Presentation on the EHR Stimulus package (ARRA) in Austin, TX covering the important topics of "meaningful use" and "certified EHR" and how the EHR stimulus will be paid to doctors.
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2. How much EHR Stimulus Money? ARRA – HITECH Act – EHR Stimulus Estimated $19.5 Billion Spent on Stimulus $2 Billion for Office of National Coordinator (ONC) $36.3 Billion for Medicare and Medicaid Incentives Savings of $18.8 Billion Improved Efficiencies Tax Revenue Reduce Fee Schedule Payments from Penalties Medicare or Medicaid Bonuses
6. Medicaid Details More Complicated Process Reimbursement is Percentage of EHR expenditures Extended Time Horizon (through 2021) Must Demonstrate 20-30% of Patients are Covered by Medicaid Must Show “Meaningful Use” GW Study 15% of Physicians Qualify 99% of Federally Qualified Health Centers (FQHC) 45,000 Office Based Physicians
8. EHR Sales Lines Move quickly…EHR deployment back-log! You won’t be ready to show “meaningful use!” The government requires you buy an EMR Simply buy a CCHIT-certified product
9. 2 Main Requirements “Meaningful Use” “Certified EHR” Challenge Still Only Partially Defined
10. Meaningful Use Matrix Measures Improve quality, safety, efficiency and reduce health disparities Engage patients and families Improve care coordination Improve population and public health Ensure adequate privacy and security protections for personal health information Requirements Increase Over Time Provide Patients e-copy of Data (2011) Real Time PHR Access (2015)
11. EHR Certification CCHIT Only Current EHR Certification Other EHR Certifications? “ Many certified EHRs are neither user-friendly nor designed to meet HITECH's ambitious goal of improving quality and efficiency in the health care system.“ - Dr. David Blumenthal, NEJM April 2009
12. Proposed CCHIT Certification Paths EHR-C EMR Company Certification EHR-M “Module” Certification EHR-S Site Certification
13. Cost of Certified EHR EHR Matrix of Prices Average for Certified EHR - $30,690.80 Average for Non-Certified EHR - $17,066.00 Cost of EHR Certification $20-30k Cost of Extra Development One EMR Vendor Estimated $200,000 in Development Costs Many Unnecessary Requirements
14. Problems with CCHIT Certification More Successful Installs – Where’s the proof? De-install Rate is Large Stability of Certified EHR Vendors Jabba the Hut EMR Companies
15. Timelines 6/16/09 – Meaningful Use Matrix 7/16/09 – HIT Policy Committee Presents Next Revision of Meaningful Use “Meaningful Use” Implementation Guide in July 7/21/09 – HIT Standards Committee Presents Standards and Certification Criteria Interim Final Rule by December 31st
16. Lessons Learned from Past Incentives PQRI, P4P and ePrescribing Only 52% of participants got paid Only $600 per individual participating Only 2 of the 10 made a profit Not notified of problems for years Scenarios
17. Guaranteed EHR Benefits Legibility of Notes Accessibility of Charts No More Lost Charts Multiple Users Accessing Chart Disaster Recovery Drug to Drug and Allergy Interactions
18. EHR Pricing Models One Time Cost Plus Annual Maintenance Monthly Cost Per Provider Cost Per Visit Free EMR
19. Online Resources EMR Forum http://www.emrupdate.com Selecting an EMR http://www.emrconsultant.com My Website http://www.emrandhipaa.com Regional EHR Training Centers?
Under the Medicaid program, nurse practitioners and nurse mid-wives can file for incentive payments. Additionally, Physician Assistants (PAs) are included but only insofar as the PA is practicing in a rural health clinic that is led by that PA or is practicing in a Federally qualified health center that is so led. Medical Assistants and Physical Therapists are not included. Mid-levels are not included in the Medicare portion of the incentives. Physicians who practice in an area that is designated as a health professional shortage area shall receive an additional 10 percent incentive.
If the Secretary finds that less than 75% of eligible healthcare professionals are utilizing EHR beginning in 2018, the Secretary can further reduce the fee schedule to 96% and then 95% in subsequent years but not further.
Incentive payments will be based on a calculation that factors the physician’s Medicaid mix in combination with up to $25,000 the first year and $10,000 each subsequent year for five years, all multiplied by 85%. The highest potential for Medicaid payments is $63,750. Additionally, physicians filing under Medicaid must first demonstrate EHR usage by 2015 and will not be eligible for payments after 2021.
A lower 20 percent threshold can be used in the case of pediatricians.99% of federally qualified health center (FQHC) physicians.If all qualifying physicians apply for the Medicaid incentives the federal government would invest more than $2.8 billion in healthcare IT.About 45,000 office-based physicians may be eligible for up to $63,750 in ARRA funding over six years
http://www.healthimaging.com/index.php?option=com_articles&view=article&id=17532Implementation Guide for "Meaningful Use" in July
Takes Less TimeFinding and Retrieving Notes (milliseconds)Doing Refills (minutes)Faxing Off Prescriptions (seconds)Making Appointments (seconds)Looking Up Results (milliseconds)Doing Calculations (DAS28, Framingham) (seconds)Drug Interactions (seconds)Reporting to Recall Patients (minutes)Reprinting Letters (seconds)Looking Up ICD9s (seconds)Takes More time Documenting an Encounter Level of Documentation Is Now Higher than BeforeEntering Initial Diagnosis List
Once a provider starts collecting incentive payments for meaningful use of an EHR (whether in 2011 or beyond), he or she can continue to collect PQRI payments but cannot continue to collect ePrescribing payments.
