Transcript Document

What the Stimulus Bill Means for
the Future of
Health Information Technology
March 16, 2009
1:30 PM EDT
Please dial 1-866-642-1665
Passcode 342441
to listen to the audio portion of the webinar
You will not be able to listen to the audio over the web
www.bakerdaniels.com
David Zook and Vince Ventimiglia
David Zook
Vincent J. Ventimiglia, Jr.
[email protected]
[email protected]
2
Agenda
 Introductions
 Overview of ARRA HIT provisions
 Office of National Coordinator:
– Policy & Standards





HIT grants and loans
Medicare & Medicaid incentives
Privacy provisions
Telemedicine overview
Impact & Engagement
3
Call for Stimulus
4
Stimulus overview
 ARRA signed into law February 17, 2009
– $787 billion in new spending and tax cuts
– Congressional Budget Office estimates that
the bill will add $185 billion to the economy in
2009 and $399 billion next year
 Federal agencies and states involved in
implementation
 Exceptional requirements for speed,
duration, transparency, and accountability
5
“Our recovery plan will invest in electronic
health records and new technology that
will reduce errors, bring down costs,
ensure privacy, and save lives.”
President Obama
Address to Joint Session of Congress
February 24, 2009
6
7
ARRA Health IT Components
 Office of the National Coordinator of HIT
 Funding to support infrastructure and EHR
adoption
 Incentives to providers through Medicare
& Medicaid
 Significant privacy and security
components
8
Office of National Coordinator

Codified through ARRA

Standards
– Review federal health IT investments to ensure they are meeting objectives of
federal health IT strategic plan
– Establish HIT Standards Committee (consider role of National eHealth
Collaborative)
– Review and determine within 45 days whether to endorse standards,
implementation specifications, and certification criteria for electronic exchange
and use of health information recommended by HIT Standards Committee

Policy
– Coordinate policy and programs
– Establish HIT Policy Committee (consider role of National eHealth Collaborative)

ONC chief privacy officer appointed by HHS Secretary within 12 months to
advise National Coordinator and assist states, regions, and other nations
9
Office of National Coordinator
 Federal Health IT Strategic Plan
– Update the plan with other federal agencies to
address several key components (electronic
exchange, overall utilization, privacy and
security, specifications, public engagement,
continuous improvements)
– Update through public and private sector
collaboration
– Measurable outcome goals
– Published and accessible
10
Office of National Coordinator
 HIT Policy Committee
– Recommend policy framework for nationwide health
information technology infrastructure
– Recommend and prioritize areas in which standards,
implementation specifications, and certification criteria
are needed
– Consider recommendations for appropriate use such
as quality, care coordination, vulnerable populations
– Encourage broad stakeholder input
– Members appointed by Secretary, Senate, House,
President, Comptroller General (specific expertise)
– Letters of nomination for GAO positions were due
March 6; appointments by the end of the month
– Letters of nomination for HHS position due to ONC on
March 16
11
Office of National Coordinator
 HIT Policy Committee
– Areas for review:
• Appropriate use of nationwide health IT infrastructure for
collection of quality data, biosurveillance, public health,
medical and clinical research, and drug safety
• Self-service technologies for exchange of patient information
• Telemedicine technologies
• Home health care
• Reduce medical errors
• Promote continuity of care
• Meet needs of diverse populations
• Facilitate secure access to PHI
12
Office of National Coordinator
 HIT Standards Committee
– Recommend standards, implementations
specifications, and certification criteria
– Provide for NIST testing
– Within 90 days, develop schedule for assessment of
recommendations for HIT Policy Committee
– Open public meetings
– Membership to include providers, ancillary healthcare
workers, consumers, purchasers, health plans,
technology vendors, researchers, federal agencies,
expert individuals
– Specific stakeholder input with sector balance
– Letters of nomination due to ONC on March 16
13
Federal Adoption of Standards
 Within 90 days, Secretary will determine
whether or not to propose adoption of
current standards
 By 12/31/09, Secretary shall adopt, by
rulemaking process, an initial set of
standards, implementation specifications,
and certification criteria
 As each agency implements IT systems, it
will use systems meeting the standards
 Voluntary adoption by private sector
14
Federal Health IT
 National Coordinator will support development
and updating of quality HIT technology unless
Secretary determines that the needs of providers
are being met through marketplace
 Pilot testing of standards and specifications by
NIST with HIT Standards Committee
 NIST to support establishment of conformance
testing infrastructure and may accredit
independent, non-federal labs to perform testing
15
HIT $
 $2 billion total through the Office of the
National Coordinator (HHS)
– $300 million to support regional health
information exchanges
– $20 million for NIST work on health care
information enterprise integration
– the balance spread among the new grant
programs in unspecified amounts and at
largely unspecified times
16
HIT $
 Other Health IT funding outside ONC
– $85 million for Indian Health Service for HIT
– $1.5 billion for community health centers,
which can be used for IT acquisition
– $500 million for Social Security Administration,
of which $40 million may be used for health IT
research and adoption
17
HIT $
 Funding to strengthen infrastructure
– Health IT architecture to support nationwide exchange and use
of health information
– Development and adoption of certified electronic health records
for providers not eligible for support under Medicare/Medicaid
– Training and dissemination on best practices to integrate health
IT and EHRs
– Acquisition of health IT that meets standards adopted by HHS
– Funded through ONC and administered by agencies with
relevant expertise (such as HRSA, AHRQ, CMS, CDC and
Indian Health Service), grants will be made available for health
information exchanges (HIEs), federal agencies, providers,
community health centers, 340B entities, telemedicine providers,
holders of health information and public health departments
– HHS is required to invest $300 million to "support regional or
sub-national efforts toward health information exchange."
18
HIT $
 Implementation assistance
– State grants to promote HIT
• Planning or implementation grants to states or state-designated
qualified entities to expand electronic health information exchange
• States must provide matching funds on sliding scale (discretionary
in FY09 and 10; 1:10 in FY11, 1:7 in FY12, 1:3 in FY13)
– Competitive grants to states and Indian tribes for loan
programs
• Funded through ONC, these grants will be made available to states
or Indian tribes to establish loan funds for health care providers to
acquire EHR technology (private contributions allowed)
– Programs to integrate HIT into education
• Competitive awards to health professions schools to develop
curricula to integrate EHR technology into education
• HHS, with NIST, provide funding to higher education for medical
health informatics education programs at undergrad and grad levels
19
HIT $

Implementation assistance (cont.)
– Health Care Information Enterprise Integration Research Centers
•
•
•
NIST grants to higher ed institutions or consortia to establish multidsciplinary centers
Generate innovative approaches to health care information enterprise integration; and
Pursue development of health information technologies and other complementary fields.
– Health Information Technology Extension Program
•
•
ONC will establish a health IT extension program to assist providers to adopt, implement, and use
certified EHR technology
Collaborate with other agencies such as NIST in implementing the program
– Health Information Technology Research Center
•
HHS will create a HIT Research Center to provide technical assistance and develop best practices to
support effective use of health IT
– Health Information Technology Regional Extension Centers
•
•
•
HHS will assist with creation of regional centers to provide technical assistance and disseminate best
practices from the national Research Center
Regional centers will be affiliated with US-based nonprofit institutions
Up to four years of federal assistance, capped at 50% of the capital and annual operating costs
20
HIT Medicare and Medicaid
Incentives
 Medicare incentives for providers
– Up to $18k if in 2011, then, 12k, 8k, 4k, 2k in subsequent years
– Payment reduction begins in 2015-- 1%, 2%, 3%
– Must meet standards
 Medicare incentives for hospitals
– Up to $16 million over 4 years if using HIT in 2011
– Additional penalties if not adopted
– Must meet standards
 Medicaid incentives
– Pays states incentive payments to support costs incurred for
adoption
21
Next steps
 ARRA provisions direct funding at high level
– Specific details, including funding targets and
processes for disbursement under development
 How does this fit into your strategic plan?
– Health provisions, but others that could impact you
(research, construction, energy, etc.)
 Are you communicating with Agency officials and
congressional representatives about your
interests/needs?
 Are you monitoring implementation?
22
Additional ARRA details
available
 www.recovery.gov
 www.HHS.gov/recovery





www.AHRQ.gov
www.CDC.gov
www.CMS.gov
www.HRSA.gov
www.NIH.gov
 www.bakerdconsulting.com
 www.bakerdaniels.com
23
B&D Consulting
 National advisory and advocacy consulting group
based in Washington, DC
– 50+ professionals with deep sector
concentrations; www.bakerdconsulting.com
– Division of Baker & Daniels LLP
 Health & Life Sciences consulting practice focused
on technical and political aspects of the U.S.
healthcare system
24
Joan S. Antokol
Joan S. Antokol
Partner, Baker & Daniels
[email protected]
25
Remember Your HIPAA Headache??
What is the impact on
Covered Entities?
What are the new
requirements for
Business Associates?
How has ARRA changed
the security breach
reporting obligations?
How has ARRA affected
enforcement?
How has ARRA expanded
HIPAA in terms of
additional entities that must
now comply?
What new rights do
patients have under the
ARRA?
What is the impact, if
any, How has ARRA
changed the security
breach reporting
obligations?
26
The Evolving Privacy and Security Landscape
 70+ countries have passed sweeping laws
 More on the way
 US is considered to be less strict than the EU,
Canada, Switzerland
 Impact of ARRA goes far beyond the US
27
ARRA Overview
 Security breaches – what has changed
 HIPAA – expansion and new requirements
 Enforcement – federal and state
28
Security Breaches
 Overview of existing state law obligations
 ARRA obligations
–
–
–
–
–
–
Who must comply?
What must you do to comply?
What has changed from prior state law obligations?
Do the state laws still apply too?
What enforcement can occur if you fail to comply?
What is the impact on patients?
29
HIPAA--Before and After ARRA
 Expanded scope of coverage
 Limitation on permissible activities
 Expanded patient access rights
 Additional administrative responsibilities
 Additional risks (enforcement, litigation)
30
HIPAA – Examples of Impact
 Third party management process
 Internal management and documentation
 Changes to procedures, training
 Changes to auditing
31
Enforcement
 New tiered penalties
 Expanded public notification
 Additional pressure on HHS to enforce
32
Moving Forward
 Next B&D webinar on privacy and security:
April 10, 2009, 1:30-3 pm
 More detailed discussion of these issues
 Call or email me at any time:
 (317) 569-4665
 [email protected]
33
David D. Storey
David D. Storey
Associate, Baker & Daniels
[email protected]
34
What Is Telemedicine?
• Telemedicine is not new.
• Definition of telemedicine varies.
• “Generally refers to the use of technology for the delivery
of healthcare when the healthcare practitioner and
patient are not in the same physical location.”
Telemedicine: Survey and Analysis of Federal and State
laws, Mayo & Kepler (AHLA).
35
Who Is Practicing Telemedicine?
• Numerous healthcare providers: Family physicians,
radiologists, dermatologists, psychiatrists, hospitals, rural
health clinics and many, many others.
• Consultation with Specialist: Telemedicine consultations
with a specialist physician is one of the more common
types of telemedicine.
• Wide variety of services: Telephone consultations,
telephone cross-coverage, live video patient
assessments, store and forward image analysis, etc.
36
Brief History of Telemedicine
Legal Issues
• Technology has continued to advance, but the law has
not kept up.
• Providers, lawmakers, payors, patients and other
interested parties have repeatedly attempted to address
telemedicine’s legal issues and expand telemedicine.
• Examples
37
Major Legal Obstacles
1. Licensure and credentialing
2. Liability for patient injuries
3. Federal and State regulations
4. Security of patient health information
5. Reimbursement
38
Recent Developments
 ABA addressed state licensure issue during
August 2008 annual meeting
 Number of “originating sites” for Medicare
reimbursement was expanded effective Jan. 1,
2009
 ARRA/HITECH Act provides additional funding
for telemedicine
39
Future of Telemedicine
• Impact of ARRA/HITECH Act
• Key obstacles to overcome
• Is telemedicine important to the future of
medicine?
40
Questions…?

David Zook
202.589.2809 phone
[email protected]

Vincent J. Ventimiglia, Jr.
202.312.7463 phone
[email protected]

Joan S. Antokol
317. 569.4665 phone
[email protected]

David D. Storey
260.460.1681 phone
[email protected]
41