Russell B Leftwich, MD

Transcription

1 Russell B Leftwich, MD Chief Medical Informatics Officer Office of ehealth Initiatives, State of Tennessee 1

2 Eligible providers and hospitals can receive incentives for meaningful use of certified EHR technology. o Missing information o Quality improvement o Care coordination o Computer decision support o Patient safety 4 2

3 EHR Incentive Programs established by law American Recovery & Reinvestment Act of 2009 Incentive programs for Medicare and Medicaid Programs for hospitals and eligible professionals Use certified EHR technology AND demonstrate adoption, implementation, upgrade or meaningful use Programs differ between Medicare and Medicaid Medicare incentive program is federally run by CMS Medicaid incentive program is run by States Eligibility determined in law Hospital-based EPs are NOT eligible for incentive DEFINITION: 90% or more of their covered professional services in either an inpatient (POS 21) or emergency room (POS 23) of a hospital Definition of hospital-based determined in law Incentives are based on the individual, not the practice 3

4 Up to $44,000 per provider over 5 years Participation must begin by 2014 Must achieve meaningful use for 90 days in first year Incentive payment capped at 75 % of previous years allowed Medicare charges Decreased Medicare payments begin in 2015 if Meaningful Use not achieved Medicaid Eligible Professionals include: Physicians Nurse practitioners Certified nurse-midwives Dentists Physicians assistants working in a Federally Qualified Health Center (FQHC) or rural health clinic (RHC) that is led by a PA 4

5 Medicaid Eligible Professionals must also meet one of the three patient volume thresholds: Have a minimum of 30% Medicaid patient volume Pediatricians ONLY: Have a minimum of 20% Medicaid patient volume (reduced amount if 20-30%) Working in FQHC or RHC ONLY: minimum 30% patient volume attributed to needy individuals CHIP, sliding scale, free care only count towards thresholds if working in RHC or FQHC Other states Medicaid patients count in patient volume Although patient volume is usually calculated per eligible provider, clinics or groups may use calculations based on the group provided: The same method is used for all providers All patients for all providers are included in denominator Only patients in the group are included (if a provider practices outside the group as well) The method used can be audited 5

6 Maximum incentives are $63,750 over 6 years Incentives are same regardless of start year The first year payment is $21,250 (A/I/U) Must begin by 2016 to receive incentives No bonus for health professional shortage areas Incentives available through 2021 Only 1 incentive payment per year $21,250 in payment for first participation year for adoption, implementation of or upgrade to certified EHR technology $8,500 in subsequent years for demonstrating Meaningful Use (through 2021) 90 days in first year of Meaningful Use, full 12 months subsequently Total incentive for 6 years: $63,750 per EP 6

7 Year $21, $8,500 $21, $8,500 $8,500 $21, $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $8, $8,500 $8,500 $8,500 $8, $8,500 $8,500 $8, $8,500 $8, $8,500 Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750 Adopt, implement, upgrade incentive is $14,167 for first year of participation For subsequent years of participation the incentive amount is $5,667 for years 2-6 if meaningful use is met Maximum total amount is $42,500 If participation begins before 2016, years do not have to be consecutive 7

8 MEDICAID only only for 1 st participation year Adopted Acquired or Installed Implemented Commenced Utilization of Upgraded to certified EHR technology Must be EHR technology certified by ONC and listed by specific version on ONC website No EHR reporting period For adopt, implement, upgrade the patient volume is based on 90 days from the previous calendar year It is at the discretion of the provider which consecutive 90 day period is chosen For Meaningful Use the patient volume is calculated based on the reporting period (90 days for the first year, 12 months thereafter) Must have NPI and TennCare provider number 8

9 An Eligible Professional who works at multiple locations, but does not have certified EHR technology available at all of them would: Have to have 50% of their total patient encounters at locations where certified EHR technology is available Would base all meaningful use measures only on encounters that occurred at locations where certified EHR technology is available Improve care coordination Engage patients and families in their health care Improve population and public health Improve quality, safety, efficiency, and reduce health disparities Meaningful Use Maintaining privacy and security 9

10 Stage I Collect structured data (coded) electronically Stage II Use data to improve quality at point of care Exchange data Stage III Improve safety, quality, efficiency with decision support Stage I Stage II Stage III and beyond Defined by Final Rule published July 2010 Draft proposal released January 2011 think uncarved block of wood 20 10

11 EPs must be enrolled in Medicare FFS/MA OR Medicaid/TennCare EP must have an NPI EP must be enrolled in PECOS EP must have an NPPES username and password rexistnpipage.do January 1 Reporting year began for eligible professionals registration is open January 3 For Medicaid providers, states may launch their programs if they so choose (15 states have launched program) April 18th Attestation for the Medicare EHR Incentive Program began (90 days of consecutive meaningful use) May EHR Incentive Payments began 11

12 October 1 Last day for EP to begin their 90-day reporting period for 2011 for the Medicare EHR Incentive Program December 31 Reporting year ends for EP and last day for A/I/U for TennCare February 29, 2012 Last day for eligible professionals to register and attest to receive an Incentive Payment for Check your software version number on your application Certification number not same as ID number Help and About Upgrade to certified version Queue Training Forms/templates Dollars 12

13 It s not about picking a piece of software It s about transforming your practice Must complete: 15 core objectives 5 objectives of 10 from menu set 6 total Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from menu set) 13

14 1. Record patient demographics as structured data for > 50 % 2. >50 % of patients age 2 and over have height, weight, BMI, & blood pressure as structured data 3. Up-to-date problem list of current & active diagnosis (ICD-9 or SNOMED CTR) recorded as structured data for 80% of all patients 4. Maintain active medication list for 80% of all patients at least 1 med or none 5. Maintain medication allergy list for 80% of all patients as structured data 6. Record smoking status as structured data for more than 50% of patients 13 years or older 7. Provide clinical summary of office visit for more than 50% visits within 3 business days 8. Provide electronic copy of health information for more than 50% of requests within 3 days 14

15 9. >40% prescriptions transmitted electronically 10. >30% have at least one med order by CPOE 11. Implement drug-drug and drug-allergy checks 12. Perform at least one test of electronic data exchange 13. Implement one clinical decision support rule 14. Implement systems to protect privacy & security 15. Report clinical quality measures to CMS By attestation for 2011 By electronic submission beginning

16 1. Implement drug formulary checks 2. Incorporate more than 40% of laboratory data in EHR as structured data 3. Generate at least one list of patients with specific condition 4. More than 10% of patients provided patientspecific education resources 5. Medication reconciliation for more than 50% of transitions of care 6. Provide summary of care record for >50% of patient transitions or referrals 7. Provide at least one test of data submission to immunization registry* 8. Perform at least one test of submission of electronic syndromic surveillance data* *must choose one of these 2 public health measures 16

17 9. More than 20% patients >65 years or <5 years sent reminders for preventative or follow-up care 10. Provide >10% of patients with electronic access to information (lab tests, problem lists, med lists) within 4 days of being updated in EHR Hypertension: Blood Pressure Measurement Preventive Care and Screening Measure Pair: a) Tobacco Use Assessment, b) Tobacco Cessation Intervention Adult Weight Screening and Follow-up 17

18 Weight Assessment and Counseling for Children and Adolescents Influenza Immunization for Patients 50 Years Old or Older Childhood Immunization Status Select 3 additional from 38 menu measures Not all EHR systems support all possible Be sure your EHR can report on selected measure 18

19 Clinical Quality Measures align with Physicians Clinical Quality reporting (PQRI) Alignment between 4 HITECH CQM and the CHIPRA initial core set that providers report to States Attestation on TennCare website TennCare will ask providers to provide and/or attest to additional information in order to make accurate and timely payments, such as: Patient Volume Licensure A/I/U or Meaningful Use Certified EHR Technology: certification number 19

20 TennCare Registration Summary by Provider Type Provider type Count Certified Nurse Midwife 28 Dentist 45 Nurse Practitioner 589 Registration Summary Total Registrations Count Physicians Assistant Physician 889 Acute Care Hospital 73 TennCare Payments to Providers & Hospitals Provider type Payment Amount Eligible Providers $ 1,763,750 Registration Summary Total Registrations Count Eligible Hospitals $ 1,542,

21 Discrete data Data element has a defined value or set of values Necessary to create interoperability and enable information exchange 42 21

22 definition: an approach to providing comprehensive primary care for adults, youth and children that promotes partnerships between patients & their primary care providers 44 22

23 1967 American Academy of Pediatrics puts forth concept of PCMH around children with special needs and chronic medical conditions 1990s major primary care associations ACP, AAP, AAFP and AOA develop PCMH initiatives 2006 IBM and other stakeholders create Patient Centered Primary Care Collaborative 2007 AAFP, AAP, ACP, and AOA publish Joint Principles of Patient Centered Med Home 45 Personal physician Physician directed medical practice Whole person orientation Coordination of care Quality and safety Enhanced access Payment recognizes value provided 46 23

24 Optimal, patient-centered outcomes that are enabled by a care planning process Evidence-based medicine and CDS Continuous quality improvement Patients actively participate & give feedback HIT utilized to support care, performance measurement, patient education, and enhanced communication. Practices go through a voluntary recognition Patients participate in quality improvement 47 reflect the value of care management work pay for services associated with coordination support adoption and use of HIT for QI support enhanced communication access -secure and telephone consultation value remote monitoring of clinical data fee-for-service payments for face-to-face recognize case mix differences share in savings from reduced hospitalization additional pay for quality improvements 48 24

25 2008 Physician Practice Connections- PCMH 2011 PCMH Recognition Program now requires Electronic Medical Record Increased emphasis on behavioral health Comprised of 6 standards Meets 2007 Joint Principles of PCMH Recognizes 3 levels of PCMH 49 Year Clinicians Sites , ,676 1,

26 Accreditation Assoc for Ambulatory Healthcare 8 core standards Joint Commission PCMH Standards & Performance 5 operational characteristics NCQA Standards for PCMH 6 standards, 3 levels of recognition Utilization Review Accreditation Council PCHCH 28 standards in 7 modules 51 Incorporate Joint Principles of PCMH Address complete scope of PC services Ensure patient/family centered care Engage multiple stakeholders in evaluation Align standards & measures with MU Identify essential standards, elements Address core concept of continuous improvement Allow for innovative ideas 52 26

27 Care coordination with PCMH neighborhood Identify requirements for training programs Ensure transparency in structure & scoring Reasonable documentation/data collection Evaluate program effectiveness Implement program improvements over time 53 Adoption of pilot & test programs by some state Medicaid Agencies Pilot projects by Medicare Pilots across the US fostered by PCPCC Test programs by some commercial payors Incorporation of PCMH into some ACO plans 54 27

28 29% reduction in ER visits 11% reduction in ambulatory sensitive adm Primary care retention improved $16/patient/year cost offset by savings 55 40% decrease in hospitalizations for asthma 16% lower ER visit rate 25% increase in asthma medication costs $135 million savings for Medicaid/SCHIP $400 million savings for aged, blind, disabled 56 28

29 50% decrease in ER visits for chronic illness 15% fewer hospitalizations for chronic illness avg hospital days 27% lower than other plans 57 36% reduction in hospital admissions for heart failure patients after 6 months Return of 2.3:1 vs program costs 58 29

30 median annual costs children $785 vs $1000 for ER visits and hospitalizations median annual cost Denver children with chronic conditions: $2,275 vs $3, % reduction in total hospital days 15% fewer ER visits 37% reduction in skilled nursing facility days annual Medicare savings $1364 per patient annual savings $75,000 per Guided Care nurse 60 30

31 61 Infrastructure HIT Electronic Medical Records Connectivity Analytics and reporting Added personnel Increased skills 62 31

32 63 That s all for now. 32