CMS and HIT Adoption Tony Trenkle Director Office of E-Health Standards and Services Centers for Medicare & Medicaid Services

CMS-The Numbers Medicare provides health insurance to approximately 45 million beneficiaries CMS also has federal oversight of the state- administered Medicaid program and Children’s Health Insurance Program (CHIP), covering about 50 million and 11 million enrollees respectively 33.7% of national health expenditures are paid by Medicare or Medicaid Medicare processes over a billion claims/yr. There are approximately one million Medicare providers

HIT Adoption  CMS’ large percentage of overall healthcare purchasing as well as its regulatory role makes it the key driver for successful HIT adoption  CMS support of standards drives industry adoption and builds a foundation to support interoperable HIT.  CMS incentives programs promote adoption but also effective use of HIT.  CMS demos and pilots provide a way to measure the impact of HIT on the Medicare and Medicaid populations.

Demos and Pilots  DOQ-IT  QIO 8 th Scope of Work  Focus on small-medium sized primary care practices  Medicare Care Management Performance  Authorized under MMA  3 year pay for performance to promote HIT adoption and use  Also focuses on small-medium sized primary care practices (up to 10 physicians)

Demos and Pilots  EHR Demonstration Project  Expands the MCMP demonstration  Over 800 practices in 4 demo sites  Began June 2009, will end May 2014  Also focuses on small-medium sized primary care practices (up to 20 physicians)  Medicaid Transformation Grants  22 states grants focused on HIT  EHRs, E-RX, HIEs

Other Drivers  Stark/Anti-Kickback Allows donation of EHR software under certain conditions  CHIPRA Promotes development of a pediatric EHR and quality measures  PQRI/RHQDAPU Promoting the reporting of quality measures through EHRs for 2010  MIPPA E-rx incentive

HITECH  HITECH Act-effective 2011 Section 4101-Medicare eligible professionals Section 4102-Medicare incentives for hospitals Section 4201-Medicaid  Game changer Scale-up to $40 billion Brings together the CMS programs (Medicare FFS, Medicare Advantage, Medicaid) Meaningful Use-potential to bring about vast changes

Challenges  Numerous CMS programs to promote adoption have begun or will start shortly.  All contribute to increased use of interoperable HIT to improve the quality and efficiency of healthcare.  Challenges in the near term  Synchronize these efforts to optimize effects and not create unintended outcomes.  Create a platform that builds in continued improvements over time.  Implement HITECH the right way Depth vs. width