Health Information Technology Incentives

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Health Information Technology Incentives
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Agenda

• HIT survey
• Health Information Technology Incentives
• HITREC- Health Information Technology Regional
  Extension Center

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Background

• American Recovery and Reinvestment Act (ARRA)
  provides incentive payments to Medicaid-eligible
  professionals and hospitals for the meaningful
  use of certified Electronic Health Record (EHR)
  technology
• For Medicaid-eligible professionals and hospitals
  to adopt and meaningfully use health information
  technology to improve health care quality,
  efficiency, and patient safety
• Avoid excessive or unnecessary burdens on
  providers in helping them to achieve meaningful
  use
• Ensure privacy and security of Personal Health
  Information (PHI)

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Division of Responsibility

• Iowa Department of Public Health e-Health and
  statewide Health Information Exchange
• Kory Schnoor 515.924.4636
• ehealth_at_idph.state.ia.us
• IFMC HIT Regional Extension Center (HITREC)
• Susan Harr 800.373.2964
• sharr_at_ifmc.org
• Iowa Medicaid Enterprise administration of
  incentive payment program
• Kelly Peiper 515.974.3071
• imeincentives_at_dhs.state.ia.us

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Provider Eligibility
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Eligible Professional (EP)

• Non-hospital based Physicians
• Hospital-based EP furnishes at least 90 of
  services in a hospital inpatient or ER setting
• Pediatricians
• Nurse Practitioners
• Certified Nurse Midwives
• Dentists
• PAs working in a FQHC/RHC when the facility is so
  led by a PA

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Hospital Eligibility

• One CMS Certification Number (CCN) one hospital
• Acute Care
• Average length of stay is less than or equal to
  25 days
• CCN range (0001-0879 1300-1399)
• Includes cancer hospitals
• Childrens Hospital
• 78 Childrens hospitals, CCN (3300-3399)
• Not childrens wings of larger hospitals
• Critical Access Hospitals are eligible under
  Medicaid

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Patient Threshold Eligibility
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Patient Threshold

• EP is also eligible when practicing
  predominately in a FQHC/RHC providing care for
  needy individuals
• Practicing predominately is when FQHC/RHC is
  the clinical location for over 50 of total
  encounters over a period of 6 months in the most
  recent calendar year for an eligible professional

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Patient Threshold, cont

• Needy individuals (for FQHC/RHC)are defined as
• Medicaid or the Childrens Health Insurance
  Program
• Receiving uncompensated care by the provider
• Furnished services at either no cost or reduced
  cost based on a sliding scale determined by the
  individuals ability to pay. 
• Must annually meet patient volume thresholds,

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Patient Threshold, cont

• Final rule gives two options.
• Option One
• (Total (Medicaid) patient encounters in any
  90-day period in the preceding calendar year)
• Divided by
• (Total patient encounters in that same 90-day
  period)
• Multiplied by 100

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Patient Threshold, cont

• Option Two
• (Total Medicaid patients assigned to the provider
  in any representative continuous 90-day period in
  the preceding calendar year with at least one
  encounter in the year preceding the start of the
  90-day period) (Unduplicated Medicaid
  encounters in that same 90-day period)
• Divided By
• (Total patients assigned to the provider in the
  same 90-day with at least one encounter in the
  year preceding the start of the 90-day period)
  (All unduplicated encounters in that same 90-day
  period)

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Patient Encounter

• 1 Services rendered on any one day to an
  individual where Medicaid or a Medicaid 1115
  grant paid for part or all of the service
• 2 Services rendered on any one day to an
  individual where Medicaid or a Medicaid 1115
  grant paid all or part of their premiums,
  co-payments and/or cost sharing

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Incentive Payments
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Incentive Payments to EPs
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Payments to Hospitals

• The calculation is (overall EHR Amount) times
  (Medicaid Share)
• Where overall EHR Amount equals
• Sum over 4 year of (Base Amount plus discharge
  related amount applicable for each year) times
  transition Factor applicable for each year
  times
• Medicaid Share equals
• (Medicaid inpatient-bed-days plus Medicaid
  managed care inpatient-bed-days) divided by
  (total inpatient-bed days) times (estimated
  total charges minus charity care charges) divided
  by (estimated total charges)

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Incentive Assignment

• EP may assign payment to an employer or billing
  entity
• EPs may assign payments to entities promoting EHR
  technology, as designated by the State
• States must establish verification procedures
  that enable the latter assignment, to ensure it
  is voluntary and that the entity does not retain
  more than 5 of the payment for non-EHR
  activities

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Adopt, Implement Upgrade

• Meaningful Use

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Timing

• Medicaid EHR incentive program starts in 2011 and
  ends in 2021
• The latest that a Medicaid provider can initiate
  is 2016
• A Medicaid provider can initiate the program
  under the Adopt, Implement and Upgrade bar, but
  must meet Meaningful Use during subsequent years
  at the stage that is currently in place (Stage 3
  by 2015)

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Adopt, Implement or Upgrade

• Adopt Acquired and installed
• E.g., Evidence of acquisition, installation, etc.
• Implement Commenced utilization
• E.g., staff training, data entry of patient
  demographic information into EHR, data use
  agreements
• Upgrade Version 2.0, expanded functionality
• E.g., Office of National Coordinator (ONC) EHR
  certification

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Meaningful Use

• A provider must demonstrate meaningful use by
• Use of certified EHR technology in a meaningful
  manner, such as through e-prescribing, and
• That the certified EHR technology is connected in
  a manner that provides for the electronic
  exchange of health information to improve the
  quality of care, and
• In using this technology, the provider submits
  clinical quality measures to CMS and likely to
  the State

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Meaningful Use Summary

• Eligible Professionals
• 80 of patients must have records in the
  certified EHR technology
• 20 of 25 Objectives and Measures
• 8 Measures require Yes or No answers
• 17 Measures require numerator and denominator
• Eligible Hospitals
• 19 of 24 Objectives and Measures
• 10 Measures require Yes or No answers
• 14 Measures require numerator and denominator
• Reporting Period 90 days for first year entire
  year subsequently

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Meaningful Use Stages

• Meaningful Use will be phased in over 3 stages
• through rulemaking
• Stage 1 2011
• Stage 2 2013
• Stage 3 2015
• Stages 2 and 3 will be defined in future CMS
  rulemaking.

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Verification

• 2011 Submit proof by attestation
• Patient threshold
• Not hospital-based
• 2012 Electronically submit summary quality
  measure data

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Clinical Quality Measures for Eligible Hospitals

• Hospitals to report summary data on 15 clinical
  quality measures to CMS (first through
  attestation, then electronically) for each
  patient to whom the QM applies
• Hospitals only eligible for Medicaid will report
  directly to the States
• If the measures dont apply, then option of
  selecting an alternative set of Medicaid clinical
  quality measures including newborn measures,
  pediatric measures, and never-event measures

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Criteria to Qualify

• Medicare vs. Medicaid

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Medicare vs. Medicaid Criteria

• Medicaid

• Medicare

• Voluntary for States to implement (may not be an
  option in every State)
• No Medicaid fee schedule reductions
• Adopt/Implement/Upgrade option for 1st
  participation year
• Maximum incentive is 63,750 for EPs
• States can adopt a more rigorous definition
  (based on common definition)

• Feds will implement (will be an option
  nationally)
• Fee schedule reductions begin in 2015 for
  providers that are not Meaningful Users
• Must be a meaningful user in Year 1
• Maximum incentive is 44,000 for EPs
• MU definition will be common for Medicare

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Medicare vs. Medicaid Criteria

• Medicare

• Medicaid

• Last year an EP may initiate program is 2016
  Last payment in program is 2021
• Medicaid managed care providers must meet regular
  eligibility requirements
• 5 types of EPs, 2 types of hospitals (including
  CAHs)

• Medicare Advantage EPs have special eligibility
  accommodations
• Last year an EP may initiate program is 2014
  Last payment in program is 2016.
• Only physicians, subsection (d) hospitals and
  CAHs

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Payments Registration through the NLR

• To prevent duplicate payments
• Supply Name, NPI, business address, phone
• TIN
• Hospitals must provide CCN
• EPs select between Medicare or Medicaid
• May switch once between programs before 2015
• If Medicaid, must select one state
• May switch states annually

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Next Steps

• Understand your eligibility and think about the
  measures that apply to you
• Evaluate your workflows in relation to capturing
  the measures
• Talk with your vendors about their plans to
  support meaningful use
• Final rule http//www.ofr.gov/OFRUpload/OFRData/20
  10-17207_PI.pdf

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HITRECHealth Information Technology Regional
Extension Center
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The HITREC

• Federally-funded Regional Extension Center
• Assistance to providers in adopting, implementing
  and achieving meaningful use of the of EHRs by
• Vendor selection
• Group purchasing
• Implementation
• Project management
• Practice workflow design
• Interoperability
• Privacy and security
• HIE

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The HITREC

• Eligible providers
• Individual and small primary care practices (10
  or fewer with prescriptive privileges)
• Public and critical access hospitals
• Community Health Centers and Rural Health Clinics
• Settings that predominately serve the uninsured,
  underinsured, and medically underserved
• In the first two years, technical assistance is
  subsidized for priority primary care providers.
  Grant funds 90 percent, participating providers
  pay approximately 10 percent.

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Questions, comments?

• Please complete the HIT survey
• What are your barriers to implementing an EHR?
• Likelihood of qualifying?
• Please send questions and comments to
  imeincentives_at_dhs.state.ia.us