Primer on HITECH Incentive Programs for Primary Care

1. Gregory J. Raglow, MD Medical Informatics Director Clinical Innovation Banner Health Primer on HITECH Incentive Programs for Primary Care

2. Purpose of this session • Broad overview of Programs • Context of Health Reform • Discussion on the implications for AzAFP members

3. EHR and ARRA HITech Incentives • Electronic Health Record Incentives • ePrescribing (eRx) incentives • Physician Quality Reporting Incentives • PQRI, now PQRS • Patient-centered Medical Home (PCMH) All share a Carrot and Stick approach over several years Encourages investment

4. EHR Story

5. HITECH for Hospitals & Physicians The American Recovery & Reinvestment Act of 2009 (ARRA) calls for incentive payments to hospitals and eligible professionals who meet requirements for the “meaningful use” of “certified electronic health record (EHR) technology”. To be eligible for these payments, hospitals and physicians must: Implement Certified EHR Technology Meaningfully Use EHR’s in Care Delivery Report Clinical Quality Measures Further, hospitals and physicians must meet these requirements within a specified time frame, and the requirements will be made increasingly stringent over time (Stage 1, Stage 2, Stage 3). 5

6. Meaningful Use Goals Improve Quality, Safety and Efficiency Engage patients and Families Improve Coordination of Care Improve Populations and Public Health Ensure Privacy and Security for Personal Health Information 3 Stages: 2011, 2013, 2015

7. Payments & “Specified Time Frame” Physicians • Incentive Payments • CY2011 – CY2014 • Medicare payments are made over a 5 year period using the amounts in the exhibit • Hospital-Based physicians are excluded. (ie: Pathologist, Anesthesiologist, ED Physicians, etc. – those who provide more than 90% of services in emergency department or inpatient setting) • Banner Health stands to gain approximately $29MM • Penalties • Physicians who fail to adopt EHRs will see their Medicare reimbursement reduced to: • 99% in 2015 • 98% in 2016 • 97% in 2017 Physician Incentive Payments (Medicare) 7

8. Medicaid EHR Incentive Payments

9. Incentives & Penalties - Physicians Based on 700 eligible Physicians Data based on an early estimate by Cerner

10. Meaningful Use For 2011 meet 20 or 25 Measures 15 required 5 of 10 menu set

11. MU Objectives/MeasuresRequired set CPOE Meds 30% Drug-Drug Allergy checking Turned on Problem list 80% eRx 40% Med List 80% Allergy list 80% Demographics 50% Vital signs 50%

12. MU Required Set, Cont Smoking Status 50% Report Clinical Qual Measures 6 1 Clinical Decision Rule Electronic copy of records (3 days) 50% Clinical Summary of visit 50% Exchange Health info 1 test Protect Health Info Security analysis

13. MU Menu Set (4 of 8) Drug formulary Checks Turn on feature Labs as structured data 40% List of Patient by condition 1 list Send reminders (age <5 or >65) 20% Electronic Access to health info 10% Pt-Specific Educational Resource 10% Med Rec (Transitions of care) 50% Summary Care doc for referrals 50%

14. MU Menu Set: Public Health Priority 1 of 2 Electronic Data to Imm Agency 1 test Electronic Syndrome Surveillance to 1 test Public Health Agency

15. Step 3 – Report Clinical Quality Measures To ‘Report Clinical Quality Measures’ a hospital or eligible professional must attest that they can report on Clinical Quality Measures (CQMs). Eligible professionals must report on 6 total measures: 3 required core measures (substituting alternate core measures where necessary) and 3 additional measures CQMs must be submitted for a 90 day reporting period for Stage 1 certification. 15

16. MU: EP CQM Core Set Objectives Hypertension: Blood Pressure Measurement Preventive Care and Screening Measure Pair: a)Tobacco use Assessment b)Tobacco Cessation Intervention Adult Weight Screening and Follow-up

17. MU: EP CQM Core Alternates Weight Assessment and Counseling for Children and Adolescents Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or Older Childhood Immunization Status

18. MU: EP CQM Additional Set (pick 3 of 38) 1.Diabetes: Hemoglobin A1c Poor Control 2.Diabetes: Low Density Lipoprotein (LDL) Management and Control 3.Diabetes: Blood Pressure Management 4.Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) 5.Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) 6.Pneumonia Vaccination Status for Older Adults 7.Breast Cancer Screening 8.Colorectal Cancer Screening 9.Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD

19. MU: EP CQM Additional Set (pick 3 of 38) 10.Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) 11.Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment 12.Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation 13.Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy 14.Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care 15.Asthma Pharmacologic Therapy 16.Asthma Assessment 17.Appropriate Testing for Children with Pharyngitis 18.Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER?PR) Positive Breast Cancer

20. MU: EP CQM Additional Set (pick 3 of 38) 19. Oncology Conon Cancer: Chemotherapy for Stage lll Colon Cancer Patients 20.Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients 21.Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies 22.Diabetes: Eye Exam 23.Diabetes: Urine Screening 24.Diabetes: Foot Exam 25.Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol 26.Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation 27.Ischemic Vascular Disease (IVD): Blood Pressure Management

21. MU: EP CQM Additional Set (pick 3 of 38) 28.Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 29.Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement 30.Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) 31.Prenatal Care: Anti-D Immune Globulin 32.Controlling High Blood Pressure 33.Cervical Cancer Screening 34.Chlamydia Screening for Women 35.Use of Appropriate Medications for Asthma 36.Low Back Pain: Use of Imaging Studies 37.Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control 38.Diabetes: Hemoglobin A1c Control (<8.0%)

22. Patient Portal

23. eRx Story

24. eRx Bonuses AND Penalties To get bonus, can report via claims or via registry or EHR reporting To avoid penalty MUST report via Claims

25. Avoiding the eRx penalty • 1% Medicare FFS cut in 2012 • Need G8553 attached to 10 MC FFS claims before 6/30/11 • 1.5% Medicare FFS cut in 2013 • Need G8553 attached to 25 total MC FFS claims by 12/31/11.

26. Free eRx

27. PQRS Story

28. Physician Quality Reporting System (PQRS) • 2011: 1% • For 2011-2014, an additional 0.5% is available if the individual professional participates via a "continuous assessment program" • 2012: 0.5%, CMS must provide timely feedback to participants • 2013 and 2014: 0.5%  • 2015: -1.5% penalty if practices are not successfully participating • 2016 and beyond: -2% penalty 

29. Penalties “Pile-on”

30. Quality Tracking Story

31. Tracking Quality • Banner Reporting • Public Reporting • Outside Consumer Evaluation

33. Personal Health Record

34. So, where is this headed? • Health IT Infrastructure is being built • The carrot is disappearing rapidly • The penalties are coming and pile on • AND STAY! • If you are not near retiring, you need to get electronic • You need full functionality to meet meaningful use

35. A look at the larger picture • Heath Reform • Accountable Care Organization

36. What to do? • Decide with whom you will connect • Marry an engineer • Application Service Provider (ASP Model) • Join a healthcare system • Form a buying group, IPA, or other larger system • Prepare to join an ACO

37. Lead it or be led • Private practice primary care will shrink • ACO models will make Primary Care desirable for goals • We need to leverage our value • We need to lead this effort • Organizing ourselves will be essential

38. Questions?