1. Daniel T. Golder, DDS, MBA Chief Information Officer Oklahoma Foundation for Medical Quality This material is provided by the Oklahoma Foundation for Medical Quality, under the Health Information Technology Regional Extension Center grant number 90RC0005/01, funded by the Office of the National Coordinator, United States Department of Health and Human Services. ARRA Incentives & Meaningful Use: How your Regional Extension Center Can Help

2. OFMQ Oklahoma Foundation for Medical Quality QIO (Quality Improvement Organization) –CMS (Centers for Medicare & Medicaid Services) Independent, non-profit, community-based organization (founded in 1972) Our Mission Statement: “Leading efforts to improve healthcare and improve lives”

3. OFMQ Organizational Vision Resource for health care quality and improving outcomes: –Evidence-Based Research –Collaboration –HIT Implementation –Health Quality –Empowering Consumers

4. OFMQHIT REC OFMQ Health Information Technology Regional Extension Center American Recovery & Reinvestment Act (ARRA): 2-17-09 “Stimulus Package” HITECH Act –Office of the National Coordinator for Health Information Technology (ONC) –Incentive payments for providers to adopt Electronic Health Records & HIE –Achieve “Meaningful Use”

5. OFMQHIT Mission Furnish assistance to providers by: –Education –Outreach –Technical Assistance To achieve: –Implementation of EHR –“Meaningful Use” of EHR

6. Scope of Services ARRA Incentive Review & “Meaningful Use” Assessment Practice & Workflow Assessment EMR Vendor Selection & Optimization Project Planning & Vendor Oversight Go-Live Support & Training Post Go-Live Practice Assessment & EMR Optimization IT Security Review & Assessment

7. “Eligible Providers” (EP)MedicareMedicaid ($44,000)($63,750) Doctor of Medicinexx Doctor of Osteopathyxx Doctor of Dental Surgeryxx Doctor of Dental Medicinexx Doctor of Podiatric Medicinex Doctor of Optometryx Chiropractorx Certified Nurse-Midwifex Nurse Practitionerx Physician Assistant (Practicing in FQHC or RHC that is led by a PA)x

8. “Eligible ‘REC Clinicians’” Individual and Small Group Practices –Less than 10 clinicians Focused on: –Service Settings: Uninsured, underinsured Medically underserved –Public & Critical Access Hospitals –Community Health Centers –Rural Health Clinics

9. REC Provider Services Target 1,000 PPCPs by February 2011 Currently ~ 250 “Priority Primary Care Providers” (PPCPs) Enrolled –Most 1-3 Providers / Practice –27% of the priority providers in the state –82% have not yet implemented an EHR Working with OKPCA to enroll 70 PPCPs working at FQHCs.

10. REC Clinicians < 10 PPCPs / Practicewith prescriptive privileges PRIMARY CARE PROVIDERMDDONPMWPA Family Practicexxxxx Obstetrics and Gynecologyxxxxx General Medicinexxxxx Internal Medicinexxxxx Pediatric Medicinexxxxx

11. PPCP Decision Tree

12. REC CAH / Rural Services Rural and CAH Supplemental Grant –Rural Hospitals (Inpatient Only) –Critical Access Hospitals Less than 50 Licensed Beds Notification of Award –September 10, 2010 62 Facilities Eligible –Need to achieve Meaningful Use by February 2012

13. Barriers Communication –Physicians may be unaware of ARRA, HITEC and availability of REC Services –Need to communicate sense of urgency to providers EHR vendors are at capacity –(months to get started) EHRs are complex to implement –(months to implement)

14. Barriers Communication –Meaningful Use incomplete (“final rule” due in “late spring”): –Final Rule released 7-13-10 (Certification Final Rule also released) Certification implications for Vendors: –Coding –Testing –Certification Process –Upgrades Delays in Physician Implementation

15. Meaningful Use Focused on Capture of Structured Data Electronic Exchange of Information Quality & Safety Empowering Patients & Families

16. Meaningful Use “Core” Set vs. “Menu” Set –Core: 15 Objectives –Menu: 5 of 10 Objectives Practice Management Deferred to Stage 2 –Electronic Claims Submission –Electronic Eligibility Checking Decreased Thresholds POS 22 – Outpatient Hospital Removed –Employed Physicians Now Eligible

17. Core Set Patient Demographics Vital Signs Problem List of Diagnoses Medication List Medication Allergy List Smoking Status Clinical Summaries for Patients Electronic Copy of Health Information for Patients ePrescribing (EP only) CPOE for Medication Orders Drug-Drug-Allergy Interaction Checks Exchange of Key Clinical Information Implement One Clinical Decision Support Rule Privacy & Security Clinical Quality Reporting to CMS or States.

18. Menu Set Drug – Formulary Checks Clinical Lab Results as Structured Data Lists of Patients by Condition Identify & Provision of Patient Education Resources Medication Reconciliation Between Care Settings Summary of Care Records for Patients Electronic Immunization Data Submission Electronic Syndromic Data Submission FOR HOSPITALS: –Advance Directives –Submit Lab Data to Public Health Agencies FOR PROVIDERS (EPs): –Patient Reminders –Electronic Access for Patients to Health Information

19. Meaningful Use Quality Measures (44 Total) –3 Core: Blood Pressure Tobacco Status Adult Weight Screening & Follow-up Alternate Core: –Children & Adolescent Weight –Influenza Screening for Patients over 50 –Childhood Immunization Status –3 Others (from set of 38)

20. Medicare Incentive Table “The longer you wait the steeper and more difficult the climb” MEDICAREAdopt EHR in: 201120122013201420152016 2011 $ 18,000 Stage 1 2012 $ 12,000 $ 18,000 Stage 2 2013 $ 8,000 $ 12,000 $ 15,000 TBD (Stage 3?) 2014 $ 4,000 $ 8,000 $ 12,000 PENALTY if < Stage 3 2015 $ 2,000 $ 4,000 $ 8,000 $ - 2016 $ - $ 2,000 $ 4,000 $ - TOTAL: $ 44,000 $ 39,000 $ 24,000 $ - HPSA: $ 48,400 $ 42,900 $ 26,400 $ -

21. Medicaid Incentive Table “The longer you wait the steeper and more difficult the climb” MEDICAIDFor EPs who BEGIN EHR adoption in: 201120122013201420152016 2011 $ 21,250 2012 $ 8,500 $ 21,250 2013 $ 8,500 $ 21,250 2014 $ 8,500 $ 21,250 2015 $ 8,500 $ 21,250 2016 $ 8,500 $ 21,250 2017 $ 8,500 2018 $ 8,500 2019 $ 8,500 2020 $ 8,500 2021 $ 8,500 TOTAL: $ 63,750 Lvol. PED: $ 42,500 Year 1 (AIU): Adopt acquired and installed Implement trained staff deployed tools exchanged data Upgrade expanded functionality or interoperability

22. Timeline Vendor Programming & Testing Vendor Certification Vendor Capacity to Implement Vendor EHR Implementation & Testing 90 Day MU Qualification Period Meaningful Use

23. Timeline Vendor Programming & Testing (90 - 120+ days?) AugSepOctNovDec 2010 Vendor Certification (30 - 60 days?) Vendor Capacity to Implement (60 - 240 days?) JanFebMarAprMayJunJulAugSepOctNovDec 2011 Vendor EHR Implementation & Testing (120 - 240+ days?) 90 Day Meaningful Use Qualification Period Meaningful Use JanFebMarAprMayJunJulAugSepOctNovDec 2012 Must achieve “Meaningful Use” by 2012 to receive maximum reimbursement You are here!

24. How Can We Work Together? Collaboration & Partnership –“Get the word out” Newsletters Websites Publications Availability of OFMQHIT REC Services –Recruitment & Referrals ARRA & Meaningful Use Sense of Urgency

25. Thank You! Daniel T. Golder, DDS, MBA http://www.ofmqhit.com ofmqhit@ofmq.com 405-302-3318