Are you having trouble navigating through the murky waters of health care legislation? Fear not! We have broken down the complexities of the HIPAAMIPPATRHCAARRAPPACA Era, provided an illustration of each initiative in action, and explained what your IT vendor should be doing to help you comply with today's health care legislation.
3. A Legislation Smorgasbord
• HIPAA
– Health Insurance Portability & Accountability Act
• MIPAA
– Medicare Improvements for Patients & Providers Act
• TRHCA
– Tax Relief & Health Care Act
• ARRA
– American Recovery & Reinvestment Act
• PPACA
– Patient Protection & Affordable Care Act
4. HIPAA
• 1996
• In short, electronic transactions: 5010/ICD-10
• The “5010 Rules” requiring the changeover
from 4010 to 5010 transactions and from ICD-
9 to ICD-10, fall under the administrative
simplification portion of HIPAA
5. MIPPA
• 2008
• In short, Medicare ePrescribing Program
• Established the Medicare ePrescribing
program that requires eligible professionals
with prescriptive privileges to eRx permissible
medications for Medicare Part B fee-for-
service patients or suffer a payment
adjustment
6. TRHCA
• 2006
• In short, Physician Quality Reporting System
(PQRS)
• Established the Physician Quality Reporting
Initiative (now known as PQRS) to collect
clinical data so that the government could
define value and purchase value
7. ARRA
• 2009
• In short, Meaningful Use of certified EHRs
• HITECH, which is 60 pages of ARRA,
establishes the MU programs to accelerate
and reward adoption of interoperable
certified electronic health record technology
8. PPACA
• 2010
• In short, defining and purchasing value for
affordable care
• Seeks to reduce the number of uninsured
Americans and make care affordable by
defining value and purchasing value
9. What do they have in common?
• All of these pieces of legislation have an
increased focus on process and
technology
• The two major laws enacted under our
current administration (ARRA and
PPACA) accelerate transformation
through the use of health IT
10. Is it time to retire?
• Providers are utterly overwhelmed trying to
figure out what systems are impacted, how to
align disparate dates of compliance, design
roadmaps, or even figuring out how close to
retirement they are
• It is nearly impossible to put all the pieces
together and translate them into usable
health IT workflows without a strong
technology partner
13. Status Quo
Pay-for-Service
Data Provider CEHRT
Health &
Human
Services
Factory
14. Status Quo
Pay-for-Service
Provider CEHRT
Data
Health &
Human
Services
Factory
15. Status Quo
Pay-for-Service
Provider CEHRT
Data
Health &
Human
Services
Factory
Comparative
Effectiveness
Research
16. Status Quo
Pay-for-Service
Provider CEHRT
Data
Health &
Human
Services
Factory
Comparative
Effectiveness
Guidelines
Research
17. Status Quo
Pay-for-Service
Provider CEHRT
Data
Health &
Human
Services
Factory
Comparative
Effectiveness
Guidelines
Research
18. Status Quo
Pay-for-Service
Provider CEHRT
Data
Educate Measures
Health & Guidelines
Human
Services
Factory
Comparative
Effectiveness
Research
19. Status Quo
Pay-for-Service
Provider CEHRT
Data
Clinical
Decision
Educate Measures Support
Health & Guidelines
Human
Services
Factory
Comparative
Effectiveness
Research
20. Status Quo
Pay-for-Service
Performance
Provider CEHRT
Data
Provider CEHRT
Data
Clinical
Decision
Educate Measures Support
Health & Guidelines
Human
Services
Factory
Comparative
Effectiveness
Research
21. New Status Quo
Pay-for-Value
Status Quo
Pay-for-Service
Performance
Provider CEHRT
Data
Provider CEHRT
Data
Clinical
Decision
Educate Measures Support
Health & Guidelines
Human
Services
Factory
Comparative
Effectiveness
Research
22. All together now!
New Status Quo
Pay-for-Value
Status Quo
Pay-for-Service
Performance
Provider CEHRT
Data
Provider CEHRT
Data
Clinical
Decision
Educate Measures Support
Health & Guidelines
Human
Services
Factory
Comparative
Effectiveness
Research
23. New Status Quo
Pay-for-Value
Status Quo
Pay-for-Service
MIPPA - eRx Provider CEHRT
Performance
Data
Provider CEHRT
Data
Clinical
Decision
Educate Measures Support
Health & Guidelines
Human
Services
Factory
Comparative
Effectiveness
Research
24. New Status Quo
Pay-for-Value
Status Quo
ARRA – Meaningful Use
Pay-for-Service
MIPPA - eRx Provider CEHRT
Performance
Data
Provider CEHRT
Data
Clinical
Decision
Educate Measures Support
Health & Guidelines
Human
Services
Factory
Comparative
Effectiveness
Research
25. New Status Quo
Pay-for-Value
Status Quo
ARRA – Meaningful Use
Pay-for-Service
MIPPA - eRx Provider CEHRT
Performance
Data
Provider CEHRT
TRHCA
– PQRS
Data
Clinical
Decision
Educate Measures Support
Health & Guidelines
Human
Services
Factory
Comparative
Effectiveness
Research
26. New Status Quo
Pay-for-Value
Status Quo
ARRA – Meaningful Use
Pay-for-Service
MIPPA - eRx Provider CEHRT
Performance
Data
Provider CEHRT
TRHCA
– PQRS
Data
Clinical
Decision
Educate Measures Support
Health & Guidelines
Human
Services
Factory
PPACA – Define “Value”
Comparative
Effectiveness
Research
27. PPACA QuoVBM
New Status –
Pay-for-Value
Status Quo
ARRA – Meaningful Use
Pay-for-Service
MIPPA - eRx Provider CEHRT
Performance
Data
Provider CEHRT
TRHCA
– PQRS
Data
Clinical
Decision
Educate Measures Support
Health & Guidelines
Human
Services
Factory
PPACA – Define “Value”
Comparative
Effectiveness
Research
28. PPACA QuoVBM
New Status –
Pay-for-Value
Status Quo
ARRA – Meaningful Use
Pay-for-Service
MIPPA - eRx Provider CEHRT
Performance
Data
Provider CEHRT
TRHCA
HIPAA – ICD-10
– PQRS
Data
Educate Measures
Clinical
Decision
Support
Health & Guidelines
Human
Services
Factory
PPACA – Define “Value”
Comparative
Effectiveness
Research
30. How your IT Vendor Should Help
• Meaningful Use and other Dashboards
– MU and PQRS metrics with analytics on each
provider
– Facilitates quick numerators / denominators for
Meaningful Use attestation
– Analytics on your practice with drill-through
details
31. How your IT Vendor Should Help
• Patient Portal Inherent with System
– If your vendor outsources its Patient Portal, you
could be paying additional license or support fees
– If your vendor is not equipped with a Patient
Portal, you could face an additional Portal vendor
and all the integration considerations that go with
it
32. How your IT Vendor Should Help
• Single database solution
– Always use a certified, complete EHR, meaning
the practice management and electronic health
record are part of the same solution
– A certified, quality vendor can seamlessly provide
both
33. How your IT Vendor Should Help
• EHR Direct PQRS
– Must be certified to do EHR Direct PQRS, not beta
testing
34. How your IT Vendor Should Help
• Support that’s more than just a phone
call (and two continents) away
– Initiative toolkits for Meaningful Use, PCMH,
PQRS, etc.
– Consulting support with domain experts
– U.S.-based staff that is well-trained, friendly and
considerate of your time and needs
35. How your IT Vendor Should Help
• Ongoing Client Educational Offerings
– Provides free educational webinars
– Offers a wealth of articles, white papers, case
studies, tips and tricks to help you become more
knowledgeable about the industry and your
specialty
– Provides CEU-approved opportunities
– Consistently communicates about new features
36. How your IT Vendor Should Help
• Quality Improvement Organization
Alignment
37. Are you getting enough from
your vendor during this
HIPAAMIPPATRHCAARRAPPACA
Era of Health Care?