Provider Incentives for HIT Adoption

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Provider Incentives for HIT Adoption

• Gerard P. Filicko, MHA, CMPE
• Sr. VP, Physician Services

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Otherwise known as
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Obstacles to ImplementationShow me the Money!

• Internal ROI Forecast
• ASP vs Client-Server EMRs
• New Funding Opportunity?
• CMS EMR Demonstration

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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

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Productivity
ROI Forecast
Cost Savings

• Eliminate paper chart supplies (up to 3/chart)
• Reduce clerical (medical records) personnel
• Reduce or eliminate transcription costs

• Improved physician workflow
• OV time reduced due to faster pre-encounter chart
  review post-encounter documentation
• Fractional FTE savings
• Reduction in clinical messaging
• Staff time to process 1 med request typically
  reduced by 80 (12 min)
• Elimination of business office outsourcing
  expenses through an interfaced PMS

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Cost Avoidance
ROI Forecast
Revenue/Profit
Operational

• Records storage
• Liability reduction
• Orders/results matching and patient follow-up
• Enhanced legibility of chart reduces potential
  for errors
• E-rx reduces multiple requests for same refill

• Accurate coding billing from interfaced PMS
• Improved patient tracking charge capture

Improvements
Profit
Contribution
Productivity
Improved
Revenue
Cost Savings
Cost
Avoidance
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Internal ROI Measures

• Non-quantifiable Benefits
• Quality improvements
• Continuity of care
• Patient satisfaction
• Improved access

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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

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Is the ASP Alternative right for you?

• CCHIT certified vendors
• Evaluate Pros Cons
• 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

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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
• Governors HIT Council Grant

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Reporting, Grant Writing
Free Clinic Pharmacy
E-Scripts
Community Pharmacy
Updated Meds
MedVirginia Health Information Exchange
Demographics Schedule
MEDfx Practice Management System
Results Discharge Meds
Hospitals
Eligibility Screening Tool
Referrals
Eligibility Data Clinicals
Specialists
Referral Back to Medical Home
Care Coordination Monitoring of Sentinel Events
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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

• PM Integration
• Practice Notes
• e- RX
• Electronic Health Record
• Interface with EMRs

Medications Allergies
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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

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CMS EMR Demonstration Project
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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 lt20 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)

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Practice Requirements

• Size
• Small to medium-sized practices (lt 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

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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

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Incentive Payments

• HIT incentive payment based on performance on
  Office Systems Survey (OSS)
• Quality incentive payment for reporting/performanc
  e 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)

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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

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Maximum Potential Payment
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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

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More Information

• MedVirginia website
• www.medvirginia.net
• CMS website
• http//www.cms.hhs.gov/
• Medicare gt Demonstration Projects

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