American Recovery and Reinvestment Act What s in it for MN Rural Health?

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1 American Recovery and Reinvestment Act What s in it for MN Rural Health? Rural Health Advisory Committee May 19, 2009 Karen Welle, Asst Director, Office of Rural Health and Primary Care Liz Carpenter, Deputy Director, Center for Health Informatics

2 Minnesota E-Health and Telehealth Update

3 Minnesota e-health Initiative accelerate the adoption and effective use of Health Information Technology to improve healthcare quality, increase patient safety, reduce healthcare costs, and enable individuals and communities to make the best possible health decisions.

4 State Mandates to Advance e-health 2011 MN e-prescribing Mandate All providers, group purchasers, prescribers, and dispensers establish and maintain an electronic prescription drug program by January MN Interoperable EHR Mandate: All healthcare providers and hospitals have interoperable EHRs. MDH: statewide plan to meet the mandate Establish uniform health data standards by January 2009 All EHRs must be certified by CCHIT if a certified EHR product available for the provider s particular setting

5 Minnesota Model for Adopting Interoperable Electronic Health Records Breaks achieving the 2015 Mandate into manageable steps Applies across organizational settings Continuum of EHR Adoption Achievement of 2015 Mandate Adopt Utilize Exchange Assess Plan Select Implement Effective Use Readiness Interoperate

6 MN EHR Adoption Rural-Urban Implementation Stage All Rural Urban Fully implemented 17% 42% 13% 20% 20% 58% Implementation in process 29% 20% 23% 28% 34% 13% Implementation in next 12 months 11% 11% 13% 15% 10% 9% Implementation in next months 16% 13% 22% 21% 11% 8% Implementation beyond 25 months **% 9% **% 11% **% 7% No plans for implementation **% 5*% **% 5% **% 4% In 2007 next two years, 86.7% of Minnesota s primary care clinics with be fully implemented. * 47.6% of those who have no plans for implementation have done some exploration in the possibility of using EHR. 50.0% are clinics with 1 physician, compared to 16.7% of all respondents having 1 physician. 76.2% are free standing, independent clinics, compared to 26.7% of all respondents being free standing, independent clinics. **In 2005, No plans for implementation in next 24 months was 27% for All, 29% for Rural, and 25% for Urban.

7 Supporting Rapid Adoption: MN Funding $14.6 million in grants and loans to support adoption of interoperable EHRs and targeted funds to rural and safety net providers. e-health Grant Program: $ 8.3 million $1.3 million $3.5 million $3.5 million EHR Loan Program: $ 6.3 million

8 Greater MN Telehealth Broadband Initiative Consortium of five health care networks representing 120 hospitals and mental health clinics FCC Rural Health Care Pilot Program Awarded ~$5.4M over 3 years in potential reimbursements for installation and support of rural broadband networks for health care

9 Greater MN Telehealth Broadband Initiative SISU Medical Systems, Duluth (16 hospitals primarily in NE), Lead Organization Medi-sota, Inc. (31 hospitals in SW) Minnesota Telehealth Network and North Region Health Alliance (38 hospitals in NW MN and NE ND) MN Assn of Community Mental Health Programs (78 clinics)

10 American Recovery and Reinvestment Act of 2009

11 ARRA Key Provisions Health Information Technology (HITECH Act) ($2 B) Medicaid and Medicare HIT Incentives for hospitals and providers ($29 B) Community Health Center Grants ($2.5 B) ($500M for operations and $1.5B for capital projects, including HIT) Health Workforce Shortages scholarships, loan repayment, grants to training programs, and NHSC ($500 M) Broadband USDA: Distance Learning, Telemedicine and Broadband Program ($2.5 B) NTIA: Broadband Technology Opportunities Program ($4.7 B) USDA Rural Community Facilities Program grants and loans (additional $130M)

12 Health Information Technology for Economic and Clinical Health Act (HITECH) Office of National Coordinator for HIT (ONCHIT) Grants to states to promote HIT Competitive grants to states and tribes to establish EHR loan programs for providers Regional HIT extension and research centers Grants to health professions programs to incorporate HIT into curriculum Grants to higher education to expand programs in health informatics and IT

13 Office of the National Coordinator for HIT: Coordinate funds to HRSA, AHRQ, CMS, CDC, IHS ($300M) HIT architecture to support exchange Training and best practices Telemedicine infrastructure and tools Promote interoperability of clinical data Improve/expand public health HIT

14 Grants to states to promote HIT: Minnesota e-health Initiative Enhance HIT adoption and effective use Identify state and local resources Provide technical assistance Promote HIT for underserved areas Assist patients to use HIT Support use of regional extension centers Support public health HIT Promote quality measurement Match: $1 to $10 (2011), $1 to $7 (2012), $1 to $3 (2013)

15 Competitive grants to states and tribes for loan programs To assist providers with: Purchase of EHR technology Enhanced use of EHR Train personnel Improve secure health information exchange Up to market rate Repayment begins after 1 year 10 year amortization $1/$5 match

16 Medicare HIT Incentives: Available for hospitals and individual providers Must be meaningful user of HIT Using certified EHR technology Demonstrates information exchange Reports clinical quality measures Incentives become penalties in 2015

17 Medicare Hospital HIT Incentives: PPS Hospitals = Base of $2M plus a prorated amount of the total based on # of discharges x Medicare share Could receive up to $8 million over 4 years. Critical Access Hospitals = Depreciation value of HIT costs x Medicare share plus 20% points

18 More about Critical Access Hospital Incentives Depreciation value of HIT costs x Medicare share plus 20% points Certified EHR definition will ultimately determine value incentive. What will be included? Can only depreciate EHR capital costs, not time costs Incentives don t begin until after the investments made; issue of need for capital financing left unaddressed Maximizing incentive bonus: strategy to leave as much Certified EHR investments undepreciated at time of reaching meaningful user designation

19 Medicare Incentive Payments: Professionals Qualified EHR user in 2011/2012 can receive up to $44,000 (or up to $48,400 if practicing in HPSA) Applies to all physicians who can prove use of a qualified EHR, regardless of purchase date Must be meaningful EHR User. Includes: Using certified EHR technology Demonstrates information exchange Reports clinical quality measures

20 Medicaid HIT Incentive Payments For providers with high Medicaid volumes to cover the providers costs for acquiring, using and maintaining certified EHR technology. Up to 85% of the providers costs Minnesota s costs to administer matched at 90% Eligible providers: Children s hospitals (regardless of Medicaid patient volume) Acute care hospitals with at least 10% Medicaid patient volume Professionals in FQHCs or RHCs with at least 30% needy individuals Other non-hospital based professionals with 30% Medicaid volume Pediatricians with at least 20% Medicaid volume

21 MDH priorities under ARRA Position providers to pull down maximum incentive $$$s under Medicare and/or Medicaid Address two largest barriers to implementing electronic health records: Help finance the capital costs of purchasing and adopting EHRs Assist health care providers in using EHRs effectively

22 MDH Activities to Prepare MN Secure state matching funds and make policy changes to position MN for funding Apply for state grant to continue promoting HIT Apply for competitive grants to states for HIT loan programs to help Minnesota providers purchase EHR systems Inform Minnesota providers and stakeholders Collaborate with DHS on Medicaid HIT incentives Support statewide partner applications for exchange, education and technical assistance, telehealth, and broadband funding

23 Preparing MN for ARRA: 2009 Policy Legislation Assigns new duties to coordinate with national activities Allows collection of data for assessment & incentive eligibility determination Identifies the Commissioner of Health as the lead applicant or designating authority for HIT funding Aligns current Minnesota EHR loan program with competitive state grant requirements

24 Securing matching funds to seize ARRA opportunities Governor s Budget: $350,000 Base Funding for e-health (1:5 Match) $4 Million Funds for EHR Loans (1:5 Match) $128,000+ State Loan Repayment for Health Professionals (1:1Match) House Proposal: Identical to Governor s Recommendation Senate Proposal: $175,000/year Base Funding for e-health $2.8 Million Funds for EHR Loans $128,000+ State Loan Repayment for Health Professionals (1:1Match)

25 What health care providers can do now If no EHR: begin a thorough planning process now If EHR in place, ensure effective use Adopt and use e-prescribing Reach out to community partners to begin exchange of information, improve broadband access, explore telehealth opportunities

26 For more information MN e-health Initiative/HITECH page Office of Rural Health and Primary Care Liz Carpenter, Center for Health Informatics, Karen Welle, Office of Rural Health & Primary Care,