Electronic Health Records and Health Information Exchange Implications

Electronic Health Records and Health Information Exchange: Implications for Rural Hospitals Rick Snyder Vice President, Finance & Information Services Oklahoma Hospital Association Brian Yeaman, MD Director, Physician Informatics Norman Regional Health System Greater Oklahoma City Hospital Council

American Recovery and Reinvestment Act of 2009 (ARRA) • Incentive payments for meaningful use of certified Electronic Health Records • Hospitals and Eligible Professionals • Medicare incentives • Medicaid incentives

Hospital Incentive Payments • Qualify as early as Oct 1, 2010 – Range for OK PPS: ~$2 million - $8 million – Median: $3. 7 million – State potential: $311 million • Qualifying after FFY 2013 reduces amount • CAH: Medicare share of capital + 20% • FFY 2015: Incentives end; penalties begin

Hospital Incentive Payments Medicaid • Requires: 10% Medicaid inpatient volume • CAHs can qualify – not based on costs – $500, 000 to $1, 200, 000 • $108 million potential for OK hospitals • State has some discretion in design

Eligible Professionals • Medicare incentives capped at $44, 000 (plus 10% in HPSAs) OR • Medicaid incentives capped at $63, 750 (if 30% of practice is Medicaid (Peds: 20%)) • Paid over 5 years beginning Jan. 2011 • Penalties for non-adoption begin Jan. 2015 • Hospital-based professionals ineligible

EHR Adoption Rates • • 2008 RWJF study of 2, 952 hospitals Comprehensive EHR: 1. 5% of US hospitals Basic EHR (physician, nursing notes): 7. 6% Rural hospitals: – 0. 6% comprehensive EHR – 4. 0% basic EHR

OHA members tell us:

OHA members tell us: Potential obstacles to your hospital adopting EHR: 1. Insufficient IT staff 2. Incentive payments will likely not cover EHR costs 3. Medical Staff is not supportive 4. Cannot find a suitable EHR

OHA members tell us: OHA can help most by… 1. 2. 3. 4. 5. Providing education on incentives Providing education on EHRs Offering a “group deal” Helping arrange financing Helping select EHR

EHR Certification • Certification Commission for Health Information Technology (CCHIT) – CCHIT Certified – Preliminary ARRA certification – Site certification • HHS Health IT Policy Committee recommendation – Allow multiple Certification organizations – Accreditation process for certifying organizations • HHS will propose rules

“Meaningful Use” • • • HIT Policy Committee HIT Standards Committee Public input Policy Committee’s August 19 matrix Proposed rule due by December 31 – 60 day comment period – Final rule: middle or end of spring 2010

• • NE Oklahoma origins Oklahoma City exchange Projects around the state Attractive pricing for hospitals and their physicians

Regional Extension Centers – ARRA Section 3012 • National: HIT Research Center – Develop or recognize best practices to support and accelerate efforts to: • Adopt, implement, and effectively utilize HIT for – Electronic exchange and – Use of information • Regional Extension Centers – Provide technical Assistance – Disseminate best practices and other information – Support and accelerate efforts to adopt, implement, and utilize HIT

Regional Extension Centers • ARRA law: – – Hospitals (public, NFP, CAH) Federally Qualified Health Centers Entities serving uninsured, medically underserved Individual and small group practices in primary care • Funding opportunity: – Primary care providers in small group practices, public hospitals & CAHs, CHCs and RHCs, other settings for the uninsured/medically underserved

Regional Extension Centers • • OFMQ selected by stakeholders Three waves of funding $6. 5 million potential for Oklahoma Substantial matching required in years 3 and 4

State Loan Program • 5: 1 federal match for loans to providers • Administered through Medicaid agencies • OHCA will apply; has requested state match in SFY 2011 budget • Projected availability: October 2010

SHIECAP • State Health Information Exchange Cooperative Agreement Program • Planning and Implementation grants • State funding required – 2011 – 2012 – 2013 1/10 1/7 1/3

SHIECAP

SHIECAP: Oklahoma Health Information Exchange • • “Network of networks” Planning phase beginning Jan. 2010 TBD: Governance, financing, … ONC approval of State plan required before implementation is funded • OHA participating in planning; volunteers?

OHA Trade Show – HIT vendors • Spectron Corp – Mc. Kesson products & more – booth 320 • CPSI – booth 800 • Phoenix Health Systems – booth 111 – Meditech, CPSI, others, including Med. Sphere Open. Vista

Resources • http: //healthit. ahrq. gov/Rural. HITtoolbox • http: //www. cchit. org/ • http: //www. okoha. com/ARRA