Health Information Technology Consulting

1. Health Information Technology Consulting Physician Education 23 June 2009

2. Louisiana Health Care Review • Founded in 1986, we have a history of providing effective and cost-efficient solutions to our clients. • We have consistently produced leading results among a national network of Medicare quality improvement organizations, particularly in the areas of disease prevention, wellness and chronic care.

3. LHCR and Health Information Technology • Since 2006, we have helped physician offices adopt EHR to their practices. • Knowledgeable of all components of certified health information systems. • Knowledgeable about federal funding opportunities. • Work with physicians and their staffs through all stages of the transformation from paper records to digital.

4. What is ARRA?American Recovery and Reinvestment Act (ARRA) 2009 ARRA has major funding allocated for HIT implementation under the following sections: • Section 4101: Medicare incentives for eligible professionals. • Section 4102: Medicare incentives for hospitals. • Section 4103: Implementation funding. • Section 4201: Medicaid provider HIT adoption and operation payments.

5. ARRA Funding

6. Medicare Up to $44,00 over the first five years. MDs operating in a “health provider shortage area” will be eligible for an incremental 10% increase. Medicaid If more than 30% of a physicians patients are paying with Medicaid, they will be eligible for up to $65,000 over the first five years. (20% for pediatricians) Types of Incentives Note: Physicians delivering care entirely in a hospital are ineligible. (anesthesiologist, pathologist & ED MDs)

7. Incentive Fee Schedule - Medicare

8. Incentive Fee Schedule - Medicaid

9. Use of a certified EHR product with e-Prescribing capability. EHR technology is connected for the electronic exchange of patient health information. Complies with submission of reports on clinical quality measures. What does it take to receive the funding? Meaningful Use Demonstration

10. What happens if one doesn’t adopt EHR?Disincentives or penalties • Providers must demonstrate meaningful use no later than 2014. • Beginning in 2015, Medicare Fee Schedules will be reduced by 1%. • Additional decreases to follow in 2016 and 2017 to a total of 97% of the regular fee schedule. • May be further reduced to 95% of the regular fee schedule if the Secretary determines that total adoption is below 75% in 2018.

11. Are there existing incentives? • 2% financial incentive for physicians to use ePrescribing. • 2% for Patient Quality Reporting Initiative (PQRI).

12. Medicare Up to $11 million using $2 million as base payment and a payment of $2,000 for each discharge between the 1,150 and 23,000 discharges annually. Medicaid For hospitals seeing more than 10% of patients with Medicaid, incentives will be determined by the same calculation as Medicare, except that payments will be fully weighted for the first four years, rather than following descending payments. What about the hospitals?

13. What about others? • Nurse practitioners & nurse mid-wives can file for incentives under the Medicaid program. • Physician Assistants can file only if they are practicing in a rural health clinic led by that PA or is practicing in a Federally Qualified Health Center that is also led by that PA. • Medicare Advantage organizations and their providers are eligible as long as the provider delivers a minimum of 20 hours/week of patient care services and the organization furnishes at least 80% of the services of the MD to clients of their organization.

14. What is HHS doing with $2 billion Discretionary Funds? • Development of standards • Grants • HIE infrastructure • Loans to states • Regional HIT resource centers • Telemedicine • New community health centers

15. What does the future look like? 90% of doctors and 70% of hospitals will be using comprehensive EHR by 2020. Congressional Budget Office estimate

16. Increase Revenue & Boost Profits Reduce Paper Costs Increase Productivity EHR can do all this ? Deliver Better Patient Care & Scheduling Improve ClinicalDecision Making Enhance Documentation So, why should I adopt EHR?

17. Benefits of EHR – Increase Productivity • Automation of clinical processes, i.e. clicking a patient's name in the EHR system replaces the manual pulling/filing of paper charts. • Integration with diagnostic devices to feed lab, imaging, x-ray results and other documents from various locations directly into patient records. • Generation of detailed and customized financial reports using electronic medical accounting and charting software. • Reduction in staff and MD time spent on prescriptions, refills, phone calls and faxes to pharmacy. • Increased office communication and efficient task management by using e-mail messaging.

18. Benefits of EHR – Increase Revenue • Identification of missed services and potential new services for patients, generating new business without the need to increase staff. • Improvement in revenue cycle management through automating charge capture, improved E & M coding, accurate claim submission, improved re-submission. • Facilitation of web consultations via secure internet connections.

19. Benefits of EHR –Reduce Costs • Elimination of chart production, chart storage and chart maintenance costs. • Reduction in staff time for copying and management of files. • Reduction in transcription costs and other outsourced services. • Reduction in physical storage space requirement as office transitions to paperless environment. • Reduction in malpractice premiums with use of audit trails and comprehensive documentation that indicates higher quality patient care and patient safety.

20. Benefits of EHR –Improve Clinical Decision Making • Provision of built-in tools at point of care to enhance decision support in such areas as • Diagnosis • Prescribing medications • Automated health maintenance reminders • Treatment plan recommendations. • Reduction in medication errors using electronic PDR-based medical dictionaries, Adverse Drug Event (ADE) alerts, generic drug and dosage recommendations. • Increased adherence to clinical protocols, improvement in population disease management, risk mitigation.

21. Benefits of EHR – Enhance Documentation • Increased accuracy by permitting multiple users to access patient charts simultaneously for real-time documentation. • Enhanced security module to manage/restrict access to patient records by setting individual user permissions. • Improved confidentiality, privacy and security; access and audit trails. • Increased legibility and completeness of patient records; ability to customize data for reporting, research, drug recalls and patient marketing.

22. Benefits of EHR –Deliver better patient care and scheduling • Increased patient satisfaction by offering interactive features that enable patients to schedule/cancel appointments online or access lab reports from home. • Improvement in patient access to care by utilizing a secure Internet connection that allows the doctor to conduct web consultations or generate reports from home or office. • Improvement in preventive care by tracking patient health maintenance reminders, compliance, follow-up activity.

23. SaaS Vendor licenses an application to customers for use as a service on demand for a monthly fee. Typically, the vendor hosts the application in a commercial data center that has tremendous connectivity and power redundancy, security, continuity planning and data protection. Minimal upfront capital investment and minimal maintenance costs. Software lifecycle management is vendor’s responsibility. What are the different typesof EHRs?

24. Client/Server Practice will host the application on their internal servers and own the license. Upfront capital investment to build the infrastructure and on-going maintenance costs. Software and hardware lifecycle management is practice responsibility and can provide flexibility in investment. Depending on the size of the practice, saves money in the long run. What are the different typesof EHRs?

25. What are typical stages of EHR adoption ? • Practice Assessment • Transition Planning • EHR Implementation • Medical Home Certification (Optional)

26. Practice Readiness Assessment • Infrastructure • Processes • Personnel

27. Practice Transition Planning • ARRA Funding Application • Transition Plan • Change Management • Vendor Selection • Contract Negotiations • Training Requirements

28. EHR Implementation • Project Management Oversight • Workflow Redesign • Change Management • Training • Installation and Go-Live

29. Medical Home Certification • Benefits • Practice Assessment • Application

30. What Next? • For additional information on LHCR please visit: www.lhcr.org • If you would like to schedule an appointment for the next steps for your practice, please contact: Kathleen Keeley, CPHIT, CPEHR Tricia Canella HIT Specialist Business Development 318-308-7272 225-248-7064 kkeeley@lhcr.orgtcanella@lhcr.org