In the Thick of ARRA & HITECH: “It’s only just begun”

1. In the Thick of ARRA & HITECH:“It’s only just begun” NC Medical Society Quality of Care and Performance Improvement Committee August 7, 2009 Presented by: Sam Spicer, MD CMO, New Hanover Regional Medical Center President, NCHICA

2.   H.R. – 1The American Recovery and Reinvestment Act of 2009(ARRA)The Health Information Technology for Economic and Clinical Health Act(HITECH)

3. $19 billion allocated to Health IT $17 Billion • incentive bonuses for providers meeting “Meaningful Use” as determined by HHS secretary. $2 Billion to HHS / ONC • standards development, evaluation and validation • infrastructure for health information exchange (HIE) • grants to states for the purpose of furthering EHR adoption • improvements in HIT manpower • the establishment of Regional Health IT Resource Centers, Extension Programs, Enterprise Integration Research Centers, etc.

4. Estimate of Potential Stimulus Impact on NC Hospital Incentives for EHR - $300M – $400M Physician Incentives for EHR - $396M – $792M HIE / HIT Competitive Grants – ? ($2B) Regional Extension Center - ? EHR Adoption Loan Funds - ? Broadband Infrastructure – Proposals ($7.2B) Workforce Training Grants - ? ($ ? ) Medical Health Informatics - ? ($ ? ) EHR in Medical School Curricula - ? ($ ? ) Worker Training - ? ($250M) Comparative Effectiveness Research - ? ($1.1B) Community Health Centers - $2.6M + ? ($2B) Prevention & Wellness (CDC) - ? ($1B) SSA - ? ($500M) } ($17.2B)

5. HITECH OverviewPhysicians Medicare Incentive Payments - 75% add-on to fee schedule payments Maximum Medicare Incentive Payments Penalty for failure to implement by FY15 –> reduction of reimbursements by 1% in 2015, 2% in 2016, etc.. Medicaid Incentive Payments - (requires Medicaid share of 30+ %) Maximum Medicaid Incentive Payments Can receive Medicare OR Medicaid Incentives Not to exceed $63,750

6. $= EHR + HIE + Quality Reporting

7. NC HIT Strategic Planning Task Force • Established by Governor Bev Perdue • Part of NC Recovery Office • Task: Develop a Strategic Plan for ARRA Healthcare Stimulus Funding investment • Weekly meetings in April and May • Draft Outline of plan established • Draft Plan out for public comment until June 17th • Final Plan delivered after incorporating comments • Governor announces NC HWTFC as “Qualified State-Designated Entity” on July 16th and will appoint NC HIT Collaborative to make recommendations on implementing the NC HIT Action Plan.

9. DRAFT DRAFT

10. NC HIT Collaborative Members • Chair • 2 Vice Chairs • NC Dept. of HHS • NC Medical Society • NC Nurses Assn. • NC Hospital Assn. • Community Care of NC • NC Assn. of Health Plans • NC Health Quality Alliance • NC AHEC Centers • NCHICA • Ex-Officio Members: • NC HWTFC Chair • NC HWTFC Executive Director • Rep. from Office of the Governor • NCHICA Executive Director • Advisory Group: • Public Sector Representatives • Private Sector Representatives

11. $ = EHR* + HIE* + Quality Reporting * By “meaningful use” of “certified” systems

12. Meaningful UseEstimated Timeframes NPRM issued by HHS/CMS (fall) Final rule issued (spring) Interim final rule issued (Dec 31) Public comment (Fall/Dec)

13. Meaningful User - Draft Sample Provider Requirements* *Complete draft requirements in the appendix

14. Meaningful User - Draft Sample Measures for Providers* * Complete draft requirements in the Appendix

15. Bi-directional Exchanges Within a Community (example) PH

16. A Community may create a Community HIE “Utility”(example) Note: Reduction of 50% of point-to-point Connections PH HIE

17. Community #1 A Community may choose to qualify their HIE to connect to the NHIN as an NHIN-HIE or “NHIE” PH NHIE DURSA NHIN

19. Thank You www.nchica.org/ARRA/intro.htm