Health Information Technology HIT: What money is available and why care

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Health Information Technology (HIT) What money
is available and why care?
Patricia MacTaggart
5/4/09 Noon
Family Voices
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Acronyms Abound

• HIT
• EHR
• EMR
• CPOE
• e-prescribing
• e-xxxx

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Consumers Seek

• Access to Insurance Coverage
• Benefits once covered for Insurance
• Capable Providers who will provide the benefits
• Deference to the Culture and Language
• Errors Dont Happen
• Fact High Percent of Homeless Have Cell Phones
• Guaranteed view of data

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(No Transcript)
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Commonwealth Interruptions in Medicaid Coverage
and Risk for Hospitalization for Ambulatory Care
Sensitive Conditions Link of Eligibility and
Health Outcomes
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Providers Seek

• Adequate Reimbursement
• Benefits to Serving Populations out way Negatives
• Cultural Competency Awareness and Tools
• Deference to Clinical Judgment
• Expedited Payment and Decision Making
• From medical record/chart to view of medical
  information for providers and patients
• Goal of Semantic Management metadata,
  terminologies, core data sets

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States Seek

• Align Incentives for Consumers, Providers,
  Taxpayers, Regulators to improve quality of
  health and health care delivery
• Balance 3 legs of the stool quality, access and
  affordability
• Continuity of Care Continuity of Providers
  Continuity of System of Care
• Develop from Payer to Purchaser using e-health
• Evidence based medicine

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Opportunities through HIT

• Actual Literacy Health Literacy Computer
  Literacy Reading Level Literacy
• Build Trust Privacy Security Consent
  (authentication/authorization)
• Complete Communication Interoperability
  Integration
• Data Dominated Information
• Evidence Based Retention of data dirty date
  data distribution
• Efficiency, Effectiveness and Ease of Use

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Balancing

• Cost of Not Doing vs Cost of Doing
• Standardization vs Innovation
• Real Time vs Privacy/Security Risks
• Fixing the Information Highway while we a
  Driving on IT

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Opportunities through Childrens Health Insurance
Program Reauthorization Act of 2009 (CHIPRA),
H.R. 2

• Expanding Eligibility Streamline
  enrollment/retention Express Lane Eligibility
  and Outreach
• Expanding Coverage wrap around dental coverage
• Payment study on provider payments
• Improving Quality
• Develop and implement evidence-based quality
  measures HHS develop core set of measures
• Encourage development and dissemination of model
  childrens e-health record
• Demonstrated program to reduce child obesity

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ARRA for Medicaid

• States have 3 very specific responsibilities in
  order to draw down the federal dollars for both
  their administration and the incentive payments
  to the Medicaid providers (100 FFP).
• States must use the funds for purposes of
  administering the incentive payments, including
  tracking of meaningful use by Medicaid providers
  
• States must conduct adequate oversight, including
  routine tracking of meaningful use attestations
  and reporting mechanisms which will require look
  behinds, and
• States must pursue initiatives to encourage the
  adoption of certified EHR technology to promote
  health care quality and the exchange of health
  care information under this title, subject to
  applicable laws and regulations governing such
  exchange

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ARRA Medicaid Process Guidance

• Regulation (where required) and Dear State
  Medicaid letter
• Based on historical Medicaid Management
  Information System (MMIS) requirements and the
  MITA framework
• MMIS structure Capability to pay the incentive
  payments. (APD).
• Adequate oversight look behind capability ( human
  and IT resources). Funding/ hiring will take time
  as will state changes via State Plan Amendments,
  state laws/regulations.
• Encourage adoption of certified EHR technology
• Need to address information exchanges with other
  state agencies within their state, with other
  public and private entities within their states,
  with other states and entities in other states
  and with ONC .
• Following the MITA framework, states need to
  establish a baseline (as is), a vision of where
  they are going (to be), and roadmap to go from
  the as is to the to be vision.

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Which Provider Eligible for ARRA Medicaid
Provider Incentives

• Requirements
• Non-hospital based professionals have at least
  30 percent patient volume attributable to
  Medicaid patients, including physicians,
  dentists, certified nurse mid-wives, nurse
  practitioners and certain physician assistants
• Non-hospital based pediatricians have at least
  20 percent of their patient volume attributable
  to Medicaid patients
• Childrens Hospitals
• Acute-care hospital has at least 10 percent
  patient volume attributable to Medicaid patients
• Federally Qualified Health center or Rural Health
  Clinic has at least 30 percent of the center or
  clinics patient volume attributable to needy
  individuals

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Incentive Payments for Meaningful Use of
Certified EHR Technology

• Meaningful Use
• Established by State
• Acceptable to the Secretary
• Aligned with Medicare
• Exchanges information across different health
  care providers
• Reporting quality measures
• Including Support Services
• Maintenance and Training
• Adoption and Operation

• Certified EHR Technology Includes
• Patient demographic and clinical health
  information
• Clinical Decision Support capacity
• Support physician order entry
• Capture and query information relevant to
  healthcare quality
• Exchange electronic health information with, and
  integrate such information from other sources.

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Maximum Medicaid Incentive Payments to Providers

• No more than 85 Percent of Net Average Allowable
  Costs for
• Certified EHR technology
• Support services including maintenance and
  training that is for, or is necessary for the
  adoption and operation
• For Hospitals Payments
• Medicare Payment Algorithm
• Two Differences from Medicare
• Fully weighted for the first four payment years
  rather descending weights in use for Medicare
  incentive payments
• Medicaid patient load instead of the Medicare
  patient

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Hospital Medicaid HIT

• Amount Overall hospital EHR amount x Medicaid
  share
• Overall hospital EHR amount sum of a base
  amount (2M) added to its discharge related
  payment
• Discharge related amount 200 for each
  discharge, for
• 1,150th through its 23,000th discharges
• For years 2-6, add growth factor average annual
  growth rate in discharges from previous 3 years
• Medicaid share Medicaid portion of inpatient
  bed days, including Medicaid HMO patients,
  adjusted upward for charity care (may not include
  bad debt)
• Secretary shall establish, in consultation with
  the State, the overall hospital amount for each
  hospital

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Hospital Medicaid HIT

• States may not pay more than 50 of an aggregate
  amount to a hospital in any year, and must spread
  payments to hospitals out over at least 3 years
  (showing meaningful use)
• Phased out over 4 years like Medicare
• First year payments must start by 2016
• Eligible acute care hospitals with 10 Medicaid
  or childrens hospitals with any percentage
  Medicaid
• May qualify for both Medicare and Medicaid
  incentives

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Top State eHealth Priorities for Next 2 Years
(N 42)
Source The Commonwealth Fund NGA eHealth
Survey, conducted by HMA, 2007.
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Questions/Comments