Orchard Software Webinar August 19, Slide 1

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2 An Update on ARRA and Its Impact on Laboratories Presented By: Curt Johnson VP of Sales & Marketing (800) Orchard Software Webinar August 19, 2010 Orchard Symposium Keynote Slide 2

3 Thank you for attending! Questions & Answers If time allows, we will answer questions at the end of the webinar. To ask questions during the presentation use the convenient dashboard toolbar (see example below) in the lower right-hand corner of your screen. Click on the? icon. If we cannot get to your questions by the end of the presentation, we will answers to your questions as soon as we can. Orchard Software Webinar August 19,Up 2010 Orchard Symposium 2007: Setting Rules in Harvest LIS Slide 3

4 Only in growth, reform, and change, paradoxically enough, is true security to be found. Anne Morrow Lindbergh Orchard Software Webinar August 19, 2010 Orchard Symposium Keynote Slide 4

5 Overview American Recovery & Reinvestment Act (ARRA)/ Health Information Technology for Economic and Clinical Health (HITECH) Incentives for EMR Adoption EMR Certification Stage 1 Meaningful Use (MU) What s Next? Stages 2 & 3 What this all means to you and your laboratory Slide 5

6 What is the ARRA? The American Recovery & Reinvestment Act (ARRA) of 2009 was signed into law by President Obama in February The ARRA set aside $787 billion to stimulate the economy through investments in infrastructure, unemployment benefits, transportation, education, and healthcare. It includes over $20 billion to aid in the development of a robust IT infrastructure for healthcare and to stimulate EMR adoption. Your facility can earn financial incentives for adopting and using an EMR. Slide 6

7 How do I earn these incentives? ARRA $787 billion HITECH $20 billion Office of National Coordinator (ONC) Defines the criteria for EMR certification Centers for Medicare & Medicaid Services (CMS) Defines meaningful use (MU) and establishes financial incentives Slide 7

8 The Basics: Here s what you need to know. Incentive monies are available to providers and hospitals over the next 5 to 6 years for EMR adoption. Up to $44,000 total per provider $2,000,000+ for hospitals Key: To earn this money, your organization must install or have installed a Certified EMR and utilize it in conjunction with the Meaningful Use criteria laid out in 3 stages over the next 5 to 6 years. Slide 8

9 The EMR Incentive Formula Adoption of Certified EMR + Prove Meaningful Use over 3 Stages = Incentives Slide 9

10 Incentives Orchard Software Webinar August 19, 2010 Orchard Symposium Keynote Slide 10

11 Who Qualifies for Incentives? Providers ELIGIBILITY FOR INDIVIDUAL PROVIDERS - ELIGIBLE PROFESSIONALS (EPs) The incentives for eligible professionals are based on individual providers. Therefore, if you are part of a practice, each eligible professional may qualify for an incentive payment provided they successfully demonstrate meaningful use. Each EP is only eligible for one incentive payment each year, regardless of how many practices or locations they provide services. Medicare: A Medicare EP is defined as a doctor of medicine or osteopathy, doctor of dental surgery or dental medicine, doctor of podiatry, doctor of optometry or a chiropractor who is not hospital-based. NOTE: A Medicare EP is considered hospital-based if 90% or more of the EP's services are performed in a hospital inpatient or emergency room setting. Medicaid: A Medicaid EP is defined as a physician, nurse practitioner, certified nurse-midwife, dentist, or physician assistant who furnish services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant. To qualify for an EHR incentive payment, a Medicaid EP must not be hospital-based and must meet one of the following criteria: Have a minimum 30% Medicaid patient volume* Have a minimum 20% Medicaid patient volume, and is a pediatrician* Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to Slide 11

12 Who Qualifies for Incentives? Hospitals ELIGIBILITY FOR HOSPITALS - ELIGIBLE HOSPITALS Medicare: An eligible hospital for Medicare incentive payments is a "subsection (d) hospital" that is paid under the hospital inpatient prospective payment system. Hospitals must be located in one of the 50 states or the District of Columbia. Critical Access Hospitals and Medicare Advantage Hospitals are also eligible to receive Medicare EHR payments provided they demonstrate meaningful use of certified EHR technology. Medicaid: Acute care hospitals (including Critical Access Hospitals) with at least 10% Medicaid patient volume, as well as children's hospitals (no Medicaid volume requirements) may be eligible for Medicaid EHR incentive payments. Slide 12

13 Details of Earning Incentives: Providers Getting Paid (note providers use calendar year, hospitals use fiscal year) 5 provider types: Physicians (MD or DO), Dentists (DDS), Podiatrists, Optometrists (ophthalmologists are MDs), Chiropractors Annual incentive capped at 75% of allowed charges, up to the maximum shown in following table First year based on claims paid from Jan 1, 2011 to Dec 31, 2011 and submitted before Feb 29, Slide 13

14 Overlay Incentives and Stages: Providers Slide 14

15 Details of Earning Incentives: Hospitals Getting Paid (note hospitals use fiscal year, providers use calendar year) FY 2011= Oct 1, 2010 Sept 2011 Paid based on provider number used for cost reporting (CCN, also known as OSCAR Number) Calculation: Product of the following 3 items Incentive Amount = [Initial Amount] [Medicare Share] [Transition Factor] Slide 15

16 Transition Factor for Hospitals Slide 16

17 Hospital Incentive Example Incentive Example: Hospital with 15,000 discharges, 1,000 Medicare bed days, 300 Medicaid bed days, 10,000 total bed days, and charity care of 20%, 1st consecutive year Initial Amount = $2M + $200 x 15,000 discharges = $2M + $3M = $5M Medicare Share = /10000*.20 = 1300/2000 =.65 Transition Factor = 1 Total 1 st year incentive = 5M x.65 x 1 = $3,250,000. If numbers remain constant: 2nd year 5x.65x.75 = $2,437,500 3rd year 5x.65x.50 = $1,625,000 4th year 5x.65x.25 = $ 812,500 Total = $8,125,000 Slide 17

18 Incentive for Critical Access Hospitals (CAH) CAH paid on reasonable cost basis (currently 101%), and not subject to IPPS (Inpatient Prospective Payment System) or OPPS (Outpatient Prospective Payment System) Secretary shall compute reasonable cost by expensing such costs in a single year and not depreciating If no meaningful use after FY2015, 101 becomes 100.6, then , then 100% after FY2017 Incentive payment to CAH for the reasonable costs for the purchase of certified EHR. Acquisition costs, excluding depreciation and interest, for computers and software necessary to administer certified EHR technology Slide 18

19 EMR Certification Orchard Software Webinar August 19, 2010 Orchard Symposium Keynote Slide 19

20 EMR Certification EMR Certification (defined by the ONC) Specifies WHAT an EMR needs to do to become certified in order to support meaningful use For more information: server.pt/community/ healthit_hhs_gov home/1204 Slide 20

21 EMR Certification Process ONC is currently accepting applications from entities and organizations interested in becoming ONC-ATCB (Authorized Testing and Certifying Bodies) CCHIT (Certification Commission for Health Information Technology) has applied and most likely will be approved; however EMRs currently certified by CCHIT will need to reapply for certification under ONC-ATCB. Slide 21

22 EMR Certification Timing For ATCBs: ONC expects to begin posting ATCBs on their website by September For Certified EMRs: ONC expects to have certified EMRs listed on their website by October Slide 22

23 Complete EMRs & EMRs w/ Modules Certification can be attained by either a single system that meets all the certification requirements (complete EMR) or through a combination of EMR modules*, that together constitute a complete EMR. However, each module must be tested and certified in accordance with the certification program established by the ONC. *EMR module means any service, component, or combination thereof that can meet the requirements of at least one of the adopted certification criterion adopted. Slide 23

24 What About Existing EMRs? Will my existing EMR qualify? Yes, as long as your EMR vendor applies for and obtains certification from the ONC-ATCB Be sure you are checking with your existing EMR vendor to determine their plans for certification. Some EMR vendors are not applying for certification on earlier versions of their software and an upgrade by your organization may be necessary to qualify for incentives. Slide 24

25 EMR Certification: What About The LIS? Laboratory Information Systems do not need to be certified because Subpart C page of the Federal Register dated July 28, 2010, 45 CFR Part 170, Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology: Final Rule, lists all of the certification criteria, and laboratory information systems do not perform any of the functions listed. Slide 25

26 Meaningful Use Orchard Software Webinar August 19, 2010 Orchard Symposium Keynote Slide 26

27 Meaningful Use Meaningful Use Criteria (defined by the CMS) Specifies HOW an EMR needs to be used by providers and hospitals to qualify for incentives For more information: EHRIncentivePrograms/ Slide 27

28 Meaningful Use (MU) Criteria Now that you have a certified EMR, what do you need to do to meet MU criteria? The ARRA specifies 3 components: Use certified EMR in a meaningful manner Use certified EMR technology for electronic exchange of health information Use certified EMR technology to submit clinical quality measures 3 Stages over 5 Years Only MU Stage 1 has been defined Slide 28

29 Meaningful Use (MU) Criteria Stage 1 15 Core Objectives (14 for hospitals) 5 out of 10 Objectives from a menu 6 total Clinical Quality Measures 3 from core measures (or alternate core measures) 3 out of 38 measures from a menu Slide 29

30 Stage 1 MU Core Objectives 1. Computerized Physician Order Entry (CPOE) of medication orders (not lab orders yet, per Stage 1 MU) 2. E-Prescribing (erx) **ambulatory only** 3. Report ambulatory/hospital clinical quality measures to CMS/States 4. Implement one clinical decision support rule 5. Provide patients with an electronic copy of their health information, upon request 6. Provide clinical summaries for patients for each office visit or discharge summaries 7. Drug-drug and drug-allergy interaction checks Slide 30

31 Stage 1 MU Core Objectives cont. 8. Record demographics 9. Maintain an up-to-date problem list of current and active diagnoses 10. Maintain active medication list 11. Maintain active medication allergy list 12. Record and chart changes in vital signs 13. Record smoking status for patients 13 years or older 14. Capability to exchange key clinical information among providers of care and patient-authorized entities electronically 15. Protect electronic health information Slide 31

32 Menu Objectives Choose 5 of 10 (and one must be a public health objective so noted by ^) Drug-formulary checks Incorporate clinical lab test results as structured data Generate lists of patients by specific conditions Send reminders to patients per patient preference for preventive/ follow-up care **ambulatory only** Provide patients with timely electronic access to their health information Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate Slide 32

33 Menu Objectives cont. Medication reconciliation Summary of care record for each transition of care/referrals Capability to submit electronic data to immunization registries/ systems^ Capability to provide electronic syndromic surveillance data to public health agencies^ Record advanced directives for patients 65 years or older **hospital only** Capability to provide electronic submission of reportable lab results to public health agencies^ **hospital only** Slide 33

34 Core Clinical Quality Measures Slide 34

35 Alternate Clinical Quality Measures Slide 35

36 Clinical Quality Measures 1. Diabetes: Hemoglobin A1c Poor Control 2. Diabetes: Low Density Lipoprotein (LDL) Management and Control 3. Diabetes: Blood Pressure Management 4. Heart Failure (HF): Angiotensin Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) 5. Coronary Artery Disease (CAD): Beta Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) 6. Pneumonia Vaccination Status for Older Adults 7. Breast Cancer Screening 8. Colorectal Cancer Screening Slide 36

37 Clinical Quality Measures cont. 9. Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD 10. Heart Failure (HF): Beta Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) 11. Anti depressant Medication Management: (a) Effective Acute Phase Treatment, (b)effective Continuation Phase Treatment 12. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation 13. Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy 14. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care 15. Asthma Pharmacologic Therapy 16. Asthma Assessment Slide 37

38 Clinical Quality Measures cont. 17. Appropriate Testing for Children with Pharyngitis 18. Oncology Breast Cancer: Hormonal Therapy for Stage IC IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer 19. Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients 20. Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients 21. Smoking and Tobacco Use Cessation, Medical assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies 22. Diabetes: Eye Exam 23. Diabetes: Urine Screening Slide 38

39 Clinical Quality Measures cont. 24. Diabetes: Foot Exam 25. Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL Cholesterol 26. Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation 27. Ischemic Vascular Disease (IVD): Blood Pressure Management 28. Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 29. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement 30. Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) 31. Prenatal Care: Anti D Immune Globulin 32. Controlling High Blood Pressure Slide 39

40 Clinical Quality Measures cont. 33. Cervical Cancer Screening 34. Chlamydia Screening for Women 35. Use of Appropriate Medications for Asthma 36. Low Back Pain: Use of Imaging Studies 37. Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control 38. Diabetes: Hemoglobin A1c Control (<8.0%) Slide 40

41 Review: Meaningful Use (MU) Criteria Stage 1 15 Core Objectives (14 for hospitals) 5 out of 10 Objectives from a menu 6 total Clinical Quality Measures 3 from core measures (or alternate core measures) 3 out 38 measures from a menu Slide 41

42 What s coming for Stages 2 & 3? The correct answer at this time is, Not sure. It is expected that eventually ALL of the menu items will become core objectives for MU. Stage 2 MU is expected in January Stage 3 MU is expected in January Slide 42

43 How does this impact your lab? Orchard Software Webinar August 19, 2010 Orchard Symposium Keynote Slide 43

44 What does this mean for the POL and clinics? Opportunities: Increase value of the lab Enhance relationship with the IT department Considerations: Educate Communicate Get involved Slide 44

45 What does this mean for hospitals? Focus: Inside Outside (What about outpatient testing and your outside provider trying to meet MU objectives with their own EMRs?) Opportunities: Increase value of the lab Enhance relationship with the IT department Considerations: Educate, communicate and get involved Single-source vendors recommending replacement of all best-of-breed systems Slide 45

46 Opportunities: What does this mean for reference labs? Leadership role for your clients Considerations: Necessary resources for integration (e.g. Systems, interface engines, and IT support) Slide 46

47 For More Information Orchard Software Webinar August 19, 2010 Orchard Symposium Keynote Slide 47

48 For more information ONC for EMR Certification CMS for Incentives and Meaningful Use Criteria Orchard Software (800) Slide 48

49 Questions & Answers If time allows, we will answer questions at the end of the webinar. To ask questions during the presentation use the convenient dashboard toolbar (see example below) in the lower right-hand corner of your screen. Click on the? icon. If we cannot get to your questions by the end of the presentation, we will answers to your questions as soon as we can. Orchard Software Webinar August 19,Up 2010 Orchard Symposium 2007: Setting Rules in Harvest LIS Slide 49

50 Submit Questions to Orchard: Slide 50

51 If you don t have time to do it right, when will you have time to do it over? John Wooden, Legendary UCLA Basketball Coach Orchard Software Webinar August 19, 2010 Orchard Symposium Keynote Slide 51