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Provider Incentives for HIT Adoption. Gerard P. Filicko, MHA, CMPE Sr. VP, Physician Services. Otherwise known as…. Obstacles to Implementation: Show me the Money!. Internal ROI Forecast ASP vs Client-Server EMRs New Funding Opportunity? CMS EMR Demonstration. ROI Forecast.

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Provider Incentives for HIT Adoption

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Provider Incentives for HIT Adoption

Gerard P. Filicko, MHA, CMPE

Sr. VP, Physician Services


Otherwise known as…


Obstacles to Implementation:Show me the Money!

  • Internal ROI Forecast

  • ASP vs Client-Server EMRs

  • New Funding Opportunity?

    • CMS EMR Demonstration


ROI Forecast

  • “Benefits Portfolio” of an EMR:

    • Quantifiable vs Anecdotal

    • Financial vs Qualitative

  • The entire portfolio is important, although only quantifiable, financial benefits form basis for ROI

  • Financial benefits are almost entirely based on Operational Improvements


Improved physician workflow

OV time reduced due to faster pre-encounter chart review & post-encounter documentation

Fractional FTE savings:

Reduction in clinical messaging

Staff time to process 1 med request typically reduced by 80% (12 min)

Elimination of business office outsourcing expenses through an interfaced PMS

Eliminate paper chart supplies (up to $3/chart)

Reduce clerical (medical records) personnel

Reduce or eliminate transcription costs

Operational

Improvements

Profit

Contribution

Productivity

Improved

Revenue

Cost Savings

Cost

Avoidance

ROI Forecast

Productivity

Cost Savings


Records storage

Liability reduction:

Orders/results matching and patient follow-up

Enhanced legibility of chart reduces potential for errors

E-rx reduces multiple requests for same refill

Accurate coding & billing from interfaced PMS

Improved patient tracking & charge capture

ROI Forecast

Cost Avoidance

Revenue/Profit

Operational

Improvements

Profit

Contribution

Productivity

Improved

Revenue

Cost Savings

Cost

Avoidance


Internal ROI Measures

  • Non-quantifiable Benefits

    • Quality improvements

    • Continuity of care

    • Patient satisfaction

    • Improved access


ASP vs Client-Server EMRs

  • Application Service Provider model

  • “Subscription based” EMR

  • Optional offering by various national vendors

  • May also include local collaborations:

    • Shared services among practices

    • “Server farm”


Is the ASP Alternative right for you?

  • CCHIT certified vendors

  • Evaluate Pros & Cons:

    • Remote support by IT professionals

    • Less costly start-up, reduced ongoing expenses

    • Worldwide accessibility thru Internet

    • Data is controlled by a third party

    • No direct oversight of maintenance, backups

    • Internet dependent


Case Study: ASP support for Safety Net Providers

  • 4 Richmond Free Clinics needed access to an integrated data platform

    • Hospital & clinic results

    • Labs & medications

  • Sought a common eligibility screening process

  • Did not have capital and needed to keep operating costs low

  • Governor’s HIT Council Grant


Reporting,

Grant Writing

Free

Clinic

Pharmacy

E-Scripts

Community

Pharmacy

Updated

Meds

MedVirginia

Health Information Exchange

Demographics

Schedule

MEDfx

Practice Management System

Results

Discharge Meds

Hospitals

& Eligibility Screening Tool

Referrals

Eligibility Data

Clinicals

Specialists

Referral Back to

Medical Home

Care Coordination

Monitoring of Sentinel Events


MedVirginia - Health Information Exchange

Physician View

  • e-Chart

  • Meds/Allergies List

  • Ancillaries

  • IP / OP

  • Secure Messaging

Data Flowing to Solution

Clinical Results from Hospitals and Providers

Discharge

Summaries

Reference Lab Results

Physician

Suite of Services

Physician

e-Prescribing

  • PM Integration

  • Practice Notes

  • e- RX

  • Electronic Health Record

    • Interface with EMRs

Medications

Allergies


Current

Clinical inbox

Clinical messaging

Community e-chart

Demographic summary

Clinical summary

Electronic prescribing

Integrated practice notes

3Q08

PACS interface

E-signatures

Rounds list

Medication histories

Free Clinic EMR: Features and Functions


CMS EMR Demonstration Project


Project Overview

  • Purpose: Drive adoption of EHRs in primary care

  • MedVirginia selected as “convener” for Virginia

  • Only 12 sites awarded in U.S.

  • Small-medium PCP practices <20 MDs

  • 200 practices in VA (100 control, 100 study)

  • Incentives (additional Medicare reimbursement) provided for:

    Year 1: Adoption of CCHIT-certified EHR

    Year 2: Reporting of quality measures

    Year 3-5: Clinical improvements (P4P)


Practice Requirements

  • Size

    • Small to medium-sized practices (<= 20)

    • NPs / PAs as well as MDs / DOs

    • At least 50 Medicare FFS beneficiaries

  • Specialty

    • Primary care (IM, FP, GP, gerontology)

    • Medical sub-specialists only if practice is predominantly primary care

  • Must adopt CCHIT-certified* EHR by end of Year 2

  • Must bill OVs electronically

    * CCHIT = Certification Commission for Healthcare Information Technology


Minimum Required EHR Functionalities

  • Demonstration Practices must be utilizing EHR to perform minimum functionalities:

    • Patient visit notes

    • Recording of lab/diagnostic tests orders & results

    • Recording of prescriptions

  • More sophisticated users get higher payment

    • Based on OSS score


Incentive Payments

  • HIT incentive payment based on performance on Office Systems Survey (OSS)

  • Quality incentive payment for reporting/performance on 26 clinical measures related to:

    • Diabetes

    • Congestive Heart Failure

    • Coronary Artery Disease

    • Preventive Services

  • Both paid on a per-beneficiary basis (increased Medicare reimbursement)


  • Incentives Vary by Year

    • Year 1:

      • Payment for use of HIT core functionalities

    • Year 2

      • Payment for reporting quality measures

      • Payment for use of HIT

      • Practice terminated from Demonstration if it has not adopted CCHIT EHR and is using minimum core functionalities

    • Years 3 -5

      • Payment for performance on quality measures

      • Payment for use of HIT

      • Minimum quality performance required to receive HIT payment


    Maximum Potential Payment


    Next Steps for Virginia

    • Virginia is a Phase II Site (1 of 8)

    • Kick off expected by Summer 2009

    • MedVirginia, as convener, will help direct CMS recruitment efforts


    More Information

    • MedVirginia website

      • www.medvirginia.net

    • CMS website

      • http://www.cms.hhs.gov/

      • Medicare > Demonstration Projects


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