Facts about the government s healthcare stimulus package

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1 Facts about the government s healthcare stimulus package For informational purposes only. Use this as a starting point to gather additional knowledge on this fast evolving opportunity.

2 ARRA American Recovery & Reinvestment Act Hitech Health Information Technology for Economic and Clinical Health Act EMR Electronic Medical Records (Local) EHR Electronic Health Records (Global) PHR Patient Health Record HHS United States Department of Health & Human Services CCHIT Certified product Commission for Healthcare Information Technology CMS Center for Medicare/Medicaid Services HCIS MEDITECH's Health Care Information System EDM Electronic Document Management Electronic Data Management OSA Open Systems Architecture

3 $787 billion Stimulus Package $2 billion available immediately for loans and grants to help health care providers implement electronic health record systems and to fund research into the use of various health systems $17+ billion for new programs rewarding doctors and hospitals over the next 5 years for the Meaningful use of e-health record systems.

4 Beginning 2011, health care providers who use electronic medical records and other health IT systems in meaningful ways will be eligible for government rewards ranging from tens of thousands of dollars for doctors to millions for hospitals. After 2014, laggards will be penalized with reduced payments from Medicare.

5 To get reimbursement, a physician or hospital has to demonstrate that the EHR is certified and: 1. Used in a meaningful manner, and they reference erx (eprescriptions) 2. Demonstrates that the certified EHR can also provide reporting on clinical quality measures. Clinical Quality Measures use information and other technology to identify those patients who may qualify for treatment, to confirm their eligibility, to notify clinicians caring for them and to work with their physicians to institute the treatment. 3. Able to demonstrate the certified EHR is connected in a manner that provides for electronic exchange of health information to improve quality of care such as care coordination. No one knows for sure how HHS will ultimately define meaningful use or what certified EHR may mean.

6 CMS will distribute on a tiered basis First year, physician gets $18k, 2nd, $12k, etc. If physician gets started quickly (by 2010) they can reap some $44K. If they drag their feet and start a couple of years later, they ll get a total of $24k. A similar tiered model is also established for hospitals.

7 Ref: * HITECH ACT PHYSICIAN REIMBURSEMENT PLAN: ELECTRONIC HEALTH RECORDS SOFTWARE EHR Adoption 2011 EHR Adoption 2012 EHR Adoption 2013 EHR Adoption 2014 EHR Adoption ($) $18, ($) $12,000 $18, ($) $8,000 $12,000 $15, ($) $4,000 $8,000 $12,000 $15, ($) $2,000 $4,000 $8,000 $12, ($) 0 $2,000 $4,000 $8,000 0 TOTAL $44,000 $44,000 $39,000 $35,000 0

8 Reduction by 1% of Medicare/ Medicaid reimbursements from Additional 1% reduction per year up to 5%

9 Managed at the State level and will institute the guidelines provided by HHS. Basic qualifications are similar, e.g., meaningful use of certified EHR Significantly more complicated process to receive reimbursement. Total reimbursement amounts up to $65,000/physician over five years. First year costs applied to purchase, install and training. Follow-on years, reimbursement for operations and maintenance. Reimbursement is for a percentage of total expenditures by physician for certified EHR. Extended time horizon, payments through Physician must demonstrate that a certain percentage of patients (20-30%) are covered by Medicaid. Table below provides physician payment schedule under Medicaid. Ref:

10 EHR is an individual patient's medical record in digital format that allows for storage and retrieval of this information It may be made up of electronic medical records (EMRs) from many locations and/or sources. Patient demographics, medical history, medicine and allergy lists (including immunization status), laboratory test results, radiology images, billing records and advanced directives. EHR systems can increase physician efficiency and reduce costs, as well as promote standardization of care. Even though EMR systems with computerized provider order entry (CPOE) have existed for more than 30 years, less than 10 percent of hospitals as of 2006 have a fully integrated system Can cost upwards of $30,000-$50,000 per doctor

11 Prior to the stimulus package the financial rewards of implementing an EHR traditionally went to insurance companies, health plans, and government programs as Medicare/Medicaid; not necessarily to the doctors or hospitals that pay them. Doctors & Hospital Benefits Reduce medical errors Reduce paperwork Reduce redundancy Automat medical claims processing Improve Workflow that delivers decision-making data from multiple systems to one screen Enable faster check deposits while eliminating courier trips Match medical record requests with receipts Improve Help Desk Services with centralized EDM Save money in paper, shipping costs Stimulus Funds can now give Doctors/Hospitals direct payout

12 A qualified e-prescribing system includes the following: 1. Formulary and benefit transactions: gives prescribers information about which drugs are covered by a Medicare beneficiary's prescription drug benefit plan. 2. Medication history transactions: provides prescribers with information about medications a beneficiary is already taking, including those prescribed by other providers, to help reduce the number of adverse drug events. 3. Fill Status notifications: allows prescribers to receive an electronic notice from the pharmacy telling them that a patient's prescription has been picked up, not picked up, or has been partially filled, to help monitor medication adherence in patients with chronic conditions. Ref:

13 Medicare recently announced a new rule, saying that by 2012, doctors participating in Medicare programs would be required to prescribe prescriptions electronically. Blue Cross Blue Shield of Massachusetts announced it was following Medicare's lead, beginning on Jan. 1, 2011, it was requiring doctors to electronically prescribe medications in order to qualify for bonus programs. BCBSMA says 99% of primary care doctors and 78% of specialists in the company's network currently participate in the insurer's incentive plans. So, that means there will likely be lots more Massachusetts doctors trading in their paper prescription pads for e- prescribing systems in the next couple of years.

14 Cut costs Improve patient safety by automatically flagging potential drug allergies and interactions Reducing errors related to illegible handwriting Bettering adherence to benefit formularies Stemming the number of callbacks between pharmacy and doctors office

15 million e-p written million e-p written 2009 (1 st Q) million e-p messages sent 1. Doctors confirming patients prescription plan benefits with payers 2. Checking patients prescription history 3. Sending e-prescriptions to pharmacies

16 80% of e-prescriptions are being generated by doctors using stand alone prescribing software, as opposed to more comprehensive, integrated EMR systems 2007, only 19,000 doctors were prescribing prescriptions electronically Today; 103,000 doctors These numbers represent doctors, physician assistance and nurse practitioners mostly in physicians practices, not clinicians in hospitals that use computerized order-entry systems

17 Congressional Budget Office estimates that stimulus provisions could drive adoption of EHR systems to nearly 90% of U.S doctor offices and hospitals in a few years. More realistic goal may be 60-70% by 2014 John Glaser, CIO Partners HealthCare Right now less than 10% of US doctors have adapted the systems, low double digits for hospitals Stimulus money will cover a good part, but the money won t be available up front. This makes the investment a challenge

18 Draft guidelines to be released no later than mid-june to allow for sufficient public comment and re-work. Final guidelines must be in place by end of calendar year Meaningful use guidelines will be tiered, less onerous in early years but slowly ratcheting up to meet broader healthcare goals. EHRs in use today that are CCHIT certified will be grandfathered in. Certification criteria for EHR vendors will be kept to a minimum in support of meaningful use, specific features/functions will by and large be left alone. CCHIT will not be the only certifying body, others will be created to insure CCHIT does not become a choke point. EHRs will not directly equate to EMRs. ONC will provide a structure that supports an overarching range of apps that when combined, like building blocks in support of meaningful use, are deemed certified. There is currently no information on regulation of implementations or how audits of the system use might be performed. Chilmark Research

19 A doctor can wait to implement an EDM,EMR or EHR for scanning, archiving and retrieving medical records until the stimulus package is finalized, the penalty for not administering a program is about to kick in and what if at that time the necessary up front funds are not available OR They can begin the process today by taking advantage of our document filing capabilities using our Content Central EDM Software by Ademero designed for the healthcare industry. It may not be an all out EHR, but it s an important first step. One that can then be integrated at a later date.

20 The benefit will be immediate in that with Content Central EDM Software by Ademero they will be able to reap the rewards of instant access to critical records and the ability to increase efficiencies. The only difference is that they are realizing the benefit today instead of later.

21 State Number Hospitals Staffed Beds Total Discharges Patient Days Revenue ($000) AK - Alaska 16 1,107 37, ,283 $2,070,824 AL - Alabama , ,880 3,536,925 $28,566,823 AR - Arkansas 57 7, ,439 1,698,892 $12,318,308 AZ - Arizona 73 12, ,381 3,048,397 $32,946,787 CA - California ,752 3,213,697 18,420,975 $217,322,432 CO - Colorado 56 8, ,185 1,986,542 $22,991,644 CT - Connecticut 34 8, ,807 2,422,563 $19,066,097 DC - Washington D.C. 9 2, , ,392 $6,419,435 DE - Delaware 8 2,143 97, ,031 $3,302,034 FL - Florida ,225 2,338,606 12,163,514 $125,971,326 GA - Georgia , ,609 5,977,533 $41,952,793 GU - Guam ,280 58,097 $123,027 HI - Hawaii 15 2,721 91, ,127 $4,417,911 IA - Iowa 38 7, ,574 1,621,187 $11,731,272 ID - Idaho 19 2, , ,151 $3,932,446 IL - Illinois ,108 1,436,546 7,746,825 $73,318,631 IN - Indiana 92 16, ,920 3,617,716 $30,750,752 KS - Kansas 59 6, ,178 1,416,873 $13,512,025 KY - Kentucky 75 13, ,506 3,127,161 $23,771,708 LA - Louisiana , ,496 3,207,097 $24,170,323 MA - Massachusetts 82 15, ,287 4,095,826 $37,921,394 MD - Maryland 51 11, ,159 3,368,006 $14,409,954 ME - Maine 23 3, , ,479 $5,610,929 MI - Michigan ,799 1,115,693 5,965,341 $51,775,334

22 State Number Hospitals Number Beds Discharges Patient Days Gross Patient Revenue ($000) MN - Minnesota 55 10, ,490 2,716,872 $22,087,887 MO - Missouri 91 17, ,423 3,989,932 $35,288,857 MS - Mississippi 74 11, ,922 2,270,909 $16,191,435 MT - Montana 19 2,319 80, ,671 $3,138,060 NC - North Carolina , ,909 5,983,391 $39,673,186 ND - North Dakota 14 2,072 72, ,052 $2,887,658 NE - Nebraska 24 4, ,926 1,122,996 $8,166,792 NH - New Hampshire 14 2, , ,771 $5,833,516 NJ - New Jersey 73 21,131 1,036,616 5,809,572 $70,052,481 NM - New Mexico 40 3, , ,255 $7,685,257 NV - Nevada 29 4, ,286 1,305,230 $15,239,915 NY - New York ,899 2,210,323 18,233,211 $105,519,318 OH - Ohio ,421 1,386,512 7,296,750 $67,850,346 OK - Oklahoma 99 10, ,125 2,412,030 $18,223,316 OR - Oregon 36 5, ,184 1,451,263 $12,727,451 PA - Pennsylvania ,950 1,687,627 9,614,855 $108,733,142 PR - Puerto Rico 53 8, ,960 2,241,605 $3,775,746 RI - Rhode Island 12 2, , ,377 $6,545,416 SC - South Carolina 62 11, ,493 2,988,853 $25,334,067 SD - South Dakota 29 2,664 86, ,801 $3,637,705 TN - Tennessee , ,675 4,639,454 $36,915,144 TX - Texas ,733 2,536,072 12,601,186 $125,054,604 UT - Utah 34 3, , ,878 $7,030,298 VA - Virginia 92 19, ,629 4,747,505 $34,814,303 VT - Vermont , ,681 $2,306,342 WA - Washington 61 9, ,149 2,370,625 $25,628,263 WI - Wisconsin 71 11, ,107 2,537,418 $21,999,086 WV - West Virginia 40 6, ,948 1,489,205 $8,522,973 WY - Wyoming 15 1,220 40, ,595 $1,411,818 Totals 4, ,280 33,277, ,112,876 $1,650,648,592

23 Definition EHR Research Firm EHR payout example FAQ CCHIT certified applications Kryptiq (in discussions with Sharp) About Hitech Information Week Search Hitech site_id=informationweek&personality=category&cid=header-search&querytext=hitech&search=go Hitech background

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