Transcript SoonerCare EHR Incentive Program

Oklahoma
Electronic Health Record Incentive Program
Oklahoma
Health Care Authority
Board Retreat
Thursday, August 26, 2010
Carol McFarland, CPA, CGFM
Melody Anthony, M.S.
Performance & Reporting Manager
Provider Services Director
Adolph Maren Jr., M.A.
Senior Planning Coordinator
Oklahoma EHR Incentive Program
Origin: American Recovery &
Reinvestment Act of 2009
Health Information Technology provisions of the ARRA
• Title XIII, Division A, HIT
• Title IV of Division B,
Medicare and Medicaid HIT
"HITECH Act"
The Health Information Technology for Economic and
Clinical Health Act established programs under
Medicare and Medicaid to provide incentive payments
for the "meaningful use" of certified EHR technology.
Oklahoma EHR Incentive Program
HITECH Legislation’s purpose:
To improve outcomes, facilitate access, simplify
care, and reduce costs of health care nationwide
by providing:
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Major financial support to provider and States;
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Learning opportunities created and leverages through technical
assistance from CMS and others;
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Will establish sustainable data-driven infrastructure that will create
a framework for improving healthcare quality and outcomes
Oklahoma EHR Incentive Program
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Federal Partner responsibilities
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Centers for Medicare & Medicaid Services
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incentive program and meaningful use (MU)
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Final Rule for EHR Incentives & MU - July 13, 2010
www.cms.gov/EHRIncentivePrograms/
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Office of the National Coordinator of Health Information
Technology
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certification standards program for EHR technology
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temporary certification program –
 final rule published June 18, 2010
 effective June 24, 2010
permanent certification program is expected to be published this
fall
www.HealthIT.hhs.gov
Oklahoma EHR Incentive Program
Incentive to . . .
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Adopt (acquire and install)
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Implement (commenced utilization, train staff,
deploy tools, exchange data)
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Upgrade (expand functionality or interoperability)
Or…
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Meaningfully Use (meet specified criteria)
. . . a certified EHR System
Oklahoma’s Program begins January 2011
Oklahoma EHR Incentive Program
Provider Eligibility,
Registration and
Attestation
Oklahoma EHR Incentive Program
EHR Incentive Eligibility:
Qualifying Eligible Professionals (EP)
1 Current SoonerCare Provider Contract
2 Hospital-based EPs are
NOT eligible
3 Provider Type
90% or more of services are performed in a hospital
inpatient or emergency room setting.
Physicians (MD,DO)
Pediatricians
Dentists
Certified Nurse Midwifes
Nurse Practitioners
Physician Assistants (PA) practicing at a FQHC/RHC so
led by a PA
4 Patient Volume over a 90
day period
30% SoonerCare
20-29% SoonerCare - Pediatricians = 2/3 of
incentive payment
30% Needy Individuals* Medical EPs practicing
predominantly in FQHC or RHC
*Needy individuals = SoonerCare members, patients receiving uncompensated care and patients receiving
services at reduced or no cost based upon ability to pay
Oklahoma EHR Incentive Program
EHR Incentive Eligibility:
Qualifying Eligible Hospitals (EH)
1 Current SoonerCare Provider Contract
2 Hospital Types
Acute Care Hospital
(includes CAHs &
cancer hospitals)
Avg. length of stay < 25 days
Children’s Hospital
CCN* last 4 of 3300 – 3399
CCN* last 4 of
0001 – 0879; 1300 – 1399
Not applicable to children’s
wings of larger hospitals
3 Patient Volume over
a Acute Care Hospital
10% SoonerCare
Children’s Hospitals
No Requirement
90 day period
* CCN - CMS Certification Number
Oklahoma EHR Incentive Program
Patient Volume Calculation
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Based upon CMS final rule
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A Patient Volume Documentation worksheet will be
provided as part of attestation process
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Provider defined 90 day period in the calendar year
Number of SoonerCare* member encounters
Number of total patient encounters
* or Needy Patient encounters for EPs
providing services at a FQHC/RHC
Oklahoma EHR Incentive Program
Registration
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EPs and EHs are required to register with the Medicare
and Medicaid registration and attestation system
 Name, NPI, business address, phone
 Tax payer ID Number (TIN)
 Hospitals must provide the CCN
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EPs must select Medicare or Medicaid
 May switch once between programs before 2015
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If Medicaid, must select one state
 May switch states annually
Oklahoma EHR Incentive Program
Registration
OHCA will:
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Connect to federal repository to facilitate provider attestation
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Continue verification of eligibility
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Disburse payment after cross-checking for potential
duplicative, inappropriate payments and verification of
supporting documentation
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Disburse payment to one eligible TIN
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Notify the national repository upon payment
Oklahoma EHR Incentive Program
Electronic Attestation Process
Provider registers with CMS
CMS directs providers to the OHCA website for
enrollment in the Oklahoma EHR incentive
program
Providers fill out attestation
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Identify your ONC-ATCB* certified EHR system
Complete patient volume worksheet
Electronically sign contract ammendment and fax
requested documention to OHCA
*Office of the National Coordinator for Health Information
Technology – Authorized Testing and Certificaiton Body
Oklahoma EHR Incentive Program
EP Electronic Attestation
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Provider is not a hospital based professional
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Provider must provide services in Oklahoma
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Provider is not receiving an incentive payment from another state for
that calendar year
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Provider has adopted, implemented or upgraded a certified EHR
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Provider inputs the certification number for the ONC-ATCB certified
EHR system
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Provider list number of FTE jobs created by implementing a certified
product
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Provider reports cash payments made for the certified EHR
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Provider confirms assignment of payment to a qualified TIN
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Providers percentage of SoonerCare patient volume is equal to or
greater than the allowed
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Provider has specified the patient volume date range of 90 days during
the calendar year
Oklahoma EHR Incentive Program
EH Electronic Attestation
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Hospital is not currently receiving an incentive payment from
another state for that federal fiscal year
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Hospital must be located in Oklahoma
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Hospitals (Medicaid only) have adopted, implemented or
upgraded a certified EHR, or meaningfully used a certified EHR
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ONC-ATCB EHR Certification number is included
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Hospital list number of FTE jobs created by implementing a
certified product
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Hospital (acute care) percentage of SoonerCare discharges is at
least 10%; Children's hospitals have no discharge percentage
Oklahoma EHR Incentive Program
Adopt / Implement / Upgrade
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Adopted – Acquired and Installed
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Implemented – Commenced Utilization
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Upgraded – Expanded Upgraded to certified EHR technology
or added new functionality to meet the definition of certified
EHR technology
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Must be certified EHR technology capable of meeting
meaningful use
No EHR reporting period
Only for first participation year
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Oklahoma EHR Incentive Program
Meaningful Use (MU) of EHR
The Recovery Act specifies the following 3 components
of Meaningful Use:
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Use of certified EHR in a meaningful manner
Use of certified EHR technology for electronic exchange of
health information to improve quality of health care
Use of certified EHR technology to submit clinical quality
measures(CQM) and other such measures selected by the
Secretary
Oklahoma EHR Incentive Program
Meaningful Use of EHR –
Health Outcome Priorities
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Improve quality, safety, efficiency, and reduce 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
Oklahoma EHR Incentive Program
Meaningful Use of EHR
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3 Stages currently proposed
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Stage 1
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EP: 20 of 25 Objectives / Measures
EH: 19 of 24 Objectives / Measures
To meet certain objectives/measures, 80% of patients must
have records in the certified EHR technology
Reporting Period –90 days for first year; one year
subsequently
Oklahoma will adopt MU measures as published.
CMS intends to propose 2 additional stages through
future rulemaking.
At this time, CMS plans on transitioning the Stage 12
menu set into the Stage 2 core set.
Oklahoma EHR Incentive Program
Eligible Professionals –15 Core Objectives
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15.
Computerized Physician Order Entry (CPOE)
E-Prescribing (eRx)
Report ambulatory clinical quality measures to CMS/States
Implement one clinical decision support rule
Provide patients with an electronic copy of their health
information, upon request
Provide clinical summaries for patients for each office visit
Drug-drug and drug-allergy interaction checks
Record demographics
Maintain an up-to-date problem list of current and active
diagnoses
Maintain active medication list
Maintain active medication allergy list
Record and chart changes in vital signs
Record smoking status for patients 13 years or older
Capability to exchange key clinical information among providers
of care and patient-authorized entities electronically
Protect electronic health information
Oklahoma EHR Incentive Program
Eligible Hospitals –14 Core Objectives
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CPOE
Drug-drug and drug-allergy interaction checks
Record demographics
Implement one clinical decision support rule
Maintain up-to-date problem list of current and active diagnoses
Maintain active medication list
Maintain active medication allergy list
Record and chart changes in vital signs
Record smoking status for patients 13 years or older
Report hospital clinical quality measures to CMS or States
Provide patients with an electronic copy of their health information,
upon request
Provide patients with an electronic copy of their discharge
instructions at time of discharge, upon request
Capability to exchange key clinical information among providers of
care and patient-authorized entities electronically
Protect electronic health information
Oklahoma EHR Incentive Program
Eligible Professionals –10 Menu Set Objectives
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Drug-formulary checks
Incorporate clinical lab test results as structured data
Generate lists of patients by specific conditions
Send reminders to patients per patient preference for
preventive/follow up care
Provide patients with timely electronic access to their health
information
Use certified EHR technology to identify patient-specific education
resources and provide to patient, if appropriate
Medication reconciliation
Summary of care record for each transition of care/referrals
*Capability to submit electronic data to immunization
registries/systems
*Capability to provide electronic syndromic surveillance data to
public health agencies
*At least 1 public health objective must be selected
Oklahoma EHR Incentive Program
Eligible Hospitals –10 Menu Set Objectives
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2.
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5.
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10.
Drug-formulary checks
Record advanced directives for patients 65 years or older
Incorporate clinical lab test results as structured data
Generate lists of patients by specific conditions
Use certified EHR technology to identify patient-specific education
resources and provide to patient, if appropriate
Medication reconciliation
Summary of care record for each transition of care/referrals
*Capability to submit electronic data to immunization
registries/systems
*Capability to provide electronic submission of reportable lab
results to public health agencies
*Capability to provide electronic syndromic surveillance data to
public health agencies
*At least 1 public health objective must be selected
Oklahoma EHR Incentive Program
Incentive
Payments
Oklahoma EHR Incentive Program
Eligible Professional Payments
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Paid in alignment with the Calendar year
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First year amount consistent regardless of stage (AIU or MU)
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Maximum incentives are $63,750 over 6 years
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Incentives are same regardless of start year
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The first year maximum payment is $21,250
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Must begin by 2016 to receive incentive payments
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No requirement for “consecutive years” participation
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Incentives available through 2021
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Only 1 incentive payment per year
Oklahoma EHR Incentive Program
Eligible Hospital Payments
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Paid in alignment with the Federal Fiscal year (FFY)
First year amount consistent regardless of stage (AIU or MU)
$2M base + per discharge amount (based on Medicare/
Medicaid share)
Medicare Meaningful Use requirements may be deemed
eligible for Medicaid payments
Payment is calculated, then disbursed over 3-6 years; we
have proposed 3 year disbursement
No annual payment may exceed 50% of the total calculation;
no 2-year payment may exceed 90%; we have proposed 50%
/ 40% / 10%
Hospitals cannot initiate payments after 2016 and payment
years must be consecutive after 2016
States must use auditable data sources in calculating the
hospital incentive (e.g., cost report)
Payments through 2021
Oklahoma EHR Incentive Program
Eligible Hospitals
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Calculate total incentive in base
year
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Calculated on a 4 year payment basis
Payment over 3 years
 Year
1: 50%
 Year 2: 40%
 Year 3: 10%
Oklahoma EHR Incentive Program
Eligible Hospitals
(Overall EHR Amount) * (Medicaid Share)
Defined as
{Sum over 4 year of [(Base Amount)+ Discharge
Related Amount Applicable for Each Year) *
Transition Factor Applicable for Each Year]}
. . . multiplied by . . .
[Medicaid inpatient-bed-days / {(Total inpatient-beddays) * (estimated total charges – charity care
charges) / (estimated total charges)}]
Oklahoma EHR Incentive Program
Monitoring,
Oversight
&
Audit
Oklahoma EHR Incentive Program
Monitoring / Oversight / Audit
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Attest to specific requirements
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Provide required documentation
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Keep supporting documentation on file
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Random sample and targeted sample
reviews will be conducted
Oklahoma EHR Incentive Program
Thank You!
[email protected]
[email protected]
[email protected]
www.okhca.org/EHR-incentive