Eligible Professionals: NH Medicaid Electronic Health Records Incentive Program Eve Fralick Project Director, NH DHHS Medicaid EHR Incentive Program
Agenda Background on HITECH NH DHHS planning efforts to date Next steps in NH DHHS planning Provider Survey #1 Results Overview of EHR incentive program criteria Basics of meaningful use Contact and website information Questions October 2010 2
The HITECH Act HITECH = Health Information Technology for Economic and Clinical Health Passed in February 2009 as part of the American Recovery and Reinvestment Act Goal: the utilization of an electronic health record (EHR) for each person in the United States by 2014 Offers reimbursement incentives through Medicare and Medicaid for providers who demonstrate they are meaningful users of certified EHRs October 2010 3
EHR Incentive Program Funding Medicare incentive program is federally run by CMS Medicaid incentive program is a voluntary program that is regulated by CMS and run by the States Medicaid payments to providers are administered by the States but reimbursed at 100% by CMS Payments to States for expenses incurred in planning, administering, overseeing, and carrying out the Medicaid incentive payment provisions are reimbursed at 90% by CMS and 10% by State funds October 2010 4
EHR Incentive Program Regulations HITECH Act Regulations; 42 CFR Subchapter D, Part 170: Health Information Technology Subchapter G, Part 495 Standards for the Electronic Health Record Technology Incentive Program Final Rule Federal Register: Document Number: 2010-17207 http://federalregister.gov/a/2010-17207 October 2010 5
NH DHHS Program Status Official CMS program start: July 1, 2010 NH DHHS is currently in the planning stages for the Medicaid EHR incentive program Tasks completed: Planning Advance Planning Document (PAPD) submitted to CMS: March 2010 CMS approved PAPD: July 2010 Provider survey #1 completed: August 2010 Project Director hired: September 2010 Massachusetts ehealth Collaborative named as NH Regional Extension Center (to support NH providers in becoming meaningful users of electronic health records): September 2010 NH DHHS launched informational website: October 2010 (www.nhmedicaidhit.org ) October 2010 6
NH DHHS Upcoming Projects Task Write/Submit State Medicaid Health Information Technology Plan (SMHP) to CMS Write/Submit Implementation Advance Planning Document (IAPD) to CMS Develop process to coordinate with National Level Repository (tool to verify provider eligibility and meaningful use and track payments) Complete implementation tasks required prior to first payment Anticipated Timeline March 2011 June 2011 3 rd / 4 th quarters 2011 TBD Pending successful approvals from CMS and timely implementation of required tasks, first Medicaid payments to eligible professionals projected during CY 2012 October 2010 7
NH DHHS Next Steps Continue to reach out to key stakeholders and stakeholder organizations to communicate program information and solicit feedback on challenges and barriers Coordinate closely with Massachusetts ehealth Collaborative (the NH Regional Extension Center) to mutually share program information and barrier concerns Solicit information from eligible professionals on individual preferences towards selection of Medicaid or Medicare incentive Under consideration: second provider survey October 2010 8
Provider Survey #1 Results October 2010 9
Provider Survey Background NH DHHS (Health Information Exchange Planning and Implementation Project) commissioned a survey to assess technology usage in NH practices with prescribing privileges (physicians and nurse practitioners) Goal: use information collected to inform multiple projects associated with federal and state health information technology and health information exchange priorities One survey component addressed the use of EHRs Survey implemented by NH Institute for Health Policy and Practice in June through August 2010 Sent to hospital-level information managers, practice-level information managers, and individual providers (some overlap) October 2010 10
Provider Survey Respondents 108 organizations (representing 2,741 providers) responded*: Facility Type Count Practice Private Solo/Group Practice 62 57% Hospital Owned/Affiliated Practice 18 17% Community Health Center 11 10% Community Mental Health Center 7 6% Nursing Home 7 6% Home Health Care 3 3% TOTAL 108 100% October 2010 *9 surveys had incomplete information 11
Provider Survey Respondents High sampling of prescribers represented, but not all Some providers may not have received survey due to lack of a comprehensive method in New Hampshire for identifying prescribers at the individual or practice level Some surveys weren t returned Hospital, and stand-alone, larger practices within New Hampshire well represented Smaller, and independent, practices under-represented October 2010 12
Provider Survey Key Findings 57% Of Respondents Used EHR In Some Form Primary Uses Least Common Uses Patient Demographics 97% Medication Histories 88% Patient Care Histories 86% Billing Integration 76% Point Of Care Functions Connections to Patient Drug 46% Formularies Best Practices 53% E-Prescribing 60% Radiology Results 64% Referrals & Consults 67% Connections Outside The Practice October 2010 13
Provider Survey EHR Barriers Cost Was The Primary Reason For Not Adopting EHRs Perceived Major Barriers To EHR Adoption Lack of Capital Resources 25% Loss of Productivity During Transition 19% Insufficient Return on Investment 16% Insufficient Time to Select, Contract, Install, and 11% Implement EHR Security and Privacy 9% Willingness to Use EHR 8% Available Software Does Not Meet Needs 6% Inability to Integrate To Billing/Claims 6% Mixed Responses October 2010 14
Provider Survey Barriers Mixed responses on several major barriers to adoption Security and privacy Whether providers would use systems Whether software/integration met practice needs Potential reasons Respondents might have been unclear on effects of technology adoption in these areas In large practices, these issues were being addressed by other staff members October 2010 15
Provider Survey Results Providers Indicated A General Need For Assistance In All Areas October 2010 16
Overview of EHR Incentive Program Criteria October 2010 17
Medicaid Eligible Professionals (EPs) Must meet volume thresholds Non-Hospital Based Physicians* Dentists Certified Nurse-Midwives Nurse Practitioners Physician Assistants Practicing in a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) led by a Physician Assistant *A Medicaid EP is considered hospital-based if 90% or more of the EP's services are performed in a hospital inpatient or emergency room setting October 2010 18
Medicare Eligible Professionals* Must bill the Medicare Physician Fee Schedule Non-Hospital Based Doctors of Medicine or Osteopathy Doctors of Oral Surgery or Dental Medicine Doctors of Podiatric Medicine Doctors of Optometry Chiropractors October 2010 *Medicare Advantage providers have other eligibility criteria 19
EHR Incentive Program Participation EPs can participate in either the Medicare or Medicaid EHR incentive program (note: hospitals can participate in both) A one-time switch is allowed (before 2015) between Medicare or Medicaid Medicaid providers can collect an incentive payment from one state only per year October 2010 20
EHR Incentive Program Participation Each EP is eligible for one incentive payment per year, regardless of how many practices or locations at which they provide services Incentives are based on individual EPs who meet program requirements not their group practice* *Clinics or group practices will be permitted to calculate Medicaid patient volume at the group practice/clinic level in accordance with statute limitations October 2010 21
Medicare versus Medicaid Availability of Incentive Funds Medicare Starting in May 2011with CMS Medicaid To be determined pending NH DHHS planning efforts (but projected later than 2011) October 2010 22
Medicare versus Medicaid Eligibility Medicare Providers must bill the Medicare Physician Fee Schedule for patient services Medicaid Non-pediatricians: minimum 30% Medicaid patient volume* Pediatricians: minimum 20% Medicaid patient volume* *Children's Health Insurance Program (CHIP) patients do not count towards Medicaid patient volume criteria October 2010 23
Medicare versus Medicaid Eligibility (cont d) Medicare Providers must bill the Medicare Physician Fee Schedule for patient services Medicaid Physician assistants who practice predominantly* in a FQHC or RHC and have minimum 30% patient volume attributable to needy individuals** *Predominantly = 50% or more patient encounters over 6-months **Needy individuals = Medicaid or Children's Health Insurance Program enrollees October 2010 Patients furnished uncompensated care by the provider Patients furnished services at either no cost or on a sliding scale 24
Medicare versus Medicaid Participation in Other CMS programs Medicare Cannot participate in the EHR incentive program and the e-prescribing program in the same year Medicaid May participate in the EHR incentive and e- Prescribing programs at the same time if eligibility requirements met Medicare & Medicaid May participate in Physicians Quality Reporting Initiative and EHR incentive programs at the same time if eligibility requirements met October 2010 25
Medicare versus Medicaid Maximum Incentive Payment* Medicare $44,000 over 5 years (plus health professional shortage bonuses) Medicaid $63,750 over 6 years Exception: Pediatricians with more than 20%, but less than 30%, Medicaid patient volume will receive 2/3 of the maximum amount *Based on average allowable costs October 2010 26
Medicare versus Medicaid Continuity of Payments Medicare Medicare5 5 payment years are successive If program criteria not met in any year, that year still counts as a payment year, regardless of whether an incentive payment is made Medicaid 6 payment years may be non-consecutive If program criteria not met in any year, EP may skip that year and still be eligible for a maximum of 6 annual incentive payments October 2010 27
Medicare versus Medicaid Medicare Last Year To Initiate Participation In Incentive Program 2014 Medicaid 2016 October 2010 28
Medicare versus Medicaid Last Payment Year Medicare 2016 Medicaid 2021 October 2010 29
Medicare versus Medicaid Total Incentive Payment Reductions Medicare Decrease after CY2012 Medicaid No decrease at any time October 2010 30
Medicare Incentive Payments Column = first calendar year EP receives a payment Row = amount of annual payment if requirements continue to be met CY 2011 CY 2012 CY 2013 CY 2014 CY2015 and later CY 2011 $18,000 - - - - CY 2012 $12,000 $18,000 - - - CY 2013 $ 8,000 $12,000 $15,000 - - CY 2014 $ 4,000 $ 8,000 $12,000 $12,000 - CY 2015 $ 2,000 $ 4,000 $ 8,000 $ 8,000 $0 CY 2016 - $ 2,000 $ 4,000 $ 4,000 $0 TOTAL $44,000 $44,000 $39,000 $24,000 $0 October 2010 31
Medicaid Incentive Payments Column = first calendar year EP receives a payment Row = amount of annual payment if requirements continue to be met CY 2011 CY 2012 CY 2013 CY 2014 CY2015 CY 2016 CY 2011 $21,250 - - - - - CY 2012 $8,500 $21,250 - - - - CY 2013 $8,500 $8,500 $21,250 - - - CY 2014 $8,500 $8,500 $8,500 $21,250 - - CY 2015 $8,500 $8,500 $8,500 $8,500 $21,250 - CY 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250 CY 2017 - $8,500 $8,500 $8,500 $8,500 $8,500 CY 2018 - - $8,500 $8,500 $8,500 $8,500 CY 2019 - - - $8,500 $8,500 $8,500 CY 2020 - - - - $8,500 $8,500 CY 2021 - - - - - $8,500 TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750 October 2010 32
Medicare versus Medicaid Reporting Medicare Year 1: 90 days meaningful use Each subsequent year: full year meaningful use Medicaid Year 1: Adopt, Implement, Upgrade Year 2: 90 days meaningful use Theoretical years 3 6: full year meaningful use October 2010 33
Medicare versus Medicaid Fee Schedule Adjustments Medicare Payment reductions MedicarePayment reductions begin in 2015 if no meaningful use Start at 1% and increase up to 5% for every year that meaningful use not demonstrated Medicaid MedicaidNo fee schedule reductions as mandated by statute October 2010 34
Medicaid versus Medicare? How to decide which program? CMS flowchart handout 2 nd box on top left - answer No to find Medicare eligibility October 2010 35
Medicaid & Meaningful Use October 2010 36
EHR Is More Than Just A System: HITECH Act requires: Meaningful Use Certified EHR technology used in a meaningful manner (example: electronic prescribing) Certified EHR technology connected in a manner that provides for the electronic exchange of health information to improve the quality of care In using certified EHR technology, the provider submits to the Secretary information on clinical quality measures and such other measures selected by the Secretary. October 2010 37
Medicaid Requisites For Payment NH DHHS must verify/audit: Year 1: certified EHR technology has been adopted, implemented, and upgraded Year 2: 90-day reporting period in which Stage 1 meaningful use has been demonstrated Theoretical Years 3-6: meaningful use demonstrated on a full year basis for each year that payment is requested October 2010 38
Meaningful Use Objectives and Measures Some criteria are optional; others required Core objectives mandatory; must be met Menu set select from a list of options with at least one population and public health measure If an objective/measure is not applicable, providers can present exception criteria to remove it from MU qualifying criteria Refer to CMS website for more information: http://www.cms.gov/ehrincentiveprograms October 2010 39
Meaningful Use Stage 1 Objectives (Final Version)* Goal: build a strong foundation Establish functionalities in certified EHR technology to allow for continuous quality improvement and ease of information exchange Criteria: Electronically capture health information in a structured format Use information to track key clinical conditions Communicate information to coordinate care CMS to publish meaningful use clarifications shortly *The Final Rule addresses stages of MU only through 2014 October 2010 40
Stage 1 Meaningful Use Criteria 15 core objectives Examples: CPOE, e-prescribing, record demographics, clinical quality measures 5 of 10 menu set objectives Examples: drug-formulary checks, incorporate clinical lab test results as structured data, generate lists of patients by specific conditions 6 Clinical Quality Measures 3 core and 3 of 38 from menu set October 2010 41
Meaningful Use Stages 2 & 3 (Draft Versions) Stage 2 expected by 2011 Intent: Stage 1 optional criteria will be required as Stage 2 core criteria Goal: expand on Stage 1 to encourage use of health IT to have information follow the patient Focus: structured information exchange and continuous quality improvement at point of care Stage 3 Focus: promote improvements in quality, safety, and efficiency leading to improved health outcomes; access to comprehensive patient data through robust, patient-centered health information exchange October 2010 42
For More Information October 2010 43
EHR Incentive Program Information CMS website: program information, tip sheets, educational materials: http://www.cms.gov/ehrincentiveprograms ONC (Office of the National Coordinator) website: certification and certified EHR systems, programs designed to support providers as they make the transition: http://healthit.hhs.gov October 2010 44
EHR Incentive Program Information Massachusetts ehealth Collaborative (MAeHC) website: Regional Extension Center; offers assistance and support to providers in adopting health information technology to achieve meaningful use goals http://www.maehc.org/index.html October 2010 45
EHR Incentive Program Information New Hampshire Department of Health and Human Services Medicaid Health Information Technology website: NH Medicaid EHR incentive program updates http://www.nhmedicaidhit.org October 2010 46
EHR Incentive Program Information New Hampshire Department of Health and Human Services Medicaid EHR incentive program email address: info@nhmedicaidhit.org October 2010 47
Questions? October 2010 48