Health Information Technology for Economic and Clinical Health Act (HITECH),

3. Health Information Technology for Economic and Clinical Health Act (HITECH), • Provisions of the American Recovery and Reinvestment Act of 2009 (ARRA) Vision – Enable significant and measurable improvements in population health through a transformed health care delivery system. • HIT Policy Committee Goals • Improve quality, safety, and efficiency • Engage patients and their families • Improve care coordination • Improve population and public health • Ensure privacy and security protections

4. Published July 13, 2010 • Contains final definition of “Meaningful Use” • 3-stage approach • 25 stage 1 requirements for eligible providers (EP’s) • “Core” and “Menu” groups • Stage 2 & 3 requirements to be determined • Specifies the following: • Process for participation by EP’s • Eligibility requirements for professionals and hospitals • Reporting methodology and timeframes • Payment periods • Payment calculations/procedures for Medicare & Medicaid • Medicare penalties for failing to meaningfully use certified EHR

5. *Indicates “payment year” in which each Stage is first introduced. Actual compliance timeframe depends on an EP’s first payment year.

6. Eligible Professional (EP) • defines those providers eligible for incentives • “Certified EHR” • Based on set of standards, implementation specifications, and certification criteria EHR vendors must meet • “Meaningful Use” • A set of measures for using a certified EHR which EP’s must meet • Continuous 90 day reporting period (first payment year) • Reporting period = All year (each subsequent year) • Choose a program • Medicare or Medicaid • Must choose one (may switch programs once)

7. Medicare Doctor of medicine or osteopathy Doctor of dental surgery or dental medicine Doctor of podiatric medicine Doctor of optometry Chiropractor Medicaid Physicians Dentists Certified nurse midwives Nurse practitioners Physicians assistants (in rural health clinic or FQHC led by a physician assistant) eligible professionals (EP’s) • EP’s may be either… • New purchasers of certified EHR • Existing users of certified EHR

8. eligible professionals (EP’s) • EP’s who see patients in multiple practices but do not have a certified EHR at each practice are eligible if more than 50% of encounters occur at an EHR-enabled practice

9. Starts in calendar year 2011 • EP’s may receive payments up to $44,000 over five years • Incentive based on percentage of Medicare allowable • Meaningful Use must be demonstrated for all patients (not just Medicare) • Incentive payments end in 2015 • Penalties - reduction in Medicare reimbursements for EP’s not demonstrating Meaningful Use starting in 2015

10. Maximum payments based upon 75% of Medicare Part B fee schedule payments up to the maximum incentive amount per year. • e.g., Minimum of $24,000 per year to be eligible for maximum $18,000 bonus

11. In 2015, reduction in Medicare reimbursement begins for physicians who are not meaningful EHR users (1% per year, capped at a 3% reduction). • Statue allows for exceptions for “significant hardship” as determined by the Secretary.

12. Starts in calendar year 2011 • EP’s may receive payments up to $63,750 over six years • Incentive based on up to 85% of state-calculated global average costs for EHR • 1st yr cost no later than 2016 • No payments made after 2021 or more than 5 years • No Medicaid penalty for failure to demonstrate Meaningful Use

14. Requires minimum 30% Medicaid patient mix • (20% for Pediatrics) • Patient mix percentage based on EP-selected 90 day average within previous 12 months, calculated by encounters or by patient panel • Group practice claim volume can used to calculate eligibility • Encounters defined as “services rendered”

15. Medicaid does not require M.U. in first year if an EP can demonstrate that they are: • Adopting • Implementing • Upgrading …their Certified EHR technology

16. 2011 – self-reporting (attestation) via CMS web portal 2012 & beyond – if available, report information directly from certified EHR using: Integrated web portal Local HIE Registries … Specifics TBA

17. HOW: A single, consolidated annual incentive payment • Medicare: paid by CMS (not via claims Fiscal Intermediary) • Medicaid: paid by State Medicaid program, or their designated intermediary • WHEN: • Payments will be made once an EP: • Demonstrates Meaningful Use for the reporting period and reaches the threshold for maximum payment, within 15-46 days after attestation

18. EP’s can reassign their Medicare or Medicaid payment, with guidelines • Incentives are calculated individually per EP, group affiliations are not considered

19. Records retention • Evidence of qualification to receive incentive payments must be retained for SIX years

20. Final Rule identifies: • 25 Stage 1 measures for how EP’s are expected to use a Certified EHR • - “Core” group” – EP’s must meet all 15 measures • - “Menu” group – EP’s must meet at least 5 measures • Clinical quality measures that must be reported to CMS 20

27. Some measures can be reported as inapplicable if the EP has no applicable patients or an insufficient # of actions that would allow calculation

28. EP’s must submit clinical data on 6 total measures – 3 Core (using alternate if necessary) … Core Measures Alternate Core Measures + - Measures are reported as numerator/denominator - EP’s can report a denominator of ZERO if there are no applicable cases

29. … and 3 “additional measures” (38 available) A few examples:

30. Select your EHR partner Develop detailed implementation plan Set goals & detailed timelines Set expectations Gain “buy in” Plan for the unexpected Pick your program (Medicare or Medicaid) Implement!

35. Q&A Panelists Betty Otter-Nickerson President, Sage Healthcare Division Mike Burger Sr. Director of Clinical Product Management and Emerging Technologies, Sage Healthcare Division Brenda Pawlak Sr. Manager of Healthcare Policy, Manatt Health Solutions

36. Thank you for joining us! • Follow up email containing white paper, Understanding the “Meaningful Use” Regulations • For more information about Sage products, contact us at: • www.SageHealth.com/ARRAWebinar • 877.932.6301, Option 1