Dominic H. Mack MD, MBAProject Director, GREC

Deputy Director,National Center for Primary Care

Morehouse School of Medicinedmack@msm.edu

404-756-8960www.primarycareforall .org

Georgia Regional Extension Center(GREC)

HITECH Act

1. Re-Establish ONC for HIT to develop rules by 2010

2. Savings -quality, care coordination & error reduction

3. Strengthening Federal privacy and security law4. $20 billion Health information technology infrastructure 60-70 Regional Extension Centers 32 centers have been awarded Medicare and Medicaid incentives

Meaningful Use Definition & RulesThe Recovery Act specifies the following 3 components of

Meaningful Use:

1.Use of certified EHR in a meaningful manner (ex: e-prescribing)

2.Use of certified EHR technology for electronic exchange of health information to improve quality of health care

3.Use of certified EHR technology to submit clinical quality and other measures

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Stage 1- Health Outcome Initiatives

Improving quality, safety, efficiency, and reducing health disparities

•Engage patients and families in their health care

•Improve care coordination•Improve population and public health •Ensure adequate privacy and security

protections for personal health information

GREC MissionGREC’s mission is to furnish assistance to help

Georgia’s providers select, successfully implement, and meaningfully use certified EHR technology to improve clinical outcomes and the quality of care provided to their patients.

Vision: GREC will work collaboratively with valued partners to assure the adoption of certified EHR technology to improve the quality of health for the community while eliminating the disparate gap of healthcare throughout Georgia.

GREC Goals and ServicesTo use a community oriented approach to provide outreach

and education to facilitate the adoption and meaningful use of EHR.

To work collaboratively with statewide partners across the 18 public health districts of GA to develop and implement programs to meet GREC objectives.

To select HIT products that meet provider’s needs and helps them to meet patient centered medical home standards.

To provide equitable group purchasing agreements for Georgia’s priority primary care providers.

To build up competent technical teams to obtain meaningful use of EHR throughout the state and grow Georgia’s HIT workforce.

To work collaboratively with State HIE (GA. DCH) to meet all meaningful use criteria.

To provide excellent quality service to our customers in order to build a national reputation as a reliable HIT resource for providers.

 

AmeriChoice Andrew Young School of Policy Studies

GA Academy of Family Physicians

GA Association for Primary Health Care

GA Hospital Association GA Institute of Technology

GA Chapter of the of Pediatrics GA Department of Community Health (DCH)

GA DCH Office of Health Information Technology and Transparency

GA State Medical Association GA State Office of Rural Health GA State Policy Institute

GMCF (QIO) Greenway Medical Technologies Hispanic Health Coalition of GA

Governor’s Office of Workforce Investment

Kibbe Group, Founding Director of the Center for HIT for the of Family Physicians

Morehouse School of MedicineOffice of Sponsored Research Administration

Kids Health First Pediatric , Independent Practice Association

Statewide Area Health Education Centers Network

The Center for Pan Asian Community Services, inc.

Medical College of GA N.W. GA Healthcare Partnership Technical College System of GA (TCSG)

University System of GA WellCare of GA Macon State College

The following organizations, serving over 9,000 PCPs, submitted letters of partnership

Key Statewide Statistics

Map of GeorgiaPCP: 15,563 Priority PCP: 8040Total Number Served:

1608 (Yr 1) 5225 (Yr 5)Georgia Population:

9,965,744Total patients served (projected) : 2.8

million

Georgia Healthcare CoverageMedicaid 12.2% 1,150,800

Medicare 10.1% 958,200

Employer 54.8% 5,185,900

Individual 3.4% 325,400

Other Public 1.7% 164,300

Uninsured 17.8% 1,682,400

Total 9,467,100

Kaiser Family State Health Facts 2007-2008

Organization Chart

Statewide Organization

Pyramid of Providers

Meaningful Use SummaryEPs25 Objectives and Measures8 Measures require ‘Yes’ or ‘No’ as structured data17 Measures require numerator and denominatorEligible Hospitals and CAHs23 Objectives and Measures10 Measures require ‘Yes’ or ‘No’ as structured

data13 Measures require numerator and denominatorReporting Period –90 days for first year; one year

subsequently

Examples of Meaningful Use EHR criteriaUse CPOEImplement drug-drug, drug-allergy, drug-formulary checksMaintain an up-to-date problem list of current and active

diagnoses based on ICD-9-CM or SNOMED CT®Check Insurance eligibility & submit claims electronicallyMaintain active medication allergy listRecord demographics Record and chart changes in vital signsRecord smoking status for 13 and oldProvide electronic syndromic surveillance data

Eligible ProvidersMedicare FFSEligible professionals (EPs)Eligible hospitals and critical access hospitals (CAHs)Medicare Advantage (MA)MA EPsMA-affiliated eligible hospitalMedicaidEPsEligible hospitals

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Medicaid Eligible Providers Eligible Professionals (EPs)•Physicians (Peds have special eligibility & payment rules)•Nurse Practitioners (NPs)•Certified Nurse-Midwives (CNMs)•Dentists•Physician Assistants (FQHC or RHC that is directed by a PA)Eligible Hospitals•Acute Care Hospitals•Children’s Hospitals

Medicare Eligible ProvidersEligible Professionals (EPs) Doctor of Medicine or OsteopathyDoctor of Dental Surgery or Dental MedicineDoctor of Podiatric MedicineDoctor of OptometryChiropractor Eligible HospitalsAcute Care HospitalsCritical Access Hospitals (CAHs)

Hospital-based Eligible Providers

Hospital-based EPs do not qualify for Medicare EHR incentive payments

Most hospital-based EPs will not qualify for Medicaid EHR incentive payments (FQHCs will qualify)

Defined as an EP who furnishes 90% or more of their services in a hospital setting (inpatient, outpatient, or emergency room)

Eligible Providers in Medicare AdvantageMA Eligible Professionals (EPs) Must furnish, on average, at least 20 hours/week of

patient-care services and be employed by the qualifying MA organization -or-

Must be employed by, or be a partner of, an entity that through contract with the qualifying MA organization furnishes at least 80 percent of the entity’s Medicare patient care services to enrollees of the qualifying MA organization

Qualifying MA-Affiliated Eligible HospitalsWill be paid under the Medicare Fee-for-service EHR

incentive program

Minimum Medicaid pt volume threshold30%-Physicians, Dentist, CNMs, NPs, Pas20%-Pediatricians10%Acute care hospitals0%-Children’s hospitalsOr the Medicaid EP practices predominantly in

an FQHC or RHC—30% needy individual patient volume threshold

Medicare Providers-Meaningful UseMeet requirements in 2011 or 2012$15,000 - $18,000 payments yr 1, $44,000 total by

yr4Declining payments through year 5The later you meet requirements, the less you getNo incentives after 2016 or for first adopters after

2014Provider payments increase 10% in HPSAPayment reduction if not adopted by 2015Excludes hospital based “eligible professionals”Special rules for Medicare Advantage

Medicare

First Calendar Year in which the EP receives an Incentive Payment

Calendar Year

2011 2012 2013 2014 2015 & later

2011 $18,000

2012 $12,000 $18,000

2013 $8,000 $12,000 $15,000

2014 $4,000 $8,000 $12,000 $12,000

2015 $2,000 $4,000 $8,000 8,000 $0

2016 $2000 $4,000 $4,000 $0

Total $44,000 $44,000 $39,000 $24,000 $0

Medicaid Providers-Meaningful Use

The Medicaid EHR Incentive Program starts in 2011 and ends in 2021

The latest that a Medicaid provider can initiate the program is 2016

A Medicaid provider can initiate the program under the Adopt, Implement and Upgrade bar but in their 2ndand subsequent years, they must meet MU at the stage that is in place, per rule-making (Stage 3 by 2015).

Medicaid First Calendar Year in which the EP receives an Incentive Payment

Calendar Year

2011 2012 2013 2014 2015 2016

2011 $21,250

2012 $8,500 $21,250

2013 $8,500 $8,500 $21,500

2014 $8,500 $8,500 $8,500 $21,500

2015 $8,500 $8,500 $8,500 $8,500 $21,500

2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,000

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

Medicare Hospitals-Meaningful Use“Eligible hospitals” meet requirements in

2011$2,000,000 base + discharge related

paymentPayments reduced over 4 year periodNon-adopters received reduced payments in

2015Critical access hospital have more generous

formula

Medicaid Hospitals-Meaningful Use

Eligible hospitals, unlike EPs, may receive incentives from Medicare and Medicaid Subsection(d) hospitals, also acute care

Hospitals meeting Medicare MU requirements may be deemed for Medicaid , even if the State has an expanded (approved) definition of meaningful use

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Workforce development

Insufficient Technical WorkforceNot much education capacity around HITEducation budget cut $1 billionGA Economy – 10% unemployment rateLow broadband access in rural areas

Challenges

Scaling capabilities of education system

HIT is a growing industry in GAHIT intellectual capital in AtlantaLarge lab space Enthusiasm of the state

Workforce development

Strengths

Workforce Development

Cost of Education and training is risingDecreasing funds for education programsEducation level in underserved communities

 

Threats

Workforce Development

Low technical capabilities leaves room for growth

Development of new partnerships• GA Board or Regents• Technical college System of GA (TCSG)• GAFP• GA Partnership for TeleHealth

New certification programs in education system

Growth of degreed programs

Opportunities

What is the importance of meaningful use to the primary provider?

Thank You