1. HealthBridge is one of the nation’s largest and most successful health information exchange organizations. David Groves, Executive Director April Smith, Project Manager Tri-State Regional Extension Center Tri-State REC: How Clinicians Can Qualify for Meaningful Use & Federal Incentives

2. What do you need to know to get paid?

3. ARRA & HITECH Acts On Feb. 17, 2009, President Obama signed the American Recovery and Reinvestment Act of 2009 (ARRA). The health IT provisions of the Recovery Act together are known as the Health Information Technology for Economic and Clinical Health Act or HITECH Act. HITECH Act authorizes creation of a number of new programs and roughly $40 Billion in new spending. The US Department of Health and Human Services (DHHS) and the States were tasked with promoting the “meaningful use” of health information technology through the use of incentives. REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services.

4. Meaningful Use – Who is eligible for incentives? REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services. Eligible Providers in MedicareEligible Providers in Medicaid Eligible Professionals (EPs) Doctor of Medicine or OsteopathyPhysicians (Pediatricians have special eligibility & payment rules) Doctor of Dental Surgery or Dental MedicineNurse Practitioners (NPs) Doctor of Podiatric MedicineCertified Nurse-Midwives (CNMs) Doctor of OptometryDentists ChiropractorPhysician Assistants (PAs) who lead a Federally Qualified Health Center (FQHC) or rural health clinic (RHC) Eligible Hospitals Acute Care Hospitals Critical Access Hospitals (CAHs)Children’s Hospitals

5. Funding is available... REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services. MEDICARE EP Incentive Payment - Based on First Calendar Year EP receives Calendar Year CY 2011CY 2012CY 2013CY 2014CY 2015 and later 2011 $18,000 2012 $12,000$18,000 2013 $8,000$12,000$15,000 2014 $4,000$8,000$12,000 2015 $2,000$4,000$8,000 0 2016 $2,000$4,000 0 TOTAL $44,000 $39,000$24,0000

6. Medicaid funding higher REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services. MEDICAID EP Incentive Payment - Based on First Calendar Year EP receives Calendar Year CY 2011CY 2012CY 2013CY 2014CY 2015CY2016 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

7. Medicaid MU Thresholds REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services. EntityMinimum Medicaid Patient Volume Threshold For Eligible Professionals (EPs) Physicians30% -Pediatricians20% Dentists30% CNMs30% PAs when practicing at an FQHC/RHC that is so led by a PA 30% NPs30% **Or the Medicaid EP practices predominantly in an FQHC or RHC—30% needy individual patient volume threshold For Eligible Hospitals Acute care hospitals10% Children’s hospitalsNo requirement

8. Meaningful use is complex To receive incentives, for example, practices have to use technology for: Medication and allergy lists E-Prescribing Access to electronic lab results Electronic orders Electronic claims submission Checking insurance eligibility Clinical summary to other providers and patients Clinical decision support Health information exchange Quality reporting to the federal government Among others… REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services.

9. The Challenges Government regulations are complex. Final Rule on “Meaningful Use” expected from HHS by June 30, 2010 As many as 30% of all EHR implementations fail. EHR Selection can be time consuming and risky EHR adoption will impact workflow EHR use will bring new challenges with regard to security and privacy of patient records EHR Implementation alone is not enough

10. An Overview REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services.

11. There is help Tri-State Regional Extension Center (REC) WHAT IS IT? New federally-funded collaboration led by HealthBridge GOAL: Help eligible professionals implement technology achieve meaningful use and qualify for incentives REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services.

12. Tri-State REC Service Area State Ohio (11 counties) Kentucky (37 counties) Indiana (19 counties)

13. Tri-State REC Partners State Ohio (11 counties) Kentucky (37 counties) Indiana (19 counties) NEKY RHIO

14. WHAT SERVICES WILL THE TRI-STATE REC OFFER? Basic Resources on Technology and Meaningful Use Group Purchased EHRs and Technology Solutions On-Site Consulting Quality Reporting Support WHAT REC DOLLARS CANNOT DO: Pay for an EHR, hardware or other software HealthBridge Tri-State Regional Extension Center (REC) REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services.

15. HealthBridge Tri-State Regional Extension Center (REC) WHO WILL IT HELP? Priority Primary Care Practitioners (PPCP) Primary Care = FPs, OB/Gyn, Peds, Int. Med Additional focus on: Small practices (<10 prescribers; physicians, PAs, ARNPs) Community health centers Rural clinicians and those with critical access hospitals Practices and clinics that serve the underserved. REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services.

16. Timeline for maximum payment: Stage I applications will be accepted between Jan. 2011 and Dec. 2012 Implementing an EHR takes ~ 12 mos. If you haven’t started planning for an EHR, now is the time to start. If you have an EHR, you will need to make sure it is certified and can meet meaningful use requirements. These things simply take time. Time is money. REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services.

17. Maximize funding available to you Speed adoption timeline Avoid common mistakes Help manage your vendor’s work Prepare a roadmap for achieving meaningful use and help your practice get there How will the REC help? REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services.

18. Bottom line: REC will help practices maximize funding minimize expenses and improve quality and efficiency of the practice Why Work with the Tri-State REC? REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services.

19. First Step: Sign the Provider Agreement What’s in it? In Binder under REC Info Tab: Basic Agreement (Pgs 1-2) Exhibit A: Basic outline of roles & responsibilities Exhibit B: Overview of Meaningful Use Proposed Rules Exhibit C: Practice and Location Data (feds require REC to collect this information) Exhibit D: Tri-State REC Contacts Assigned to Practice Exhibit E: Fee Schedule **Feds only supply 90% of costs; REC required to generate revenue Exhibit F: Business Associate Agreement REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services.

20. Fee Schedule Provider Type Designation EHR Practice Already Using EHR HIE Participant Practice Actively Using HIE- Offered Clinical Technology Paper-Based Practice Not using an EHR or HIE technology Early Adoption Period: Through 6/30/10 (Limited to the first 300 PPCPs ONLY) Fee Waived $1,000 per physician PPCP No Charge $500 per physician (Capped at $5,000) $2,000 per physician (Capped at $20,000) Non-PPCP $5,000 per physician (Capped at $40,000) $7,000 per physician (Capped at $55,000) $9,000 per physician (Capped at $75,000) REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services.

21. Second Step: Planning Tri-State REC staff will perform MU Gap Analysis or Readiness Assessment If you already have an EHR, then Tri-State REC staff will perform an independent assessment of whether it meets meaningful use criteria. If you don’t have an EHR, Tri-State REC staff will perform an EHR readiness assessment Then Tri-State REC staff will help you develop and execute a plan to get to meaningful use. REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services.

22. Third Step: Vendor Selection/Modification REC staff will assist practice with looking at options, selecting vendor and providing best practices in vendor contracting. Group Purchased EHR Available through REC Other options: Health System Stark-Safe Harbor EHR offerings OSIS Purchase independently Also support practice in selection of hardware, IT support, and other elements needed REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services.

23. Fourth Step: Implementation Assist with identifying health information exchange requirements under meaningful use Provide options for how to meet HIE requirements Workflow, Change Management Assistance Vendor – Project Management Provide recommendations and assistance with quality reporting, e-prescribing and other meaningful use requirements For select practices, assist with intensive quality improvement and enhanced work flow redesign REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services.

24. Advise practices in how to maximize their incentive funding Assist with completing application process for meaningful use incentive payments REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services. Fifth Step: Qualifying

25. Next Steps Review and sign provider agreement and return to HealthBridge to initiate work REC. Fees are waived through June 30 th for eligible practices. Contact us via phone, email or online if you have additional questions. Tri-State REC Information Phone: 513-469-7222, option 3 Email: rec@healthbridge.orgrec@healthbridge.org Online: www.healthbridge.orgwww.healthbridge.org REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services.