AHIMA s 2010 Advocacy and Policy Update Don Asmonga, MBA, CAE AHIMA Director of Government Relations

1. AHIMA�s 2010 Advocacy and Policy UpdateDon Asmonga, MBA, CAEAHIMA Director of Government Relations

3. Who is Don? Senior Director of Government Relations 16-years with AHIMA Not an HIM professional Capitol Hill Veteran Mount Saint Mary�s College, BS in Economics Frostburg State University, MBA Certified Association Executive Hockey and volleyball dad!

4. Policy & Government Relations Staff 4

5. Before we go any further�Fun with Acronyms! HIT � Health Information Technology HHS � Health and Human Services ONC � Office of the National Coordinator HITSC�HIT Standards Committee HITPC�HIT Policy Committee AHRQ � Agency for Healthcare Research and Quality AHA � American Hospital Association NCHS � National Center for Health Statistics NCVHS � National Committee on Vital and Health Statistics CMS � Centers for Medicare and Medicaid Services HITSP�Health Information Technology Standards Panel AAAC�AHIMA-AMIA Advocacy Committee NSF�National Science Foundation CCHIT�Certification Commission for Health Information Technology

6. What is Policy and Government Relations? Policy is what AHIMA stands for Policy Statements, testimony, issue briefs, practice briefs, press statements Government relations is advocating to achieve our policy

7. Who do we work with? External Federal and state legislators Federal and state regulators The Administration (HHS, ONC, CMS) Coding standards groups (Cooperating parties, ICD-9/ICD-10, CPT) AHIMA members Alliance partners (eHI, Siemens, AHA, AdvaMed, Coalition for Genetic Fairness) AAAC (External/Internal)�AHIMA and AMIA Industry and functional experts Trade and public press

8. Who do we work with? Internal Professional Practice Teams/Practice Leadership Public Relations Publications and Web Education and Training Meetings Marketing and Sales AHIMA Foundation Other�

9. Who do we work with? Member Support Practice Councils and Workgroups State Advocacy Workgroup AHIMA Board of Directors Industry Team CSA and CSA Liaisons State Advocacy Workgroup (SAW) Specialty Groups (AOE, etc�) Communities of Practice You!

10. Advocacy and Policy Priorities: Why do we do this? Support day-to-day and future HIM roles Provide a uniform and sustaining environment for HIM and coding efforts Protect health information: privacy, confidentiality, security, and integrity Advance the healthcare system: quality, efficiency, cost, and patient safety

11. Advocacy and Policy Priorities: How are they fashioned? Member involvement: CSAs, Team Talks, COPs, Leadership, Annual Meeting, etc� AHIMA Committees, Task Forces, & HOD Professional Staff AHIMA Practice Councils BOD and BOD Industry Team AHIMA/AMIA Advocacy Committee (AAAC)

12. How Do Advocacy Activities Occur? Education and Understanding Individual member efforts and engagements CSA and COP Efforts Volunteer and professional staff involvement AHIMA�s Policy and Government Relations Team

13. Example: Hill Day 2009 & 2010 Hill day, March 23, 2009 110+ attendees 34 states + DC 200+ meetings Hill Day, March 23, 2010 180+ registrations 40 states + DC New York: Julie Brucker, Tracy D�Errico, Brenda Embry, Diane Cohen, Kimberly White,

14. State Advocacy Workgroup Instituted in 2008 Address how we can enhance the ability to advocate at the state and local level. No policy discussions The structure of state advocacy programs Tools necessary for states to monitor state/local public policy issues Serve as a consulting body for AHIMA/AHIMA Foundation projects with a state/policy component. Tools necessary for states to engage in public policy advocacy and grassroots activity Education necessary to enhance volunteer knowledge and ability for state level advocacy This will include advocacy focus areas for the AHIMA Leadership conference. Other potential advocacy education efforts as teleconferences, Web-ex programs, and maybe even potentially a �train-the-trainer� program as the PHR campaign. This would include the communication of various AHIMA/AHIMA Foundation projects where state-level input may be necessary. Plans and strategies for local advocacy outreach at national and CSA conventions. This would include: An agenda for local and state elected officials and policymakers�this would include federal house/senate and applicable staff The development of an advocacy track for AHIMA members. The track would include education topics for advocacy and updates on specific policy topics The structure of state advocacy programs Tools necessary for states to monitor state/local public policy issues Serve as a consulting body for AHIMA/AHIMA Foundation projects with a state/policy component. Tools necessary for states to engage in public policy advocacy and grassroots activity Education necessary to enhance volunteer knowledge and ability for state level advocacy This will include advocacy focus areas for the AHIMA Leadership conference. Other potential advocacy education efforts as teleconferences, Web-ex programs, and maybe even potentially a �train-the-trainer� program as the PHR campaign. This would include the communication of various AHIMA/AHIMA Foundation projects where state-level input may be necessary. Plans and strategies for local advocacy outreach at national and CSA conventions. This would include: An agenda for local and state elected officials and policymakers�this would include federal house/senate and applicable staff The development of an advocacy track for AHIMA members. The track would include education topics for advocacy and updates on specific policy topics

15. Advocacy 101

16. Best Practices for CSA Advocacy

17. Planning a State Hill Day

18. AHIMA�s Key Advocacy Issues for 2010 Workforce and Education National Health Information Networks/Health Information Exchange Administrative Simplification�Operating Rules Privacy and Security ICD-10/5010 readiness (Medicaid) Terminologies and Classifications

19. Where We Have Been Primary committees that we work with: House: Energy and Commerce, Ways and Means, Science and Technology Senate: Health, Education, Labor and Pensions (HELP), Finance

20. Where We Have Been ARRA (http://ahima.org/arra/index.asp Codification of ONC Chief Privacy Officer (Joy Pritts) $20 billion for HIT: �meaningful use� The Office of the National Coordinator (ONC) held meetings and testimony through its HIT Policy and Standard Committee to define meaningful use December 2009 - The Centers for Medicare & Medicaid (CMS) published a Notice of Proposed Rulemaking (NPRM) to define meaningful use Medicare and Medicaid incentive program developed for the adoption and meaningful use of certified EHR technology Meaningful use of certified EHR technology Electronic exchange of health information to improve the quality of health care Reporting on measures using EHR Program begins 2011 and ends at the completion of 2015 Improving quality, safety, efficiency, and reducing health disparities Engage patient and families in their health care Improve care coordination Improve population and public health Ensure adequate privacy and security protections for personal health information November 2009 - A call for volunteers was issued to develop a response team and prepare comments Shortly after NPRM was published on December 30, 2009 the �Meaningful Use Response Team� was kicked off Comprised of approximately 25 AHIMA member volunteers Met on a weekly basis Divided into 6 teams (domain areas) to review and prepare comments for CMS Comments submitted to CMS March 12, 2010 http://www.ahima.org/dc/documents/AHIMAEHRIncentiveProgramResponse_100312.pdf Expect a Final Rule late spring/early summer 2010 Medicare and Medicaid incentive program developed for the adoption and meaningful use of certified EHR technology Meaningful use of certified EHR technology Electronic exchange of health information to improve the quality of health care Reporting on measures using EHR Program begins 2011 and ends at the completion of 2015 Improving quality, safety, efficiency, and reducing health disparities Engage patient and families in their health care Improve care coordination Improve population and public health Ensure adequate privacy and security protections for personal health information November 2009 - A call for volunteers was issued to develop a response team and prepare comments Shortly after NPRM was published on December 30, 2009 the �Meaningful Use Response Team� was kicked off Comprised of approximately 25 AHIMA member volunteers Met on a weekly basis Divided into 6 teams (domain areas) to review and prepare comments for CMS Comments submitted to CMS March 12, 2010 http://www.ahima.org/dc/documents/AHIMAEHRIncentiveProgramResponse_100312.pdf Expect a Final Rule late spring/early summer 2010

21. Where We Have Been ARRA http://ahima.org/arra/index.asp HIT Research Centers Distinct body to recognize best practices to support and accelerate efforts through the exchange of knowledge Assemble, analyze, and disseminate evidence and experience related to implementation Regional Extension Centers Geographically dispersed centers to provide technical assistance, disseminate best practices, onsite support and other implementation support efforts $598 million in funding issued through grant opportunities: 2 cycles (February and April 2010) AHIMA response to RFI, June 2009: http://www.ahima.org/dc/documents/AHIMA_ONCRFI_RegionalCenters_FINAL_090611.pdf Education and Outreach National Learning Consortium Vendor Selection & Group Purchasing Implementation and Project Management Practice and Workflow Redesign Functional Interoperability and Health Information Exchange Privacy and Security Best Practices Progress Towards Meaningful Use Local Workforce Support Education and Outreach National Learning Consortium Vendor Selection & Group Purchasing Implementation and Project Management Practice and Workflow Redesign Functional Interoperability and Health Information Exchange Privacy and Security Best Practices Progress Towards Meaningful Use Local Workforce Support

22. Where We Have Been ARRA http://ahima.org/arra/index.asp New privacy and security rules Initial Requirements � February 2009 Breach Notification and Penalties � Fall 2009 One-year Requirements � February 2010? Accounting for Disclosures � IFR Standard 2/12 HHS, Chief Privacy Officer � Joy Pritts appointed 2/19 Extend protections to non-covered entities Other HITECH Elements The ARRA - HITECH rule made significant changes to HIPAA Privacy and Security requirements effective with passage and the signing into law on February 17, 2009, by President Obama. Effective immediately with the signing of ARRA: business associate agreements are required with HIEOs, RHIOs, and similar bodies; individuals became subject to HIPAA requirements just as facilities, practices, health plans, and so forth were The potential for increase dollar penalties fell into place as did the provision for state action on possible HIPAA violations and privacy and security audits. In the early fall the Breech Notification Rules from the HHS Office of Civil Rights (OCR) and the Federal Trade Commission (FTC) became effective. Both ONC and the FTC provided a grace period for compliance. These grace periods ended on February 22nd. Since the HIPAA-related rule from ONC was an interim final rule (IFR), we are still waiting for a final rule to be posted. Also in the fall the IFR for new HIPAA penalties became effect on November 30. Again we are waiting for a final rule. A number of privacy sections of HITECT were to take affect on February 18, 2010 � one year from the legislation taking affect. We have been waiting for some type of rule since late December and all we know is that it is coming and will be in the form of a Notice of Proposed Rule Making. Among the items in this proposal are: Application of some of the HIPAA privacy and security requirements directly on business associates; Consumer restrictions on the release of information to health plans; New opt-out requirements for fund raising; New marketing restrictions ; New rules on consumer access to EHRs. A standard for the Accounting of Disclosures was published as part of the IFR on Certificaiton Criteria, and was effective February 12th. This means that we will probably see a NPRM for Accounting for Disclsoures from EHRs some time in August of this year. A new Chief Privacy Office was named on February 19th � Professor Joy Pritts now joins the Office of the National Coordinator (ONC) staff. Ms Pritts is no stranger to AHIMA. There are a number of other HITECH elements on the horizon but without clear dates at this point. These include: New guidance on security, New guidance on �minimum necessary,� and Rules for the sale of records or PHI. Since the advent of the HITECH privacy legislation AHIMA�s ARRA Swat team has been placing materials on the AHIMA ARRA Web Page � www.ahima.org/arra � and more materials will be added to this page as needed. I�d note that among these materials is an ARRA calendar that includes the privacy schedule. AHIMA is monitoring the various HIT Policy and Standards Committees and Workgroups and this includes those associated with Privacy and Security. AHIMA continues to also monitor and participate with the NCVHS. In all of these bodies, comments are offered when requested or necessary.. In January the Interim Final Rule for Certification Standards included a Standard for the Accounting for Disclosures. Working with the Privacy and Security Practice Council, AHIMA commented on this standard. Under the HITECH legislation, the Secretary is to proposed a regulation on the Accounting for Disclosures six months after the standards is adopted, which was February 12th, so we should expect a NPRM in August. The ARRA - HITECH rule made significant changes to HIPAA Privacy and Security requirements effective with passage and the signing into law on February 17, 2009, by President Obama. Effective immediately with the signing of ARRA: business associate agreements are required with HIEOs, RHIOs, and similar bodies; individuals became subject to HIPAA requirements just as facilities, practices, health plans, and so forth were The potential for increase dollar penalties fell into place as did the provision for state action on possible HIPAA violations and privacy and security audits. In the early fall the Breech Notification Rules from the HHS Office of Civil Rights (OCR) and the Federal Trade Commission (FTC) became effective. Both ONC and the FTC provided a grace period for compliance. These grace periods ended on February 22nd. Since the HIPAA-related rule from ONC was an interim final rule (IFR), we are still waiting for a final rule to be posted. Also in the fall the IFR for new HIPAA penalties became effect on November 30. Again we are waiting for a final rule. A number of privacy sections of HITECT were to take affect on February 18, 2010 � one year from the legislation taking affect. We have been waiting for some type of rule since late December and all we know is that it is coming and will be in the form of a Notice of Proposed Rule Making. Among the items in this proposal are: Application of some of the HIPAA privacy and security requirements directly on business associates; Consumer restrictions on the release of information to health plans; New opt-out requirements for fund raising; New marketing restrictions ; New rules on consumer access to EHRs. A standard for the Accounting of Disclosures was published as part of the IFR on Certificaiton Criteria, and was effective February 12th. This means that we will probably see a NPRM for Accounting for Disclsoures from EHRs some time in August of this year. A new Chief Privacy Office was named on February 19th � Professor Joy Pritts now joins the Office of the National Coordinator (ONC) staff. Ms Pritts is no stranger to AHIMA. There are a number of other HITECH elements on the horizon but without clear dates at this point. These include: New guidance on security, New guidance on �minimum necessary,� and Rules for the sale of records or PHI. Since the advent of the HITECH privacy legislation AHIMA�s ARRA Swat team has been placing materials on the AHIMA ARRA Web Page � www.ahima.org/arra � and more materials will be added to this page as needed. I�d note that among these materials is an ARRA calendar that includes the privacy schedule. AHIMA is monitoring the various HIT Policy and Standards Committees and Workgroups and this includes those associated with Privacy and Security. AHIMA continues to also monitor and participate with the NCVHS. In all of these bodies, comments are offered when requested or necessary.. In January the Interim Final Rule for Certification Standards included a Standard for the Accounting for Disclosures. Working with the Privacy and Security Practice Council, AHIMA commented on this standard. Under the HITECH legislation, the Secretary is to proposed a regulation on the Accounting for Disclosures six months after the standards is adopted, which was February 12th, so we should expect a NPRM in August.

23. Where We Have Been ARRA http://ahima.org/arra/index.asp HIT Policy Committee and HIT Standards Committee Meaningful Use, Certification & Adoption, Information Exchange, Nationwide Health Information Network (NHIN), Strategic Plan, Privacy & Security Policy Established HIT Standards Committee Clinical Operations, Clinical Quality, Privacy & Security, Implementation

24. Where We Have Been ARRA http://ahima.org/arra/index.asp Workforce Community College Consortia to Educate HIT Professionals Assistance for University-Based Training Curriculum Development Centers Competency Training Toward Completion of Non-Degree Training The ARRA Stimulus funding which was earmarked to ONC for distribution covers the following grant solicitations which I am happy to say, many of our academic programs have applied for (announcement should occur on March 18). The funding is to support design and implementation of the programs just mentioned. Community College Consortia � the US was divided into 5 geographic regions for which a consortia of community colleges and other stakeholders such as workforce boards collaborated to bid on creation of certificate programs of 6 months or less in some of the categories just mentioned. A similar proposal covers University-based training programs at the post-baccalaureate and graduate levels � also for some of the categories mentioned primarily within the permanent staff and research areas. One consortium will be designated as the national curriculum dissemination center, for which AHIMA and AMIA partnered to be included as a The ARRA Stimulus funding which was earmarked to ONC for distribution covers the following grant solicitations which I am happy to say, many of our academic programs have applied for (announcement should occur on March 18). The funding is to support design and implementation of the programs just mentioned. Community College Consortia � the US was divided into 5 geographic regions for which a consortia of community colleges and other stakeholders such as workforce boards collaborated to bid on creation of certificate programs of 6 months or less in some of the categories just mentioned. A similar proposal covers University-based training programs at the post-baccalaureate and graduate levels � also for some of the categories mentioned primarily within the permanent staff and research areas. One consortium will be designated as the national curriculum dissemination center, for which AHIMA and AMIA partnered to be included as a

25. Where We Have Been Healthcare Reform PL 111-148 (HR 3590), the �Patient Protection and Affordable Care Act� PL 111-443 (HR 4872), the �Health Care and Education Reconciliation Act�

26. Where We Have Been Healthcare Reform Administrative Simplification Streamlined process to adopt and update HIPAA standards Operating rules for HIPAA�s electronic administrative and billing transactions Accelerates HHS adoption of uniform standards and operating rules for the electronic transactions that occur between providers and health plans that are governed under the Health Insurance Portability and Accountability Act (such as benefit eligibility verification, prior authorization and electronic funds transfer payments). Establishes a process to regularly update the standards and operating rules for electronic transactions and requires health plans to certify compliance or face financial penalties collected by the Treasury Secretary. The goal of this section is to make the health system more efficient by reducing the clerical burden on providers, patients, and health plans Accelerates HHS adoption of uniform standards and operating rules for the electronic transactions that occur between providers and health plans that are governed under the Health Insurance Portability and Accountability Act (such as benefit eligibility verification, prior authorization and electronic funds transfer payments). Establishes a process to regularly update the standards and operating rules for electronic transactions and requires health plans to certify compliance or face financial penalties collected by the Treasury Secretary. The goal of this section is to make the health system more efficient by reducing the clerical burden on providers, patients, and health plans

27. Where We Have Been Healthcare Reform�other HIT Reporting requirements to ensure quality of care under several scenarios Payment policy to ensure value and lower premiums HIT enrollment standards and protocols Sec. 3002. Improvements to the physician quality reporting initiative. Extends payments under the PQRI program, which provide incentives to physicians who report quality data to Medicare. Creates appeals and feedback processes for participating professionals in PQRI. Establishes a participation pathway for physicians completing a qualified Maintenance of Certification program with their specialty board of medicine. Includes integration of quality reporting and EHRs Secondary Uses Quality Reporting Sec. 3003. Improvements to the physician feedback program. Expands Medicare?s physician resource use feedback program to provide for development of individualized reports by 2012. Reports will compare the per capita utilization of physicians (or groups of physicians) to other physicians who see similar patients. Reports will be risk-adjusted and standardized to take into account local health care costs. Secondary Uses Reporting Sec. 3004. Quality reporting for long-term care hospitals, inpatient rehabilitation hospitals, inpatient psychiatric hospitals and hospice programs. Establishes a path toward value-based purchasing for long-term care hospitals, inpatient rehabilitation facilities, and hospice providers by requiring the Secretary to implement quality measure reporting programs for these providers in FY2014. Providers under this section who do not successfully participate in the program would be subject to a reduction in their annual market basket update. Section 10322 also establishes a quality measure reporting program for inpatient psychiatric hospitals beginning FY2014. Quality Reporting Sec. 3005. Quality reporting for PPS-exempt cancer hospitals. Establishes a quality measure reporting program for PPS-exempt cancer hospitals beginning in FY2014. Providers under this section who do not successfully participate in the program would be subject to a reduction in their annual market basket update. Quality Reporting Section 3011-- National Strategy to Improve Health Care Quality. Direct the Secretary to establish a national quality improvement strategy that includes priorities to improve the delivery of health care services, patient health outcomes, and population health through a transparent and collaborative process. In developing these priorities, and among other items, the Secretary would consider how the priorities would: enhance the use of health care data to improve quality, efficiency, transparency, and outcomes. Secondary Uses Quality Measures Sec. 3012. Interagency Working Group on Health Care Quality. Requires the President to convene an Interagency Working Group on Health Care Quality comprised of Federal agencies to collaborate on the development and dissemination of quality initiatives consistent with the national strategy. Secondary Uses Quality Improvement Sec. 3002. Improvements to the physician quality reporting initiative. Extends payments under the PQRI program, which provide incentives to physicians who report quality data to Medicare. Creates appeals and feedback processes for participating professionals in PQRI. Establishes a participation pathway for physicians completing a qualified Maintenance of Certification program with their specialty board of medicine. Includes integration of quality reporting and EHRs Secondary Uses Quality Reporting Sec. 3003. Improvements to the physician feedback program. Expands Medicare?s physician resource use feedback program to provide for development of individualized reports by 2012. Reports will compare the per capita utilization of physicians (or groups of physicians) to other physicians who see similar patients. Reports will be risk-adjusted and standardized to take into account local health care costs. Secondary Uses Reporting Sec. 3004. Quality reporting for long-term care hospitals, inpatient rehabilitation hospitals, inpatient psychiatric hospitals and hospice programs. Establishes a path toward value-based purchasing for long-term care hospitals, inpatient rehabilitation facilities, and hospice providers by requiring the Secretary to implement quality measure reporting programs for these providers in FY2014. Providers under this section who do not successfully participate in the program would be subject to a reduction in their annual market basket update. Section 10322 also establishes a quality measure reporting program for inpatient psychiatric hospitals beginning FY2014. Quality Reporting Sec. 3005. Quality reporting for PPS-exempt cancer hospitals. Establishes a quality measure reporting program for PPS-exempt cancer hospitals beginning in FY2014. Providers under this section who do not successfully participate in the program would be subject to a reduction in their annual market basket update. Quality Reporting Section 3011-- National Strategy to Improve Health Care Quality. Direct the Secretary to establish a national quality improvement strategy that includes priorities to improve the delivery of health care services, patient health outcomes, and population health through a transparent and collaborative process. In developing these priorities, and among other items, the Secretary would consider how the priorities would: enhance the use of health care data to improve quality, efficiency, transparency, and outcomes. Secondary Uses Quality Measures Sec. 3012. Interagency Working Group on Health Care Quality. Requires the President to convene an Interagency Working Group on Health Care Quality comprised of Federal agencies to collaborate on the development and dissemination of quality initiatives consistent with the national strategy. Secondary Uses Quality Improvement

28. Where We Have Been ICD-10 October 1, 2013 compliance date Candidate standard for use in achieving Stage II Meaningful Use (TBD) CSA Medicaid Project

29. What We Are Doing Hill Day 2010 Update DOL- BLS HIM Definitions Allied Health Education Fund - Title VII

30. Where We Are Going DOL- BLS HIM Definitions � the Problem Definitions of the HIM profession are decades old and misclassified Misclassification makes it difficult to specify HIM work force needs Accurate BLS statistics will assist policymakers and educators to plan for the demand for HIM and account for baby boomer retirement Attempts to get the BLS to change definitions have proven difficult

31. Where We Are Going Update DOL-BLS HIM Definitions � the Ask Congress should direct the Department of Labor � Bureau of Labor Statistics to incorporate appropriate identification of HIM professionals Allows industry to identify shortages in this crucial profession and plan appropriate recruitment and education of necessary students and educators Seek an �author� for our Dear Colleague letter requesting BLS changes to the HIM Standard Occupational Classifications

32. Where We Are Going Allied Health EHR Education Funding� the Problem Most funding for Allied Health education in Public Health Title VII has been eliminated, except for physicians, nurses, and pharmacists Allied Health professionals make up some 60% of the healthcare profession The AHIMA/AMIA Joint Workforce indicates that there is a lack of EHR core competencies in many Allied Health education programs �Health Information Management and Informatics Core Competencies for Individuals Working with Electronic Health Records� 2008 http://www.ahima.org/infocenter/whitepapers/workforce_2008.pdf All healthcare professionals need education in the adoption, implementation, and use EHRs

33. Where We Are Going Allied Health EHR Education Funding� the Ask Congress should add funding to Title VII to cover Allied Health education including an EHR curriculum Introduce and enact the AHIMA developed �Allied Health and Health Information Investment Act�

34. AHIMA Resources AHIMA Public Policy: www.ahima.org/advocacy AHIMA Advocacy Assistant: www.ahima.org/dc/aa Congress: http://thomas.loc.gov ONC: www.hhs.gov/healthit White House: www.whitehouse.gov HIPAA: www.hhs.gov/ocr/hipaa; http://aspe.hhs.gov/admnsimp HHS: www.hhs.gov CMS: www.cms.gov HRSA: www.hrsa.gov

35. Let�s Chat Your thoughts? What do you find the most troubling? What do you find the most interesting?

36. Contact Information Don.Asmonga@ahima.org 202-659-9440 www.ahima.org/advocacy

37. Good luck! �Just use your intuition, you�ll get less competition, from the clock up on the wall�� Blue Guitar, Jimmy Buffett