Transcript MHA: Its Business and Governance - Hospital Industry Data Institute

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 hospitalspecific 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
Sample Special Report
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
Sample map
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
ARRA
American Recovery & Reinvestment Act
The American Recovery and Reinvestment Act of
2009 distributes $787 billion
Nearly $20 billion 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 ACT
Health 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.
Improve quality,
safety and
efficiency, reduce
disparities
Improve population
health
Engage patients and
families
Goals of Meaningful
Use of EHR
Ensure privacy and
security for personal
health information
Improve care
coordination
• 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
*Slide designed by Christopher Jackson, D.O., Sisters of Mercy Health System
Meaningful Use Definition Details
24 Objectives of Meaningful Use
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
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
15.
16.
17.
18.
19.
20.
21.
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
22. Submit data to immunization registries
23. Submit lab results to public health
24. Submit syndromic surveillance data
19 Objectives Required in Stage 1
14 Core
Objectives
Required of
All Hospitals
Choose 5
from
Menu Set
1. CPOE for Medications
2. Drug-drug/drug-allergy checks
3. Record demographics
4. Structured problem list
5. Structured medication list
6. Structured medication allergy list
7. Record and chart changes in vital signs
8. Record smoking status
9. 1 clinical decision support rule
10. Report clinical quality measures
11. Electronic health info to patients
12. Electronic copy of discharge instructions
13. Exchange key clinical information (capability)
14. Protect electronic health information
15.
16.
17.
18.
19.
19.
Option 1
Option 2
Option 3
Option 4
Option
5
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
*Slide designed by American Hospital Association
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
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
Stage 1 Hospital Quality Reporting
Measures
Condition
Measure Name
Emergency
Department
Throughput
Median time from ED arrival to ED departure for
admitted patients
Admission decision time to ED departure time for
admitted patients
Discharge on anti-thrombotics
Anticoagulation for A-fib/flutter
Thrombolytic therapy for patients arriving within 2
hours of symptom onset
Anti-thrombotic therapy by day 2
Discharge on statins
Stroke education
Rehabilitation assessment
VTE prophylaxis within 24 hours of arrival
Intensive care unit VTE prophylaxis
Anticoagulation overlap therapy
Platelet monitoring on unfractionated heparin
VTE discharge instructions
Incidence of potentially preventable VTE
Stroke
Venous Thromboembolism (VTE)
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 1st yr cost
no later than 2016
Medicaid: EPs - no payments after
2021 or more than 5 yrs.
ONC Final Rules
2010
2011
2012
2013
2014
2015
2016
2017......2021
CMS Final Rule
on Incentives
Medicare: penalties begin
Medicare: incentives
for non-meaningful users
begin Oct. 2010
Medicare: phase down incentive
FY15 for hospitals
(FY2011)
payments for EPs
calendar 2015 for EPs
for hospitals
Medicare: incentives
Medicare: incentives
Medicare: EPs who 1st payment
begin Jan 2011 for EPs
End 2016
is after 2014 receive no incentives
MEDICARE
*Slide designed by Manatt Health Solutions
Total Incentive
Funding: Approx.
$20-$30 billion in
outlays/payments
•On-going Penalties
for Non-Adopters
Incentive Payments
Eligibility
Begins
◦ For Eligible Hospitals (EHs) any federal fiscal year starting
October 2010.
◦ For Eligible Professionals (EPs) any calendar year starting
January 2011.
Reporting
&
Payment
Period
◦ The 1st Payment Year means the 1st year an EH or EP receives
an incentive payment (as opposed to the 1st year of the program).
◦ For EH’s of EP’s 1st Payment Year only, the reporting period is
any continuous 90-day period in which the provider successfully
demonstrates meaningful use of a certified EHR. In subsequent
years, the reporting period is the entire Payment Year.
Payments
Begin
CMS expects to initiate Medicare incentive payments May 2011.
◦ For Medicaid, States determine their own deadlines, but are
required to make timely payments. CMS expects the majority of
States will have launched their programs by Summer 2011.
*Slide designed by Manatt Health Solutions
Meaningful Use Stages
Stage 3: 2015
Improved outcomes
Stage 2: 2013
Advanced care processes
with decision support
Stage 1: 2011
Capture/share data
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
1. REC partners will be offering assistance
to primary care physicians & clinics in
your trading area
2. 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
REC Services for Hospitals
EHRCompass™
EHRAssist™
EHRConnect™
Assistance
Center Loan
Services
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
Group purchasing arrangement for feefor service consulting
Vendor selection
Project management
Shoulder to shoulder
implementation
management
Practice workflow
redesign
Assistance with
interoperability and
HIE
Implementation of
privacy & security best
practices
Technical
infrastructure support
IT staffing
Data center hosting
Cooperative Grant Funding –
How it Works
The REC is paid for reaching each of the following
three milestones
1. signed technical assistance contract
2. provider “go live” with certified EHR
3. 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)
Parting
Thoughts to
Move Us
Forward
Do not get yourself in trouble!
Aim High!
Stay focused on your job
Exercise to maintain good
health
Practice Team Work
Rely on your trusted partner to
watch your back
Save for raining day
Rest and Relax!!!
Always smile when your boss
is around
And remember … nothing is
impossible!
QUESTIONS
Resources
Website:
http://ehrhelp.missouri.edu
E-Mail:
[email protected]
[email protected]
Thank you!