Make the SW IT CH

1. Make the SWITCH Indiana Rural Health Association October 27, 2010 www.switch.purdue.edu

2. CMS Final Rule Understanding the Final Rule • Eligible Professional (EP) • defines those providers eligible for incentives • “Certified EHR” • Based on set of standards, implementation specifications, and certification criteria EHR vendors must meet • “Meaningful Use”- currently in Stage 1 • A set of measures for using a certified EHR which EP’s must meet • Continuous 90 day reporting period (first payment year) • Reporting period = All year (each subsequent year) • Choose a program • Medicare or Medicaid • Must choose one (may switch programs once)

3. CMS Final Rule *Indicates “payment year” in which each Stage is first introduced. Actual compliance timeframe depends on an EP’s first payment year.

4. $44,000 for Medicare & $63,750 for Medicaid Make the SWITCH: Incentive Bonuses REC Grant Federal Incentives 2012 2015 www.switch.purdue.edu

5. CMS Final Rule • Starts in calendar year 2011 • EP’s may receive payments up to $44,000 over five years • Incentive based on percentage of Medicare allowable • Meaningful Use must be demonstrated for all patients (not just Medicare) • Incentive payments end in 2015 • Penalties - reduction in Medicare reimbursements for EP’s not demonstrating Meaningful Use starting in 2015

6. Medicare Payment Schedule • Maximum payments based upon 75% of Medicare Part B fee schedule payments up to the maximum incentive amount per year. • e.g., Minimum of $24,000 per year to be eligible for maximum $18,000 bonus

7. Medicare Penalties • In 2015, reduction in Medicare reimbursement begins for physicians who are not meaningful EHR users (1% per year, capped at a 3% reduction). • Statue allows for exceptions for “significant hardship” as determined by the Secretary.

8. Medicaid Program • Starts in calendar year 2011 • EP’s may receive payments up to $63,750 over six years • Incentive based on up to 85% of state-calculated global average costs for EHR • 1st yr cost no later than 2016 • No payments made after 2021 or more than 5 years • No Medicaid penalty for failure to demonstrate Meaningful Use

9. Medicaid Payment Schedule

10. How Will Participation Be Reported? • 2011 – self-reporting (attestation) via CMS web portal • 2012 & beyond – if available, report information directly from certified EHR using: • Integrated web portal • Local HIE • Registries … Specifics TBA

11. How and When Will EP’s be Paid? HOW: A single, consolidated annual incentive payment • Medicare: paid by CMS (not via claims Fiscal Intermediary) • Medicaid: paid by State Medicaid program, or their designated intermediary • WHEN: • Payments will be made once an EP: • Demonstrates Meaningful Use for the reporting period and reaches the threshold for maximum payment, within 15-46 days after attestation

12. 25 Stage 1 Measures • Stage 1 Meaningful Use Measures • 15 Core (required) objectives • 10 Menu objectives • May defer 5 of 10 • All will be required in Stage 2

13. 25 Stage 1 Measures

14. 25 Stage 1 Measures

15. 25 Stage 1 Measures

16. 25 Stage 1 Measures

17. 25 Stage 1 Measures

18. 25 Stage 1 Measures

19. Make the SWITCH : Our Core Services

20. Infrastructure Services • Infrastructure and HW Assessment (ISP/connectivity, wireless, existing devices and specifications, etc.) • Minimum Necessary and Best Practice Recommendations (desktops, mobile devices/ipads/tablets, printers, scanners, etc.) • Supply Management (ordering, delivery, trouble shooting, etc.) • Installation & Set-Up

21. Vendor Services • Preferred EHR Partners • 3 preferred vendors for groups without EHR • Criteria-based selection to best meet physician / practice needs • Leveraged pricing / terms, including rapid implementation cycles • Group contracts directly with vendor • Meaningful Use Partners • RFI’s returned • Selecting 2-4 with established footprint in Indiana primary care market

22. Making the SWITCH: Our Selection Process Six + Month Process Initial EHR Vendors (200+ Vendors) CCHIT 08/11 ARRA Certified (65+ Vendors) RFP ‘s Scored 7 Vendors invited for Demos • Researched and Interviewed the 65 vendors against criteria: • SaaS/ASP • 3+years SaaS / ASP • 300+ Provider users • Integrated Practice Management • 10 Vendors met criteria and RFP’s issued EHR Demonstration to Physician Advisory Committee 5 Vendor Finalists • MU demos, due diligence, discussion, and scoring against REC Overall and Milestone Key Factors: • Clarity in Messaging / Marketability • Implementation Model / Cycle • Meaningful Use • 3 Vendors Selected: • athenahealth • iSalus • MDLand

23. Meaningful Use Services • Comprehensive EHR / MU go-live action plans • Data Transmission Plan • Security Plan • Information/Data Exchange Plan • Care Coordination Plan • Clinical Encounter Workflow/Process Plan • MU Gap Analysis and Fill Plan • MU Project Management (with MU Partners) • MU metrics monitoring

24. HealthLINC is… HealthLINC is a community collaboration that includes 90% of the physicians launched in 2005 with ASP with Health Bridge HIE (Axolotl, MIRTH…) Helps providers use technology to improve efficiencies and significantly reduce medical mistakes Clinical Messaging—2007 ePrescribing—2009 Office encounters—2010 Registry—2010 Regional Extension Center services to Primary Care—2010 Community partners are many but to date not including insurers or employers Working 4 federal projects (SSA, CMS, ONC, HRSA) and Initiating 2nd Physician Foundation Grant Sub-grantee Tri-State REC; Partner in Beacon with HealthBridge

25. Regional Extension Centers: Making IT Meaningful • DONE • Partner in Tri-State REC (Indiana) • Achieved 25% sign-up (68) • Simple Gap Analysis with Final Rule • Monthly standing meetings • TO DO • Get 200 more eligible practitioners signed up • Meet milestones 2 and 3 for MU • Find the quality in the activity

26. Our approach We want to exchange data with other communities—not done We need to agree on the data we need to exchange—is this CCD? what data needs to be between specialist and primary care physicians what data behavioral health allows to be shared What data needs shared for epidemiologic safety We want to participate in all of the pay for performance programs We want to enhance clinical practice (at the point of care) We want to support physicians as they rapidly adopt a variety of EMRs Our approach to interoperability allows a flexible approach to clinical messaging, EMRs, and other HIEs Need LOINC and other standards for data sharing and trending

27. Selected EMR Vendors • Five chosen vendors after very in-depth process involving all partners plus University of Kentucky • Connection with Health Information Exchange assured • Openness to collaborate with all other vendors desired by our served physicians and providers

28. Tri-State REC announces vendors The five vendors and products that have been named to the supported vendor list are: Allscripts – Professional Athenahealth - AthenaNet eClinicalWorks – eCW EHR GE Healthcare - Centricity NextGen Healthcare - NextGen EHR “The process of choosing an EHR can be difficult for physicians,” said David Groves, Executive Director of the Tri-State REC. “We have created this supported vendor list to identify products that offer exceptional usability, meet meaningful use requirements, and support high-quality patient care. However, we are committed to working with any practice or provider, regardless of which certified EHR vendor they choose.”

29. Physicians + Hospital(s) of choice Work with Eligible Providers Work with 50 bed or less hospitals, including the CAHs Work with those who care for the underserved With MU activities, bring data sharing for safer patient care.

30. Tri-State REC Partners NEKY RHIO

31. How Do I Get Started? • Enroll with your Regional Extension Center! • We exist to help you achieve Meaningful Use and receive the maximum incentive!