Neo healthconnect ehr financial incentives

1. Neo healthconnectehr financial incentives November 6, 2010

2. OHIP’s Initial Board • In September 2009, Governor Strickland designated the Ohio Health Information Partnership (OHIP), a unique public-private collaboration, as the entity to lead the implementation and support of health information technology throughout Ohio. • OHIP is a non-profit organization with 501(c )(3) IRS status

3. Functions of OHIP • OHIP was established to serve two functions in Ohio: • Develop a statewide health information exchange for Ohio to allow hospitals and physicians to communicate electronically • Coordinate the regional extension centers (RECs) to assist with the adoption of health information technology by physicians in Ohio

4. HIE DEVELOPMENT

5. State Health Information Exchange (HIE) Federal Matching Total $14,872,199 $2,106,801 $16,979,000

6. STATE LEVEL SERVICES: • Master Patient Locator Index • Provider Index • Trust Agreements – Privacy and Security • Integration with Agencies – Medicaid • Eligibility Verification • Remittance Advice, Claims & Claim Status • Coordination of Benefits & Pre Authorization • Quality and Aggregate Reporting Requirements 6

7. HIE State Plan • Ohio submitted the state plan for HIE development to the federal government in July, 2010. • The plan has passed initial review by the federal HIE experts (as of September 15, 2010) • Additional functionality review will occur between now and the end of the year

8. Ohio HIE Development • Forty vendors bid last spring in the initial Request for Proposal to develop the statewide HIE. • A final selection of the HIE vendor is expected to occur by January, 2011

9. HIE SUMMARY FOR OHIO • To access the Executive Summary of the HIE White Paper that lays out the development of the HIE in Ohio, go to: http://www.ohiponline.org/External%20Documents/HIE%20White%20Paper.pdf

10. Programs for EHR Adoption OHIP and REC SERVICES

11. Regional Extension Center Federal Matching Total $28,500,000 $17,893,199* $46,393,199*

12. Regional Extension Center Regions Northeast Central Ohio Regional Extension Center (NECO REC) Case Western Reserve University (CWRU) Central Ohio Health Information Exchange (COHIE) Dayton-West Central Ohio Regional Extension Center (DWCO REC) Northwest Ohio Regional Extension Center (NW Ohio REC) Ohio University Appalachian Health Information Exchange (OU) Northeast Ohio Health Connect (NEOHC) HealthBridge REC (non-OHIP)

13. REC Grant Funding • Funding goes directly to OHIP and from OHIP on to the regional partners and their sub-contractors for providing education and assistance in EHR adoption. • Does not include the stimulus dollars for the physicians, hospitals and other health care providers who purchase and implement EHR systems in a meaningful way.

14. Distribution of Grant Funding REC (Services) HIE (Structure) HEALTHBRIDGE OHIP OHIP REGIONAL PARTNERS MEDICARE EHR INCENTIVES MEDICAID EHR INCENTIVES PHYSICIANS, HOSPITALS, PROVIDERS “MEANINGFUL USE” OF ELECTRONIC HEALTH RECORDS

15. Physicians/Providers Served • RECs can provide services to all physicians • Priority Primary Care Providers receive subsidized services paid for by Medicare and Medicaid and provided by the REC

16. Priority Primary Care Providers • The physician or other provider must practice in a primary care area, defined as internal medicine, family practice, pediatrics or obstetrics/gynecology • Need not be board certified in the specialty area, but must practice in primary care

17. PPCP: Definition • Priority primary-care providers in individual or group settings • Fewer than ten primary care physicians or other primary care professionals with Rx privileges • If group has more than ten primary care physicians/providers, the direct technical assistance will be capped at the ten-provider level

18. PPCP: Definition • Physicians, PAs, or NPs who provide primary care services in: • Public or Critical Access Hospitals • Federally Qualified Health Centers (FQHCs) • Rural Health Clinics • Other settings for predominantly uninsured, underinsured or medically underserved populations

19. Provider Eligibility Medicare/Medicaid EHR Incentive Programs

20. Who Are Eligible Professionals for the Medicare Incentive Program? MEDICARE “eligible professionals” include: • Doctor of Medicine or Osteopathic Medicine • Dentist or Dental Surgeon • Optometrist • Podiatrist • Chiropractor

21. Who Are Eligible Professionals for the Medicaid Incentive Program? MEDICAID “eligible professionals” include: • Physicians • Dentists • Certified Nurse Midwives • Nurse Practitioners • Physician Assistants operating at an FQHC led by a Physician Assistant

22. Hospital-Employed Physicians • Eligible Providers who are hospital-based but provide services in the ambulatory setting, including ambulatory clinics, are eligible for Medicare incentive payments.

23. Who is Excluded? Hospital-based physicians (e.g., radiology, pathology, anesthesiology, ER) are excluded from incentive paymentsif: • More than 90% of the patients seen are hospital-based, either inpatient or emergency room; and • The provider uses the hospital’s facilities and equipment.

24. Understanding the Incentives How the Incentive Programs Are Structured

25. Differences in the Incentive Programs • Time for qualifying • Medicare providers can only qualify for incentive payments from 2011 to 2014 • Medicaid providers can qualify anytime from 2011 to 2016

26. Differences in the Incentive Programs Medicare incentive payments • Medicare incentive payments will be based on a percent of your total traditional fee-for-service Medicare billings for the preceding year • For Medicare incentives, there is no requirementthat a minimum percentage of the practice be Medicare.

27. Differences in the Incentive Programs • The incentives run to the professional and not to the practice. It is the physician or other professional who must qualify and direct the incentive payments. • Eligibility is determined for each professional’s billing for Medicare. For Medicaid, eligibility is usually based on the professional’s individual patient mix. There are special rules for FQHCs and rural health clinics.

28. Differences in the Incentive Programs Medicaid incentives require a certain percentage of the practice to be Medicaid (as measured in a 90 day period): • For pediatric practices, 20% of the patients must be Medicaid. • For non-pediatric practices, 30% of the patients must be Medicaid (either managed care or fee for service).

29. Differences in the Incentive Programs • Payments • Medicare payments extend for a maximum of 5 years; last potential payments are in 2016 • Medicaid payments extend for 6 years; last potential payments are in 2021

30. Differences in the Incentive Programs • Amount of incentive payment • Medicare maximum incentive is $44,000 if provider meets Meaningful Use (MU) in 2011 or 2012. Incentive payment decreases to $39,000 if qualify for MU in 2013. Payment decreases to $24,000 if qualify for MU in 2014 • Medicaid maximum incentive is $63,750 and providers are eligible for the full amount if they qualify for MU any time between 2011 and 2016

31. Medicare Incentives

32. Medicaid Incentives

33. Differences in the Incentive Programs • Meaningful Use • Medicare providers must show meaningful use from the first year of eligibility (for 90 days) and all subsequent years • Medicaid providers do not need to show meaningful use in the first year. They do need to demonstrate MU for 90 days in the second year and all subsequent years.

34. Differences in the Incentive Programs Medicaid will pay incentives in the first year to: • Adopt (i.e., acquire, purchase or secure access to) • Implement (i.e., install or commence utilization, “go live”) or • Upgrade certified EHR technology as early as 2010.

35. Differences in the Incentive Programs • Penalties • Decreased reimbursement to providers of Medicare starting in 2015 if practice has not adopted EHR and achieved meaningful use • There are no penalties for EHR non-use under Medicaid.

36. Understanding the Incentives HOW THE EHR INCENTIVE PAYMENTS WORK

37. When Can Payments Start? • Certification of EHR systems will begin in Fall 2010 • For Medicare and Medicaid incentives, registration for the incentive programs will start online in January 2011 • Attestations of meeting meaningful use can be made as early as April 2011 • Medicare payments will start in May 2011

38. Early Adoption • For 2011 and 2012, only have to show meaningful use for 90 consecutive days. • Must adopt and meaningfully use no later than October, 2011 to receive Medicare incentive payments for that year. The 2011 period needs to be followed up with a full year of EHR use in 2012.

39. Early Adoption • You may receive the same level of Medicare incentive payment by adopting anytime in 2011 or 2012 with a minimum of 90 days meaningful use in the first year.

40. Change of Incentive Programs Permitted • If there is a change in the provider’s patient mix during the incentive period (e.g., Medicaid population decreases or physician moves to a different practice), then the rule permits a one-time switch between programs, either Medicare to Medicaid or vice versa. • Reimbursement will pick up at the same point in the new program.

41. How Are Payments Calculated? Medicare Advantage • Calculations for Medicare incentives do not include Medicare Advantage in the totals, unless the provider is employed by a Medicare Advantage organization (HMO) or by a partner of the MA organization that furnishes at least 80% of the Medicare patient care services

42. How Are Payments Calculated? • Payments are based on the claims received by Medicare by the end of February of the following year.

43. Calculating Payments (cont’d) Medicare Incentives • Payments are calculated using 75% of Medicare fee-for-service allowed charges for that year, up to the maximum permitted. • For maximum reimbursement, would need to have $24,000 in traditional Medicare allowed charges for a given year.

44. Medicaid Incentives • Medicaid payments come from the state of Ohio, so the exact mechanism and the timing for payments are still being worked out.

45. Calculating Payments (cont’d) Medicaid Incentives • Payments are based on actual costs once a physician or provider qualifies. These costs can include the cost of support and training. • The Medicaid reimbursement is capped at 85% of the assumed physician cost of $25,000 (i.e. $21,250). The physician can receive up to $29,000 from outside sources (such as Stark dollars from the hospital) without having it deducted from his/her payment.

46. Additional Incentives for HPSA Practices • If the physician or provider has at least 50% of his/her practice in a Health Professional Shortage Area (HPSA), then the physician or provider is eligible for an additional 10%incentive payment over his/her Medicare incentive.

47. More than one site? • If you are a multiple-practice site, you must have 50% or more of the patient encounters occurring at a location or locations that have certified EHR technology to draw down incentive payments in that year.

48. Understanding Meaningful Use Understanding The Term

49. The Meaningful Use Model HITECH’s incentives and assistance programs seek to improve the health of Americans and the performance of their health care system through “meaningful use” of EHRs to achieve five health care goals: • Improve quality • Engage patients and families • Improve care coordination • Ensure adequate privacy and security • Improve population and public health

50. What is Meaningful Use? Three elements of “meaningful use”: • Use of a certified electronic health record (EHR) in a meaningful way (e.g., e-prescribing). • The technology is connectedin a way that provides electronic exchange of health information to improve the quality of care. • Clinical quality measures are submitted to CMS.