ARRA / HITECH “Meaningful Use” (MU) of Electronic Health Records (EHRs)

1. ARRA / HITECH “Meaningful Use” (MU) of Electronic Health Records (EHRs) Bobby Gladd, member ASQ REC Project Coordinator HealthInsight This material was prepared by HealthInsight as part of our work as the Regional Extension Center for Nevada and Utah, under grant #90RC0033/01 from the Office of the National Coordinator, Department of Health and Human Services.

2. Who is HealthInsight? HealthInsight is a non-profit community based organization We are the Medicare Quality Improvement Organization (QIO) for Nevada and Utah HealthInsight is a recognized leader in: Transparency & public reporting Health information technology initiatives Payment reform efforts Human factors science research and application Quality assurance activities

3. Meaningful Use Incentives Don’t drop the ball!

4. ARRA Stimulus Package Includes $34B in incentives to physicians who use EHRs in a “meaningful” manner Includes $2B for the Office of the National Coordinator of Health Information Technology (ONC) to build support services HIT Regional Extension Centers (RECs) to assist providers throughout the country in adopting and using EHRs

5. Eligible Professional (EP) Medicare Medicaid Dr. of Medicine or Osteopathy (MD, DO) Dr. of Dental Surgery or Medicine (DDS, DMD) Dr. of Podiatric Medicine (DPM) Dr. of Optometry (OD) Chiropractor (DC) Physician Dentist Certified Nurse-Midwife Nurse Practitioner Physician Assistant (PA) practicing in a Federally-Qualified Health Center (FQHC) or Rural Health Clinic (RHC) that is led by a PA

6. Eligibility for Incentives • UsecertifiedEHR technology in a meaningful manner • Exchange health information to improve the quality of care • Report on clinical quality measures *Additional Medicaid requirements

7. Eligibility (Medicaid) • An eligible professional, not hospital-based, with at least 30% of patient volume attributable to Medicaid • A pediatrician, not hospital-based, with at least 20% of patient volume attributable to Medicaid • These physicians will be eligible for only 2/3 of the indicated payments

8. Eligibility (Medicaid) • Providers practicing predominantly in a FQHC or RHC with at least 30% of patient volume attributable to needy individuals* • *Needy individual • receiving Medicaid • receiving assistance under Title XXI (SCHIP) • being furnished uncompensated care by the provider • being charged a reduced rate based on ability to pay

9. Medicare Incentives 75% of allowable charges (based on charges of $24,000+)

10. Medicaid Incentives • Beginning 2011, states will pay Medicaid EP up to 85% of net average allowable costs for certified EHR, and support services • Net average allowable costs not to exceed • Year 1 $25,000 • Year 2 $10,000

11. What is Meaningful Use? • 556 page Notice of Proposed Rule Making released December 30, 2009 by CMS • Outlines criteria needed for meeting meaningful use and earning incentives • Phased approach: Stage 1, Stage 2, Stage 3 • The guidelines set out the criteria from 2011 to 2015, they get more ambitious over time • Comment period closed March 15th

12. Conceptual Approach to Meaningful Use

13. Phased Approach

14. Meaningful Use – Stage 1 • 25 objectives & measures • Divided among five priority areas • Improving quality, safety, efficiency, and reducing health disparities • Engage patients and families in their health care • Improve care coordination • Improve population and public health • Ensure adequate privacy and security protections for personal health information

15. Meaningful Use Stage 1 - Measures • CPOE (meds, labs, referrals, images) 80% • Up-dated patient problem list in 80% ICD-9-CM or SNOMED CT • E-Prescribing 75% • Active medication list 80% • Active medication allergy list 80% • Patient demographics 80%

16. Meaningful Use Stage 1 - Measures • Vital signs 80% • Smoking Status (13 and older) 80% • Lab results 50% • Patient reminders 50% • Insurance eligibility (electronically) 80% • Claims submission 80% • Electronic copy of patient health record within 48 hours 80%

17. Meaningful Use Stage 1 - Measures • Electronic access to patient health record within 96 hours 10% • Clinical summaries 80% • Medication reconciliation 80% • Summary of care record 80%

18. Meaningful Use Stage 1 - Measures • Submission of the following to public health agencies • Immunization registries 1 test • Syndromic surveillance data 1 test • Clinical information exchange 1 test • Reportable lab data 1 test

19. Clinical Quality Measures (CQM) Cardiology Pulmonology Endocrinology Oncology Proceduralist/Surgery Primary Care Radiology Gastroenterology Nephrology • Physicians • Pediatrics • Obstetrics and Gynecology • Neurology • Psychiatry • Ophthalmology • Podiatry

20. Reporting CQM 2011: attestation methodology to submit summary clinical quality measurement information For 2012: electronic information via a web portal, connection to local HIEs and connection to specialty registries Certified EHR technology to capture the data elements and calculate the results is required

21. HIT Regional Extension Center Program • What is an REC? • HIT Regional Extension Centers (REC) were made to assist providers throughout the country in adopting and using EHRs to achieve meaningful use • RECs launched in February 2010 • HealthInsight was named as the REC for Utah and Nevada

22. Regional Extension Center (REC) • REC contract to work with over 1,500 providers in Nevada and Utah in the next two years – 1,000+ after that • HealthInsight history • 30+ years experience as Utah & Nevada's QIO • In last five years, helped over 400 practices adopt and use EHRs

23. Who will the REC assist? • General Education - all providers • Website materials, informational webinars and presentations, etc. • Hands on, 1-on-1 assistance to “priority” providers (ONC defined) to reach the meaningful use requirements

24. Priority Providers As defined by ONC - • Individual and Small Group Practices focused on Primary Care • Family Practice, Internal Medicine, Pediatrics, OB/GYN • Federally Qualified Health Centers, Rural Health Clinics, others serving underserved • Primary Care Clinics associated with CAHs and public/non-profit hospitals

25. Services Available from the REC • Initial readiness assessment • Workflow analysis • Tailored vendor selection tools and check sheets • Referrals to mentor clinics • Contract negotiation tools • Project management and implementation

26. Services Available from the REC • Meaningful Use Assessment – current status of vendor product and processes • Plan development (e.g., MU SOPs) • Privacy and security best practice • Assistance with the Health Information Exchange (HIE)

27. Subsidized Services forPriority Providers • HealthInsight’s fee will be a small % of the incentive to cover some required matching • 2010-2011: • $1K for priority providers already using an EHR • $2K for priority providers that are not using an EHR • Fee dueonly when provider qualifies for meaningful use • 2012-2013: • $2.5K for priority providers already using an EHR • $4K for priority providers that are not using an EHR • Fee due½ up front, ½ at meaningful use

28. Summary • Reaching Meaningful use and the Incentive payment requires action on the part of the practice – the sooner the better! • HealthInsight, as the REC,is a neutral, trusted source that can help you take advantage of the incentives to reach the goal of meaningful use

29. The RECs and ASQ:Potential for collaboration? Google “ASQ Marshall Plan” See also RegionalExtensionCenter.blogspot.com

30. Leaning up the office visit

35. Questions? • For additional information: www.healthinsight.org Bobby Gladd REC Project Coordinator 702-933-7339 Bgladd@healthinsight.org