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MHA Leadership Forum. Theresa Rogers Senior Vice President of Data & Information Services. Hospital Industry Data Institute. Incorporated October 1985 The data company of the Missouri Hospital Association (MHA)
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MHA Leadership Forum Theresa Rogers Senior Vice President of Data & Information Services
Hospital Industry Data Institute • Incorporated October 1985 • The data company of the Missouri Hospital Association (MHA) • A comprehensive data organization providing services to hospitals and hospital association state partners • Customizes services to meet member hospital needs
HIDI State Partners • Missouri • Alaska • Georgia • Kansas • Oklahoma • Tennessee • Virginia • Washington • Wyoming
HIDI • Serves over 900 hospitals across the country • Processes over 40 million discharges annually
HIDI Core Service Offerings • Data Collection • Data Analysis • Data Reporting • Advocacy Support to MHA • Utilization, Management and Other Surveys • Mandated Submissions to DHSS • AHRQ (Agency Healthcare Research & Quality) HCUP Partner Submissions • AHRQ Indicator Reports • AHA Survey Collection & Editing • Special Projects
HIDI Data Policy • Signed HIDI master agreement for release of data on file & must participate • Must sign a data use agreement if requesting patient level data; HIPAA limited data set for research, public health or healthcare operations • Must sign a data release policy for hospital-specific reporting of limited data set
HIDI Participating Hospital Use of Data • Strategic Planning/Marketing • Market Share • Service Line Analysis • Physician Loyalty • Health Improvement/Quality • MHA Hospital Performance Project • MHA QualityWorks • Research • Trends • Advocacy/Policy Development • Policy Impact Analysis • Modeling
Report Services Provided by HIDI to Participating Hospitals • Annual and interim inpatient report series (quarterly available upon request) • Annual outpatient report series • Annual census data • HIDI drill-down report tool • Monthly Utilization Reporting (MUR) • Quarterly Management Reporting • Focus Series Reports • Data Analytics & Modeling – NEW! • Special Projects/Consulting – optional w/fee • Medpar Data Purchase – optional w/fee
HIDI Data Committee • Representative committee from Missouri hospitals and health systems • Provides guidance & recommendations on use and reporting of data
HIDI Discharge Data System • Secure Web site address provided to authorized users • Online data submission • Quick turnaround time • Error reporting • Validation reporting
Hospital Inpatient Discharge Reports • PO reports are patient origin type • Hospital-specific • DRG, RE, BD, and MDC reports are based on clinical data • Not hospital-specific
Hospital Outpatient Reports • Includes hospitals and ASCs (if reported) • Patient origin reports are similar to inpatient • RC reports are based on major revenue categories • Reporting of all outpatient visits is not mandated • Encourage non-hospital sites to report
HIDI Online • Interactive drill down cube using remote access to secure Web site – available only to authorized users • Makes large volumes of multidimensional data easily and quickly accessible • Inpatient and outpatient data updated quarterly
Focus Reports • RACs • Readmissions • Present on Admission • Hospital Acquired Conditions
Custom Reports • Reports available in electronic or printed format • Reports customized to meet user’s needs • Physician loyalty • Service line, etc. • HIPAA compliant
HIDI Census* Data Report • Data purchased from Claritas • Contains 2000 census data, current year estimates and 5-year projections • CD-ROM version contains ZIP codes for entire HIDI area • Printed version contains ZIP codes for a hospital’s base county & adjoining counties • *Census reports require additional licensing fee costs
Health Information Technology • Services related to HIT • Leadership through MHA’s HIT Committee • HIDI TechConnect e-newsletter updates (included in MHA Today as of January 1, 2010) • HITECH activities including webinars, representation in HIE planning, Meaningful Use Symposium, issue briefs and more • Regional Extension Center partner for hospital services • Active participation and monitoring of HIE activities • Visit the HIT Web site at www.mhanet.com
ARRAAmerican Recovery & Reinvestment Act • The American Recovery and Reinvestment Act of 2009 distributes $787 billion • Nearly $20billion for incentive program to be a “meaningful user of Electronic Health Record (EHR)” through: • Medicare to PPS Hospitals, CAHs and Physicians • Medicaid incentives to Physicians with 30 percent Medicaid volume, Children’s hospitals and other acute care hospitals with 10 percent Medicaid volume • Otherwise, penalties start 2015
HITECH ACTHealth Information Technology for Economic and Clinical Health Act • Incentives/penalties related to Meaningful Use • Certification and Standards • Regional Extension Centers • State designated entity HIE support • State Medicaid support including HIT • Comparative Effectiveness Research • Broadband Expansion and Innovation • Privacy and Security beyond HIPAA
HITECH Act and Meaningful Use • The Health Information Technology for Economic and Clinical Health Act (HITECH) was enacted as part of the American Recovery and Reinvestment Act (ARRA) in 2009. • Under the HITECH Act, eligible professionals (physicians) and hospitals can receive financial incentives based on timely adoption of EHRs and meeting the criteria for “meaningful use” of certified EHR technology Goals of Meaningful Use of EHR *Slide designed by Christopher Jackson, D.O., Sisters of Mercy Health System
Meaningful Use Definition Details 24 Objectives of Meaningful Use 19 Objectives Required in Stage 1 CPOE for Medications Drug-drug/drug-allergy checks Record demographics Structured problem list Structured medication list Structured medication allergy list Record and chart changes in vital signs Record smoking status 1 clinical decision support rule Report clinical quality measures Electronic health info to patients Electronic copy of discharge instructions Exchange key clinical information (capability) Protect electronic health information Drug-formulary checks Record advanced directives Incorporate structured clinical-lab data Generate patient lists by condition Identify patient-specific education resources Medication reconciliation Summary care record transitioned or referred patients Submit data to immunization registries Submit lab results to public health Submit syndromic surveillance data CPOE for Medications Drug-drug/drug-allergy checks Record demographics Structured problem list Structured medication list Structured medication allergy list Record and chart changes in vital signs Record smoking status 1 clinical decision support rule Report clinical quality measures Electronic health info to patients Electronic copy of discharge instructions Exchange key clinical information (capability) Protect electronic health information 14 Core Objectives Required of All Hospitals 15. Option 1 16. Option 2 17. Option 3 18. Option 4 19. Option 5 Choose 5 from Menu Set 19. Public Health reporting option Choose at least 1 Public Health Option *Slide designed by American Hospital Association
Possible Exclusions • Can exclude certain objectives if they are not applicable to you • Hospitals can exclude up to seven objectives • Must meet specific exclusion criteria detailed in final rule • Exclusion reduces total number of objectives to be met Examples of Hospital Objectives that can be excluded as not applicable: • Provide electronic copy of discharge instructions, if NO patients request it • Submit data to immunization registries, if NO immunizations given or NO registry can receive data • Submit reportable lab results, if NO public health agencies can accept data *Slide designed by American Hospital Association
Required Quality Reporting • Hospitals must report 15 measures (three sets) • Endorsed by National Quality Forum • Not in current quality reporting program (RHQDAPU) • “e-specified” but not field tested • Calculation through the EHR, but submission is through attestation in 2011 • Numerators • Denominators • Patient exclusions • Anticipate electronic submission in 2012
Meaningful Use Timeline MEDICAID Medicaid: hospitals that adopt after 2017 not eligible for incentives Medicaid: incentives begin (Medicaid payment systems expected to be on-line by Summer 2011) Medicaid: EPs - no payments after 2021 or more than 5 yrs. Medicaid: EPs 1st yr cost no later than 2016 ONC Final Rules 2010 2011 2012 2013 2014 2015 2016 2017......2021 CMS Final Rule on Incentives Medicare: penalties begin for non-meaningful users FY15 for hospitals calendar 2015 for EPs Medicare: incentives begin Oct. 2010 (FY2011) for hospitals Medicare: phase down incentive payments for EPs • Total Incentive Funding: Approx. $20-$30 billion in outlays/payments • On-going Penalties for Non-Adopters Medicare: incentives begin Jan 2011 for EPs Medicare: incentives End 2016 Medicare: EPs who 1st payment is after 2014 receive no incentives MEDICARE *Slide designed by Manatt Health Solutions
Incentive Payments *Slide designed by Manatt Health Solutions
Level of Collaboration Required Meaningful Use Stages
Regional Extension Centers (REC) • Created last year under the Health Information Technology Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009 • 62 Regional Extension Centers (RECs) located in 9 regional areas
Purpose • Purpose of the Regional Extension Centers is to assist providers within their geographic areas on selection, acquisition, meaningful use, and implementation of EHRs and HIEs to improve health care quality and outcomes. • Serve as resource for all providers in an area; target assistance to eligible primary care providers in smaller practices, small and rural hospitals and public health clinics
Missouri HIT Assistance Center • Partnership of: • University of Missouri’s Department of Health Management and Informatics; Center for Health Policy; Department of Family and Community Medicine • Missouri Telehealth Network • Primaris • Missouri Primary Care Association • Kansas City Quality Improvement Organization • Hospital Industry Data Institute
What this means to hospitals • REC partners will be offering assistance to primary care physicians & clinics in your trading area • Supplemental expansion grant provides opportunity to create service offerings for hospitals
Assistance to Primary Care Providers & Clinics • Direct assistance support in the form of onsite technical assistance to providers • Training and support services to assist physicians and other providers in adopting EHRs • Guidance to help with EHR implementation & meeting meaningful use • *Contact the AC for physician services pricing schedule
REC Supplemental Expansion Grant • Expansion supplement to original REC grant awards • Intended to ensure the provision of services to CAHs and rural hospitals • HIDI is the REC partner to provide and coordinate REC services to 55 designated small rural hospitals but services can be used by all MHA hospitals
Web-based interactive toolkit designed to assist hospitals to implement and achieve meaningful use of electronic health records
Roadmap providing best practices to navigate an EHR implementation • Mile markers • Preparation • Selection • Implementation • Meaningful Use
See who uses what EHR in your area • Identify resources to connect to other hospitals • Phone consultations with experienced users • See vendor products in use through site visits
Cooperative Grant Funding – How it Works • The REC is paid for reaching each of the following three milestones • signed technical assistance contract • provider “go live” with certified EHR • provider attains meaningful use
Next Steps • Coordinate GPO fee-based services & deploy EHRAssist™ (April 2011) • Update MHA HIT pages (May 2011) • Continue to encourage signed technical assistance contracts between REC-eligible hospitals and the MU HIT AC (June 2011) • “Meaningful Use” early adopter panel presentation (June 2011) • 2011 MHA Meaningful Use Symposium (Aug 2011)
