HITECH Act Update February 18, 2010

1. HITECH Act UpdateFebruary 18, 2010 Mike Spencer Regional Sales Consultant KIG Healthcare Solutions NextGen Healthcare Information

2. HITECH Act: Overview • American Recovery and Reinvestment Act 2009 (ARRA) • Health Information Technology for Economic and Clinical Health (HITECH) Act • Formal establishment of the Office of the National Coordinator for Health Information Technology (ONC) • Funding to support regional and state initiatives to promote the adoption of electronic health record (EHR) technology and best practices • Estimated $17-$19 billion in Medicare and Medicaid incentive funds for eligible hospitals and providers that adopt EHR technology before 2015 • Directed the ONC to issue regulations 2

3. HITECH Act: Regulations • Two regulations published in the Federal Register on January 13, 2010 • NPRM: Proposed rule governing the definition of “meaningful use” • The calculation of incentive payment amounts, and other related issues • Not yet effective • 60 day comment period ends on March 15, 2010 • Following comment period interim final rule to be issued • Final Rule – Late Spring – Takes effect 60 days later • IFR: Interim final rule governing the initial set of standards, implementation specifications, and certification criteria for EHRs • Effective February 12, 2010 • 60 day comment period ends on March 15, 2010 • Final Rule – Late Spring – Takes effect 60 days later 3

4. HITECH Act: NPRM Overview • Proposed rule: • Defines the initial criteria for eligible professionals (EP) and eligible hospitals (EH) to qualify for incentive payments • Creates 3 Stages of implementation • Defines Stage 1 MU and specific criteria to meet definition • Defines payment years and reporting periods • Calculates the incentive payment amounts • Other program requirements 4

5. HITECH Act: Interim Final Rule Overview • Interim final rule covers: • Adoption of initial set of standards • Implementation, specifications, and certification criteria for EHRs 5

6. Meaningful Use Definition • Meaningful EHR User – An EP who, for an EHR reporting period for a Payment Year, demonstrates meaningful use of a certified EHR technology in the form an manner consistent with CMS standards. • Payment Year – For EPs and calendar year beginning in 2011. The “first Payment Year” would mean the first calendar or Federal fiscal year for which an EP receives an incentive payment. • EHR Reporting Period – For the first Payment Year only, CMS proposes to define “EHR Reporting Period” to mean any continuous 90-day period within a Payment Year in which an EP successfully demonstrates meaningful use of certified EHR technology. • Eligible Professionals may choose to start their EHR reporting period on any date beginning with the first day of the Payment Year that allows for a 90-day period to be completed by the last day of the Payment Year. For the second Payment Year and all subsequent Payment Years, the EHR reporting period would be the entire Payment Year. 6

7. Meaningful Use Definition • “Meaningful Use” is described in the Act as: • Use of "EHR technology in a meaningful manner" (which for physician incentives shall include the use of e-prescribing) • Electronic exchange of health information to improve the quality of care such as promoting coordination of care • Reporting on clinical quality measures (which shall become more stringent over time) 7

8. Definition of Eligible Professional (non-hospital-based) • If an Eligible Professional (EP) is eligible for both Medicare and Medicaid, the Eligible Professional may choose to accept the Medicare or Medicaid incentive, but may not receive both. • An EP is permitted to change their election once during the life of the EHR incentive program, after making the initial election. 8

9. Medicare Incentives for EP’s An EP is eligible for a 10% increase in the annual Medicare incentives if more than 50 percent of the EP’s Medicare covered professional services are furnished in a geographic health professional shortage area (HPSA). 9

10. Medicaid Incentives for EPs (non-Pediatricians) 10

11. MU Components: Stage 1 Certified EHR Defined in IFR HIE (health information exchanges) Structured data To patients, to public health agencies Quality measures reporting CPOE Data collection—problem list, medication list, allergy list, demographics, vital signs, smoking status, test results Functions---drug screening, reminders to patients, summary of each visit, generate patient lists; 5 CDS rules, medication reconciliation Protect health information 11

12. Certified EHR • Complete EHR or a combination of EHR Modules, each of which: • Meets the requirements included in the definition of a Qualified EHR • Has been tested and certified in accordance with the certification program established by the National Coordinator 12

13. Qualified EHR • An electronic record of health-related information on an individual that • Includes patient demographic and clinical health information, such as medical history and problem lists • Has the capacity • To provide clinical decision support • To support CPOE • To capture and query information relevant to health care quality • To exchange electronic health information with, and integrate such information from other sources 13

14. MU Components: Stage 1 Certified EHR Defined in IFR HIE (health information exchanges) Structured data To patients, to public health agencies Quality measures reporting CPOE Data collection—problem list, medication list, allergy list, demographics, vital signs, smoking status, test results Functions---drug screening, reminders to patients, summary of each visit, generate patient lists; 5 CDS rules, medication reconciliation Protect health information 14

15. Health Information Exchange Objectives and Measures • 25 objectives and measures • 8 Measures require ‘Yes’ or ‘No’, 5 as structured data • 17 Measures require numerator and denominator 15

16. Examples of Stage 1: Objectives and Measures 16

17. MU Components: Stage 1 Certified EHR Defined in IFR HIE (health information exchanges) Structured Data to patients, to public health agencies Quality Measures reporting CPOE Data collection — problem list, medication list, allergy list, demographics, vital signs, smoking status, test results Functions — drug screening, reminders to patients, summary of each visit, generate patient lists; 5 CDS rules, medication reconciliation Protect health information OurFocus 17

18. Clinical Quality Measures Definition • Measures of processes, experience, and/or outcomes of patient care • Observations or treatment that relate to one or more quality aims for health care such as effective, safe, efficient, patient-centered, equitable, and timely care 18

19. Clinical Quality Measure Overview • Stage 1 – Providers required to submit summary quality measure data to CMS by attestation • EP required to submit clinical data on the 2 measure groups: core measures and a subset of clinical measures most appropriate to the EP’s specialty • EH required to report summary quality measures for applicable cases • Stage 2 and 3 – All Providers required to electronically submit summary quality measure data to CMS 19

20. Sources of Quality Measures • Preference given to the clinical quality measures endorsed by the NQF • Including NQF endorsed measures that have previously been selected for the Physician Quality Reporting Initiative (PQRI) program • HITECH Act does not require the use of NQF endorsed measures, nor limit the measures to those included in PQRI 20

21. Submitting Quality Measures • There are several potential routes to report quality information outlined in the proposed rules including: • Use the CMS portal to perform upload process based on specified structures and accompanying templates produced as output from your “certified” EHR module. • Submit the required clinical quality measures data using certified EHR technology through Health Information Exchange (HIE) / Health Information Organizations (HIO). • Accept submission through registries. • This is dependent upon the future development of the necessary capacity and infrastructure to do so using certified EHRs. • Attestation on achieving meaningful use will be required as part of the submission. • Specifications for quality submissions will be developed by July 1, 2011. 21

22. Reporting Period for MU • In Stage 1, the EHR reporting period is any continuous 90-day period within a payment year. • In all subsequent Stages, the EHR reporting period must be the entire payment year. • Reporting in Stage 1 will be by attestation • Tied to calendar year, not adoption year • CMS expects to move to electronic reporting to some degree starting in Stage 2 • This applies for both Meaningful Use stage criteria, as well as quality reporting 22

23. Remember the Carrot and Stick 23

24. Points of Importance – Excerpt from Regulations • E-scribe “At least 80 percent of all unique patients seen by the eligible professional or admitted by the eligible hospital have at least one entry (or an indication of ‘none’ if the patient is not currently prescribed any medication) recorded in structured data.” • Lab Data “At least 50 percent of all clinical laboratory results ordered by the eligible professional or by an authorized provider of the eligible hospital…who results are in either…a positive/negative or numerical format are incorporated in certified EHR technology as structured data.” 24

25. Points of Importance – Excerpt from Regulations • CMS proposes that EPs and EHs provide attestation through a secure mechanism, such as through claims-based reporting or an online portal. • CMS proposes to make payments on a rolling basis. The EP’s carrier or MAC would be authorized to make an incentive payment “as soon as” it has ascertained that an EP has: • Demonstrated meaningful use for the applicable EHR Reporting Period and • Has reached the threshold for maximum payment. 25