ARRA HITECH Programs and Goals Where is Nevada?

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1 ARRA HITECH Programs and Goals Where is Nevada? Regional Extension Center HealthInsight NV and UT $7,151,783 awarded, 50% to NV or $3,575,892 Feb Feb Approx. 700 NV providers enrolled out of 3,000 eligible providers. Workforce Training Estimated 2,500-3,000 IT professionals needed in NV over next 3-5 yrs. College of Southern Nevada (CSN) awarded $717,430 for new program, 300 graduates required by Dec Graduates to date, 102 currently enrolled. Medicare & Medicaid Incentives Approx. $500K initial incentives disbursed to 30 NV Medicare eligible providers. Anticipated $80M in NV Medicaid Incentives to be paid Adoption of EHRs Meaningful Use of EHRs as of October 3, 2011 Improved individual and population health outcomes Increased transparency and efficiency Improved ability to study and improve care delivery State HIE Cooperative Agreement $36B appropriated nationally, NV awarded $6,133,426 Funds 4 state level positions, including required State HIT Coordinator, through grant period, 2/8/10 2/7/14. Approximated $635K required match (not General Funds). Potential new small business opportunities for HIT services. Beacon Communities 17 Awards Nationwide, $265M Total Renown unsuccessful after applying during both submission opportunities Security & Privacy framework Exchange of Health Information NV Senate Bill 43 (2011) Research to enhance HIT Adoption Collaborative efforts by the Univ. of IL at Urbana-Champaign, 1eebngggeee the Univ. of TX at Houston, Harvard, and the Mayo Clinic of Medicine, $60M Total Standards & Interoperability Framework Over 500 Certified EHR Products Available to Providers 32 products in use in NV, 12 products make up approx. 88% of market.

2 HITECH CMS EHR Incentives for Eligible Providers and Hospitals The Medicare EHR Incentive Program The Medicare EHR Incentive Program provides incentive payments to eligible professionals, eligible hospitals, and CAHs that demonstrate meaningful use of certified EHR technology. Participation can begin as early as Eligible professionals can receive up to $44,000 over five years under the Medicare EHR Incentive Program. There's an additional incentive for eligible professionals who provide services in a Health Professional Shortage Area (HPSA). To get the maximum incentive payment, Medicare eligible professionals must begin participation by Incentive payments for eligible hospitals and CAHs may begin as early as 2011 and are based on a number of factors, beginning with a $2 million base payment. For 2015 and later, Medicare eligible professionals, eligible hospitals, and CAHs that do not successfully demonstrate meaningful use will have a decreased payment adjustment in their Medicare reimbursement. The Medicaid EHR Incentive Program The Medicaid EHR Incentive Program provides incentive payments to eligible professionals, eligible hospitals, and CAHs as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in their first year of participation and demonstrate meaningful use for up to five remaining participation years. The Medicaid EHR Incentive Program is voluntarily offered by individual states and territories and may begin as early as 2011, depending on the state. Eligible professionals can receive up to $63,750 over the six years that they choose to participate in the program. Eligible hospital incentive payments may begin as early as 2011, depending on when the state begins its program. The last year a Medicaid eligible hospital may begin the program is Hospital payments are based on a number of factors, beginning with a $2 million base payment. There are no decreased payment adjustments under the Medicaid EHR Incentive Program.

3 Adoption of Health Information Technology Physician Incentives as described in the American Recovery and Reinvestment Act of Rev. Jul 13, 2010 Page 1: Payment Incentives, Medicare Penalties, Other Incentives Page 2: Eligibility, Definitions PAYMENT INCENTIVES Physicians must choose between Medicare and Medicaid incentives Medicare Beginning with professional services provided in 2011, physicians who adopt and use electronic health records (EHRs) to improve care may receive to up to $44,000 over five years if they have at least $24,000 in Medicare allowed charges per year. Incentive payments would be equal to 75% of the allowed charges for all covered professional services furnished each year up to a maximum payment as shown in the following table: MAXIMUM MEDICARE INCENTIVE Year of Services First Year of Meaningful Use of EHR * 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 $ $2,000 $4,000 $4,000 $0 Total Max $44,000 $44,000 $39,000 $24,000 $0 *There will be no incentive payments for those who reach meaningful use after 2014 and penalties will begin in 2015 Eligible professionals predominantly furnishing services in a health professional shortage area will be eligible for an additional 10% maximum incentive payment each year. Medicare Penalties Medicaid Beginning in 2011, states will pay eligible Medicaid providers up to $63,750 (reduced by payments from any other sources) for certified EHR technology and support services including maintenance and training necessary for adoption and operation. Incentives may not exceed: 1) Year 1: $ 21,500. per provider 2) Subsequent Years: $8,500 per provider, for up to five years, but no later than If a provider has completed adopting, implementing, or upgrading such technology prior to the first year of payment, #1 & #2 above will still apply. This translates to a maximum payment of: Year MAXIMUM MEDICAID INCENTIVE Year 2 Year 3 Year 4 Year 5 Year 6 Total Max $21,250 $8,500 $8,500 $8,500 $8,500 $8,500 $63,750 Please ask your HealthInsight representative about your specific incentive amount if you received payments for EHR technology or support services from other sources. Otherwise, the maximum incentives above apply. There will be no incentive payments after If the eligible professional has not demonstrated meaningful use of their EHR by 2015, the fee schedule for furnished services will be reduced by 1% each year beginning in 2015, to a maximum reduction of 3%. Hardship exceptions may apply. OTHER INCENTIVES 1) All Medicare providers who become meaningful users of an EHR will be recognized on the CMS website. 2) Low cost loans and grants may be available for purchase of hardware, software, and implementation. 3) Assistance with selection, adoption, and workflow re-design will be provided by the Health Information Technology Regional Extension Center For information see or contact HealthInsight by phone, , fax or rec@healthinsight.org. This material was prepared by HealthInsight as part of our work as the Regional Extension Center for Nevada and Utah, under grant #90RC0033/01 from the Office of the National Coordinator, Department of Health and Human Services.

4 ELIGIBILITY Medicare To be eligible for the payment incentives, providers must: 1) Use a certified EHR in a meaningful* manner; 2) Exchange* health information to improve the quality of care; and 3) Report* on clinical quality measures. 4) Meet these requirements by the 2014 payment year, although those ready by will earn the most 5) Be a practicing MD, DO, DDS, DMD, DPM, OD, or Chiropractor *See definitions below Medicare Advantage (MA)-Affiliated Physicians: Physicians employed by a MA organization are eligible if the organization attests that they are meaningful EHR users. A contracted physician is eligible if he/she furnishes at least 80% of the entity s Medicare patient care services; at least 80% of his/her services are provided to the entity s enrollees; and provides at least 20 hours per week of patient care service. Medicaid To be eligible for the payment incentives, providers must: 1) Be an eligible professional* that is not hospital-based and has at least 30% of patient volume attributable to Medicaid; or 2) Be a pediatrician, who is not hospital-based and at least 20% of the volume is attributable to Medicaid (These physicians will be eligible for two-thirds of the indicated payments); or 3) Practice predominantly in a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) and have at least 30% of patient volume attributable to needy individuals* To receive Medicaid incentives in the initial year, an EP only needs to demonstrate that they have engaged in efforts to adopt, implement, or upgrade certified EHR technology but by the second year they need to show meaningful use* of the EHR. DEFINITIONS *See definitions below. Meaningful Use of Certified EHR Technology: The eligible professional demonstrates that he/she is using certified EHR technology in a meaningful manner (see HealthInsight s What is Meaningful Use document), which includes the use of electronic prescribing. Demonstration of Meaningful Use A professional may satisfy the demonstration requirement through means specified by the Secretary, which may include: 1) An attestation 2) The submission of claims with appropriate coding 3) A survey response 4) Reporting on clinical quality measures using an EHR 5) Other means specified by the Secretary Note: The Secretary may not require the electronic reporting of information on clinical quality measures unless the Secretary has the capacity to accept the information electronically, which may be on a pilot basis. Program Registration To be eligible, all providers must meet the following registration requirements: Register via the EHR Incentive Program website (registration will be available early 2011) Be enrolled in Medicare FFS, MA, or Medicaid (FFS or managed care) Have a National Provider Identifier (NPI) Be enrolled in PECOS (Medicare providers only) MEDICAID SPECIFIC DEFINITIONS Eligible Professional: 1) Physician 2) Dentist 3) Certified nurse mid-wife 4) Nurse practitioner 5) Physician assistant practicing in a rural health clinic that is led by a physician assistant, or is practicing in a FQHC Needy Individual 1) Receives Medicaid 2) Receives assistance under Title XXI (SCHIP) 3) Furnished uncompensated care by the provider 4) Charged a reduced rate based on ability to pay This material was prepared by HealthInsight as part of our work as the Regional Extension Center for Nevada and Utah, under grant #90RC0033/01 from the Office of the National Coordinator, Department of Health and Human Services.

5 HITECH CMS EHR Incentives for Eligible Providers and Hospitals The Medicare EHR Incentive Program The Medicare EHR Incentive Program provides incentive payments to eligible professionals, eligible hospitals, and CAHs that demonstrate meaningful use of certified EHR technology. Participation can begin as early as Eligible professionals can receive up to $44,000 over five years under the Medicare EHR Incentive Program. There's an additional incentive for eligible professionals who provide services in a Health Professional Shortage Area (HPSA). To get the maximum incentive payment, Medicare eligible professionals must begin participation by Incentive payments for eligible hospitals and CAHs may begin as early as 2011 and are based on a number of factors, beginning with a $2 million base payment. For 2015 and later, Medicare eligible professionals, eligible hospitals, and CAHs that do not successfully demonstrate meaningful use will have a decreased payment adjustment in their Medicare reimbursement. The Medicaid EHR Incentive Program The Medicaid EHR Incentive Program provides incentive payments to eligible professionals, eligible hospitals, and CAHs as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in their first year of participation and demonstrate meaningful use for up to five remaining participation years. The Medicaid EHR Incentive Program is voluntarily offered by individual states and territories and may begin as early as 2011, depending on the state. Eligible professionals can receive up to $63,750 over the six years that they choose to participate in the program. Eligible hospital incentive payments may begin as early as 2011, depending on when the state begins its program. The last year a Medicaid eligible hospital may begin the program is Hospital payments are based on a number of factors, beginning with a $2 million base payment. There are no decreased payment adjustments under the Medicaid EHR Incentive Program.

6 MEANINGFUL USE (MU) FAST FACTS Intent: Better health care does not come from the adoption of technology itself. It is accomplished through the exchange and use of health information for effective clinical decisions at the point of care. Definition: Providers need to show they are using federally-certified EHR technology in ways that can be measured significantly in quality and in quantity. The three stages of MU criteria each include both a core set and a menu set of objectives that are specific to eligible professionals or eligible hospitals and CAHs. MU Stage 1: Electronically capturing health information in a coded/structured format Using that information to track key clinical conditions Communicating that information for care coordination purposes First Incentive Payment Year: 2011 Priority Area #1: Improve quality, safety, efficiency, and reduce health disparities Priority Area #2: Engage patients and their families in health care Priority Area #3: Improve care coordination Priority Area #4: Improve public health (e.g., coordination with immunization registries) MU Stage 2: The use of HIT for continuous quality improvement at the point of care The electronic exchange of information in the most structured format possible Stage 1 Menu Set objectives/measures will be transitioned into the Stage 2 Core Set, with increased thresholds required First Incentive Payment Year: 2013 MU Stage 3: Improving quality, safety, and efficiency by requiring physicians to meet a minimum expected performance level Decision support for national high priority conditions Patient access to self-management tools Access to comprehensive patient data Improving population health First Incentive Payment Year: 2015

7 32 Federally-Certified EHR Products Used in Nevada as of Oct. 4, 2011 Top 12 Products - combined 88% market share * Allscripts MedServices-Data Net * Alteer * Micro MD Amazing Charts EHR * NextGen EHR eclinicalworks Practice Fusion * e-mds Solution Series EMR * Sage * Greenway Prime Suite SOAPware * E-Prescribing module approved by the Nevada State Board of Pharmacy, pursuant to NRS , NRS and NAC (Effective 2003) Remaining 20 Products AltaPoint Aprima Athenahealth Chartlogic Digichart/Advanced MD EncounterPro Epic HealthProbe I Patient Care InforMed Praxis Insync Intergy InTuun MedInformatix Medisoft Clinical EMR Medstreaming OfficeAlly PrognoCIS Quest 360 EHR SB Clinical Additional E-Prescribing Systems Approved by the Nevada State Board of Pharmacy BioMedix Vascular Solutions/TRAKnet DPM Cardinal Health Nuclear Pharmacy Services Catalis Inc. Cleveland Clinic Desert Orthopaedic Center DrFirst Inc. GE Healthcare Gmed H2H Solutions, Inc. (H@H Disgital Rx) iknowmed, US Oncology Life-File meridianemr, Inc. McKesson MedPlus MinuteClinic Misys Healthcare Systems Mountain Medical Technologies, Inc. Netsmart Technology NewCrop, LLC Renown Health RxNT SRSsoft SuiteMed + Meditab Software SureScripts, LLC University Medical Center of S Nevada