates admitted to practice in New York state; • names of hospitals where the licensee has practice privileges; • appointments to medical school faculties; responsibility for GME • publications in peer reviewed medical literature • professional or community service activities or awards • location of practice setting and names of other practitioners at setting • translating services that may be available at the location • participation in Medicaid, Medicare, other state or federal insurance programs • participation in other health care plans

17. Data Work Group RecommendationsSources Reviewed • New York State:DOH Profile, Center for Health Workforce Studies Registration Survey, NYSED Licensure Files, Medicaid Managed Care Directory, Medicaid Provider Enrollment Data • Federal:National Plan and Provider Enumeration System (NPI), Medicare Enrollment Files and PECOS, National Provider Data Bank, DEAA, TRICARE (Dept of Defense) • Association: CAQH, AMA Profile, Medical Society of the State of NY (MSSNY), Federation of State Medical Boards (FSMB), American Board of Medical Specialties (ABMS) • Commercial: SK&A, Treo Solutions, Maximus, ZocDoc, Health Market Science, FolioMed, Medical Marketing Services (AMA License), MEDICAlistings, Medical Mailing Services and similar services (USAData, Physicians Lists, DoctorListPro)

18. Data Work Group Recommendations Desired Data Elements – Examples • name • degree and type of licensure • key identifying information (NPIN, License Number) • associated practice group(s) • practice location(s) • specialization & sub-specialization • professional education, advanced training, & certifications • nature of professional activity • PCMH status • FT/PT status and clinical work hours/FTE • time devoted to patient care • birth date or age • staff appointments at hospitals • willingness to accept new patients and/or Medicaid patients (or % of practice allocated to Medicaid patients) • practice volume & productivity • geographic identifiers • analytical algorithms/classifiers

19. Relationship to Other Initiatives • Physician Profile Redesign • Innovation Plan/Primary Care Development • All Payer Database • Medicaid Information System RFP • NYeC/HIT/Info Exchange • Health Benefit Exhange

20. Desired Database Capabilities • is searchable, queryable, and able to produce simple tables and tabulations. • can be downloaded and readily incorporated into user projects • has geographic and other algorithmic fields that support data analysis and file linking • has internal validation and/or error correction capabilities • able to incorporate or receive user input (e.g. updates and feedback on the status of practitioners)

22. System Development IssuesOpen Discussion • Where should the system be housed or operated • how should it be supported • how should it be related or connected to other data systems • how can data be shared with the widest range of users? • should different classes of users or privilege levels be established • are legal and regulatory changes needed

23. Some Potential Hosting Options • creation of a state sponsored system such as the Statewide Planning and Research Cooperative System (SPARCS) that is used for hospital discharge abstract data. Such a system could be run by NYSDOH which oversees the provision and quality of health care, NYSED which is responsible for licensing or joint venture of both departments • creation of a statewide collaborative that involves governmental and non-governmental entities such as the New York eHealth Collaborative (NYeC) which coordinates the joint activities of NYSDOH and regional health information organizations (RHIOs) • use of an existing independent non-profit entity with workforce expertise such as the Center for Heath Workforce Studies (CHWS) • contract with a proprietary entity that specializes in practitioner databases and provider directories

24. Potential Financing Options • licensing and registration fees • assessments and user fees • state and federal budget appropriations • Medicaid waivers, or use of funds related to implementation of the Accountable Care Act and NYS Health Care Reform. • Demonstration program funded by Federal, State, and Foundation Sources

25. Potential for Connectionsand Program Expense Sharing One could argue, for example, that such a file • should be a component of the proposed all payer database • is needed to tract Patient Centered Medical Home implementation, use of EHRs, quality improvement, provider network adequacy, workforce development needs • is needed to support the responsibilities of Consumer Assistance Programs

26. Next Meeting • Experiences in other states • Private Vendor Capabilities • Continued Discussion/Consensus on Developmental Issues

27. How to reach us HealtheConnections Health Planning (CNYHSA) 109 South Warren Street, State Tower Building Suite 500 Syracuse, NY 13202 (315) 472-8099 Sara Wall Bollinger, Executive Director swbollinger@healtheconnections.org Terry Richmond, Deputy Director/Senior Associate gmrichmond@healtheconnections.org