ARRA Incentives and Meaningful Use

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ARRA Incentives and Meaningful Use

• Jerry Powell
• CIO
• University of Rochester Medical Center

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University of Rochester Medical Center

• Multi-facility Tertiary Care Academic Medical
  Center
• Rochester largest employer
• Medical, Nursing, Dental, and Graduate Research
  Schools
• Acute care facilities
• Strong Memorial Hospital
• 760 acute care beds, 7 ICUs
• Highland Hospital
• 260 acute care beds
• Over 1,300,000 visits / year
• Over 40,000 discharges / year
• Over 120,000 ED visits / year (SMH HH)
• 2 Nursing Homes, and a Visiting Nurse Service,
  serving a nine county radius
• 850 full time attending faculty
• 1500 admitting / attending physicians
• 500 residents in over 20 departments
• Over 400 medical students
• Many NPs, PAs, other physician extenders

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University of Rochester Medical Center

• Major Clinical IT Applications
• Allscripts TouchWorks Ambulatory EMR
• Flowcast Practice Management (Sched, BAR)
• Flowcast Hospital PA/PM
• Siemens Invision CPOE, LCR CDR
• GE Centricity Pharmacy
• EPIC Clinical Transformation Project
• Kodak PACS Archive
• ImageCast RIS and PACS Browser
• Locally created Provider Portal

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HHS overall objective is to ensure that
providers make use of, and patients have access
to, clinically relevant electronic information,
not just existence of technology
For HHSThese goals can be achieved only through
the effective use of information to support
better decision-making and more effective care
processes that improve health outcomes and reduce
cost growth
Phased-in series of improved clinical data
capture supporting more rigorous and robust
quality measurement and improvement.
Connecting for Health, Markle Foundation
Achieving the Health IT Objectives of the
American Recovery and Reinvestment Act April 2009
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The definition of meaningful use of an EHR will
be quantified, evolving over time, and span the
inpatient and outpatient data exchange within a
given organization
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Qualifying Criteria

• Meeting specified HIT standards, policies,
  implementation specifications, timeframes, and
  certification requirements.
• Still in development
• CMS generally expects that under Medicare,
  meaningful EHR users would demonstrate each of
  the following meaningful use of a certified EHR,
  the electronic exchange of health information to
  improve the quality of health care, and reporting
  on clinical quality and other measures using
  certified EHR technology, integrated decision
  support, and computerized provider order entry.

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Ambulatory Incentive Opportunities
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Meaningful Use

• Incentives for meaningful use in one of two
  programs (not both)
• Two programs
• Medicaid or Medicare
• Penalty if not doing meaningful use by 2015

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Incentives and Timing

• January 2011 - Incentives for eligible
  professionals (EPs) who are meaningful EHR users.
  
• Full stimulus dollars available to those that
  qualify as late as 2012
• January 2015 - payment adjustments will be
  imposed on EPs who are not meaningful EHR users.
• Hospital-based physicians who substantially
  furnish their services in a hospital setting are
  not eligible.

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Medicare ARRA Physician Payment Incentives Must
have already implemented certified EHR meeting
meaningful use criteria to qualify.
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Medicare Ambulatory Stimulus Funding

• Incentives are for meaningful use of a certified
  EHR
• Penalty if not doing meaningful use by 2015
• Incentives are 75 of allowable Medicare charges
  with a CAP
• Year 1 if 2011 or 2012 - 18,000
• Year 1 - 15,000
• Year 2 - 12,000
• Year 3 - 8,000
• Year 4 - 4,000
• Year 5 - 2,000
• (2017) NONE

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Hospital Incentive Opportunities
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CMS Criteria

• Hospital is using certified EHR technology in a
  meaningful manner
• The certified EHR technology is connected to
  allow "for the electronic exchange of health
  information to improve the quality of care
• The hospital makes reports on clinical quality
  and other measures HHS chooses.
• The eligible hospital must already have EHR in
  place before it can receive any incentive payment.

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Hospital Incentive Calculations

• Calculations
• multiplying a 2 million base rate plus an
  inpatient discharge rate times a Medicare share
  fraction and then times a transition factor.
• The discharge rate will vary, but larger
  hospitals will have larger discharge rates.
• The transition factor changes every year for four
  years to create a step-down incentive payment
  structure.
• Medicare will only make incentive payments to an
  eligible hospital for a maximum of four years.
• The transition factor after the fourth payment
  year is zero.
• An eligible hospital can begin to receive
  payments in fiscal year 2011, and CMS will end
  all incentive payments to all hospitals after
  2015.
• CMS will also start to reduce market basket
  adjustments to eligible hospitals that have not
  adopted EHR technology after 2015.

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