CMS and HIT Adoption

1. CMS and HIT Adoption Tony Trenkle Director Office of E-Health Standards and Services Centers for Medicare & Medicaid Services

2. CMS-The Numbers • Medicare provides health insurance to approximately 45 million beneficiaries • CMS also has federal oversight of the state-administered Medicaid program and Children’s Health Insurance Program (CHIP), covering about 50 million and 11 million enrollees respectively • 33.7% of national health expenditures are paid by Medicare or Medicaid • Medicare processes over a billion claims/yr. • There are approximately one million Medicare providers

3. HIT Adoption • CMS’ large percentage of overall healthcare purchasing as well as its regulatory role makes it the key driver for successful HIT adoption • CMS support of standards drives industry adoption and builds a foundation to support interoperable HIT. • CMS incentives programs promote adoption but also effective use of HIT. • CMS demos and pilots provide a way to measure the impact of HIT on the Medicare and Medicaid populations.

4. Demos and Pilots • DOQ-IT • QIO 8th Scope of Work • Focus on small-medium sized primary care practices • Medicare Care Management Performance • Authorized under MMA • 3 year pay for performance to promote HIT adoption and use • Also focuses on small-medium sized primary care practices (up to 10 physicians)

5. Demos and Pilots • EHR Demonstration Project • Expands the MCMP demonstration • Over 800 practices in 4 demo sites • Began June 2009, will end May 2014 • Also focuses on small-medium sized primary care practices (up to 20 physicians) • Medicaid Transformation Grants • 22 states grants focused on HIT • EHRs, E-RX, HIEs

6. Other Drivers • Stark/Anti-Kickback • Allows donation of EHR software under certain conditions • CHIPRA • Promotes development of a pediatric EHR and quality measures • PQRI/RHQDAPU • Promoting the reporting of quality measures through EHRs for 2010 • MIPPA • E-rx incentive-2009-2013

7. HITECH • HITECH Act-effective 2011 • Section 4101-Medicare eligible professionals • Section 4102-Medicare incentives for hospitals • Section 4201-Medicaid • Game changer • Scale-up to $40 billion • Brings together the CMS programs (Medicare FFS, Medicare Advantage, Medicaid) • Meaningful Use-potential to bring about vast changes

8. Challenges • Numerous CMS programs to promote adoption have begun or will start shortly. • All contribute to increased use of interoperable HIT to improve the quality and efficiency of healthcare. • Challenges in the near term • Synchronize these efforts to optimize effects and not create unintended outcomes. • Create a platform that builds in continued improvements over time. • Implement HITECH the right way • Depth vs. width