2. Before ARRA (American Recovery and Reinvestment Act
of 2009)
PQRI
E-Prescribing
EHR Adoption and Reporting Grant Programs
Medical Home Pilot Project
Since ARRA
“Meaningful use”
Medicaid, Medicare incentives
HIT Regional Extension Centers
HIE grants
Multiple HIT related workforce development and research
grants
3. American Reinvestment and Recovery Act
Economic stimulus
Job creation
HITECH (HIT for Economic and Clinical Health)
Act
Focus on the use of health information technology
Improve healthcare outcomes
Improve healthcare system performance
Huge appropriation of money to healthcare IT industry
4. Over $36B for Provider Incentives
(Medicare/Medicaid)
Over $4.5B for National Telecommunications
Program
$2.5B for USDA Telemedicine efforts
$2B for HIE development (infrastructure)
$1.5B for FQHCs/CHCs
Over $1B for Research
$500M for Social Security Administration
$85M for Indian Health Service
$50M for Veterans Administration
This is the largest HIT specific appropriation in US history!
5. Government to lead standards development for nationwide
exchange and use of health information
Goal is to improve quality and coordination of care
Over $40B for HIT infrastructure, HIE, and especially
Medicare/Medicaid incentives to doctors and hospitals for
“meaningful” use of certified HIT
Saves federal funds and generates additional savings
throughout the health sector through improved quality and
care coordination, reductions in medical errors and
duplicative care
Strengthens HIPAA to protect identifiable health
information from misuse as use of HIT increases
6. Physicians must elect to receive incentives
EITHER through the Medicaid or Medicare
program (but can switch once)
Incentives do not penalize physicians who
already have adopted EHR (just need to
demonstrate meaningful use).
Hospital-based physicians, e.g., ED,
pathologists, anesthesiologists, are not eligible
for these incentives
7. EPs that provide substantially all of their
professional services (90% or greater) in an
inpatient or outpatient hospital setting are
considered hospital-based EPs and not eligible
for incentive payments.
POS (place of service codes will be used to
determine eligibility)
Rule subsequently relaxed to allow for hospital
employed physicians who practice in clinical
settings to receive incentive payments
8. The “Carrots”
Incentives begin in Calendar Year 2011 (1/1/2011)
For maximum bonus ($44,000), must be a “meaningful” user of
certified EHR in CY11 or CY12
Only need to be a meaningful user for a 90-day-period in first
year!
Incentive amount is calculated as 75% of allowable Part B
charges for the payment year with an annual caps (defined
below)
Maximum incentive payments are as follows
Year 1 - $18,000 (If year 1 is 2011 or 2012, otherwise $15,000)
Year 2 - $12,000
Year 3 - $8,000
Year 4 - $4,000
Year 5 - $2,000
Year 6 - $0
Physicians in health professional shortage areas receive a 10%
increase (e.g., $19,800 in year one)
10. The “Sticks”
Bonus amounts decrease starting in CY13
If not a “meaningful” user by CY15,
No bonus payments
Penalties will be applied
Physicians receive a reduction in fee schedule
2015 - 1% reduction
2016 - 2% reduction
2017 - 3% reduction
2018 - HHS Secretary has authority to increase penalties
if percentage of physicians who are “meaningful” users is
less than 75%
Maximum reduction is 5%
11. Eligibility Requirements for Providers
Non-hospital-based professionals with ≥ 30% patient
volume attributable to individuals receiving medical
assistance
Non-hospital-based pediatricians with ≥ 20% of patient
volume attributable to individuals receiving medical
assistance
Eligible professionals (physicians, dentists, nurse
midwives, rural practice setting PAs, nurse practitioners)
who practice predominately in a Federally-qualified
health center or rural health clinic with ≥ 30% patient
volume attributable to needy individuals
12. States
authorized to make payments of
$21,250.00 per provider for either
purchasing or implementing an EHR
Just purchasing alone released funds (Adopt,
Implement or Upgrade to certified EHR – AIU)
Maximum is $63,750 for physicians
Canskip years and still be eligible for
payments
13. For professional who see over 30% Medicaid
$21,250 in year one
$8,500 in years 2-6
Total of $63,750 over 6 years
For pediatricians with more than 20% but less than
30% Medicaid
$14,167 in year one
$5,667 in years 2-6
Total of $42,500 over 6 years
Medicaid incentives will have the same total amount
over 6 years regardless of start year (through 2016)
Provider starting MU in 2016 will still receive up to
$63,750
14. Meaningful Use Dollars Paid to
Ambulatory Providers
:
EPs getting Medicare EPs getting Medicaid pay
Month
incentive pay (amount paid) (amount paid)
May 2011 282 ($5 million) 570 ($12 million)
June 2011 298 ($5 million) 807 ($17 million)
July 2011 669 ($12 million) 1,039 ($22 million)
August 2011 1,232 ($22 million) 1,563 ($33 million)
September 2011 1,427 ($26 million) 1,887 ($40 million)
October 2011 2,050 ($37 million) 2,171 ($46 million)
November 2011 4,351 ($78 million) 2,659 ($56 million)
December 2011 5,001 ($90 million) 3,782 ($79 million)
January 2012 7,666 ($138 million) 3,977 ($83 million)
February 2012 12,365 ($223 million) 4,920 ($103 million)So
15.
16. CMS and the Office of the National
Coordinator Based MU Criteria on the
recommendation of the HIT Policy
Committee
Five policy goals
Based on NQF National Priorities Partnership
17. Improve quality, safety, efficiency, and reduce
health disparities
Engage patients and families
Improve care coordination
Improve population and public health
Ensure adequate privacy and security
protections for personal health information
18. Using certified EHR technology
Certified – Certification Process Final Rule
recently released
E-prescribing
Interoperability
Reports on clinical quality measures
Final meaningful use criteria published July 13th,
2010
Three stages of meaningful use to be rolled
out
19. By the HIT Policy Committee
2011 2013 2015
*From HIT Policy Comm. update
Achieving Meaningful Use of Health Data
20. The Stage 1 meaningful use criteria focus on:
Electronically capturing health information in a
coded format
Using that information to track key clinical
conditions and communicating that information
for care coordination purposes
Structured or unstructured, but structured preferred
Implementing clinical decision support tools to
facilitate disease and medication management
Testing the ability to report clinical quality
measures and public health information.
21. Criteria will be proposed by the end of 2011
Goals for the Stage 2 meaningful use:
Expand on Stage 1 criteria
Encourage the use of health IT for continuous
quality improvement at the point of care
Exchange information in the most structured format
possible:
E.g., electronic transmission of orders entered using
computerized provider order entry (CPOE)
E.g., electronic transmission of diagnostic test results (such
as blood tests, microbiology, urinalysis, pathology tests,
radiology, cardiac imaging, nuclear medicine tests,
pulmonary function tests, etc.
22. Criteria to be proposed by the end of 2013
Goals:
Promote improvements in quality, safety and
efficiency
Focus on decision support for national high
priority conditions
Increase patient access to self management tools
Provide increased access to comprehensive
patient data
Improve population health
23. Measurement Concepts (proposed by HIT
Policy Committee to guide later stages of MU)
Increased codification of health care data
Expanded interoperability
Patient engagement
Outcomes based analysis
Medical genomics
Order tracking
100% HIT Adoption
24. 1. “Measures of patient activation, including skills, knowledge
and self-efficacy
2. “Measures of patient self management”
3. “Measures of shared decision making or decision quality that
address a combination of patient knowledge and
incorporation of patient”
4. “Measures of patient preferences/experiences of care”
5. “Measures of patient health outcomes, including health risk
status, functional health status, and global measures of
patient health”
6. “Measures of patient access to community resources for
improved/sustainable care coordination”
25. “Measures assessing ambulatory care-sensitive
preventable admissions”
Defined as “This measure concept relates to
admissions caused by unaddressed ambulatory
conditions at the onset of symptoms due to
multiple reasons such as inappropriate clinical
management or inefficient systems issues.”
Physicians need to be engaged to make sure
this type of measure concept is used
appropriately
26. Requirements:
Core Set (15)
Menu Set (pick 5 of 10, include one population/public
health measure)
Thresholds for use reduced
Administrative requirements removed
Decision Support requirements reduced
Reduced Quality Metrics
Additional Quality options
27. 1. Record patient demographics
¥ Sex
¥ Race
¥ Ethnicity
¥ Date of Birth
¥ Preferred language
¥ For hospitals date and preliminary cause of death in the
event of mortality).
More than 50% of patients’ demographic data must
be recorded as structured data
28. 1. Record vital signs and chart changes
Height
Weight
Blood pressure
Body mass index (BMI)
Growth charts for children
More than 50% of patients 2 years of age or older must have height,
weight and blood pressure recorded as structured data.
(Pulse and respirations not required)
2. Maintain up-to-date problem list of current and
active diagnoses.
More than 80% of patients must have at least one entry
recorded as structured data.
29. 1. Maintain an active medication list.
More than 80% of patients have at least one entry
recorded as structured data.
2. Maintain an active medication allergy list.
More than 80% of patients have at least one entry
recorded as structured data.
3. Record smoking status for patients 13 and older
More than 50% if patients age 13 or older have smoking
status recorded as structured data.
30. 1. For professionals, provide patients with clinical
summaries for each office visit; for hospitals provide an
electronic copy of hospital discharge instructions upon
request.
Clinical summaries provided to patients for more
than 50% of all visits within 3 business days.
More than 50% of all patients who are discharged
from an inpatient or ED of a hospital who request
an electronic copy of their discharge instructions
must be provided with it.
31. 1. Upon request, provide patients with an electronic
copy of their health information (including
diagnostic test results, problem list, medication list,
medication allergies, and for hospitals discharge
summary and procedures).
More than 50% of requesting patients must
receive an electronic copy within 3 business
days.
Patient portal and personal health records are
seen as vehicles for this transfer
32. 1. Generate and transmit permissible prescriptions
electronically (does not apply to hospitals).
More than 40% must be transmitted
electronically using certified EHR technology.
2. Computerized Provider Order Entry for Medication
Orders.
More than 30% of patients with at least one
medication in their medication list must have at
least one medication ordered through CPOE
33. 1. Implement drug-drug and drug-allergy interaction
checks.
Functionality must be enabled for these checks for the
entire reporting period.
2. Implement capability to electronically exchange key
clinical information among providers and patient-
authorized entities.
Must perform at least one test of the EHR’s capacity to
electronically exchange information.
34. 1. Implement one clinical decision support rule and
track compliance with that rule.
One rule must be implemented.
2. Implement systems to protect privacy and security
of patient data in the EHR
Must conduct or review a security risk analysis,
implement security updates as necessary and correct
identified security deficiencies
35. 1. Report clinical quality measures to CMS or states.
For 2011, provide aggregate numerator and
denominator through attestation
For 2012, electronically submit measures
36. Implement drug formulary checks.
Drug formulary check system must be implemented and
it must provide access at least one internal or external
drug formulary during the reporting period.
Incorporate clinical laboratory test results into
EHRs as structured data
More than 40% of clinical laboratory test results are in
positive/negative or numerical format and are
incorporated into EHRs as structured data
37. Generate lists of patients by specific conditions for
use for quality improvement, reduction of
disparities, research or outreach.
Must generate one listing of patients with a specific
condition
Use EHR technology to identify patient-specific
education resources and provide those to the
patient as appropriate.
More than 10% of patients are provided patient specific
education resources
38. Perform Medication reconciliation between care
settings.
Medication reconciliation must be performed for more
than 50% of transitions of care.
Provide summary of care record for patients
referred or transitioned to another provider or
setting.
Summary of care record must be provided for more than
50% of patient transitions or referrals
39. Submission of electronic immunization data to
immunization registries or immunization
information systems.
Must perform at least one test of data
submission and follow-up submission (where
registries can accept electronic submissions)
Submission of electronic syndromic surveillance
data to public health agencies.
Must perform at least one test of data
submission and follow-up submission (where
public health agencies can accept electronic
data)
40. For hospitals - record advanced directives for
patients 65 years or older
More than 50% of patients aged 65 or older must have an
indication of an advanced directive status recorded.
For hospitals - submission of electronic data on
reportable laboratory results to public health
agencies.
Perform at least one test of data submission and follow-up
submission (where public health agencies can accept
electronic data)
41. For professionals - Send reminders to patients (per
patient preference) for preventative and follow-up
care.
More than 20% of patients aged 65 or older or age 5 or
younger must be sent appropriate reminders.
For professionals - Provide patients with timely
electronic access to their health information
(including laboratory results, problem list, medication
list, medication allergies).
More than 10% of patients must be provided with
electronic access to information within 4 days of its being
updated in the EHR.
42. Criteria to be proposed by the end of 2013
Reach the full extent of HIT in clinical care
Advanced interoperability including extensive sharing of
structured data via HIEs
Lifecycle of structured data
Captured at the point of care as codified data
Concept and modifiers
E.g., Doubt seizure, myocardial infarction ruled out, etc.
Stored locally and in data warehouses
Relationships to modifiers must be preserved
Retrieved and used for clinical care, reporting, research
Must be “recomposed” accurately with appropriate context
Must be in a standard format to allow for cross-platform usage
Data integrity issues will need to be a focal point to ensure
patient safety and reap the benefits of HIT