1. Health Information Technology EHR Meaningful Use Milestones for HIT Funding Michele Madison mmadison@mmmlaw.com

2. Presentation Overview Purpose and Function of Stimulus Package Provider Financial Incentives Meaningful Use Certification Standards

3. Governmental Incentives American Recovery and Reinvestment Act of 2009 (ARRA) Medicare Incentives for Eligible Professionals Medicaid Incentives for Eligible Professionals

4. Direct Provider Funding WHO: DHHS – CMS WHEN: 2011 ---- HOW: Financial Incentive Payments TO WHOM: Eligible Professional and Hospitals

5. GENERAL RULE “Eligible Professionals” who adopt and “meaningfully use” “certified” electronic health records are eligible for Medicare and Medicaid Financial Incentives

6. Eligible Professionals Medicare Incentives may be paid to “Eligible Professionals” –Physicians –Does not Apply to Hospital Based Physicians Emergency Room Anesthesia Pathologists (Determined based upon Site of Service)

7. Eligible Professionals Medicare A physician as defined in section 1861(r) of the Social Security Act*, which includes the following five types of professionals: –Doctor of medicine or osteopathy –Doctor of dental surgery or medicine –Doctor of podiatric medicine –Doctor of optometry –Chiropractor Medicaid Physicians Dentists Certified nurse-midwives Nurse practitioners Physician assistants who are practicing in Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs) led by a physician assistant.

8. Medicare Incentives Incentives for Adoption and Meaningful Use of Certified EHR Paid to the Eligible Professional or Facility or Employer No payments after 2016 No incentive if first adopting after 2014 Payment is either single consolidated payment or periodic installment payments

9. Meaningful Use Incentives by Adoption Year 9 Meaningful User 2009 2010 201120122013201420152016 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 201412,000 $ 8,000$ 4,000 $ 24,000 2015 + $ Penalties

10. Medicare Dis-Incentive Failure to Meaningfully Use Certified EHR Starting in 2015 reduce reimbursement to 99% –2016 – 98%... –2017-- 97%... –2018 -- 96%... –Not less than 95% Unless Significant Hardship applies (5 year Limitation)

11. Hospital Payments Hospital Specific Calculation:  [$2Million + (0 x (1149-1 discharges) +(200 x (23,000-1150 discharges) + (>23000 x 0)] x [Medicare Share] x [Transition Factor].  If the adoption is after 2013 the payment will reduce based upon modified Transition Factor  Critical Access Hospital:  Paid through prompt interim payment– cost reporting period  No payment after 2015 and no payments for more than 4 consecutive years

12. Development of Meaningful Use ARRA –February 17, 2009 Meaningful Use Proposed Definition –Health IT Policy Committee –June 16, 2009 –Provided a Matrix to Define Terms –Comments received until June 26, 2009

13. Meaningful Use under ARRA Use of E-prescribing Use Certified EHR to report on clinical quality measures selected by DHHS DHHS may set alternative requirements for a group practice DHHS shall seek to improve the use of electronic health records and health care quality over time by requiring more stringent measures of meaningful use

14. Information exchange - ARRA EHR technology is connected in a manner that provides, in accordance with law and standards applicable to the exchange of information, for the electronic exchange of health information to improve the quality of health care, such as promoting care coordination.

15. Meaningful Use Meaningful Use Criteria must be selected and approved by DHHS The Measures must be published for public comment Must be measures that DHHS can accept for reporting

16. Demonstration of Meaningful Use Demonstrate Use (1) attestation; (2) submit claims; (3) survey; or (4) reporting Meaningful Users will be identified on CMS website

17. HIT Policy Committee Recommendations Established “Health Outcome Policy Priorities” Care Goals 2011, 2013 and 2015 Objectives 2011, 2013 and 2015 Measures

18. Ultimate Goal of HIT Policy Committee The ultimate goal of meaningful use of an Electronic Health Record is to enable significant and measurable improvements in population health through a transformed health care delivery system. The ultimate vision is one in which all patients are fully engaged in their healthcare, providers have real-time access to all medical information and tools to help ensure the quality and safety of the care provided while also affording improved access and elimination of health care disparities.

19. Health Outcome Policy Priorities Improve Quality, Safety, Efficiencies and Reduce Health Disparities Engage Patients and Families Improve Care Coordination Improve Population and Public Health Ensure Adequate Privacy and Security Protections for Personal Health Information

20. HIT Policy Committee July 16, 2009 Revised Meaningful Use Objectives and Measures August 14, 2009—Final Meaningful Use Objectives and Measures Final Matrix for Review http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_888532_0_0 _18/FINAL%20MU%20RECOMMENDATIONS%20TABLE.pdf

21. HIT Standards Committee August 20, 2009 Meaningful Use Measures and Data Grid Clinical Operations Workgroup Privacy and Security Workgroup

22. Meaningful Use Workgroup Standards Committee Standard Categories Quality Data Types HITEP Definitions Data Elements Standards http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_880493_0 _0_18/MU%20Grid%20Data%20Element%20Standards_08202009.pdf

23. Measure Process Workflow

24. Clinical Operations Subject Area Recommended for 2011 and 2013 Implementation Recommended Directional Statement for 2013 and 2015 http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_88049 0_0_0_18/Ferguson_Clinical%20Operations%20WG%20Recommendatio ns%20Revised%20Summary.pdf

25. Privacy and Security Standards Source Standards Services Supported Recommended Implementation Time Frame http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_880497_0_ 0_18/PRIVACY%20AND%20SECURITY%20STANDARDS%20APPLICABLE %20TO%20ARRA%20REQUIREMENTS.pdf

26. Certification Process Once a certification process is proposed, HHS in consultation with other relevant federal agencies, will review the recommendations and propose adoption of the standards, implementation specifications and certification criteria and jointly determine adoption Adoption pursuant to the formal rulemaking process Refusal to adopt requires notice to ONC and the Standards Committee with rationale Voluntary use of standards and implementation specifications by private entities Certification of private technologies will be voluntary. Federal agencies will require by contract that healthcare providers, health plans or health insurance issuers upgrade to IT Systems that meet the standards – catalyst to adopt.

27. Certification Process ONC will keep or recognize programs to certify technology that is in compliance with applicable certification criteria. Certification criteria means criteria to establish the technology meets with the standards and implementation specifications. The National Coordinator will consult with the Director of the National Institute of Standards and Technology in creating the certification programs. Implications of certification standards that do not support or require “interoperable” health network

28. Providers Focus on Certification and Standards Foundation: Functionality - ensuring that the systems can support the activities and perform the functions for which they are intended; Security - ensuring that systems can protect and maintain the confidentiality of data entrusted to them; and Interoperability - ensuring that systems implement the recognized standards and can exchange information and work with other systems.

29. Providers Evaluate current Technology Determine if the Technology is being programmed to address Objectives 2011 Measures 2011 Focus on Interoperability, Functionality and Security Evaluate Current Operations Evaluate New Technology

30. Take Pro-active Steps Monitor Objectives and Measures Monitor Technology Compliance Evaluate Disparate Programs Take steps to ensure compliance with measures Reporting mechanisms

31. Thank you Michele Madison Partner, Healthcare Practice 404.504.7621 mmadison@mmmlaw.com This presentation is provided as a general informational service to clients and friends of Morris, Manning & Martin LLP. It should not be construed as, and does not constitute, legal advice on any specific matter, nor does this message create an attorney-client relationship. These materials may be considered Attorney Advertising in some states. Please note, prior results discussed in the material do not guarantee similar outcomes.