CTS - ARRA (Stimulus) Overview Briefing
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Briefing document to share the impact of the American Recovery Reinvestment Act (ARRA) on healthcare.
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CTS - ARRA (Stimulus) Overview Briefing
- 1. CareTech Solutions The American Recovery & Reinvestment Act of 2009 Health Care Perspective
- 2. What is it? $790 billion total Approximately $30 billion allocated towards the improvement of healthcare Training for HITECH “Comparative Chronic Community more primary includes $19 Effectiveness” care Health IT Diseases Health Centers billion for Research Renovation research physicians and health nurses information technology 2 Confidential – This document shall not be disclosed or used outside Customer Name and its affiliates without the consent of CareTech Solutions, Inc. – Date
- 3. $19 Billion Break Down Hospital & Physician Incentive Bonuses from $17 Medicare/Medicaid Billion $19 Billion HHS Discretionary Funds : $2 Standards, Grants , HIE Infrastructure, Billion Loans to the States for EHR, Regional HIT Resource Centers, Telemedicine, Efficacy Studies 3 Confidential – This document shall not be disclosed or used outside Customer Name and its affiliates without the consent of CareTech Solutions, Inc. – Date
- 4. HITECH Act: Overview HIT infrastructure for interoperability Establish CCHIT Standards Save by 2010 Government $12 billion Strengthen Privacy and Security Laws Results: 90% of Doctors and 70% of Hospitals using comprehensive EHR by 2020 4 Confidential – This document shall not be disclosed or used outside Customer Name and its affiliates without the consent of CareTech Solutions, Inc. – Date
- 5. HITECH Act: Physician Incentives “Meaningful” use of • $17 billion certified product that is • Starting FY11. connected and compiles • Decreasing sliding scale over time. with submission of • Penalties for non-compliance FY15 clinical quality measures • Choose one program Medicare/caid • $44 – 66 K from over 5 years if utilizing by 2011 Reimbursements: • Fee Reductions for non-EHR users Physician EHR adoption • Penalties Start 2015 for noncompliance benefits • Site of Service defined as not in hospital • Up to $2 million plus discharge bonuses (estimated $10 million+ Hospitals payout per hospital) 5 Confidential – This document shall not be disclosed or used outside Customer Name and its affiliates without the consent of CareTech Solutions, Inc. – Date
- 6. HITECH Act: HHS Discretionary Funds • $2 billion Secretary HHS has 90 days to • 90 day window started develop spending 04.30.09 plan • Standards requirements due by 12.31.09 • HIE Infrastructure & National Health Information Network (NHIN) • Regional Health IT Resource Centers Areas of focus • Federal grants through AHRQ, HRSA, CMS • Grants to the states in 2010 for HIT and EHR Loans • Promote advanced EHR – disease mgmt., quality care measures 6 Confidential – This document shall not be disclosed or used outside Customer Name and its affiliates without the consent of CareTech Solutions, Inc. – Date
- 7. HITECH Act: Standards & Privacy • Focused on rapidly increasing interoperability capabilities, EHR privacy protections and Standards regional HIE efforts • Standards to harmonization organization and a health IT certification organization (CCHIT) • Define breach actions • Impose restrictions on certain disclosures, sales, & marketing of Privacy – Expand protected health information • Require an accounting of disclosures to a patient upon request HIPAA for EHR • Authorize increased civil monetary penalties for HIPAA violations • Grant authority to state attorneys general to enforce HIPAA 7 Confidential – This document shall not be disclosed or used outside Customer Name and its affiliates without the consent of CareTech Solutions, Inc. – Date
- 8. Additional Funding Prevention & • $1 billion Wellness Community Health • $1.5 billion Centers Primary Care • $200 million Provider Training Indian Health • $415 million ($85 million for IT) Services NIH Research & • $10 billion Facilities 8 Confidential – This document shall not be disclosed or used outside Customer Name and its affiliates without the consent of CareTech Solutions, Inc. – Date
- 9. EHR - Big Goal! Fact: • There are over 800,000 clinicians in the US. • 17% * have EHRs today. • This leaves 664,000 who need EHRs. • Over the next 5 years the early to mid-adopters will work hard to gain the full stimulus incentive amounts available in 2011-2012. • Late adopters will gain the reduced stimulus available in 2013-2014. • Resistors will begin receiving penalties in 2015. * The Wall Street Journal reports that only 9% of Clinicians utilize a Comprehensive EHR (03.26.09) Source: Certification Commission for Healthcare Information Technology (CCHIT) 9 Confidential – This document shall not be disclosed or used outside Customer Name and its affiliates without the consent of CareTech Solutions, Inc. – Date
- 10. EMR Adoption Model It is believed that a hospital rated stage 4 or higher on the HIMSS EMR Adoption Model will meet “Meaningful Use” criteria as defined in ARRA. % of U.S. % of U.S. HIMSS Hospitals Cumulative Capabilities Hospitals Analytics 2007 2008 (Final) (Final) Medical record fully electronic; 310 of the 5,166 Stage 7 Organization able to contribute to Electronic Health 0.0% 0.3% surveyed meet Record (EHR) as byproduct of EMR level 4 Physician documentation (structured templates), requirements Stage 6 0.3% 0.5% full CDSS (variance and compliance), full PACS Stage 5 Closed loop medication administration 1.9% 2.5% Stage 4 CPOE, CDSS (clinical protocols) 2.2% 2.5% Clinical documentation (flow sheets), CDSS Stage 3 25.1% 34.7% (error checking), PACS available outside Radiology Clinical Data Repository, Controlled Medical Vocabulary, Stage 2 37.2 31.4% Clinical Decision Support System (CDSS) Capability Stage 1 Ancillaries - Lab, Radiology, Pharmacy 14.0% 11.5% Stage 0 All three ancillaries not installed 19.3% 15.6% Total Hospitals N=5,703 N=5,166 10 Confidential – This document shall not be disclosed or used outside Customer Name and its affiliates without the consent of CareTech Solutions, Inc. – Date
- 11. Key Questions • Incentive Payments Begin in FY 2011 (October 1, 2010), however The Secretary needs to determine if the payment will be installments or lump sum. • No restrictions on how you may spend the money. • “Hospital based” physicians are not eligible; ie Pathologists, ER Physicians, Anesthesiologists. (Site of Service) • “Meaningful Use” must be defined by December 31, 2009. • CCHIT will most likely be named as the EHR system certification committee. Yr of Adoption 2011 2012 2013 2014 2015 2016 2017 • How does the Payment for adopting in FY 100% 75% 50% 25% Hospital Medicare 2011 or prior “sliding scale” First Adoption 2012 100% 75% 50% 25% for adoption work? First Adoption 2013 100% 75% 50% 25% First Adoption 2014 75% 50% 50% First Adoption 2015 50% 25% Penalties if not adopted by 33% 66% 100% 2015. three-quarters of the market basket update is reduced by: 11 Confidential – This document shall not be disclosed or used outside Customer Name and its affiliates without the consent of CareTech Solutions, Inc. – Date
- 12. Next Steps • The time to start is now • Update/ Create a Strategic Plan for IT Tied to Hospital Business Drivers • Evaluate Current Process & Procedures • Launch/ Optimize Current Procedures to Meet EHR Requirements • Demonstrate “Meaningful Use” of certified EHR product with e Prescribing capability • Connect Physician Offices & Other Providers for Improved Access to Patient Records • Insure Ability to Report Technology Use to HHS • Review Training Programs for Primary Care Providers 12 Confidential – This document shall not be disclosed or used outside Customer Name and its affiliates without the consent of CareTech Solutions, Inc. – Date
Notes de l'éditeur
- So what is next?These provision are being further defined as we speak. We know that framework or destination for what is required moving forward, but we don’t have an exact map. The guidance we have been given by leader in the healthcare industry has been consistent though – YOU MUST HAVE A PLAN. You need to review your current process and procedures. Are you ready for a connected healthcare world.Check with your current HIS providers and make sure they have a plan to have their products/ tools certified quickly. You need to make sure that your physicians/ staff is trained on your current technology. They need to have proficient computer skills to be able to input patient/ clinical data. The time to plan is now, once the details of the provisions/ incentives are release you must be able to move quickly to put them in place so that you can benefit.
- This high-level break down shows that potential opportunity available for Healthcare. There are also other potential funds that might be secured in other areas of the bill. For example, several billions of dollars have been provisioned for infrastructure related improvements broadband expansion in rural areas. It is noted in this provision that $2.5 billion of the $7.2 billion will be authorized through the Rural Electrification Act of 1936 for Distance Learning, Telemedicine and Broadband programs. The other $4.7 billion is provisioned as grants to entities of public interest (like non-profit hospitals and foundations) that are found to be in the public interest. These grants can be used to acquire equipment and other technologies related to providing broadband service infrastructure. It is noted that entities that use this money to enhance the delivery of healthcare will receive special consideration. In these cases you need to read the fine print as well. Recipients of these loans may only secure money for one of the two provisions, not both.
- There are four goals of the HITECH provision.The government through (we believe) Certification Commission for Healthcare Information Technology (CCHIT) will take the leadership position to develop and establish the standards for a nation-wide electronic exchange of health information by 2010. The intent is that is will result in improving quality and the coordination of care.This will establish the foundation for a HIT infrastructure for interoperability. The outlined government incentives in the HITECH provision are there to reward the physicians/ hospitals to install & utilize “certified” systems or products that support electronic exchange of patient’s health care information (HIT). These certified products support a standard definition of a EHR record as defined by CCHIT (we believe, but not defined at this time) and allow for interoperability, meaning that system or product has the ability to work with other systems or products without special effort on the part of the customer/ user. The government believes this will save then $12 billion by generating additional healthcare savings through quality of care and care coordination, and reductions in medical errors and duplicative care.They also believe it will also strengthen Federal privacy and security laws to protect identifiable health information from misuse as the health care sector continues to increase the use of Health IT.The desired result is that 90% of Doctors and 70% of Hospitals will be using a comprehensive EHR by 2020.
- The physician/ hospital will need to show (and let me read this quote) “meaningful use” of a certified product that is connected and complies with submission of clinical quality measures.This means that the physician/ hospital will need to be using products/ tools that meet certain standards of data capture and quality. They must demonstrate the ability to share data across other entities (physicians/ hospitals) and they will need to submit data to other entities, potentially government agencies reviewing patient care data.Options may exist for home-grown tools to be “certified” by the government, but this will take time, effort and money to accomplishment.The incentives are tiered and big. Both physician and hospitals will benefit. I have attached a separate calculator that was released by the AHA so that you can calculate incentives. The calculations are fairly complicated, but the spreadsheet will make it easy to understand your drivers to gain those benefits.It must be noted that “early adopters” receive the most money. Late adopter will receive less. Non-adopters will be penalized starting in 2015.
- Defining Health Information Technology (HIT) and Electronic Health Records (EHR) A “qualified electronic health record” is defined as an electronic record of health-related information on an individual. It contains patient demographics and clinical health information, such as medical history and problem lists. The system should have the capacity to provide clinical decision support and support physician order capacity. In addition, it should be able to capture and query quality information and have the capacity to exchange and integrate electronic health information fro other sources.HIT is defined as hardware, software, integrated technologies and related licenses, intellectual property, upgrades and packaged solutions sold as services that are specifically designed for use by health care entities for the electronic creation, or exchange of health information.A “Certified EHR Technology” is a qualified EHR that is certified according to a process developed by the National Institute of Standards and Technology (NIST) that is applicable to the type of record involved, such as ambulatory EHR or an inpatient hospital EHR. NIST will define the record, data capture and exchange standardsCCHIT will certify the solutions/ products to insure that they meet those standards and review quality measures.Further definition/ language has been defines for privacy and security of the data and what will happen if a breach occurs.
- Other opportunities exist for funding. Prevention and Wellness – This fund provide $650 million to carry out evidence-based clinical & community prevention and wellness strategies to address chronic disease rates, and $50 million to states to implement health care acquired infection reduction strategies.CHC – There is $1.5 billion for the modernization of CHCs. This includes renovation, construction, equipment and technology improvements. There is also an additional $500 million to provide care to uninsured and underserved rural and urban populations.Training - $200 million is allocated to physician and nurse training programs. (An additional $500 million is allocated to address health professional workforce shortages. This is for scholarships, grants and training programs. Additional money is also allocated to the National Health Services Corps program.)Indian Health Services - $415 million for maintenance of current and construction of new facilities. $85 million of the provision is allocated to HIT activities.NIH Research & Facilities - $10 billion to National Institute for Health (NIH) for clinical trials, research activities, facility improvements, and renovations.
- This is what is driving the market today. In order to meet ARRA defintion of “meaningful use”, but will need to achieve the capabilities listed as stage 4 in the HIMSS Analytical model. Based on the current number released, there is much work to be done