American Recovery & Reinvestment Act of 2009 Increasing Access to HIT

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1 American Recovery & Reinvestment Act of 2009 Increasing Access to HIT Robert Hunter, DO, FACOEP, FACOFP Health Policy Fellowship Class of 2010

2 Acknowledgments AOA Bureau of Federal Health Programs Ohio Osteopathic Foundation Grandview Hospital/Foundation/MEC Care Source Management Group Ohio Osteopathic Association Dayton District Academy Health Policy Fellowship Class of 2010

3 Background Only 17% of physicians and 10% of hospitals have EMR Cost of EMR is a barrier to implementation Meaningful use criteria complicated and ever changing Distribution of funds?

4 Benefits of EMR Track key clinical conditions and coordinate care Implement clinical decision support tools Report clinical quality measures and public health information

5 Benefits of EMR Manage PCP information Increase accessibility & facilitate data sharing Speed work flow Lessen time spent on paperwork Improve communication with patient Improve patient safety E-prescribing and legible prescriptions Improve revenue

6 Benefits of EMR Data collection for research Evaluate practice habits Easier use of evidence-based medicine Reduction in need for staff Lessen storage of medical records

7 Cost - $20K- $50K Barriers Doctors may see only.11 cents of every dollar saved through the use of EMR Five to six years to recoup its cost Incentive payments are offered after physicians purchase an EMR system Lack of loans for EMR Blue Cross/Blue Shield of Mass. will not require EMR Unrealistic investment

8 Other Barriers Meaningful use criteria difficult to understand Meaningful use changing before EMR companies can update systems Multiple EMR companies to choose from Life expectancy of EMR (five years) Economic recession

9 Rationale to Use EMR Patient safety Quality of care Access to information Incentives for meeting Meaningful Use Penalties for not participating

10 ARRA and HIT Supply $19.2 Billion for HIT and EMR Eligible professionals stand to get up to $44,00 under Medicare and $63,750 under Medicaid

11 Incentive Payments Payments are determined by October of the following year Reporting is through attestation Payment is delayed at least a year after proving compliance Some studies show only 30% of EP will qualify today

12 Overcoming Barriers Incentives/MU need to be simplified Access to grants and government loans Government control of EMR companies Integration of information Timeline for incentives/mu

13 Meaningful Use Essentials for EMR meaningful use Getting started Focus of the future Final regulations released $27 billion in bonus Medicare payments

14 Core Set: All 15 Required Meaningful Use Objective 1. Record patient demographics 2. Record VS, chart changes (Ht, Wt, BP, BMI, growth charts) 3. UTD problem list 4. Active medication list 5. Med allergy list 6. Smoking status 7. Eps-clinical summary each OV 8. Patients get e-copy of their health info on request 2011 Measure (structured data) >50% of unique patients >50% age>2years of age or older (Ht, Wt, BP) >80% of patients 1+entry >80% of patients 1+entry >80% of patients 1+entry >50% of patients age 13+ years >50% of all OVS <3 business days >50% of requesting patients get e- Copy by 3 business days

15 Core Set: All 15 Required Meaning Use Objective 2011 Measure (structured data) 9. erx - permissible Rx (Eps only) 10. CPOE for medication orders 11. Implement interaction checks (drug-drug/allergy) 12.Implement capability to e- exchange key clinical info (info (providers, pt-auth entities) 13.Implement one clinical decision support rule, ability to track compliance >40% e-transmitted (certified EHR) >30% of patients w/ 1+med in list have 1+ entered via CPOE Functionality enabled for entire reporting period Perform at least one test 1 CDS RULE implemented

16 Core Set: All 15 Required Meaning Use Objective 2011 Measure (structured data) 14. Implement systems to protect privacy, security of patient data EMR 15. Report clinical quality measures to CMS or states Security risk analysis, security updates PRN, correct deficiencies 2011: attestation, aggregate Numerator and denominator 2012: e-submit measures

17 Menu Set: 5 of 10 Required Meaningful Use Objective 2011 Measure 1. Implement drug formulary check 2. Structured lab test results in EMRs as structured data 3. Generate lists of patients by specific conditions 4. Use EMR to identify/provide ptspecific education resources PRN 5. Perform MED REC between care settings Implemented & access to 1+ int/ext drug formulary (entire period) >40% of numerical or pos/neg results in EMR as structured data Generate 1+ list(s) of patients with a specific condition >10% of patents provided pt-specific education resources MED REC >50% of transitions

18 Brief Description: Menu Set (5/10) Meaningful Use Objective 2011 Measure 6. Provide summary of care record for referrals or transitions 7. Submit e-immunization data to registries 8. Submit e-syndromic surveillance 9. Send reminders to patients (per patient preference) for preventive and follow-up care

19 Brief Description: Menu Set (5/10) Meaningful Use Objective 2011 Measure 10. Provide patients with timely e- access to their health information (lab results, problem list, med lists, med allergies) >10% of patients provided e-access to info within 4 days of being updated in EMR Blumenthal, D.(August 4, 2010), Meaningful Use its Implications for Your Practice [American EHR] Retrieved August 16, 2010, from

20 Adopt, Install & Implement EMR Data Capture & Sharing Advanced Clinical Processes Improved Patient Outcomes 2013

21 Meaningful Users Meaningful User Money to reward investment for healthcare change Demonstrative support and improvement in quality and value measures Preparation and eligibility for new payment models Non-Meaningful User No incentives, no rewards Payments decreased to 1-5% Decreased data, poorer quality and value Decreased preparedness to participate in new payment models

22 Incentives and Penalties

23 Meaningful Use The meaningful use criteria need to be revised The AOA and AMA proposed revisions to a CMS rule on meaningful use HHS received approximately 2,000 letters on proposed rule CMS decreased number of requirements

24 Payment Reform Based on quality measures Payment for coordination of care, prevention, early detection, chronic disease management and medical homes Shared responsibility Bundling Optimization of resources Healthcare organizations held accountable for quality

25 Payment Reform Quality Incentives Costs Penalties

26 Recommendations Eliminate the objectives that don t directly apply to the EMR Decrease the number of quality measure reporting requirements Allow physicians to pick only three clinically relevant measures Time period for reporting needs to be extended

27 Recommendations The factor most frequently cited as a facilitator of EMR adoption is financial incentives Congress needs to ensure that continued financial support is available Small Business Health Information Technology Financing Act H.R. 3014

28 Already have EMR? Ensure that your EMR qualifies for meaningful use Utilize it in a meaningful way Engage positively within your practice Demonstrate EMR leadership and meaningful use by all

29 Don t Have EMR? Do not wait to implement system Make a plan Do not wait Go alone? Ask for assistance, receive help from those with experience and resources

30 Conclusion Shifting the rewards of the current health care market Physicians need access to private lenders/grants through guarantees MU needs to be changed Reporting period needs to be lengthened

31 Questions? Thank you for time and attention Congratulations to the HPF 2010!

32 References Association, American Medical (2010, March 15). AMA Comments on CMS Proposed Rule on Meaningful Use Of EHR Blumenthal, D.(August 4, 2010), Meaningful Use it s Implications for Your Practice [American EHR] Retrieved August 16, 2010, from DesRoches, C., Campbell, E., Rao, S., Donelan, K., Ferris, T., & Jha, A. (2008). Electronic Health Records in Ambulatory Care-A National Survey of Physicians. The New England Journal of Medicine, Dolan, P. (2008, March 10). Insurer finds EMRs won't pay off for its doctors. Retrieved May 1, 2010, from American Medical News: Ebell, M, Frame, P. (2001). What can technology do to, and for, family medicine? Family Medicine,

33 References Shaw, G. (2010, July 13), Winners and Losers in HHS Final Meaningful Use Rule. Health Leaders. Retrieved August 8, Simmons, J. (2010, July 13). Meaningful Use Final Rule Released by HHL. Health Leaders. Retrieved August 8, 2010: Rule-Release Society, H. I. (2010, January 8). "The Basics" Frequently Asked Questions on Meaningful Use and the American Recovery & Reinvestment Act of Retrieved May 1, 2010, from HIMSS:

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