Daniel T. Golder, DDS, MBAChief Information Officer

Oklahoma Foundation for Medical QualityThis material is provided by the Oklahoma Foundation for Medical Quality, under the Health Information Technology Regional Extension Center grant number 90RC0005/01,

funded by the Office of the National Coordinator, United States Department of Health and Human Services.

The OFMQHITRegional Extension Center

(REC)ARRA Incentives & Meaningful Use:

How your Regional Extension Center Can Help

OFMQ

• Oklahoma Foundation for Medical Quality• QIO (Quality Improvement Organization)

– CMS (Centers for Medicare & Medicaid Services)

• Independent, non-profit, community-based organization (founded in 1972)

• Our Mission Statement:

“Leading efforts to improve healthcare and improve lives”

OFMQ Organizational Vision

• Resource for health care quality and improving outcomes:– Evidence-Based Research– Collaboration– HIT Implementation– Health Quality– Empowering Consumers

OFMQHIT REC

• OFMQ Health Information TechnologyRegional Extension Center

• American Recovery & Reinvestment Act (ARRA): 2-17-09 “Stimulus Package”

• HITECH Act– Office of the National Coordinator for

Health Information Technology (ONC)– Incentive payments for providers to adopt

Electronic Health Records & HIE– Achieve “Meaningful Use”

OFMQHIT Mission

• Furnish assistance to providers by:– Education– Outreach– Technical Assistance

• To achieve:– Implementation of EHR– “Meaningful Use” of EHR

Scope of Services• ARRA Incentive Review &

“Meaningful Use” Assessment• Practice & Workflow Assessment• EMR Vendor Selection & Optimization• Project Planning & Vendor Oversight• Go-Live Support & Training• Post Go-Live Practice Assessment &

EMR Optimization• IT Security Review & Assessment

“Eligible Providers” (EP) Medicare Medicaid($44,000) ($63,750)

Doctor of Medicine x xDoctor of Osteopathy x x

Doctor of Dental Surgery x xDoctor of Dental Medicine x x

Doctor of Podiatric Medicine xDoctor of Optometry x

Chiropractor xCertified Nurse-Midwife x

Nurse Practitioner xPhysician Assistant

(Practicing in FQHC or RHC that is led by a PA) x

“Eligible ‘REC Clinicians’”

• Individual and Small Group Practices– Less than 10 clinicians

• Focused on:– Service Settings:

• Uninsured, underinsured• Medically underserved

– Public & Critical Access Hospitals– Community Health Centers– Rural Health Clinics

REC Provider Services

• Target 1,000 PPCPs by February 2011• Currently ~ 250 “Priority Primary Care

Providers” (PPCPs) Enrolled– Most 1-3 Providers / Practice– 27% of the priority providers in the state– 82% have not yet implemented an EHR

• Working with OKPCA to enroll 70 PPCPs working at FQHCs.

REC Clinicians

< 10 PPCPs / Practice with prescriptive privilegesPRIMARY CARE PROVIDER MD DO NP MW PA

Family Practice x x x x xObstetrics and Gynecology x x x x x

General Medicine x x x x xInternal Medicine x x x x x

Pediatric Medicine x x x x x

PPCP Decision Tree

REC CAH / Rural Services

• Rural and CAH Supplemental Grant– Rural Hospitals (Inpatient Only)– Critical Access Hospitals

• Less than 50 Licensed Beds• Notification of Award

– September 10, 2010• 62 Facilities Eligible

– Need to achieve Meaningful Use byFebruary 2012

Barriers

• Communication– Physicians may be unaware of ARRA, HITEC

and availability of REC Services– Need to communicate sense of urgency to

providers• EHR vendors are at capacity

– (months to get started)

• EHRs are complex to implement – (months to implement)

Barriers

• Communication– Meaningful Use incomplete

(“final rule” due in “late spring”):– Final Rule released 7-13-10

• (Certification Final Rule also released)• Certification implications for Vendors:

– Coding– Testing– Certification Process – Upgrades

• Delays in Physician Implementation

Meaningful Use

• Focused on Capture of Structured Data• Electronic Exchange of Information• Quality & Safety• Empowering Patients & Families

Meaningful Use

• “Core” Set vs. “Menu” Set– Core: 15 Objectives– Menu: 5 of 10 Objectives

• Practice Management Deferred to Stage 2– Electronic Claims Submission– Electronic Eligibility Checking

• Decreased Thresholds• POS 22 – Outpatient Hospital Removed

– Employed Physicians Now Eligible

Core Set• Patient Demographics• Vital Signs• Problem List of

Diagnoses• Medication List• Medication Allergy List• Smoking Status• Clinical Summaries for

Patients• Electronic Copy of Health

Information for Patients

• ePrescribing (EP only)• CPOE for Medication

Orders• Drug-Drug-Allergy

Interaction Checks• Exchange of Key Clinical

Information• Implement One Clinical

Decision Support Rule• Privacy & Security• Clinical Quality Reporting

to CMS or States.

Menu Set• Drug – Formulary Checks• Clinical Lab Results as

Structured Data• Lists of Patients by

Condition• Identify & Provision of

Patient Education Resources

• Medication Reconciliation Between Care Settings

• Summary of Care Records for Patients

• Electronic Immunization Data Submission

• Electronic Syndromic Data Submission

• FOR HOSPITALS:– Advance Directives– Submit Lab Data to Public

Health Agencies

• FOR PROVIDERS (EPs):– Patient Reminders– Electronic Access for

Patients to Health Information

Meaningful Use

• Quality Measures (44 Total)– 3 Core:

• Blood Pressure• Tobacco Status• Adult Weight Screening & Follow-up• Alternate Core:

– Children & Adolescent Weight– Influenza Screening for Patients over 50– Childhood Immunization Status

– 3 Others (from set of 38)

Medicare Incentive Table

“The longer you wait the steeper and more difficult the climb”

MEDICARE Adopt EHR in: 2011 2012 2013 2014 2015 2016

2011 $ 18,000 Stage 12012 $ 12,000 $ 18,000 Stage 22013 $ 8,000 $ 12,000 $ 15,000 TBD (Stage 3?)2014 $ 4,000 $ 8,000 $ 12,000 $ 12,000 PENALTY if < Stage 32015 $ 2,000 $ 4,000 $ 8,000 $ 8,000 $ - 2016 $ - $ 2,000 $ 4,000 $ 4,000 $ - $ - TOTAL: $ 44,000 $ 44,000 $ 39,000 $ 24,000 $ - $ - HPSA: $ 48,400 $ 48,400 $ 42,900 $ 26,400 $ - $ -

Medicaid Incentive Table

“The longer you wait the steeper and more difficult the climb”

MEDICAID For EPs who BEGIN EHR adoption in: 2011 2012 2013 2014 2015 2016

2011 $ 21,250 2012 $ 8,500 $ 21,250 2013 $ 8,500 $ 8,500 $ 21,250 2014 $ 8,500 $ 8,500 $ 8,500 $ 21,250 2015 $ 8,500 $ 8,500 $ 8,500 $ 8,500 $ 21,250 2016 $ 8,500 $ 8,500 $ 8,500 $ 8,500 $ 8,500 $ 21,250 2017 $ 8,500 $ 8,500 $ 8,500 $ 8,500 $ 8,500 2018 $ 8,500 $ 8,500 $ 8,500 $ 8,500 2019 $ 8,500 $ 8,500 $ 8,500 2020 $ 8,500 $ 8,500 2021 $ 8,500

TOTAL: $ 63,750 $ 63,750 $ 63,750 $ 63,750 $ 63,750 $ 63,750 Lvol. PED: $ 42,500 $ 42,500 $ 42,500 $ 42,500 $ 42,500 $ 42,500

Year 1 (AIU):

• Adopt • acquired and installed

• Implement• trained staff• deployed tools• exchanged data

• Upgrade• expanded functionality or

interoperability

Timeline

Vendor

Programming &

Testing

Vendor Certification

Vendor

Capacity

to Impleme

nt

Vendor

EHR Implementation

& Testin

g

90 Day MU

Qualification

Period

Meaningful Use

TimelineVendor Programming & Testing

(90 - 120+ days?)

Aug Sep Oct Nov Dec2010

Vendor Certification (30 - 60 days?)

Vendor Capacity to Implement(60 - 240 days?)

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec2011

Vendor EHR Implementation & Testing(120 - 240+ days?)

90 Day Meaningful UseQualification Period

MeaningfulUse

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec2012

Must achieve “Meaningful Use” by 2012 to receive maximum reimbursement

You arehere!

How Can We Work Together?

• Collaboration & Partnership– “Get the word out”

• Newsletters• Websites• Publications

• Availability of OFMQHIT REC Services– Recruitment & Referrals

• ARRA & Meaningful Use• Sense of Urgency

Thank You!

Daniel T. Golder, DDS, MBAhttp://www.ofmqhit.com

ofmqhit@ofmq.com405-302-3318