An Unprecedented Opportunity:

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An Unprecedented Opportunity

• Federal Stimulus Funds Advancing
• Health IT in California
• Mark D. Smith, MD, MBA
• Network of Ethnic Physician Organizations
• September 26, 2009

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Outline

• The Promise of IT
• Where are we now?
• HITECH and Californias share
• What does it mean for practicing physicians?
• Other important policy developments
• CHCF work

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The Promise of HIT

• Quality of care for patients
• Quality of life for physicians
• Reduction of administrative waste
• Systemic quality assessment and improvement
• ?Public Health surveillance and response

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Quality of Care for Patients

• Evidence-based care
• Safety
• Allergies
• Drug-drug interactions
• Cost/Convenience
• Test results
• Rx refills
• e-visits
• Elimination of duplicated tests

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Provider Adoption of e-Prescribing

• Electronic transactions have tripled in the last
  year.

Only 1.2 of prescriptions in California outside
of Kaiser and the VA are electronic
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HITECH is Game-Changing

• 10,000 increase in federal health IT spending
• Contains as many risks as opportunities
• Provides a down payment on health reform

• Still needed
• Payment reform
• Lower-cost models of care
• Increased patient participation in their own care
• Simpler, cheaper technology

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Policy AnalysisFederal Policy and Standards
Framework
HHS Secretary Reviews ONC endorsements and
decideswhether to adopt no later than 90 days
from receipt
Endorses
Office of the National Coordinator Receives
recommendations and decides whetherto endorse to
HHS Secretary
Recommends
HIT Policy Committee Recommends policies relating
to a national health IT infrastructure and
priorities for the development, harmonization,
and recognition of standards, specifications, and
certification criteria.
HIT Standards Committee Recommends standards,
implementation specifications, and certification
criteria forthe use of electronic exchange and
use of health information.
National Institute of Standards and
Technology Tests standards and creates a
conformance testing infrastructure
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New Privacy Provisions

• Extension of HIPAA to Business Associates
• Security Breach Notification Mandate
• New Use and Disclosure Restrictions
• Consumer Access Requirements
• Increased HIPAA Enforcement

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EHR Incentive Program Funding
Recipients
Entitlement Funds (roughly 34 billion in gross
outlays)
Use of Funds
Distribution Agency
Program
Acute Care and Childrens Hospitals
Medicare Payment Incentives
Incentive Payments through Carriers
CMS
Incentive Payments through State Agencies
Medicaid Payment Incentives
CMS and states
Physicians and Dentists
Nurse Practitioners and Midwives
FQHC
CMS is Center for Medicare and Medicaid Services
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Estimate of California HITECH Funding
Program Federal Allocation California Fair Share Estimate
Medicare EHR Incentive Program 20 billion 2 billion
Medicaid EHR Incentive Program 14 billion 1.4 billion
Other Grant Programs 2 billion TBD
Congressional Budget Office (CBO) estimate of
outlays
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What Physicians Can Receive
Program Total Over 5 Years
Medicare EHR Incentive Program Up to 44,000 per physician
Medicaid EHR Incentive Program Up to 63,750 per physician
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Sams Club Bundled EHR
An Example of Bundled EHR Offering

• Dell Computer
• 3 desktop computers
• Tablet computer
• Fax server
• Laser printer
• Scanner
• Firewall and router
• Cables, straps, surge protector, locks, etc.
• Onsite assessment
• Installation

• eClinicalWorks
• Practice management software
• EHR software
• ePrescribing software
• One year license, maintenance and technical
  support
• Software as a Service (SaS) model
• Installation
• 5-days onsite training

25,000 for one-physician practice 10,000 each
for second and third physician Annual maintenance
- 2,400 to 4,000
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Meaningful Use of certified technologies(as
recommended by ONCHIT)

• Use of EHR in a meaningful manner, which includes
  electronic prescribing
• Capturing ethnicity, language race to help to
  address health disparities and improve access to
  healthcare.
• Capable of exchanging electronic health
  information to improve the quality of health
  care, such as promoting care coordination
• Submission of information on clinical quality
  measures
• Electronic eligibility and claims information

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Meaningful Use, cont.

• ONCHIT recommends, CMS decides
• Rule will be out for comment in December 2009
• Standards evolve over time to be more demanding
• Bonuses begin 2011, penalties begin 2017

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Health Information Exchange (HIE)

• Development of a state plan
• State or state-designated entity to carry it out
• Compete for planning or implementation grants

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Related Areas of Funding
Broadband and Telehealth

• 4.3B for broadband and 2.5B for distance
  learning / telehealth grants
• Directs ONC to invest in telehealth
  infrastructure and tools and FACA Policy
  Committee to consider telehealth recommendations

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CHCFs Work in this Area

• Publishing information to inform providers and
  the public

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CHCFs Work in this Area

• Publishing information to inform providers and
  the public
• Support to the CA Health Human Services Agency
  to develop state plan for Health Information
  Exchange
• Support to the CA Department of Health Services
  to develop and carryout plan for administration
  of the Medicaid EHR Incentive Program
• Pilot effort to support 30 small physician
  practices implement EHRs in Tulare County
• Facilitation of industry stakeholders to develop
  multi-payer portal in California

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Why Practices Want to Participate
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Questions Answers