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DVHIMSS Summer Education Program Stage 2 and Regulatory Update

DVHIMSS Summer Education Program Stage 2 and Regulatory Update. Peg Meadow Director, Government & Industry Affairs, Siemens Healthcare June 14, 2012. A global company With a local footprint in over 190 countries. 1847 Founding of 'Telegraphen-Bauanstalt von Siemens & Halske' in Berlin

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DVHIMSS Summer Education Program Stage 2 and Regulatory Update

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  1. DVHIMSS Summer Education ProgramStage 2 and Regulatory Update Peg Meadow Director, Government & Industry Affairs, Siemens Healthcare June 14, 2012

  2. A global company With a local footprint in over 190 countries 1847 Founding of 'Telegraphen-Bauanstalt von Siemens & Halske' in Berlin 1850 First international sales agency in London 1853 Office opens in St. Petersburg, Russia 1904 First permanent office in China 1905 Founding of Siemens do Brasil 1924 Founding of Siemens India Ltd. 1961 Exports exceed 1 billion DM for first time 1968 Siemens passes the 100-country mark 1970 Founding of Siemens Corporation, USA

  3. Siemens Sectors and Divisions Energy Healthcare Industry Infrastructure & Cities Divisions • Fossil Power Generation • Wind Power • Solar & Hydro • Oil & Gas • Energy Service • Power Transmission Divisions • Imaging & Therapy Systems • Clinical Products • Diagnostics • Customer Solutions (HIT) Divisions • Industry Automation • Drive Technologies • Customer Services Divisions • Rail Systems • Mobility and Logistics • Low and Medium Voltage • Smart Grid • Building Technologies • OSRAM* * In March 2011, Siemens announced its intention to publicly list OSRAM and, as an anchor shareholder, to hold a minority stake in OSRAM AG over the long term

  4. Siemens in the U.S. Is Home to NineWorldwide Businesses/Divisions Siemens Employs Over 60,000 People in All 50 States Healthcare Molecular Imaging Hoffman Estates, IL Industry VAI Metals Worcester, MA Healthcare Diagnostics Tarrytown, NY Healthcare Health Services Malvern, PA Healthcare Oncology Care Concord, CA Industry Water Tech. Warrendale, PA Healthcare Ultrasound Mountain View, CA Industry PLM (Product Lifecycle Mgt.) Plano, TX Energy Energy Service Orlando, FL

  5. First Steps Adoption of certified EHRs Meaningful use of EHRs Incentive payments to eligible professionals and hospitals Investment in nationwide HIT infrastructure Grant money for demonstration projects The Intended Destination High quality, safe, effective, and equitable care for all Seamless patient-centric care Realigned incentives and measures that foster prevention, intervention, coordination, effectiveness Regional clinical information interoperability on a national backbone American Recovery & Reinvestment Act (ARRA)HITECH – February 17, 2009 “The goals are quality and efficiency…If we encourage better performance, then physicians are going to find ways to improve. And health information technology is one crucial way to do that.” David Blumenthal MD, MPP National Coordinator for Health Information Technology, ONC

  6. ARRA HITECH Framework for Meaningful Use of Electronic Health Records (EHRs) - $30B/Program Blumenthal D. N Engl J Med 2009;10.1056/NEJMp0912825

  7. ONC (Office of the National Coordinator) FTEs 189 149 84 32

  8. HITECH Meaningful Use and the Affordable Care ActThe Market Will Develop in Two Waves Affordable Care Act Meaningful Use 2013 2009 2017

  9. ARRA HITECH EHR Incentive $$$$$ - BASICSAn eligible provider using a certified EHR and demonstrating meaningful use qualifies for $$$ • Eligible Hospitals / Critical Access Hospitals (EH/CAH) • Medicare AND Medicaid Incentive Funds • For Medicare, • Four Consecutive Payment Years • EH Must start in 2011, 2012, 2013 for Full Payment • CAH must start in 2011 or 2012 for Full Payment • Penalties begin in 2015 if not a meaningful user, increase over time, and remain in force • Fiscal Year boundaries • Eligible Professional (EP) • Medicare OR Medicaid Incentive Funds • For Medicare, • Five Consecutive Payment Years • Must start in 2011 or 2012 for Full Payment • Penalties for those who are not meaningful users beginning in 2015 that increase over time • Calendar Year

  10. Achieving Meaningful Use in Stages HIT-enabled Health Reform SOURCE:

  11. Ensure privacy and security protections Health Outcomes Policy Priorities* Increase quality, safety, efficiency, and reduce health disparities Engage patients and families Improve population health Improve care coordination *Adapted from National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America’s Healthcare. Washington, DC: National Quality Forum; 2008.

  12. What Defines the ARRA HITECH Process? “Meaningful Use”* Final Rule (CMS) Standard & Criteria Final Rule (ONC) Certification Process Final Rule (ONC) Test Tools & Procedures

  13. HIT Policy CommitteeMeaningful Use Workgroup HITPC MU Work Group Paul Tang, MD Co-Chair, Palo Alto Medical Foundation George Hripcsak, MD Co-Chair, Columbia University Michael Barr, MD American College of Physicians David Bates, Brigham & Women’s Hospital Christine Bechtel, National Partnership for Women & Families Neil Calman, MD The Institute for Family Health Tim Cromwell Dept of Veterans Affairs Art Davidson, MD Denver Public Health Marty Fattig Nemaha County Hospital Joe Francis Veterans Administration Leslie Kelly Hall Healthwise Yael Harris HRSA David Lansky Pacific Business Group/Health Deven McGraw Center/Democracy & Technology Greg Pace Social Security Administration Latanya Sweeney Carnegie Mellon University Robert Tagalicod CMS/HHS Charlene Underwood, Siemens Amy Zimmerman Rhode Island Office of Health & Human Services HIT Policy/ Standards Committees Consumer/Patient Groups, Employers, Government,Multi-stakeholder Groups, Providers,Vendors

  14. Trends In Year-To-Date Payments From May 2011 To April 2012 ($ Millions) $5,030 $4,484 $3,850 $3,119 $2,533 $1,836 $1,239 $860 $652 $397 $273 $190 May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr Data from CMS, as of April, 2012

  15. Actual Year-To-Date Spending vs. Projections Medicaid and Medicare EHR Incentive Spending In 2011 Actual Year-To-Date Spending versus Projections $5.03B $4.7B $1 to 2.8B $860.1M Paid Thru 4/12 Actual Spending In FY 2011 CMS Projection for FY 2011 CBO Score For FY 2011 Core HIS Components Data from CMS, as of April, 2012

  16. Actual Providers Paid & Amount Paid Through April 2012 Providers PaidAmount Paid Program-to-DateProgram-to-Date Medicare Eligible Professionals                  56,214                                $953,388,119 Medicaid Eligible Professionals                  35,040                             $735,578,046 Eligible Hospitals                                        2,843**                         $3,341,140,043 Total                                                       94,097                          $5,030,106,208 ** 2843 – 566 (Dups paid by both) = 2101/5,011 is 42% of EHs whereas 949/ 5,011 EHs who received Medicare funds only for achieving meaningful use, represents 19%. Core HIS Components Data from CMS, as of April 30, 2012

  17. Congratulations to Siemens Customers Who Have Achieved Stage 1 MU - 36 enterprises and 62 facilities June 6, 2012 • Main Line Health • MedCentral Health System • Mercy Health Partners • Meridian Health System • Nason Hospital • Nebraska Heart Hospital, Inc. • Niagara Falls Memorial Medical Center • Nix Health Care System • Pinnacle Health System • Riverside Health System • Saint Joseph Hospital (Boston) • St. Joseph’s Hospital and Med Ctr • South Jersey Health System • Temple University Health (Jeanes) • Texas Regional Medical Center • Westchester Medical Center • Winthrop University Hospital • Wyoming Valley Health Care System • Alegent Health • Altoona Regional Health System • John D. Archbold Memorial Hospital • Bethesda Memorial Hospital • Caldwell Memorial Hospital • Caromont Memorial Health, Inc. • Catholic Health System • CentraState Medical Center • Champlain Valley • Clearfield Hospital • Crozer Keystone Health System • Danbury Hospital • Ellis Medicine • EMH Healthcare • Faith Regional Health Services • Grenada Lake Medical Center • HealthAlliance Hospital • Lifespan

  18. Trends in Hospital EHR Adoption Show Increasing Adoption but Low Penetration of Full Function Percent of Non-Federal Acute Care Hospitals With Adoption of EHR Systems By Level of Functionality: 2008 - 2011 Basic EHR With Clinician Notes Basic EHR Without Clinician Notes Comprehensive EHR 40% 35% 30% 25% 20% 15% 10% 5% 0% 34.8%* 7.2* 19.1%* 16.1%* 13.4% 18.8* 3.5 3.9 4.0 12.0* 9.4* 7.8 8.8* 3.6 2.8* 1.6 2008 2009 2010 2011 *Significantly different from previous year. Source: ONC/AHA, AHA Annual Survey Information Technology Supplement

  19. Physician Adoption of EHRs has Increased Steadily 60% 50% 40% 30% 20% 10% 0% 56.9 50.7 48.3 42.0 Any EMR/EHR System 33.8 34.8 29.2 24.9 23.9 21.8 20.8 Basic EMR/EHR System 18.2 17.3 17.3 16.9 11.8 10.5 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Source: CDC/NCHS, National Ambulatory Medical Care Survey

  20. However, Physician EHR Adoption is Uneven 40 35 30 25 20 15 10 5 0 26 Fully Functional EHR Basic EHR 19 11 13 5 6 3 2 1-2 Physicians 3-5 Physicians 6-10 Physicians 11+ Physicians Source: Rao, SR, et al. JAMIA, May 2011.

  21. Q1 Q2 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Rollout of Meaningful Use Stage 2 Timeline January 13 HIT Policy Committee (HIT-PC) – Meaningful Use (MU) Workgroup issued a request for input on Draft Objectives/ Measures for Stage 2. June – September HIT Standards Committee identifies standards and certification criteria. March 7, 2012 Federal Register CMS Proposed Rule (EHR Incentive Program) and ONC Proposed Rule (Standards & Certification Criteria). 2Q 2012? CMS and ONC publish Final Rules. 2011 2012 March – June MU Workgroup prepared recommendations to the HIT-PC which will then modify/ approve and send to CMS. Approved on June 8th. September – 1Q 2012 CMS and ONC formulate proposed rules for objectives, measures, standards, and certification criteria.

  22. Meaningful Use Stage 2: Two Proposed Rules • CMS Medicare and Medicaid Programs; Electronic Health Record Incentive Program – Stage 2 Link to Federal Register 3/7/12 • Overview • Key Summary Points • Timeline Change • Objectives/Measures • Clinical Quality Measures • Payment Adjustments • Appeal Process • Medicaid EHR Incentive Program • General Information/Stats • ONC Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology Link to Federal Register 3/7/12 • Standards & Certification • Interoperability • Privacy & Security • Usability/Patient Safety

  23. Meaningful Use Stage 2: Two Additional Documents Published • CMS Medicare and Medicaid Programs; Electronic Health Record Incentive Program – Stage 2 CORRECTIONS – 4/18/12 • 5/2/12 NIST releases EHR Technical Evaluation, Testing, and Validation of the Usability of EHRs (100+ pgs) • Rationale for EHR Usability Protocol (EUP) and outlines procedures for design evaluation and human user performance testing of EHR systems.

  24. Proposed Timeline Change: Stage of MU Criteria by First Payment Year Red line indicates payment adjustments beginning in FY 2015

  25. Subsection (d) Hospital Payment Adjustments EHs/CAHs: July 1, 2014 (90-day reporting period must begin by April 3, 2014) % DECREASE IN THE PERCENTAGE INCREASE TO THE IPPS PAYMENT RATE THAT THE HOSPITAL WOULD OTHERWISE RECEIVE FOR THAT YEAR • For example if the increase to IPPS for 2015 was 2% than a hospital subject to the payment adjustment would only receive a 1.5% increase To avoid Payment Adjustments EHs/CAHs must first meet MU by July 1, 2014 (90-day reporting period must begin by April 3, 2014) Source: CMS at HIMSS12 Table 13: CMS NPRM

  26. EP Payment Adjustments % ADJUSTMENT ASSUMING LESS THAN 75 PERCENT OF EPs ARE MEANINGFUL EHR USERS FOR CY 2018 AND SUBSEQUENT YEARS % ADJUSTMENT ASSUMING MORE THAN 75 PERCENT OF EPs ARE MEANINGFUL EHR USERS FOR CY 2018 AND SUBSEQUENT YEARS To avoid Payment AdjustmentsEPs must first meet MU by 10/1, 2014 (90-day reporting must begin by 7/ 3, 2014) Source: CMS at HIMSS12

  27. Proposed Meaningful Use Objectives Proposed Stage 2 Stage 1 Eligible Professionals 15 core objectives 5 of 10 menu objectives 20 total objectives Eligible Professionals 17 core objectives 3 of 5 menu objectives 20 total objectives Eligible Hospitals & CAHs 14 core objectives 5 of 10 menu objectives 19 total objectives Eligible Hospitals & CAHs 16 core objectives 2 of 4 menu objectives 18 total objectives Source: CMS at HIMSS12

  28. Proposed Changes to Stage 1 Effective 2013:Included in Stage 2 Proposed Rules

  29. Proposed Clinical Quality Measures Proposed Stage 2 Stage 1 Eligible Professionals 3 core OR 3 alt. core CQMs plus 3 menu CQMs 6 total CQMs Eligible Professionals 1a) 12 CQMs (> 1 per domain) 1b) 11 core + 1 menu CQMs 2) PQRS or Group Reporting 12 total CQMs Eligible Hospitals & CAHs 15 total CQMs Eligible Hospitals & CAHs 24 CQMs (> 1 per domain) 24 total CQMs Align with ONC’s 2014 Edition Certification Align with ONC’s 2011 Edition Certification

  30. Additional Reference Information - Hidden Slides in Appendix • Additions/Changes/Deletions comparing Stage 2 to Stage 1 per each of the five Health Policy Outcomes (5 Slides) • Stage 2 Objective and Measures Detail with Stage 1 (8 Slides) • Clinical Quality Measures: Eligible Hospitals and CAHs (1 Slide) • 49 Proposed Measures which includes 15 from Stage 1 (24 Required) • Reporting and Reporting Methods • Clinical Quality Measures: EP Reporting Options (1 Slide) • 125 Proposed Measures includes 41 from Stage 1 (12 Required) • Reporting Options, Reporting Methods and Group Reporting • Vocabulary Standards (1 Slide) • Consolidated CDA Sample with new data sections (1 Slide)

  31. Additions: Medication tracking from order to administration using assistive technology - EHs ePrescribing(for discharge prescriptions)- EH menu set Image results and information accessible - EP and EH menu set Record patient family health history as structured data - EP and EH menu set Changes: Thresholds increases/changes: CPOE, demographics, ePrescribing for EPs, vital signs, smoking status, preventative reminders for EPs Lab and Radiology ordering required for CPOE Age requirements changed: Blood pressure, growth charts Clinical Decision support rules increased from 1to 5 and expected to support CQMs Consolidated Objectives: Drug-drug and drug-allergy checks, problem list, medication list, medication allergy list, drug formulary check Reporting Clinical Quality Measures separated from MU objectives Increase quality, safety, efficiency, and reduce health disparities ** (stage 2 compared to Stage 1) - SEE APPENDIX **Health Outcomes Policy Priorities

  32. Stage 2 Objectives and Measures – SEE APPENDIX

  33. Industry Calls for Stage 2 Changes….. > 400 comments for each NPRM. Many requests for clarifications. Timeframe impact on Final Rules and confusion over “single source of truth.” • Make the transition period from Stage 1 to 2 realistic • Requests for 90 Day Reporting for Stage 2 • Delay Payment Adjustment reporting period to be in line with FY15 • Reduce volume of Objectives/Measures and Quality Measures • Actually 17 new to core or new to MU Objectives in Stage 2, some with multiple measures • 174 Quality Measures (49 EH/CAH, 125 EP) • Reduce complexity of 2011/2014 Edition CEHRTs and Stage 1 and 2 • Allow use of 2011 Edition until CY 2015 so all will have same opportunity to spend two years on the same technology. • Maintain link between Stage 1 and 2011 CEHRT Edition • Eliminate holding providers responsible for patient’s actions • Delete inclusion of ICD-10 and usability metrics • Delete or delay to Stage 3 those standards and quality measures that are not vetted in the industry (i.e. Implementation experience of smoking status and NQF endorsement of measures)

  34. Executive’s Role in Orchestrating Health Reform … • ICD-10 CM • Meaningful Use • Hospital Value-based Purchasing Program • Accountable Care Organizations • Hospital Readmissions • Hospital-acquired Conditions • Payment Bundling

  35. Office of the National Coordinator of Health Information Technology: www.hhs.gov/healthit/ CMS Electronic Health Record Incentive Programs: https://www.cms.gov/EHRIncentivePrograms/ HIMSS Meaningful Use OneSource http://www.himss.org/ASP/topics_meaningfuluse.asp HealthIT.govhttp://www.healthit.gov/ Links & References

  36. Thank You.

  37. DVHIMSS Summer Education ProgramStage 2 and Regulatory Update APPENDIX Peg Meadow Director, Government & Industry Affairs, Siemens Healthcare June 14, 2012

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