2. Agenda HIT survey Health Information Technology Incentives HITREC- Health Information Technology Regional Extension Center 2

3. Background American Recovery and Reinvestment Act (ARRA) provides incentive payments to Medicaid-eligible professionals and hospitals for the meaningful use of certified Electronic Health Record (EHR) technology For Medicaid-eligible professionals and hospitals to adopt and meaningfully use health information technology to improve health care quality, efficiency, and patient safety Avoid excessive or unnecessary burdens on providers in helping them to achieve meaningful use Ensure privacy and security of Personal Health Information (PHI) 3

4. Division of Responsibility Iowa Department of Public Health – e-Health and statewide Health Information Exchange Kory Schnoor: 515.924.4636 ehealth@idph.state.ia.us IFMC – HIT Regional Extension Center (HITREC) Susan Harr 800.373.2964 sharr@ifmc.org Iowa Medicaid Enterprise – administration of incentive payment program Kelly Peiper 515.974.3071 imeincentives@dhs.state.ia.us 4

6. Eligible Professional (EP) Non-hospital based Physicians Hospital-based EP furnishes at least 90% of services in a hospital inpatient or ER setting** Pediatricians Nurse Practitioners Certified Nurse Midwives Dentists PAs working in a FQHC/RHC when the facility is so led by a PA 6

7. Hospital Eligibility One CMS Certification Number (CCN) = one hospital Acute Care Average length of stay is less than or equal to 25 days CCN range (0001-0879; 1300-1399) Includes cancer hospitals Childrens Hospital 78 Childrens hospitals, CCN (3300-3399) Not childrens wings of larger hospitals Critical Access Hospitals are eligible under Medicaid 7

8. Patient Threshold Eligibility 8

9. Patient Threshold EP is also eligible when practicing predominately in a FQHC/RHC providing care for needy individuals Practicing predominately is when FQHC/RHC is the clinical location for over 50% of total encounters over a period of 6 months in the most recent calendar year for an eligible professional 9

10. Patient Threshold, cont Needy individuals (for FQHC/RHC)are defined as: Medicaid or the Childrens Health Insurance Program Receiving uncompensated care by the provider Furnished services at either no cost or reduced cost based on a sliding scale determined by the individuals ability to pay. Must annually meet patient volume thresholds, 10

11. Patient Threshold, cont Final rule gives two options. Option One: (Total (Medicaid) patient encounters in any 90-day period in the preceding calendar year) Divided by (Total patient encounters in that same 90-day period) Multiplied by 100 11

12. Patient Threshold, cont Option Two: (Total Medicaid patients assigned to the provider in any representative continuous 90-day period in the preceding calendar year with at least one encounter in the year preceding the start of the 90-day period) + (Unduplicated Medicaid encounters in that same 90-day period) Divided By (Total patients assigned to the provider in the same 90-day with at least one encounter in the year preceding the start of the 90-day period) + (All unduplicated encounters in that same 90-day period) 12

13. Patient Encounter 1 – Services rendered on any one day to an individual where Medicaid or a Medicaid 1115 grant paid for part or all of the service 2 – Services rendered on any one day to an individual where Medicaid or a Medicaid 1115 grant paid all or part of their premiums, co-payments and/or cost sharing 13

15. Incentive Payments to EPs 15

16. Payments to Hospitals The calculation is (overall EHR Amount) times (Medicaid Share) Where overall EHR Amount equals {Sum over 4 year of {(Base Amount plus discharge related amount applicable for each year) times transition Factor applicable for each year}} times Medicaid Share equals {(Medicaid inpatient-bed-days plus Medicaid managed care inpatient-bed-days) divided by {(total inpatient-bed days) times (estimated total charges minus charity care charges) divided by (estimated total charges)]} 16

17. Incentive Assignment EP may assign payment to an employer or billing entity EPs may assign payments to entities promoting EHR technology, as designated by the State States must establish verification procedures that enable the latter assignment, to ensure it is voluntary and that the entity does not retain more than 5% of the payment for non-EHR activities 17

18. Meaningful Use

19. Timing Medicaid EHR incentive program starts in 2011 and ends in 2021 The latest that a Medicaid provider can initiate is 2016 A Medicaid provider can initiate the program under the Adopt, Implement and Upgrade bar, but must meet Meaningful Use during subsequent years at the stage that is currently in place (Stage 3 by 2015) 19

20. Adopt, Implement or Upgrade Adopt: Acquired and installed E.g., Evidence of acquisition, installation, etc. Implement: Commenced utilization E.g., staff training, data entry of patient demographic information into EHR, data use agreements Upgrade: Version 2.0, expanded functionality E.g., Office of National Coordinator (ONC) EHR certification 20

21. Meaningful Use A provider must demonstrate meaningful use by: Use of certified EHR technology in a meaningful manner, such as through e- prescribing, and That the certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of care, and In using this technology, the provider submits clinical quality measures to CMS and likely to the State 21

22. Meaningful Use Summary Eligible Professionals 80% of patients must have records in the certified EHR technology 20 of 25 Objectives and Measures 8 Measures require Yes or No answers 17 Measures require numerator and denominator Eligible Hospitals 19 of 24 Objectives and Measures 10 Measures require Yes or No answers 14 Measures require numerator and denominator Reporting Period – 90 days for first year; entire year subsequently 22

23. Meaningful Use Stages Meaningful Use will be phased in over 3 stages through rulemaking: Stage 1 – 2011 Stage 2 – 2013 * Stage 3 – 2015 * *Stages 2 and 3 will be defined in future CMS rulemaking. 23

24. Verification 2011 – Submit proof by attestation Patient threshold Not hospital-based 2012 – Electronically submit summary quality measure data 24

25. Clinical Quality Measures for Eligible Hospitals Hospitals to report summary data on 15 clinical quality measures to CMS (first through attestation, then electronically) for each patient to whom the QM applies Hospitals only eligible for Medicaid will report directly to the States If the measures dont apply, then option of selecting an alternative set of Medicaid clinical quality measures – including newborn measures, pediatric measures, and never-event measures 25

26. Medicare vs. Medicaid

27. Medicare vs. Medicaid Criteria Medicare Medicaid Feds will implement (will be an option nationally) Fee schedule reductions begin in 2015 for providers that are not Meaningful Users Must be a meaningful user in Year 1 Maximum incentive is $44,000 for EPs MU definition will be common for Medicare Voluntary for States to implement (may not be an option in every State) No Medicaid fee schedule reductions Adopt/Implement/Upgrade option for 1st participation year Maximum incentive is $63,750 for EPs States can adopt a more rigorous definition (based on common definition) 27

28. Medicare vs. Medicaid Criteria Medicare Medicaid Medicare Advantage EPs have special eligibility accommodations Last year an EP may initiate program is 2014; Last payment in program is 2016. Only physicians, subsection (d) hospitals and CAHs Last year an EP may initiate program is 2016; Last payment in program is 2021 Medicaid managed care providers must meet regular eligibility requirements 5 types of EPs, 2 types of hospitals (including CAHs) 28

29. Payments: Registration through the NLR To prevent duplicate payments Supply Name, NPI, business address, phone TIN Hospitals must provide CCN EPs select between Medicare or Medicaid May switch once between programs before 2015 If Medicaid, must select one state May switch states annually 29

30. Next Steps Understand your eligibility and think about the measures that apply to you Evaluate your workflows in relation to capturing the measures Talk with your vendors about their plans to support meaningful use Final rule http://www.ofr.gov/OFRUpload/OFRData/2010- 17207_PI.pdf http://www.ofr.gov/OFRUpload/OFRData/2010- 17207_PI.pdf 30

32. The HITREC Federally-funded Regional Extension Center Assistance to providers in adopting, implementing and achieving meaningful use of the of EHRs by: Vendor selection Group purchasing Implementation Project management Practice workflow design Interoperability Privacy and security HIE 32

33. The HITREC Eligible providers: Individual and small primary care practices (10 or fewer with prescriptive privileges) Public and critical access hospitals Community Health Centers and Rural Health Clinics Settings that predominately serve the uninsured, underinsured, and medically underserved In the first two years, technical assistance is subsidized for priority primary care providers. Grant funds 90 percent, participating providers pay approximately 10 percent. 33

34. Questions, comments? Please complete the HIT survey What are your barriers to implementing an EHR? Likelihood of qualifying? Please send questions and comments to imeincentives@dhs.state.ia.us imeincentives@dhs.state.ia.us 34