Transcript Slide 1

HITECH Act Update
February 18, 2010
Mike Spencer
Regional Sales Consultant
KIG Healthcare Solutions NextGen
Healthcare Information
HITECH Act: Overview
 American Recovery and Reinvestment Act 2009 (ARRA)
– Health Information Technology for Economic and Clinical Health
(HITECH) Act
– Formal establishment of the Office of the National Coordinator for
Health Information Technology (ONC)
 Funding to support regional and state initiatives to promote the
adoption of electronic health record (EHR) technology and best
practices
 Estimated $17-$19 billion in Medicare and Medicaid incentive funds for
eligible hospitals and providers that adopt EHR technology before 2015
 Directed the ONC to issue regulations
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HITECH Act: Regulations
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Two regulations published in the Federal Register on January 13, 2010
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NPRM: Proposed rule governing the definition of “meaningful use”
The calculation of incentive payment amounts, and other related issues
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Not yet effective
60 day comment period ends on March 15, 2010
Following comment period interim final rule to be issued
Final Rule – Late Spring – Takes effect 60 days later
IFR: Interim final rule governing the initial set of standards, implementation
specifications, and certification criteria for EHRs
– Effective February 12, 2010
– 60 day comment period ends on March 15, 2010
– Final Rule – Late Spring – Takes effect 60 days later
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HITECH Act: NPRM Overview
• Proposed rule:
– Defines the initial criteria for eligible professionals (EP) and eligible
hospitals (EH) to qualify for incentive payments
– Creates 3 Stages of implementation
– Defines Stage 1 MU and specific criteria to meet definition
– Defines payment years and reporting periods
– Calculates the incentive payment amounts
– Other program requirements
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HITECH Act:
Interim Final Rule Overview
• Interim final rule covers:
 Adoption of initial set of standards
 Implementation, specifications, and
certification criteria for EHRs
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Meaningful Use Definition
 Meaningful EHR User – An EP who, for an EHR reporting period for a
Payment Year, demonstrates meaningful use of a certified EHR
technology in the form an manner consistent with CMS standards.
 Payment Year – For EPs and calendar year beginning in 2011. The
“first Payment Year” would mean the first calendar or Federal fiscal
year for which an EP receives an incentive payment.
 EHR Reporting Period – For the first Payment Year only, CMS
proposes to define “EHR Reporting Period” to mean any continuous
90-day period within a Payment Year in which an EP successfully
demonstrates meaningful use of certified EHR technology.
 Eligible Professionals may choose to start their EHR reporting period on any date
beginning with the first day of the Payment Year that allows for a 90-day period to be
completed by the last day of the Payment Year. For the second Payment Year and all
subsequent Payment Years, the EHR reporting period would be the entire Payment Year.
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Meaningful Use Definition
• “Meaningful Use” is described in the Act as:
 Use of "EHR technology in a meaningful manner" (which
for physician incentives shall include the use of eprescribing)
 Electronic exchange of health information to improve the
quality of care such as promoting coordination of care
 Reporting on clinical quality measures (which shall
become more stringent over time)
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Definition of Eligible Professional (nonhospital-based)
Medicare
FFS or MA
Medicaid
Doctor of Medicine
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Doctor of Osteopathy
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Dentist
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Doctor of Podiatric Medicine
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Doctor of Optometry
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Chiropractor
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Nurse Practitioner
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Certified Nurse Mid-wife
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Physicians Assistant
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(practicing in FQHC or RHC led by physician)
• If an Eligible Professional (EP) is eligible for both Medicare and Medicaid, the Eligible Professional may choose
to accept the Medicare or Medicaid incentive, but may not receive both.
• An EP is permitted to change their election once during the life of the EHR incentive program, after making
the initial election.
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Medicare Incentives for EP’s
An EP is eligible for a 10% increase in the annual Medicare incentives if more than
50 percent of the EP’s Medicare covered professional services are furnished
in a geographic health professional shortage area (HPSA).
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Medicaid Incentives for EPs
(non-Pediatricians)
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MU Components: Stage 1
• Certified EHR
– Defined in IFR
• HIE (health information exchanges)
– Structured data
– To patients, to public health agencies
• Quality measures reporting
– CPOE
– Data collection—problem list, medication list, allergy list,
demographics, vital signs, smoking status, test results
– Functions---drug screening, reminders to patients, summary of
each visit, generate patient lists; 5 CDS rules, medication
reconciliation
– Protect health information
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Certified EHR
•Complete EHR or a combination of EHR Modules, each of
which:
–Meets the requirements included in the
definition of a Qualified EHR
–Has been tested and certified in accordance
with the certification program established by
the National Coordinator
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Qualified EHR
•An electronic record of health-related information on an
individual that
– Includes patient demographic and clinical health
information, such as medical history and
problem lists
– Has the capacity
 To provide clinical decision support
 To support CPOE
 To capture and query information relevant to health
care quality
 To exchange electronic health information with, and
integrate such information from other sources
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MU Components: Stage 1
• Certified EHR
– Defined in IFR
• HIE (health information exchanges)
– Structured data
– To patients, to public health agencies
• Quality measures reporting
– CPOE
– Data collection—problem list, medication list, allergy list,
demographics, vital signs, smoking status, test results
– Functions---drug screening, reminders to patients, summary of
each visit, generate patient lists; 5 CDS rules, medication
reconciliation
– Protect health information
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Health Information Exchange
Objectives and Measures
•25 objectives and measures
– 8 Measures require ‘Yes’ or ‘No’, 5 as structured
data
– 17 Measures require numerator and
denominator
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Examples of Stage 1:
Objectives and Measures
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MU Components: Stage 1
• Certified EHR
– Defined in IFR
• HIE (health information exchanges)
– Structured Data
– to patients, to public health agencies
Our
Focus
• Quality Measures reporting
– CPOE
– Data collection — problem list, medication list,
allergy list, demographics, vital signs, smoking
status, test results
– Functions — drug screening, reminders to
patients, summary of each visit, generate patient
lists; 5 CDS rules, medication reconciliation
– Protect health information
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Clinical Quality Measures Definition
Measures of processes, experience, and/or
outcomes of patient care
Observations or treatment that relate to
one or more quality aims for health care
such as effective, safe, efficient, patientcentered, equitable, and timely care
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Clinical Quality Measure Overview
 Stage 1 – Providers required to submit summary quality
measure data to CMS by attestation
–EP required to submit clinical data on the 2
measure groups: core measures and a subset
of clinical measures most appropriate to the
EP’s specialty
–EH required to report summary quality
measures for applicable cases
 Stage 2 and 3 – All Providers required to electronically
submit summary quality measure data to CMS
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Sources of Quality Measures
 Preference given to the clinical quality
measures endorsed by the NQF
–Including NQF endorsed measures that have
previously been selected for the Physician
Quality Reporting Initiative (PQRI) program
 HITECH Act does not require the use of NQF
endorsed measures, nor limit the measures
to those included in PQRI
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Submitting Quality Measures
 There are several potential routes to report quality information outlined
in the proposed rules including:
1. Use the CMS portal to perform upload process based on specified structures and
accompanying templates produced as output from your “certified” EHR module.
2. Submit the required clinical quality measures data using certified EHR technology
through Health Information Exchange (HIE) / Health Information Organizations
(HIO).
3. Accept submission through registries.
 This is dependent upon the future development of the necessary capacity and
infrastructure to do so using certified EHRs.
 Attestation on achieving meaningful use will be required as part of the
submission.
 Specifications for quality submissions will be developed by July 1, 2011.
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Reporting Period for MU
In Stage 1, the EHR reporting period is any continuous 90-day
period within a payment year.
In all subsequent Stages, the EHR reporting period must be the
entire payment year.
Reporting in Stage 1 will be by attestation
–Tied to calendar year, not adoption year
CMS expects to move to electronic reporting to some degree
starting in Stage 2
– This applies for both Meaningful Use stage criteria, as well
as quality reporting
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Remember the Carrot and Stick
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Points of Importance – Excerpt from
Regulations
 E-scribe “At least 80 percent of all unique patients
seen by the eligible professional or admitted by the
eligible hospital have at least one entry (or an
indication of ‘none’ if the patient is not currently
prescribed any medication) recorded in structured
data.”
 Lab Data “At least 50 percent of all clinical laboratory
results ordered by the eligible professional or by an
authorized provider of the eligible hospital…who
results are in either…a positive/negative or
numerical format are incorporated in certified EHR
technology as structured data.”
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Points of Importance – Excerpt from
Regulations
 CMS proposes that EPs and EHs provide
attestation through a secure mechanism, such
as through claims-based reporting or an online
portal.
 CMS proposes to make payments on a rolling
basis. The EP’s carrier or MAC would be
authorized to make an incentive payment “as
soon as” it has ascertained that an EP has:
 Demonstrated meaningful use for the applicable
EHR Reporting Period and
 Has reached the threshold for maximum payment.
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