Presentation given in Med-eTel 2011 - Describing the Quality Reporting Initiative in the USA as a stepping stone towards full adoption of EHR in the USA.

1. Physician Quality Reporting Initiative (PQRI) The stepping stone towards EHR adoption in the USA Med@Tel April 2011 Roberto Schliesser VP telemedicine Solutions eWave MD schliesser@ewavemd.com

2. The Cost of Healthcare Is Destroying the Competitiveness of the U.S.A. The Average cost of an MRI is $100 in Japan and $1,000+ in the U.S. Source: World Health Organization OECD 2005-2006 - CDC 2006 - CIA Fact Book 2007 2

3. Bush and Obama Have Created The New World Order of Healthcare 3

4. Winston Churchill “The Americans will always do the right thing . . . After they've exhausted all the alternatives.” 4

5. Kathleen Sebelius Secretary of the Department of Health and Human Services “When electronic health records are well-designed and implemented correctly, they can be a powerful force for reducing errors, lowering costs, raising quality of care, and increasing doctor and patient satisfaction.” 5

6. Dr. David Blumenthal National Coordinator for H.I.T “We need a system in place to be sure that patient information is where it’s needed. It is a core technical competence for physicians to know how to use an EHR.” 6

7. 2000“To Err Is Human”Would You Fly if a 747 Crashed Every Day? Centers for Disease Control and Prevention American Cancer Society, Cancer Facts & Figures 2008 National Highway Traffic Safety Administration, Traffic Safety Facts, August 2010 To Err is Human, Building a Safer Health System By Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, Editors. Committee on Quality of Healthcare in America, Institute of Medicine, National Academy Press, Washington, D.C. (2000)

8. 2002McGlynn’s “U.S. Adults Receive 55% of Recommended Care” Source: McGlynn, et. al., “The Quality of Health Care Delivered to Adults in the United States,” The New England Journal of Medicine, June 26, 2003: 2635-2645.

10. Mandatory hospital quality reporting

11. Deficit Reduction Act of 2005 (DRA)

12. Fee for Valueby 2014

13. 30% reduction in physician payments by 2014

14. Tax Relief and Health Care Act of 2006 (TRHCA)

15. Physician Quality Reporting Initiative (PQRI)

16. Medicare Improvements for Patients and Providers of 2008 (MIPPA)

18. CMS Quality Initiative for Hospitals“The Hawthorne Effect” 92% 91% 70% 64% 2006 2003 2006 2003 CMS/Premier Hospital Quality Incentive Demonstration

19. Dramatic Improvement in Surgery Related Infections Due to Checklist Measures Instituted by CMS in 2006-7 DR. ATUL GAWANDE on PBS NEWSHOUR: In Michigan, when the -- every hospital there adopted a cleanliness checklist to keep infected lines from happening, they had a two-thirds reduction in infections within a year. They saved more than 1,500 lives and more than $200 million. Spreading this across the country multiplies that by 50-fold. See the video and complete transcript here: http://www.pbs.org/newshour/bb/health/jan-june10/gawande_02-08.html

20. CMS Hospital Quality InitiativeFrom Voluntary to Mandatory Reporting Mandatory 2% payment deduction Mandatory 0.4% payment deduction 13

21. 2006Physician Quality Reporting Initiative (PQRI) 2% 1.5 % Voluntary

22. Reporting Methods PQRI Registry Based Reporting Claim Based Reporting Group Measure Reporting Individual Measures Reporting

23. PQRI Bonuses and Penalties

24. 2009Medicare E-Prescribing

25. PQRI and E-Prescribing Initiatives Are Getting Easier to Complete 2009 2010 PQRI Requirement 30 Consecutive Encounters PQRI Requirement 30 Non-consecutive Encounters eRx Requirement 50% of Prescriptions eRx Requirement 25 Prescriptions

26. Carrots and Sticks PQRI Bonus 2% in 2009 PQRI Penalty 2012 ePrescribing Bonus 2% in 2009 ePrescribing Penalty 2012 ARRA Medicare Payments $44,000 for 2011-2016 ARRA Medicare Penalty 2015 ARRA Medicare and Medicaid Payments $44,000-$63,750 for 2011-2016

27. ‘Meaningful Use’

28. $50,000,000,000+Of ARRA* Funding To Revolutionize Healthcare I.T. Sections 3011-3016 Section 6001 and Titles I, XII Sections 4101, 4102, 4201 Grants $10 Billion Entitlements $42 Billion For Healthcare Providers and Hospitals For HIEs, Rural Broadband, Regional Extension Centers, Education and Training *Title IV Health Information Technology for Economic and Clinical Health Act (HITECH)

30. MD/DO

31. Podiatrist

32. Optometrist

33. Oral Surgeon

34. Dentist

35. Chiropractor

36. Therapists

37. Physical Therapist

38. Occupational Therapist

39. Qualified Speech-Language Pathologist

40. Practitioners

41. Physician Assistant

42. Nurse Practitioner

43. Clinical Nurse Specialist

44. Certified Registered Nurse

45. Anesthetist

46. Certified Nurse Midwife

47. Clinical Social Worker

48. Clinical Psychologist

49. Registered Dietician

50. Nutrition Professional

51. AudiologistELIGIBLE professionals are defined by the Tax Relief and Health Care Act of 2006.

52. ARRA Section 4101 – Up to $44,000 For Medicare Providers and Penalties Assumes a Minimum of $25,000 of Medicare Part B Payments Source: Avalere Health LLC

53. Section 4201 — Up to $63,750 For Medicaid Providers Assumes a Minimum of 30% of Medicaid or Underprivileged Patients* *20% for pediatricians ** Subject to reduction This schedule also applies to eligible professionals in a Federally Qualified Health Center or Rural Clinic. 24

54. Examples of “Meaningful Use” Quality Reporting ePrescribing Medication Reconciliation Availability of Lab Results Interoperability Certified by CCHIT* Etc. “Meaningful Use” Will Be Determined By Both the Federal Government and the States *Certification Commission for Healthcare Information Technology

55. Automated PQRI Reporting Using the eHealth Made EASY Registry

56. Login Screen

57. Reporting Homepage

58. Reporting Wizard #1

59. Reporting Wizard #2

60. Reporting Wizard #3 List of available codes is calculated relative to the selected QM settings

61. Reporting Wizard #3 Rule Based engine calculates eligible QM for the encounter and patient, leading the provider in coding the PQRI

62. Sample Compliance Report

63. Thank you!