Medical Billing and Meaningful Use of EHR
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1 Meaningful Use of EHR Technology GA-HIT Regional Extension Center (GA-HITREC) Dominic H. Mack MD, MBA Project Director, GA-HITREC Deputy Director, National Center for Primary Care Morehouse School of Medicine
2 GA-HITREC MEANINGFUL USE & FEDERAL INCENTIVE PROGRAMS
3 3
4 HITECH Act Health Information Technology for Economic and Clinical Health Act 1. Re-Establish ONC for HIT to develop rules by Savings -quality, care coordination & error reduction 3. Strengthening Federal privacy and security law 4. $20 billion Health information technology infrastructure HIT Research Center Health Information Exchange 60 Regional Extension Centers Medicare and Medicaid incentives
5 Meaningful Use Components The Recovery Act specifies the following 3 components of Meaningful Use: Use of certified EHR in a meaningful manner (ex: e-prescribing) Use of certified EHR technology for electronic exchange of health information to improve quality of health care Use of certified EHR technology to submit clinical quality and other measures Copyright 2010 All Rights Reserved. 5
6 Meaningful Use Stage 1- Health Outcome Initiatives Improve quality, safety, efficiency Reduce health disparities Engage patients and families in their health care Improve care coordination Improve population and public health Ensure adequate privacy and security protections
7 Meaningful Use Definition Eligible Providers (EPs) Eligible Hospitals Criteria flexibility 15 core measures and 5 of 10menu of choices More flexible timeline for implementation and Payment Copyright 2010 All Rights Reserved. 7
8 Examples of Meaningful Use EHR criteria Use CPOE Implement drug-drug, drug-allergy, drug-formulary checks Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT Maintain active medication allergy list Record demographics Record and chart changes in vital signs Record smoking status for 13 and old Provide electronic syndromic surveillance data\ Implement electronic capability to exchange key clinical info
9 Medicaid Eligible Providers Eligible Professionals (EPs) Physicians (Peds have special eligibility & payment rules) Nurse Practitioners (NPs) Certified Nurse-Midwives (CNMs) Dentists Physician Assistants (FQHC or RHC that is directed by a PA) Eligible Hospitals Acute Care Hospitals Children s Hospitals
10 Minimum Medicaid pt volume threshold 30%-Physicians, Dentist, CNMs, NPs, Pas 20%-Pediatricians 10%Acute care hospitals 0%-Children s hospitals Or the Medicaid EP practices predominantly in an FQHC or RHC 30% needy individual patient volume threshold
11 Medicare Eligible Providers Eligible Professionals (EPs) Doctor of Medicine or Osteopathy Doctor of Dental Surgery or Dental Medicine Doctor of Podiatric Medicine Doctor of Optometry Chiropractor Eligible Hospitals Acute Care Hospitals Critical Access Hospitals (CAHs) Medicare Advantage Providers
12 Hospital-based Eligible Providers Hospital-based EPs do not qualify for Medicare EHR incentive payments Most hospital-based EPs will not qualify for Medicaid EHR incentive payments (FQHCs will qualify) Defined as an EP who furnishes 90% or more of their services in a hospital setting (inpatient, outpatient, or emergency room)
13 Medicare First Calendar Year in which the EP receives an Incentive Payment Calendar Year & later 2011 $18, $12,000 $18, $8,000 $12,000 $15, $4,000 $8,000 $12,000 $12, $2,000 $4,000 $8,000 8,000 $ $2000 $4,000 $4,000 $0 Total $44,000 $44,000 $39,000 $24,000 $0
14 Medicaid First Calendar Year in which the EP receives an Incentive Payment Calendar Year $21, $8,500 $21, $8,500 $8,500 $21, $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $8, $8,500 $8,500 $8,500 $8, $8,500 $8,500 $8, $8,500 $8, $8,500 Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750
15 Hospitals-Meaningful Use Eligible hospitals meet requirements in 2011 Uses formulas- $2,000,000 base + discharge related payment Medicare non-adopters received reduced payments in 2015 Hospitals can qualify for incentives from Medicaid and Medicare
16 GA-HITREC STATE WIDE IMPLEMENTATION PLAN
17 GA Health Information Exchange GA Dept of Community Health 13 million dollars Develop strategic HIT Plan for the state Implement Statewide HIE Develop Medicaid Incentive Plan 17
18 GA-HITREC Funding & 2-Year Objectives $19.5 million to assist providers with selection, successful implementation, and meaningful use of certified EHR systems $1.5 million Core Funding $18 million Direct Assistance 5225 Priority Primary Care Providers Family Medicine, Internist, OB-GYN, Peds MD, DO, NP, PA 56 Critical Access and Acute Care Hospitals Work collaborative with Statewide HIE (13m) Copyright 2010 All Rights Reserved. 18
19 Extension Center Financial Facts Providers do not receive direct funding from GA-HITREC. Bulk of funding ($18 mil) is drawn down per implementation. Copyright 2010 All Rights Reserved. 19
20 Georgia Healthcare Coverage Medicaid 12.2% 1,150,800 Medicare 10.1% 958,200 Employer 54.8% 5,185,900 Individual 3.4% 325,400 Other Public 1.7% 164,300 Uninsured 17.8% 1,682,400 Total 9,467,100 Kaiser Family State Health Facts
21 Key Statewide Statistics Map of Georgia PCP: 15,563 Priority PCP: 8040 Total Number Served: 1608 (Yr 1) 5225 (Yr 5) Georgia Population: 9,965,744 Total patients served (projected) : 2.8 million
22 GA-HITREC Goals & Services To use a community-oriented approach to provide outreach and education to facilitate the adoption and meaningful use of EHR. To work collaboratively with statewide partners across the 18 public health districts of GA to develop and implement programs to meet GA- HITREC objectives. To select HIT products that meet provider s needs and help them to meet patient-centered medical home standards. Copyright 2010 All Rights Reserved. 22
23 GA-HITREC Goals and Services To provide equitable group purchasing agreements for Georgia s priority primary care providers. To build up competent technical teams to obtain meaningful use of EHR throughout the state and grow Georgia s HIT workforce. To work collaboratively with State HIE (GA. DCH) to meet all meaningful use criteria. To provide excellent quality service to our customers in order to build a national reputation as a reliable HIT resource for providers. Copyright 2010 All Rights Reserved. 23
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25 Statewide Organization Copyright 2010 All Rights Reserved. 25
26 Outreach/Education/Technical Partnerships CAAP Community Health Works GAFP GMCF GSMA GA Board of Regents GA Partnership for Telehealth Georgia Tech Health One Alliance East GA Cooperative 26
27 GA-HITREC Current Activities Constructing Operation Ongoing meetings w/onc and Extension Centers Public meetings and conferences with provider groups Provider Agreements Sub-recipients and Partner Agreements Vendor Selection and Group purchasing agreement Copyright 2010 All Rights Reserved. 27
28 Determine Selection Criteria Conduct Request for Proposal to Obtain Best Pricing Screen EMRs Against Criteria Develop Standard EMR Configurations with Physician Organizations Work with EMR Vendors to Create Standard Configurations Evaluate EMRs Against Practice Assessment Criteria
29 GA-HITREC Services Outreach and Education to providers Meaningful Use Education and Training Vendor Selection and Group Purchasing EHR implementation Follow through to meaningful use Workforce Development Copyright 2010 All Rights Reserved. 29
30 GA-HITREC Provider Relationship Management Lifecycle Partner Relations Communities of Practice Best Practices Collaboration & Support Outreach & Education Targeted Marketing Campaigns Lead Management Signing up Providers Project Management and Implementation Vendor Selection & Group Purchasing Program Management Project/Site Information Key Milestone Details Practice Workflow Design Vendor Relations Vendor Management Practice Demographics Site Information
31 Ensure that the privacy and security of health information is maintained according to HHS Privacy and Security Framework Principles.
32 Ongoing data capturing, monitoring, evaluation and reporting Local GA-HITREC quality teams will perform systematically reviews of the utilization of EHRs within participating practices. Within this review process, a set of core performance measures will be identified, monitored and analyzed on a regular basis
33 Conceptual Approach to Meaningful Use Copyright 2010 All Rights Reserved. 33
34 What is the importance of Meaningful Use to the primary provider? HIT Quality reporting Interoperability HIE Patient info at my fingertips New Technology Financial incentives Copyright 2010 All Rights Reserved. 34
35 Thank You! Dominic H. Mack MD, MBA Project Director, GA-HITREC Deputy Director, National Center for Primary Care Morehouse School of Medicine Copyright 2010 All Rights Reserved. 35
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