Transcript Document

Electronic Health Records and
Health Information Exchange:
Implications for Rural Hospitals
Rick Snyder
Vice President, Finance & Information Services
Oklahoma Hospital Association
Brian Yeaman, MD
Director, Physician Informatics
Norman Regional Health System
Greater Oklahoma City Hospital Council
American Recovery and
Reinvestment Act of 2009 (ARRA)
• Incentive payments for meaningful use of
certified Electronic Health Records
• Hospitals and Eligible Professionals
• Medicare incentives
• Medicaid incentives
Hospital Incentive Payments
• Qualify as early as Oct 1, 2010
– Range for OK PPS: ~$2 million - $8 million
– Median: $3.7 million
– State potential: $311 million
• Qualifying after FFY 2013 reduces amount
• CAH: Medicare share of capital + 20%
• FFY 2015: Incentives end; penalties begin
Hospital Incentive Payments
Medicaid
• Requires: 10% Medicaid inpatient volume
• CAHs can qualify – not based on costs
– $500,000 to $1,200,000
• $108 million potential for OK hospitals
• State has some discretion in design
Eligible Professionals
• Medicare incentives capped at $44,000
(plus 10% in HPSAs) OR
• Medicaid incentives capped at $63,750 (if
30% of practice is Medicaid (Peds: 20%))
• Paid over 5 years beginning Jan. 2011
• Penalties for non-adoption begin Jan. 2015
• Hospital-based professionals ineligible
EHR Adoption Rates
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2008 RWJF study of 2,952 hospitals
Comprehensive EHR:1.5% of US hospitals
Basic EHR (physician, nursing notes): 7.6%
Rural hospitals:
– 0.6% comprehensive EHR
– 4.0% basic EHR
OHA members tell us:
Plan to qualify?
Yes
No
Selected EHR?
Begun to install?
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10
20
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60
70
OHA members tell us:
Potential obstacles to your hospital adopting
EHR:
1. Insufficient IT staff
2. Incentive payments will likely not cover
EHR costs
3. Medical Staff is not supportive
4. Cannot find a suitable EHR
OHA members tell us:
OHA can help most by…
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Providing education on incentives
Providing education on EHRs
Offering a “group deal”
Helping arrange financing
Helping select EHR
EHR Certification
• Certification Commission for Health Information Technology
(CCHIT)
– CCHIT Certified
– Preliminary ARRA certification
– Site certification
• HHS Health IT Policy Committee recommendation
– Allow multiple Certification organizations
– Accreditation process for certifying organizations
• HHS will propose rules
“Meaningful Use”
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HIT Policy Committee
HIT Standards Committee
Public input
Policy Committee’s August 19 matrix
Proposed rule due by December 31
– 60 day comment period
– Final rule: middle or end of spring 2010
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NE Oklahoma origins
Oklahoma City exchange
Projects around the state
Attractive pricing for hospitals and their
physicians
Regional Extension Centers –
ARRA Section 3012
• National: HIT Research Center
– Develop or recognize best practices to support and
accelerate efforts to:
• Adopt, implement, and effectively utilize HIT for
– Electronic exchange and
– Use of information
• Regional Extension Centers
– Provide technical Assistance
– Disseminate best practices and other information
– Support and accelerate efforts to adopt, implement, and
utilize HIT
Regional Extension Centers
• ARRA law:
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Hospitals (public, NFP, CAH)
Federally Qualified Health Centers
Entities serving uninsured, medically underserved
Individual and small group practices in primary care
• Funding opportunity:
– Primary care providers in small group practices, public
hospitals & CAHs, CHCs and RHCs, other settings for
the uninsured/medically underserved
Regional Extension Centers
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OFMQ selected by stakeholders
Three waves of funding
$6.5 million potential for Oklahoma
Substantial matching required in years 3 and 4
State Loan Program
• 5:1 federal match for loans to providers
• Administered through Medicaid agencies
• OHCA will apply; has requested state
match in SFY 2011 budget
• Projected availability: October 2010
SHIECAP
• State Health Information Exchange
Cooperative Agreement Program
• Planning and Implementation grants
• State funding required
– 2011
– 2012
– 2013
1/10
1/7
1/3
SHIECAP
SHIECAP:
Oklahoma Health Information Exchange
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“Network of networks”
Planning phase beginning Jan. 2010
TBD: Governance, financing, …
ONC approval of State plan required before
implementation is funded
• OHA participating in planning; volunteers?
OHA Trade Show – HIT vendors
• Spectron Corp – McKesson products &
more – booth 320
• CPSI – booth 800
• Phoenix Health Systems – booth 111
– Meditech, CPSI, others, including MedSphere
OpenVista
Resources
• http://healthit.ahrq.gov/RuralHITtoolbox
• http://www.cchit.org/
• http://www.okoha.com/ARRA