Transcript Document

The California HIT Landscape and the
EHR Meaningful Use Incentives
July 30, 2010
Andie Martinez
Associate Director of Policy
California Primary Care Association
1
Overview
I. Federal chain of command
II. HIE
III. Regional Extension Centers
IV.EHR Loan Fund
V. Broadband/Telehealth
VI.EHR and meaningful use
2
Federal Chain of Command
HHS Secretary
Reviews ONC endorsements and approves adoption;
Collaborates with CMS in the rule making process
CMS
Office of the National Coordinator
•
•
•
•
$2 billion
Regional Extension Centers
EHR Loan Fund
Health Information Exchange
•
•
$34 billion
Medicare/Medicaid EHR incentives
for meaningful use
3
Federal to State to Provider Flow of
Funds
CMS
Office of the National
Coordinator
•
•
•
•
$2 billion
Regional Extension Centers
EHR Loan Fund
Health Information Exchange
Regional Extension
Centers
• CalHIPSO
• LA Care
Local
Extension
Centers
Service
Providers
EHR Loan
Fund
• On hold
•
•
Health Information
Exchange
• Cal eConnect
(State
designated
entity)
Local health information
organizations
$34 billion
Medicare/Medicaid EHR
incentives for meaningful use
Medicare
Incentives
• Eligible
providers
who
choose the
Medicare
m.u. $$
Medicaid
Incentives
• State
Medicaid
Offices
Eligible
professionals
4
Health Information Exchange
General Overview
• Only states or state designated entities can apply for
funding
• All states have an allocation based on size
• California has begun the process to apply for $38.8
million
– Jonah Frohlich, Deputy Secretary of HIT, is in charge of
HIE for California
– Cal eConnect was chosen as the State Designated Entity
– ONC must approve the Strategic and Operational plan in
order to receive the full $38.8 million
5
Health Information Exchange
HIE Operational Plan
• Cal eConnect
– Will oversee and manage the HIE build out in California
– Will use majority of funds for grants to existing and new health
information exchanges
• Shared services
– In the proposed operational plan there is a provider to provider
look-up, no patient look-up
6
Health Information Exchange
What will HIE Governance Entity do?
Convene






Provide neutral forum for all
stakeholders
Educate constituents & inform
HIE policy deliberations
Advocate for statewide HIE
services
Serve as an information
resource for local HIE and
health IT activities
Track/assess national HIE and
health IT efforts
Facilitate consumer input
Coordinate





Develop and lead plan for
implementation of statewide
standards, rules and solutions
for interoperability.
Facilitate alignment of
statewide, interstate, &
national HIE strategies, RECs,
Medi-Cal, etc.
Coordinate with CalPSAB
around privacy and security
policies
Promote consistency and
effectiveness of statewide HIE
policies and practices
Support integration of HIE
efforts with other healthcare
goals, objectives, & initiatives
Manage








Issue and manage grants
Develop legal analyses
Oversee accounting and
budgeting
Enforce state policy guidance
Possibly contract for
statewide shared services
such as master patient index
Evaluate and assess progress
Develop accountability
measures
Develop sustainable business
models for HIE
7
Regional Extension Centers
General Overview
• 60 nationwide, in two rounds of funding (totaling $640
million).
• US-based nonprofit organization.
• Must be a multi-stakeholder collaborative.
• Must serve at least 1,000 Priority Primary Care Providers
(PPCPs).
• Cannot overlap with another REC.
• Purpose: Deliver outreach, education, and technical
assistance services to PPCPs to facilitate their adoption of
certified EHRs and achievement of meaningful use
• Disseminate best practices and education
8
Regional Extension Centers
CalHIPSO
• Awarded $31 million
• Northern California
– Total REC PPCPs - 4094
• Southern California
– Total REC PPCPs – 3350
LA Care
• Serving only LA County
• Awarded $15.5 million to serve approximately 3,000
PPCPs
9
EHR Loan Fund
General Overview
• Written into HITECH as a “may”
• ONC has decided not to fulfill this provision as of now
What is CPCA doing?
• CPCA working with CHFFA to create an EHR loan
program
• Concept
– No interest, revolving loan
– Apply for as much as you could receive in incentives
– Paid back upon receipt
10
Broadband and Telehealth
General Overview
• NOT a HITECH Grant
• California Telehealth Network awarded vendor contract
to AT & T
• Just announced the Interim Executive Director- Eric
Brown
• 863 sites
• Dedicated broadband network
• Still determining what value-added services to run over
the network
11
Broadband and Telehealth
CTN Pricing
12
Electronic Health Records and
Incentive Funds
General Overview: Federal
• Approximately $34 billion for Medicare/Medicaid EHR
Incentive Funds
• CMS developing rules and regulations on incentive funds
• ONC developing rules on standards and HIT certification
• Eligible professional must choose Medicare or Medicaid
incentive program (before CY 2015)
• Medicare incentives must start October 1, 2010, but no date
in statute for when Medicaid incentives must start (expected
January 2011)
13
Electronic Health Records and
Incentive Funds
General Overview: California (Medi-Cal)
•
•
•
CA eligible professionals (EPs) expected to receive $1.5 billion in
Medicaid EHR incentives
Incentive funds for EPs will flow through DHCS (state Medicaid
office) and 100% of the funds must be distributed to providers
State Medicaid offices are eligible for a 90/10 match for
administrative work related to EHR incentives. DHCS has received
$2.5 million.
– Created Office of Health Information Technology (OHIT)
– HITECH Advisory Group
• 2 Clinic/Health Center representatives on Advisory Group: CPCA
and Dr. Moore, Medical Director for Clinic Ole/ RCHC
•
State Medicaid offices will get to set some parameters for how the
funding is distributed, reporting, and measures
14
Medicaid Incentive Payments for
Adoption/Implementation/Upgrade and Meaningful Use of Certified EHR
$21,250 = 85% of $25,000
$8,500 = 85% of $10,000
2011
2011
2012
2013
2014
2015
2016
2012
$21,250 $8,500
$21,250
2013
2014
2015
2016
2017
2018
2019
2020
2021
Total
$8,500
$8,500
$8,500
$8,500
$0
$0
$0
$0
$0
$63,750
$8,500
$8,500
$8,500
$8,500
$8,500 $0
$0
$0
$0
$63,750
$21,250 $8,500
$8,500
$8,500
$8,500 $8,500 $0
$0
$0
$63,750
$21,250 $8,500
$8,500
$8,500 $8,500 $8,500 $0
$0
$63,750
$8,500 $8,500 $8,500 $8,500 $0
$63,750
$21,250 $8,500
$21,250 $8,500 $8,500 $8,500 $8,500 $8,500 $63,750
15
Eligible Professionals in the
Medicaid Program
Who are Eligible Professionals?
Non-hospital based
• Physicians (doctors of medicine or osteopathy),
• Dentists,
• Certified nurse-midwives,
• Nurse practitioners, and
• Physician assistants who are practicing in a Federally
Qualified Health Centers (FQHCs) or Rural Health Clinics
(RHCs) led by a physician assistant. ** None in CA
16
Eligible Professionals in the
Medicaid Program
Who are Eligible Professionals?
•
•
If the pediatrician
can only reach the
20% he/she is
eligible for 2/3 of
the amount of
incentives, but if
the pediatrician can
reach the 30% then
he/she is eligible
for the full amount.
•
Who have at least 30% of their patient volume (encounters)
attributable to Medi-Cal, or
Who is a pediatrician and who has at least 20% of their patient
volume (encounters) attributable to Medi-Cal, or
Who practices predominantly at an FQHC or RHC and has at least
30% of their patient volume (encounters) attributable to “needy”
individuals.
•
•
Needy patients receive medical assistance from Medi-Cal or Healthy
Families, are furnished uncompensated care by the provider, or are
furnished services at either no cost or reduced cost based on a sliding
scale determined by the individual’s ability to pay.
Over any continuous 90-day period within the most recent calendar
year prior to reporting.
Practices Predominantly- An EP practices predominantly at an FQHC or an
RHC when the clinical location for over 50 percent of his/her patient
encounters over a period of 6 months in the most recent calendar year occurs
at the FQHC or RHC.
17
Getting the first year of payment
An EP must submit the following:
•
•
•
•
•
Name of EP
National Provider Identifier (NPI)
Business address and phone number
Taxpayer Identification Number (TIN) which may be the EP’s Social
Security Number (SSN) to which the EP’s incentive payment should be
made.
– EPs are permitted to reassign their incentive payments to their
employer or to an entity with which they have a contractual
arrangement allowing the employer or entity to bill and receive
payment for the EP’s covered professional services.
– EPs may also assign their incentive payments to a TIN for an entity
promoting the adoption of EHR technology
– Each EP may reassign the entire amount of the incentive payment to
only one employer or entity.
If you qualify as both a Medicare EP and a Medicaid EP you must tell CMS
18
which program you choose
Getting the first year of payment
AND attest to one of the following:
1. Adopting/implementing/upgrading an EHR
1. Adopting: acquire, purchase or secure access to certified EHR technology
2. Implementing: install or commence utilization of certified EHR technology
capable of meeting meaningful use requirements
3. Upgrading: expand the available functionality of certified EHR technology
capable of meeting meaningful use requirements at the practice site,
including staffing, maintenance, and training, or upgrade from existing EHR
technology to certified EHR technology per the ONC EHR certification
criteria.
4. THERE IS NO REPORTING PERIOD
2. Achieving the meaningful use objectives and clinical measures over a
continuous 90 day period within a calendar year.
19
Getting the second year of
payment
The EP must re-attest to the patient volume criteria and
A. If the EP chose to A/I/U in the first payment year, he/she must
now report on the meaningful use objectives and measures
over a continuous 90 day period within the calendar year. The
third and remaining years (up to 6) of participation will require
a full calendar year of reporting.
B. If the EP chose to attest to achieving meaningful use in the first
year of payment, the EP must report on meaningful use for a
full calendar year. The EP is required to report on a full
calendar year for the remaining years (up to 6) of participation.
Participation in the Medicaid Meaningful Use EHR program does not
need to be consecutive. An EP can participate in 2011 and postpone
until 2013. EP can only receive 6 years of payment for a total of
$63,750.
20
Eligible Professionals in the
Medicaid Program
Encounters to report
To be a meaningful EHR user an EP must have 50 percent or more of
their patient encounters during the EHR reporting period at a
practice/location or practices/locations equipped with certified EHR
technology.
An EP for who does not conduct 50 percent of their patient
encounters in any one practice/location would have to meet the 50
percent threshold through a combination of
practices/locations equipped with certified EHR technology.
As long as an EP has certified EHR technology available for 50
percent or more of their patient encounters during the EHR reporting
period they only have to include those encounters where certified
EHR technology is available at the start of the EHR reporting period.
21
Meaningful Use Incentives
Costs
•
•
•
•
Incentives are not based on the cost of purchasing EHR
technology. As long as a EP meets all necessary requirements for
qualifying for incentive payments, they may receive the
maximum allowed amount regardless of what their EHR
technology or implementation costs were.
Net average allowable costs are 85% of $25K for the first year,
and 85% of $10K for 5 subsequent years
Incentive funds are directed at providers, not clinics or health
centers
Funds from federal government received by clinic or FQHC do
not count against incentive payments an EP can receive.
22
Meaningful Use Stages and
Final Rule
Stage 1
• Electronically capturing health information in a coded format,
• Using that information to track key clinical conditions and
communication for care coordination purposes
• Reporting clinical quality measures and public health information.
Stage 2
• Health information exchange in the most structured format
possible,
• Example: computerized provider order entry (CPOE) and the
electronic transmission of diagnostic test results (such as blood tests,
microbiology, urinalysis)
There will likely be a Stage 3
23
Meaningful Use Stages
First
Payment
Year
2011
2012
2013
2014
2015
2011
Stage 1
Stage 1
Stage 2
Stage 2
TBD
Stage 1
Stage 1
Stage 2
TBD
Stage 1
Stage 1
TBD
Stage 1
TBD
2012
2013
2014
Payment Year
24
Meaningful Use Stages and
Final Rule
Stage 1
• Must report on 15 core objectives and associated measures and 5
objectives and associated measures from the menu set; 1 measure
from the menu set must be related to public health.
* Expect all of the menu set objectives to be included in Stage 2
• Additionally, EPs must report on 3 core clinical measures, and then
choose 3 additional clinical measures to report on.
• If any of core clinical measures are not applicable to the EP, he/she
may choose to report on one of the 3 alternative core measures. And
if the alternative measures are not applicable the EP must attest to
this and the EP does not have to report on that measure.
25
Additional Rules Impacting
EHRs
HIT Certification Rule (Office of the National Coordinator)
• Can only receive incentives if you are meaningfully using
certified- EHR technology
• Temporary Certification Program- anticipated to run through
Q1 of FY 2012
• Permanent Certification Program- anticipated to start Q1 FY
2012
26
Meaningful Use Criteria
Health outcomes policy priorities
1.
2.
3.
4.
Improving quality, safety, efficiency and reducing health
disparities
Engage patients and families in their health care
Improve care coordination
Ensure adequate privacy and security protections for
personal information
27
NCQA Patient
Centered
Medical Home =
Meaningful Use Core Objectives
and Measures Stage 1
1. Improving quality, safety, efficiency and reducing health
disparities
• Objective: Use CPOE for medication orders directly entered
by any licensed healthcare professional who can enter
orders into the medical record per state, local and
professional guidelines.
• Measure: More than 30% of unique patients with at least
one medication in their medication list seen by the EP have
at least one medication order entered using CPOE.
• Objective: Implement drug-drug and drug-allergy
interaction checks
• Measure: The EP has enabled this functionality for the
entire EHR reporting period.
28
Meaningful Use Core Objectives
and Measures Stage 1
1. Improving quality, safety, efficiency and reducing health
disparities
•
•
•
•
•
•
Objective: Generate and transmit permissible prescriptions
electronically.
Measure: More than 40% of all permissible prescriptions written by
the EP are transmitted electronically using certified EHR technology.
Objective: Record demographics: preferred language, gender, race,
ethnicity, and date of birth
Measure: More than 50% of all unique patients seen by the EP
have demographics recorded as structured data.
Objective: Maintain up-to-date problem list of current and active
diagnoses
Measure: More than 80% of all unique patients seen by EP have at
least one entry or an indication that no problems are known for the
patient recorded as structured data.
29
Meaningful Use Core Objectives
and Measures Stage 1
1. Improving quality, safety, efficiency and reducing health
disparities
• Objective: Maintain active medication list
• Measure: More than 80% of all unique patients seen by EP
have at least one entry (or an indication that the patient is
not currently prescribed any medication) recorded as
structured data
• Objective: Maintain active medication allergy list
• Measure: More than 80% of all unique patients seen by EP
have at least one entry (or an indication that the patient has
no known medication allergies) recorded as structured data
30
Meaningful Use Core Objectives
and Measures Stage 1
1. Improving quality, safety, efficiency and reducing health
disparities
•
•
•
•
Objective: Record and chart changes in the following vital signs:
height, weight, and blood pressure and calculate and display body
mass index; plot and display growth charts for children 2-20 years,
including BMI.
Measure: For more than 50% of all unique patients age 2 and over
seen by EP record height, weight, and blood pressure are recorded
as structured data.
Objective: Record smoking status for patients 13 years old or older
Measure: More than 50% of all unique patients 13 years and old
and older seen by EP have smoking status recorded as structured
data.
31
Meaningful Use Core Objectives
and Measures Stage 1
1. Improving quality, safety, efficiency and reducing health
disparities
•
•
•
•
Objective: Implement one clinical decision support rule relevant to
specialty or high clinical priority along with the ability to track
compliance to that rule
Measure: Implement one clinical decision support rule
Objective: Report ambulatory quality measures to CMS or the States.
Measure: For 2011, provide aggregate numerator, denominator, and
exclusions through attestation. For 2012, electronically submit the
clinical quality measures
32
Meaningful Use Core Objectives
and Measures Stage 1
2. Engage patients and families in their health care
•
•
•
•
Objective: Provide patients with an electronic copy of their health
information (including diagnostic test results, problem list, medication
lists, medication allergies), upon request
Measure: More than 50% of all patients of the EP who request an
electronic copy of their health information are provided it within 3
business days.
Objective: Provide clinical summaries for patients for each office
visit.
Measure: clinical summaries are provided for at least 80% of all
office visits.
Meaningful Use Core Objectives
and Measures Stage 1
3. Improve care coordination
•
•
Objective: Capability to exchange key clinical information (for
example, problem list, medication list, medication allergies, diagnostic
test results), among providers of care and patient authorized entities
electronically.
Measure: Performed at least one test of certified EHR technology’s
capacity to electronically exchange key clinical information.
Meaningful Use Core Objectives
and Measures Stage 1
4. Ensure adequate privacy and security protections for
personal health information
•
•
Objective: Protect electronic health information created or
maintained by the certified EHR technology through the
implementation of appropriate technical capabilities.
Measure: Conduct or review a security risk analysis per 45 CFR
164.308(a)(1) and implement security updates as necessary and
correct identified security deficiencies as part of its risk
management process
35
Meaningful Use Menu Objectives
and Measures Stage 1
** Must
choose 5
menu
objectives,
and 1 must
be public
health related
1. Improving quality, safety, efficiency, and reducing health
disparities
•
•
•
•
Objective: Implement drug-formulary checks
Measure: The EP has enabled this functionality and has access to
at least one internal or external drug formulary for the entire EHR
reporting period.
Objective: Incorporate clinical lab-test results into certified EHR
technology as structured data
Measure: More than 40% of all clinical lab tests results ordered by
the EP during the EHR reporting period whose results are either in
a positive/negative or numerical format are incorporated in
certified EHR technology as structured data.
36
Meaningful Use Menu Objectives
and Measures Stage 1
1. Improving quality, safety, efficiency, and reducing health
disparities
•
•
•
•
Objective: Generate lists of patients by specific conditions to use
for quality improvement, reduction of disparities, and research and
outreach.
Measure: Generate at least one report listing patients of the EP
with a specific condition.
Objective: Send reminders to patients per patient preference for
preventive/follow up care.
Measure: More than 20% of all unique patients 65 years or older or 5
years old or younger were sent an appropriate reminder during the
EHR reporting period.
37
Meaningful Use Menu Objectives
and Measures Stage 1
2. Engage patients and families in their health care
•
•
•
•
Objective: Provide patients with timely electronic access to their
health information (including lab results, problem list, medication
lists, medication allergies) within 4 business days of the information
being available to the EP.
Measure: More than10% of all unique patients seen by the EP are
provided timely (available to the patient within four business days of
being updated in the certified EHR technology) electronic access to
their health information subject to the EP’s discretion to withhold
certain information.
Objective: Use certified EHR technology to identify patientspecific education resources and provide those resources to the
patient if appropriate.
Measure: More than10% of all unique patients seen by the EP are
provided patient-specific education resources.
38
Meaningful Use Menu Objectives
and Measures Stage 1
3. Improve Care Coordination
•
•
•
•
Objective: The EP who receives a patient from another setting of
care or provider of care or believes an encounter is relevant should
perform medicatio reconciliation.
Measure: The EP performs medication reconciliation for more
than 50% of transitions of care in which the patient is transitioned
into the care of the EP.
Objective: The EP who transitions their patient to another setting
of care or provider of care or refers their patient to another
provider of care should provide summary of care record for each
transition of care or referral.
Measure: The EP who transitions or refers their patient to another
setting of care or provider of care provides a summary of care
record for more than 50% of transitions of care and referrals.
39
Meaningful Use Menu Objectives
and Measures Stage 1
4. Improve population and public health
•
•
•
•
Objective: Capability to submit electronic data to immunization registries
or Immunization Information Systems and actual submission in
accordance with applicable law and practice.
Measure: Performed at least one test of certified EHR technology’s
capacity to submit electronic data to immunization registries and follow up
submission if the test is successful (unless none of the immunization
registries to which the EP submits such information have the capacity to
receive the information electronically).
Objective: Capability to submit electronic syndromic surveillance data to
public health agencies and actual submission in accordance with applicable
law and practice.
Measure: Performed at least one test of certified EHR technology’s
capacity to provide electronic syndromic surveillance data to public health
agencies and follow up submission if the test is successful (unless none of
the public health agencies to which an EP submits such information have
the capacity to receive the information electronically.
40
Meaningful Use Core Clinical
Measures Stage 1
Table 7- Measure Group: Core for all EPs, Medicare or
Medicaid
Measure No.
Clinical quality measure title
NQF 0013
Hypertension: Blood Pressure Management
NQF 0028
Preventive Care and Screening Measure
Pair: a. tobacco use assessment; b. tobacco
cessation intervention
NQF 0421
PQRI 128
Adult Weight Screening and Follow up
41
Meaningful Use Alternative Core
Clinical Measures Stage 1
Table 7- Measure Group: Alternative Core for all EPs,
Medicare or Medicaid
Measure No.
Clinical quality measure title
NQF 0024
Weight Assessment and Counseling for
Children and Adolescents
NQF 0041
PQRI 1110
Preventive Care and Screening: Influenza
Immunization for Patients > 50 Years Old
NQF 0038
Childhood Immunization Status
42
Resources
CPCA
• HIT Newsletter- bimonthly, send Andie an email if you want to be on list to
receive
• On-demand webinar coming soon!
• HIT Policy Pagehttp://www.cpca.org/govaffairs/caissues/HealthInformationTechnology.cfm
Centers for Medicare and Medicaid Services
• Website on EHR Incentives- http://www.cms.gov/ehrincentiveprograms/
• PDF version of 864 page rule (not federal register version)http://www.ihs.gov/recovery/mu_documents/CMS%20Final%20Rule.pdf
California’s Office of Health Information Technology
• Website about Medi-Cal EHR Incentiveshttp://www.dhcs.ca.gov/Pages/DHCSOHIT.aspx
43
Questions? Concerns?
Andie Martinez, MPP
Associate Director of Policy
California Primary Care Association
[email protected]
916-440-8170
44