Transcript SW VA HIT Conference - Southwestern Virginia Technology

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
Operational
Improvements
Profit
Contribution
Productivity
Improved
Revenue
Cost Savings
Cost
Avoidance
ROI Forecast
Productivity
Cost Savings
• Eliminate paper chart supplies (up
Operational
to $3/chart)
Improvements
• Reduce clerical (medical records)
• Improved physician
workflow
• OV time reduced due to faster
Profit &
pre-encounter chart review
Contribution
post-encounter
documentation
• Fractional FTE savings:
personnel
• Reduce or eliminate transcription
Productivity
costs
– Reduction in clinicalImproved
Revenue
messaging
– Staff time to process 1 med
request typically reduced by Cost
Avoidance
80% (12 min)
• Elimination of business office
outsourcing expenses through
an interfaced PMS
Cost Savings
ROI Forecast
Cost Avoidance
• Records storage
• Liability reduction:
Revenue/Profit
Operational
• Accurate coding & billing
Improvements
from interfaced PMS
– Orders/results matching
Profit
Contribution
and patient follow-up
– Enhanced legibility of
chart reduces potential for
Improved
errors
• Improved patient tracking &
charge capture
Productivity
Revenue
• E-rx reduces multiple
requests for same refill
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:
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–
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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
Updated
Meds
Community
Pharmacy
MedVirginia
Health Information Exchange
Demographics
Schedule
MEDfx
Practice Management System
& Eligibility Screening Tool
Results
Discharge Meds
Hospitals
Referrals
Eligibility Data
Clinicals
Referral Back to
Medical Home
Care Coordination
Monitoring of Sentinel Events
Specialists
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
Medications
Allergies
• PM Integration
• Practice Notes
• e- RX
• Electronic Health Record
• Interface with EMRs
Free Clinic EMR:
Features and Functions
• 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
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
Basis of Payment
Years Applicable
Max Annual Award per
Provider/Year
Max Annual Award
per Practice/Year
EHR Adoption
(OSS)
All 5 years
$5,000
$25,000
Reporting of
Clinical Quality
Measures
Year 2
$3,000
$15,000
Performance on
Clinical Quality
Measures
Years 3-5
$10,000
$50,000
$58,000
$290,000
Total Potential
Payment (5 years)
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