Greenway Economic Stimulus And Impacts Overview 3 23 2009
1. American Recovery and Reinvestment Act
(ARRA) of 2009
Health IT Provisions Overview
Spring 2009
2. HIT Programs & Funding
General Summary
• HHS to lead standards development for nationwide exchange and
use of health information to improve quality and coordination of
care.
• Over $30B of direct adoption incentives for “meaningful use” of
certified EHRs. Specifically, $17.7B in Medicare incentives and
$12.4 in Medicaid incentives. Over $2B for infrastructure, health
information exchange (HIE) and clinical research funding.
• Conservative CBO estimates show that ARRA funding will save
over $15B in government spending throughout the health sector
through improved quality and care coordination, reductions in
medical errors and duplicative care.
• Strengthens HIPAA to protect identifiable health information from
misuse as use of HIT increases.
3. Federal HIT Leadership
• Office of the National Coordinator
– Codifies ONC, to be headed by the National Coordinator appointed by
the Secretary of HHS
– Primary purpose is to develop a nationwide health information
technology infrastructure that allows for the electronic use and
exchange of information
• HIT Policy Committee
– Make recommendations on national HIT infrastructure and
implementation of the ONC Strategic Plan
– Prioritize focus for interoperability and certification
– Federal Advisory Committee Act (FACA)
• HIT Standards Committee
– Recommend standards, implementation specs, and certification criteria
in accordance with the policies developed by the HIT Policy Committee
– HITSP role is to be determined
4. Office of the
National Coordinator
• Purpose
– Develop a nationwide health information technology infrastructure
that allows for the electronic use and exchange of information
• Duties
– Review and endorse standards, implementation specs and
certification criteria recommended by the HIT Standards Committee
– Initial set of standards to be defined by 12/31/2009
• Those adopted previously may be applied toward meeting this
requirement
– Coordinates HIT investments and programs of Federal agencies
– In consultation with NIST, keep or recognize a program for the
voluntary certification of HIT (CCHIT)
– Establish a governance mechanism for the nationwide health
information network
– Appoint a Chief Privacy Officer
5. HIT Policy Committee
• Purpose
– Make policy recommendations to the National Coordinator relating to
implementation of a nationwide health information technology
infrastructure including implementation of the Federal HIT Strategic
Plan
• Duties
– Recommend a policy framework for the development and adoption of
a nationwide health information technology infrastructure
– Prioritize areas in which standards, implementation specs and
certification criteria are needed
• Membership
– Members appointed by government and to include at least one
information technology vendor
6. HIT Standards Committee
• Purpose
– Recommend standards, implementation specs and certification criteria
in accordance with the policies developed by the HIT Policy
Committee
• Duties
– Recommend standards, implementation specs and certification criteria
that have been developed, harmonized or recognized by the HIT
Standards Committee
– Recognize harmonized or updated standards from an entity or entities
– As appropriate, provide for the pilot testing of standards and specs by
NIST
– With NIST, establish conformance testing infrastructure which may
include a program to accredit independent labs to perform testing
• Membership
– Members are appointed and include a broad range of stakeholders
(providers, ancillary healthcare works, consumers, purchasers, health
plans, technology vendors, researchers, Federal agencies, and
individuals with relevant expertise)
– Allows for open public comment
7. Medicare Physician Incentives
• Incentives begin in CY11 (1/1/2011)
• For maximum bonus, must be a “meaningful” user of certified
EHR in CY11 or CY12
• Bonus amounts decrease starting in CY13
• If not a “meaningful” user by CY15, no bonus payments and
penalties will be applied
• Physicians receive a reduction in fee schedule
– 2015 - 99%
– 2016 - 98%
– 2017 - 97%
– 2018 - HHS Secretary has authority to increase penalties if
percentage of physicians who are “meaningful” users is less than
75%
– Maximum reduction is 95% of fee schedule
8. Medicare Physician Incentives
• “Meaningful” use
– Using certified EHR technology, which includes e-prescribing
– Demonstrates EHR is connected to provide electronic exchange of
health information to improve quality and promote care coordination
– Reports on clinical quality measures selected by the Secretary
– HHS Secretary to decide on further definitions which may change over
time
• Incentive amount is calculated as 75% of allowable Part B charges
for the payment year
• Maximum incentive payments are as follows
– Year 1 - $18,000 (If year 1 is 2011 or 2012, otherwise $15,000)
– Year 2 - $12,000
– Year 3 - $8,000
– Year 4 - $4,000
– Year 5 - $2,000
– Year 6 - $0
• Physicians in health professional shortage areas receive a 10%
increase
10. Medicaid Incentives for
Physicians & Hospitals
• Eligible Providers
– Non-hospital-based professionals with ≥ 30% patient volume attributable to
individuals receiving medical assistance
– Non-hospital-based pediatricians with ≥ 20% of patient volume attributable
to individuals receiving medical assistance
– Eligible professionals who practice predominately in a Federally-qualified
health center or rural health clinic with ≥ 30% patient volume attributable to
needy individuals
– Children’s hospitals or acute care hospitals that have ≥ 10% patient volume
attributable to individuals receiving medical assistance
• Incentives
– Professionals
• Must choose either Medicare or Medicaid
• States authorized to make payments totaling no more than 85% of the
net average allowable costs for acquiring, upgrading, implementing and
ongoing “meaningful” use of certified EHRs and associated services
• Maximum is $63,750.for physicians
– Hospitals
• Maximum Medicare and Medicaid bonus is projected to be $11M
11. Medicare Incentives
for Hospitals
• Requirements for incentives begin in FY11 (10/1/2010)
• For maximum bonus, must be a “meaningful” user of a certified
EHR in FY11, FY12 or FY13
• Bonus amounts decrease beginning in FY14 with further
reductions in FY15
• If not a “meaningful” user by FY15, there are penalties
– Reduction in market basket increase
12. Medicare Hospital Incentives
• “Meaningful” use
– Use of a certified EHR technology in a “meaningful” manner
– Demonstrates EHR is connected to provide electronic exchange of
health information to improve quality and care coordination
– Able to report clinical quality measures as specified by HHS
Secretary
– HHS Secretary to decide on further definitions which may change
over time
• Year 1 Incentive Calculation $2M Base
+ Discharge Amount*
x Medicare Share**
x Transition Factor ***
Year x Payout Amount
*Discharge Amounts calculated as discharge amount = For the 1150th – 23,000th discharge - $200
per discharge – regardless of payer
**Medicare Share calculated as Medicare Inpatient bed days + Medicare Advantage inpatient bed
days (Number of inpatient bed days * (Total charges – charges for charity care) /Total Charges
*** Transition Factor – see next slide
13. Medicare Hospital Payout Example
Hospital with 10,000 discharges, 25% Medicare share, 25% charity care
Base Amount: $2,000,000
Discharge Amount + $1,770,200
$3,770,200
Factor (Medicare & Charity) x .3333
Year 1 Payout Amt $1,256,730
Performance FY11 FY12 FY13 FY14 FY15 FY16 Total
Yr ->
Starting Yr
FY11 $1,256K $942K $628K $314K 0 0 $3,141K
FY12 $1,256K $942K $628K $314K 0 $3,141K
FY13 $1,256K $942K $628K $314K $3,141K
FY14 $942K $628K $314K $1,885K
FY15 $628K $314K $942K
FY16 $0 $0
14. Grants and Loans
$2B in Funding
• Health Information Technology Implementation Assistance
– Establish Health IT Research Center
• Provide technical assistance and develop best practices to accelerate efforts
to implement and utilize HIT that allows for electronic exchange and use of
information
– Provide assistance for the creation of HIT Regional Extension Centers
(details to be published in Federal Register within 90 days of enactment)
• Provide technical assistance and disseminate best practices and other
information learned from the Center
• Regional Centers can be affiliated with any US-based non-profit organization
– State grants to promote HIT
• Grants issued to states or qualified state-designated entities to facilitate and
expand electronic movement and use of health information among
organizations
• States required to match funds increasing over time
• States can spend funds on certified EHRs
15. Grants and Loans
• Competitive grants to states and Indian tribes for loan programs
– Development of loan programs to providers to facilitate the widespread
adoption of certified EHRs
– Awards can begin in 2010
– Matching funds required
• Demonstration programs to integrate certified HIT into clinical
education
– Develop academic curricula integrating certified EHRs into clinical
education
– Matching funds required
– Funds cannot be used to purchase hardware, software or services
• Information technology professionals in health care
– Assist institutions to establish or expand medical and health informatics
education programs for health care and information technology
– Preference to short-term existing programs
16. Privacy & Security
• Notification of breach
– Defines breach
– Individuals must be notified of unauthorized disclosure of their health
information
• Accounting for disclosures
– Gives patients the right to request an accounting of disclosures of their
health information made through an electronic record
– Requires HHS Secretary to promulgate regulations regarding what
information must be included in the accounting of disclosures
• Restrictions on certain disclosures
– Permits individuals to request that their PHI regarding a specific item or
service not be disclosed by a covered entity to a health plan for purposes of
payment or healthcare operations if the individual has paid out-of-pocket for
the item or service
17. Privacy & Security
• Requirements for Business Associates (BAs)
– BAs now subject to same HIPAA privacy and security provisions and
penalties that apply to Covered Entities (CEs)
• Sales/Marketing of protected health information (PHI)
– Provides new restrictions on marketing use of PHI and on the
circumstances under which any entity can receive remuneration for PHI
• New HIPAA Business Associate categories
– New entities not contemplated when HIPAA was written (such as PHR
vendors, RHIOs, HIEs, etc.) are subject to same privacy and security rules
as providers and health insurers by requiring BA contracts and treating the
entities as BAs under HIPAA
• Enforcement allowed through states’ attorneys general
18. HHS Reports & Studies
• Report on actions taken to facilitate adoption, barriers to achieve adoption and
further recommendations
• Examine methods to create reimbursement incentives for improving health
care quality for Federally-qualified health centers, rural health clinics and free
clinics
• Potential use of technology to assist seniors, individuals with disabilities and
their caregivers
• Various reports on privacy and security
• Report on open source technology (by 10/1/2010)
– HHS Secretary, Veterans’ Health Administration, Secretary of Defense,
AHRQ and Federal Communications Commission
– Current availability of open source health IT systems to Federal safety net
providers
– Total cost of ownership of such systems in comparison to the cost of
proprietary commercial products available
– Ability of such systems to respond to the needs of, and be applied to,
various populations (including children and disabled individuals)
– Capacity of such systems to facilitate interoperability
19. Research Programs
• NIST and the National Science Foundation to issue competitive
grants to institutions of higher education (or consortia)
– Generate innovative approaches to enterprise integration by
conducting cutting-edge, multidisciplinary research on the systems
challenges to healthcare delivery
– Development and use of health information technologies and other
complementary fields
– Research areas may include:
• Interfaces between human information and communications technology
• Software that improves interoperability among health information systems
• Software dependability
• Health information enterprise management
• HIT security and integrity
• Relevant HIT to reduce medical errors
20. Greenway - Moving Forward
• Ongoing planning, monitoring and education
• There will be ongoing issues that require education and influence.
Greenway will prioritize these issues based on:
– Legislative movements
– Regulatory interpretations and movements
– Impact (+/-) on care provider and stakeholder communities
• For key issues
– Determine positioning
– Determine monitoring and education process
– Educate/ engage Congress and Administration for specific or broad actions
• Staying informed
– Greenway web site - http://www.greenwaymedical.com
– Blog ~ http://healthitforthe21stcentury.blogspot.com/
21. Additional Resources
• Greenway’s Economic Stimulus Page on the Stimulus Package
– http://www.greenwaymedical.com/news/stimulus/
– Stimulus Package Overview of Health IT Funding and Incentives
• Government & HHS Stimulus Sites
– www.recovery.gov
– http://www.hhs.gov/recovery/
• Link to Final Congressional Language
– http://fdsys.gpo.gov/fdsys/pkg/BILLS-111hr1ENR/pdf/BILLS-
111hr1ENR.pdf
22. Greenway Educational Materials
and Positioning
• National Health IT Leadership
– http://www.greenwaymedical.com/news/leadership/
• Government Affairs Testimonies & Leadership
– http://www.greenwaymedical.com/company/government/
• Privacy & Security
– EHR Association Privacy Position Statement
23. Greenway Medical Technologies, Inc.
Corporate Headquarters
121 Greenway Boulevard
Carrollton, Georgia 30117
Phone: 770-836-3100 Toll-free: 866-242-3805
Fax: 770-836-3200
www.greenwaymedcial.com
