1. MIPPA Update

2. MIPPA Incentives Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)

3. MIPPA Penalties Penalties for not e-Prescribing YearPenalty 2012-1% 2013-1.5% 2014 and later-2%

4. Are You Eligible to Participate? You must be an eligible professional whose estimated allowed Medicare Part B charges for the e-prescribing measure codes are at least 10% of their total Medicare Part B allowed charges Example: –Eligible professional has $100,000 in estimated allowed Medicare Part B charges –At least $10,000 of charges must be based on the HCPCS codes that are in the denominator of the E-prescribing Incentive Program measure

5. “Qualified” eRx Application 1. Generate a complete medication list that incorporates data from pharmacies and benefit managers (if available) 2. Select medications, transmit prescriptions electronically* using the applicable standards, and warn the prescriber of possible undesirable or unsafe situations 3. Provide information on lower-cost, therapeutically-appropriate alternatives (for 2009, tiered formulary information, if available, meets this requirement) 4. Provide information on formulary or tiered formulary medications, pt. eligibility, & authorization requirements received electronically from the patient’s drug plan*

6. MIPPA Changes 2009 -> 2010 Item20092010 (subject to change) Reporting denominator Specific codes for office E&M: 90801-9, 92002, 92004, 92012, 92014, 96150-2, 99201-5, 99211-5, 99241-5, G0101, G0108-9 Modify to include SNF and home care: add 99304; 99305; 99306; 99307; 99308; 99309; 99310; 99315; 99316; 99341; 99342; 99343; 99344; 99345; 99347; 99348; 99349; 99350; and 90862 Remove: 99241-99245 (outpatient consultation) from list at left Reporting numerator One of 3 G-codes: G8443 (all scripts eRx), G8445 (no scripts written), G8446 (some paper/phoned for various acceptable reasons inc. pt. request, State or Fed law, pharmacy unable to receive, controlled drugs). Modify G8553: at least 1 Rx for the visit billed was electronically generated and transmitted with a qualified eRx system (Faxes do not qualify); eliminate the three older codes (G8443, G8445, G8446). G- code must be billed on same claim submission as denominator code if claims- based reporting. “Successful e-prescriber” >50% of reportable claims include an eRx g-code Report G8553 25 times during 2010 Successful e-prescriber reporting Claims-based reporting (g-code on same claim as E&M code) 1) Claims-based reporting 2) Registry reporting 3) “Qualified” EMR reporting

7. MIPPA for Group Practices New for 2010 –Practices >200 providers will be able to apply for MIPPA incentives as a practice –For 2010, practice must also report PQRI to report e-prescribing as a group –10% E&M threshold met as a group –Report G8443 with 2500 eligible visit claims for a 200 prescriber group (50% of 200 providers, times 25 G8443 reports/provider) –Unclear if individual prescribers must also report –Report by claims, registry, or EMR

8. ARRA All you need to know (so far)” –“Meaningful Use” Final rule due Spring 2010 http://healthit.hhs.gov/portal/server.pt/gateway/PT ARGS_0_11113_872719_0_0_18/Meaningful%20 Use%20Matrix.pdf

9. Meaningful Use Matrix http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11113_872719_0_0_18/Meaningful%20Use%20Matrix.pdf

10. Meaningful Use Incentives by Adoption Year 10 Meaningful User 20092010201120122013201420152016 Total Incentive 2011$ 18,000$ 12,000$ 8,000$ 4,000$ 2,000$ 44,000 2012$ 18,000$ 12,000$ 8,000$ 4,000$ 2,000$ 44,000 2013$ 15,000$ 12,000$ 8,000$ 4,000$39,000 2014$ 12,000$ 8,000$ 4,000$ 24,000 2015 +$ Penalties

11. Medicaid Incentives for Physicians and Hospitals

12. Medicare Incentives for Hospitals

13. Medicare Hospital Incentives

14. Medicare Hospital Payout Example

15. Questions? Peter N. Kaufman, MD Chief Medical Officer DrFirst