Transcript NCHICA Activities - North Carolina Medical Society

In the Thick of ARRA & HITECH:
“It’s only just begun”
NC Medical Society
Quality of Care and Performance
Improvement Committee
August 7, 2009
Presented by:
Sam Spicer, MD
CMO, New Hanover Regional Medical Center
President, NCHICA
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H.R. – 1
The American Recovery and
Reinvestment Act of 2009
(ARRA)
The Health Information
Technology for Economic and
Clinical Health Act
(HITECH)
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$19 billion allocated to Health IT
$17 Billion
– incentive bonuses for providers meeting “Meaningful Use”
as determined by HHS secretary.
$2 Billion to HHS / ONC
– standards development, evaluation and validation
– infrastructure for health information exchange (HIE)
– grants to states for the purpose of furthering EHR
adoption
– improvements in HIT manpower
– the establishment of Regional Health IT Resource
Centers, Extension Programs, Enterprise Integration
Research Centers, etc.
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Estimate of Potential Stimulus Impact on NC
• Hospital Incentives for EHR - $300M – $400M
• Physician Incentives for EHR - $396M – $792M
• HIE / HIT Competitive Grants – ?
($17.2B)
($2B)
– Regional Extension Center - ?
– EHR Adoption Loan Funds - ?
• Broadband Infrastructure – Proposals
($7.2B)
• Workforce Training Grants - ?
($ ? )
–
Medical Health Informatics - ?
($ ? )
–
EHR in Medical School Curricula - ?
($ ? )
–
Worker Training- ?
($250M)
• Comparative Effectiveness Research - ?
($1.1B)
• Community Health Centers - $2.6M + ?
($2B)
• Prevention & Wellness (CDC) - ?
($1B)
• SSA - ?
($500M)
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HITECH Overview
Physicians
Qualification based upon the setting in which the provider furnishes their services
• Excludes “hospital based” professionals | Physician billing/employment relationship is irrelevant
Medicare Incentive Payments -
75% add-on to fee schedule payments
Maximum Medicare Incentive Payments
2011
2012
2013
2014
$18,000 $12,000 $8,000 $4,000
- $18,000 $12,000 $8,000
- $15,000 $12,000
- $12,000
2015
$2,000
$4,000
$8,000
$8,000
2016
$0
$2,000
$4,000
$4,000
Medicaid Incentive Payments Can receive
Medicare
OR
Medicaid
Incentives
Total
$44,000
$44,000
$39,000
$24,000
Penalty for failure to
implement by FY15 –>
reduction of
reimbursements by 1% in
2015, 2% in 2016, etc..
(requires Medicaid share of 30+ %)
Maximum Medicaid Incentive Payments
2011
2012
$25,000 $10,000
- $25,000
-
2013
$10,000
$10,000
$25,000
-
2014
$10,000
$10,000
$10,000
$25,000
-
2015
$10,000
$10,000
$10,000
$10,000
$25,000
-
2016
$0
$10,000
$10,000
$10,000
$10,000
$25,000
2017
$0
$0
$10,000
$10,000
$10,000
$10,000
2018
$0
$0
$0
$10,000
$10,000
$10,000
Total
$65,000
$65,000
$65,000
$65,000
$55,000
$45,000
Not to
exceed
$63,750
$ = EHR + HIE + Quality Reporting
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NC HIT Strategic Planning Task Force
• Established by Governor Bev Perdue
• Part of NC Recovery Office
• Task: Develop a Strategic Plan for ARRA Healthcare
Stimulus Funding investment
• Weekly meetings in April and May
• Draft Outline of plan established
• Draft Plan out for public comment until June 17th
• Final Plan delivered after incorporating comments
• Governor announces NC HWTFC as “Qualified State-Designated
Entity” on July 16th and will appoint NC HIT Collaborative to make
recommendations on implementing the NC HIT Action Plan.
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NC HIT Collaborative
Members
• Chair
• 2 Vice Chairs
• NC Dept. of HHS
• NC Medical Society
• NC Nurses Assn.
• NC Hospital Assn.
• Community Care of NC
• NC Assn. of Health Plans
• NC Health Quality Alliance
• NC AHEC Centers
• NCHICA
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Ex-Officio Members:
• NC HWTFC Chair
• NC HWTFC Executive Director
• Rep. from Office of the Governor
• NCHICA Executive Director
Advisory Group:
• Public Sector Representatives
• Private Sector Representatives
$ = EHR* + HIE* + Quality Reporting
*
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By “meaningful use” of “certified” systems
Meaningful Use
Estimated Timeframes
2009
Jan
Apr
2010
July
Oct
NPRM
issued by
HHS/CMS
(fall)
Public
comment
(Fall/Dec)
Jan
Apr
Final rule
issued
(spring)
Interim
final rule
issued
(Dec 31)
July
Oct
Meaningful User - Draft
Sample Provider Requirements*
Outcome
2011 (Oct 1, 2010)
2013
2015
Improve quality,
safety, and efficiency
• CPOE for all order sets
• Drug-drug; allergy; formulary checks
• Problem list of diagnosis based on
ICD-9 or SNOMED
• e-prescribing
• Active medication list
• Active medication allergy list
• Record demographics, advanced
directives, vital signs, smoking status
• Patient reminders
• One clinical decision rule
• Progress note for each encounter
• Online eligibility verification
• Evidence-based order sets
• Clinical documentation
• Chronic condition management using patient
lists and clinical decision support
• CDSS at point of care
• Specialists report to registries
• Closed loop medication management
Engage patients and
families
• Electronic copy of health information
(PHR, patient portal, CD, USB drive)
• Clinical summaries for each encounter
•
•
•
•
Improve care
coordination
• Capability to exchange key clinical
information among providers
• Medication reconciliation at relevant
encounters and each transition of care
• Retrieve/act on e-Rx fill data
• Summary care record for every care transition
• Medication reconciliation at each transition
from all settings
• Comprehensive patient
data from all available
sources
Improve population
& public health
• Data to immunization registries
• Reportable lab results to public health
• Electronic syndromic surveillance data
to public health
• Receive immunization histories from registries
• Receive health alerts from public agencies
• Electronic syndrome surveillance data with
capacity to link to personal identifier
• Use epidemiologic data
• Automated real-time
surveillance
• Clinical dashboards
Ensure privacy and
security of PHI
• Compliance with HIPAA and NHIN data
sharing practices
• Use summarized or de-identified data for
population health reporting
• Full accounting of TPO
disclosures
*Complete draft requirements in the appendix
Real-time populated PHR
Patient preferences
Family medical history
Home monitoring device uploads
• CDS for national highpriority conditions
• Medical device
interoperability
• Multi-media support
• Self-management tools
• Electronic reporting on
experience of care
Meaningful User - Draft
Sample Measures for Providers*
Outcome
2011 (Oct 1, 2010)
2013
2015
Improve quality,
safety, and
efficiency
• % diabetics with A1c under control
• % hypertensive patients with BP under
control
• % offered smoker cessation
• % patients with recorded BMI
• % CPOE orders
• Many other preventative screenings
(mammogram, flu vaccine, etc.)
• Additional NQF-endorsed quality reports
• Inappropriate use of imaging report
• Critical outcomes measures
(TBD)
• Efficiency measures (TBD)
• Safety measures (TBD)
Engage patients
and families
• % patients with access to electronic
PHI
• % encounters with clinical summaries
•
•
•
•
% of patients with real-time populated PHR
% patients with recorded preferences
% patients with secure patient messaging
% of transitions with shared summary care
record
• Ability to upload home monitoring device
data
• NPP quality measures related
to patient and family
engagement
Improve care
coordination
• % encounters with med reconciliation
• Implemented HIE capability
• % of transitions in care where summary
care record is shared
• Improved NQAF-endorsed measures
• Clinical summary aggregation
from multiple sources
• NQF Care coordination
measures (TBD)
Improve
population &
public health
• Childhood immunizations report
• % of electronically submitted reportable
lab results
• % patients with immunization assessment
completed during visit
• % patients where public health alert
needed to be triggered/audit evidence that
trigger occurred
• HIT enabled population
measures
• HIT enabled surveillance
measures
Ensure privacy
and security of
PHI
• Conduct/update security risk
assessment
• Summarized de-identified data for health
reporting
• Timely accounting of TPO
• Technology to segment
sensitive data
* Complete draft requirements in the Appendix
Bi-directional Exchanges Within a Community (example)
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A Community may create a Community HIE “Utility”(example)
Note: Reduction of 50%
of point-to-point Connections
HIE
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A Community may choose to qualify their HIE to
connect to the NHIN as an NHIN-HIE or “NHIE”
Community #1
NHIE
NHIN
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Thank You
www.nchica.org/ARRA/intro.htm
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