1. www.bakerdaniels.com What the Stimulus Bill Means for the Future of Health Information Technology March 16, 2009 1:30 PM EDT Please dial 1-866-642-1665 Passcode 342441 to listen to the audio portion of the webinar You will not be able to listen to the audio over the web

2. 2 David Zook and Vince Ventimiglia David Zook david.zook@bakerd.com Vincent J. Ventimiglia, Jr. vincent.ventimiglia@bakerd.com

3. 3 Agenda  Introductions  Overview of ARRA HIT provisions  Office of National Coordinator: –Policy & Standards  HIT grants and loans  Medicare & Medicaid incentives  Privacy provisions  Telemedicine overview  Impact & Engagement

4. 4 Call for Stimulus

5. 5 Stimulus overview  ARRA signed into law February 17, 2009 –$787 billion in new spending and tax cuts –Congressional Budget Office estimates that the bill will add $185 billion to the economy in 2009 and $399 billion next year  Federal agencies and states involved in implementation  Exceptional requirements for speed, duration, transparency, and accountability

6. 6 “Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy, and save lives.” President Obama Address to Joint Session of Congress February 24, 2009

7. 7

8. 8 ARRA Health IT Components  Office of the National Coordinator of HIT  Funding to support infrastructure and EHR adoption  Incentives to providers through Medicare & Medicaid  Significant privacy and security components

9. 9 Office of National Coordinator  Codified through ARRA  Standards –Review federal health IT investments to ensure they are meeting objectives of federal health IT strategic plan –Establish HIT Standards Committee (consider role of National eHealth Collaborative) –Review and determine within 45 days whether to endorse standards, implementation specifications, and certification criteria for electronic exchange and use of health information recommended by HIT Standards Committee  Policy –Coordinate policy and programs –Establish HIT Policy Committee (consider role of National eHealth Collaborative)  ONC chief privacy officer appointed by HHS Secretary within 12 months to advise National Coordinator and assist states, regions, and other nations

10. 10 Office of National Coordinator  Federal Health IT Strategic Plan –Update the plan with other federal agencies to address several key components (electronic exchange, overall utilization, privacy and security, specifications, public engagement, continuous improvements) –Update through public and private sector collaboration –Measurable outcome goals –Published and accessible

11. 11 Office of National Coordinator  HIT Policy Committee –Recommend policy framework for nationwide health information technology infrastructure –Recommend and prioritize areas in which standards, implementation specifications, and certification criteria are needed –Consider recommendations for appropriate use such as quality, care coordination, vulnerable populations –Encourage broad stakeholder input –Members appointed by Secretary, Senate, House, President, Comptroller General (specific expertise) –Letters of nomination for GAO positions were due March 6; appointments by the end of the month –Letters of nomination for HHS position due to ONC on March 16

12. 12 Office of National Coordinator  HIT Policy Committee –Areas for review: Appropriate use of nationwide health IT infrastructure for collection of quality data, biosurveillance, public health, medical and clinical research, and drug safety Self-service technologies for exchange of patient information Telemedicine technologies Home health care Reduce medical errors Promote continuity of care Meet needs of diverse populations Facilitate secure access to PHI

13. 13 Office of National Coordinator  HIT Standards Committee –Recommend standards, implementations specifications, and certification criteria –Provide for NIST testing –Within 90 days, develop schedule for assessment of recommendations for HIT Policy Committee –Open public meetings –Membership to include providers, ancillary healthcare workers, consumers, purchasers, health plans, technology vendors, researchers, federal agencies, expert individuals –Specific stakeholder input with sector balance –Letters of nomination due to ONC on March 16

14. 14 Federal Adoption of Standards  Within 90 days, Secretary will determine whether or not to propose adoption of current standards  By 12/31/09, Secretary shall adopt, by rulemaking process, an initial set of standards, implementation specifications, and certification criteria  As each agency implements IT systems, it will use systems meeting the standards  Voluntary adoption by private sector

15. 15 Federal Health IT  National Coordinator will support development and updating of quality HIT technology unless Secretary determines that the needs of providers are being met through marketplace  Pilot testing of standards and specifications by NIST with HIT Standards Committee  NIST to support establishment of conformance testing infrastructure and may accredit independent, non-federal labs to perform testing

16. 16 HIT $  $2 billion total through the Office of the National Coordinator (HHS) –$300 million to support regional health information exchanges –$20 million for NIST work on health care information enterprise integration –the balance spread among the new grant programs in unspecified amounts and at largely unspecified times

17. 17 HIT $  Other Health IT funding outside ONC –$85 million for Indian Health Service for HIT –$1.5 billion for community health centers, which can be used for IT acquisition –$500 million for Social Security Administration, of which $40 million may be used for health IT research and adoption

18. 18 HIT $  Funding to strengthen infrastructure –Health IT architecture to support nationwide exchange and use of health information –Development and adoption of certified electronic health records for providers not eligible for support under Medicare/Medicaid –Training and dissemination on best practices to integrate health IT and EHRs –Acquisition of health IT that meets standards adopted by HHS –Funded through ONC and administered by agencies with relevant expertise (such as HRSA, AHRQ, CMS, CDC and Indian Health Service), grants will be made available for health information exchanges (HIEs), federal agencies, providers, community health centers, 340B entities, telemedicine providers, holders of health information and public health departments –HHS is required to invest $300 million to "support regional or sub-national efforts toward health information exchange."

19. 19 HIT $  Implementation assistance –State grants to promote HIT Planning or implementation grants to states or state-designated qualified entities to expand electronic health information exchange States must provide matching funds on sliding scale (discretionary in FY09 and 10; 1:10 in FY11, 1:7 in FY12, 1:3 in FY13) –Competitive grants to states and Indian tribes for loan programs Funded through ONC, these grants will be made available to states or Indian tribes to establish loan funds for health care providers to acquire EHR technology (private contributions allowed) –Programs to integrate HIT into education Competitive awards to health professions schools to develop curricula to integrate EHR technology into education HHS, with NIST, provide funding to higher education for medical health informatics education programs at undergrad and grad levels

20. 20 HIT $  Implementation assistance (cont.) –Health Care Information Enterprise Integration Research Centers NIST grants to higher ed institutions or consortia to establish multidsciplinary centers Generate innovative approaches to health care information enterprise integration; and Pursue development of health information technologies and other complementary fields. –Health Information Technology Extension Program ONC will establish a health IT extension program to assist providers to adopt, implement, and use certified EHR technology Collaborate with other agencies such as NIST in implementing the program –Health Information Technology Research Center HHS will create a HIT Research Center to provide technical assistance and develop best practices to support effective use of health IT –Health Information Technology Regional Extension Centers HHS will assist with creation of regional centers to provide technical assistance and disseminate best practices from the national Research Center Regional centers will be affiliated with US-based nonprofit institutions Up to four years of federal assistance, capped at 50% of the capital and annual operating costs

21. 21 HIT Medicare and Medicaid Incentives  Medicare incentives for providers –Up to $18k if in 2011, then, 12k, 8k, 4k, 2k in subsequent years –Payment reduction begins in 2015-- 1%, 2%, 3% –Must meet standards  Medicare incentives for hospitals –Up to $16 million over 4 years if using HIT in 2011 –Additional penalties if not adopted –Must meet standards  Medicaid incentives –Pays states incentive payments to support costs incurred for adoption

22. 22 Next steps  ARRA provisions direct funding at high level –Specific details, including funding targets and processes for disbursement under development  How does this fit into your strategic plan? –Health provisions, but others that could impact you (research, construction, energy, etc.)  Are you communicating with Agency officials and congressional representatives about your interests/needs?  Are you monitoring implementation?

23. 23 Additional ARRA details available  www.recovery.gov www.recovery.gov  www.HHS.gov/recovery www.HHS.gov/recovery  www.AHRQ.gov www.AHRQ.gov  www.CDC.gov www.CDC.gov  www.CMS.gov www.CMS.gov  www.HRSA.gov www.HRSA.gov  www.NIH.gov www.NIH.gov  www.bakerdconsulting.com www.bakerdconsulting.com  www.bakerdaniels.com

24. 24 B&D Consulting  National advisory and advocacy consulting group based in Washington, DC –50+ professionals with deep sector concentrations; www.bakerdconsulting.com –Division of Baker & Daniels LLP  Health & Life Sciences consulting practice focused on technical and political aspects of the U.S. healthcare system

25. 25 Joan S. Antokol Partner, Baker & Daniels joan.antokol@bakerd.com

26. 26 Remember Your HIPAA Headache?? What is the impact on Covered Entities? What are the new requirements for Business Associates? How has ARRA changed the security breach reporting obligations? How has ARRA expanded HIPAA in terms of additional entities that must now comply? How has ARRA affected enforcement? What new rights do patients have under the ARRA? What is the impact, if any, How has ARRA changed the security breach reporting obligations?

27. 27 The Evolving Privacy and Security Landscape  70+ countries have passed sweeping laws  More on the way  US is considered to be less strict than the EU, Canada, Switzerland  Impact of ARRA goes far beyond the US

28. 28 ARRA Overview  Security breaches – what has changed  HIPAA – expansion and new requirements  Enforcement – federal and state

29. 29 Security Breaches  Overview of existing state law obligations  ARRA obligations –Who must comply? –What must you do to comply? –What has changed from prior state law obligations? –Do the state laws still apply too? –What enforcement can occur if you fail to comply? –What is the impact on patients?

30. 30 HIPAA--Before and After ARRA  Expanded scope of coverage  Limitation on permissible activities  Expanded patient access rights  Additional administrative responsibilities  Additional risks (enforcement, litigation)

31. 31 HIPAA – Examples of Impact  Third party management process  Internal management and documentation  Changes to procedures, training  Changes to auditing

32. 32 Enforcement  New tiered penalties  Expanded public notification  Additional pressure on HHS to enforce

33. 33 Moving Forward  Next B&D webinar on privacy and security: April 10, 2009, 1:30-3 pm  More detailed discussion of these issues  Call or email me at any time:  (317) 569-4665  Joan.antokol@bakerd.com

34. 34 David D. Storey Associate, Baker & Daniels david.storey@bakerd.com

35. 35 What Is Telemedicine? Telemedicine is not new. Definition of telemedicine varies. “Generally refers to the use of technology for the delivery of healthcare when the healthcare practitioner and patient are not in the same physical location.” Telemedicine: Survey and Analysis of Federal and State laws, Mayo & Kepler (AHLA).

36. 36 Who Is Practicing Telemedicine? Numerous healthcare providers: Family physicians, radiologists, dermatologists, psychiatrists, hospitals, rural health clinics and many, many others. Consultation with Specialist: Telemedicine consultations with a specialist physician is one of the more common types of telemedicine. Wide variety of services: Telephone consultations, telephone cross-coverage, live video patient assessments, store and forward image analysis, etc.

37. 37 Brief History of Telemedicine Legal Issues Technology has continued to advance, but the law has not kept up. Providers, lawmakers, payors, patients and other interested parties have repeatedly attempted to address telemedicine’s legal issues and expand telemedicine. Examples

38. 38 Major Legal Obstacles 1.Licensure and credentialing 2.Liability for patient injuries 3.Federal and State regulations 4.Security of patient health information 5.Reimbursement

39. 39 Recent Developments  ABA addressed state licensure issue during August 2008 annual meeting  Number of “originating sites” for Medicare reimbursement was expanded effective Jan. 1, 2009  ARRA/HITECH Act provides additional funding for telemedicine

40. 40 Future of Telemedicine Impact of ARRA/HITECH Act Key obstacles to overcome Is telemedicine important to the future of medicine?

41. 41 Questions…?  David Zookdavid.zook@bakerd.comdavid.zook@bakerd.com 202.589.2809 phone  Vincent J. Ventimiglia, Jr. vincent.ventimiglia@bakerd.comvincent.ventimiglia@bakerd.com 202.312.7463 phone  Joan S. Antokoljoan.antokol@bakerd.com 317. 569.4665 phone  David D. Storey david.storey@bakerd.com 260.460.1681 phone