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Electronic Medical Records (EMRs) & The Stimulus Plan

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Topics:I. Government Stimulus Act for Electronic Medical Records

(EMRs) • Medicare Incentives • Medicaid (Medical) Incentives

II. How to Qualify for Government Incentive Payments?• What You Need to Participate in an EHR Program• Specifics of Stage 1 Meaningful Use • Beyond Stage 1 Meaningful Use

III. Why SuiteMed IMS?• Certification• IMS Meaningful Use Dashboard

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I. American Recovery and Reinvestment Act

Health Information Technology for Economic & Clinical Health (HITECH) Act

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Stimulus Act In February 2009, President Obama signed into In February 2009, President Obama signed into

law the American Recovery & Reinvestment Act, law the American Recovery & Reinvestment Act, authorizing $27 billion to:authorizing $27 billion to:

Transform the healthcare system and improve the Transform the healthcare system and improve the qualityquality safety and safety and efficiency of careefficiency of care

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What Does This Mean to You as a Provider?

• Eligible Providers (EP) to receive from $44,000 to $63,750 in incentives from Medicare, or Medicaid over the next 5 years:

• As they adopt, implement & demonstrate meaningful use of certified EHR technology

• Incentives available under only one of the programs for office-based providers

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Medicare/ Medicaid Summary Table

Incentive Program Medicare Medicaid Maximum Incentive $44,000; $48,400 if in health provider $64,000

shortage area (HPSA)Additional Requirement 30% of services must be Medicaid;

20% if PediatriciansWho would be eligible? Physicians* and chiropractors Physicians* Mid-Level providers Do Not qualify Certified NMVs & NPs;

PAs only if lead provider in a rural health clinic Payment amount per year Calculations: 75% of submitted allowable No calculations based on fees; flat payments

charges by physicians; up to cap for the year intended to offset purchase of the EHR andmaintenance costs

Penalties Penalties for non-compliance No Penalties (yet)

Medicare vs. Medicaid Incentive Summary

* Physicians (defined in Section1861 Social Security Act) include: doctors of medicine, osteopathy, dental surgery, dental medicine, podiatry, and optometry

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I.A. Medicare Incentives

Start 2011 2012 2013 2014 2015 2016 Total

2011 18,000 12,000 8,000 4,000 2,000 0 $44,000

2012 18,000 12,000 8,000 4,000 2,000 $44,000

2013 15,000 12,000 8,000 4,000 $39,000

2014 12,000 8,000 4,000 $24,000

2015 0 0 0

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I.A. Medicare Incentive• Eligible professionals (EP) who are Eligible professionals (EP) who are meaningful meaningful EHR users can receive up EHR users can receive up

to $44,000 over 5 yearsto $44,000 over 5 years

• The incentive payment is equal to The incentive payment is equal to 75% of Medicare allowable charges75% of Medicare allowable charges for for covered services furnished by the physician in a year, subject to a maximum covered services furnished by the physician in a year, subject to a maximum payment (not to exceed this table).payment (not to exceed this table).

• A hospital-based EP who furnishes 90% or more of their services in the A hospital-based EP who furnishes 90% or more of their services in the hospital setting is not qualified as an EP to receive meaningful use hospital setting is not qualified as an EP to receive meaningful use incentives.incentives.

• Physicians operating in a "provider shortage area" will be eligible for an Physicians operating in a "provider shortage area" will be eligible for an incremental increase of 10%.incremental increase of 10%.

• For the 1For the 1stst year for which an EP applies for and receives an incentive year for which an EP applies for and receives an incentive payment (2011), the EHR payment (2011), the EHR Reporting Period is 90 daysReporting Period is 90 days. After 2011, the . After 2011, the EHR reporting period is EHR reporting period is the entire yearthe entire year..

• Physicians who do not adopt and use an EHR by 2015 will be penalized by Physicians who do not adopt and use an EHR by 2015 will be penalized by reduced Medicare payments (to a potential maximum of 5%):reduced Medicare payments (to a potential maximum of 5%):

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I.B. Medicaid Incentives

Start 2011 2012 2013 2014 2015 2016 2017 2018 Total

2011 21,250 8,500 8,500 8,500 8,500 8,500 0 0 $63,750

2012 21,250 8,500 8,500 8,500 8,500 8,500 0 $63,750

2013 21,250 8,500 8,500 8,500 8,500 8,500 $63,750

2014 21,250 8,500 8,500 8,500 8,500 $55,250

2015 21,250 8,500 8,500 8,500 $46,750

2016 21,250 8,500 8,500 $38,250

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I.B. Medicaid (Medical) Incentives Available to non-hospital based physicians, dentists, certified nurse Available to non-hospital based physicians, dentists, certified nurse

midwives, and physician assistants – only if they lead providers in rural midwives, and physician assistants – only if they lead providers in rural health clinics or FQHCshealth clinics or FQHCs

Incentive payments will go to Incentive payments will go to Eligible ProvidersEligible Providers (EPs) as they adopt, (EPs) as they adopt, implement, upgrade, or demonstrate implement, upgrade, or demonstrate meaningful usemeaningful use of certified EHR of certified EHR technology in their 1technology in their 1stst year year andand for up to 5 remaining participation years. for up to 5 remaining participation years.

Upfront Funding:Upfront Funding: Start up incentives up to $21,250 for the purchase, Start up incentives up to $21,250 for the purchase, implementation and upgrade of a certified EHR technology.implementation and upgrade of a certified EHR technology.

After receiving start up fundsAfter receiving start up funds, EPs who can prove “Meaningful Use” can , EPs who can prove “Meaningful Use” can receive up to $8,500 incentive payments for the next 5 years.receive up to $8,500 incentive payments for the next 5 years.

To be eligible,To be eligible, more than 30% of patient volumemore than 30% of patient volume must be attributable to must be attributable to Medicaid and/or Badger Care Plus (20% attributable to pediatrics).Medicaid and/or Badger Care Plus (20% attributable to pediatrics).

No penalties for lack of adoption (yet).No penalties for lack of adoption (yet).

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II. How to Qualify for Incentive Payments?

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What You Need to Participate in an EHR Program: 1. Certified EHR Technology: All eligible professionals (EP) need to

have certified EHR technology. Standards are now available in government sites, which establishes the

required capabilities of that technology to support the achievement of meaningful use.

2. NPI, NPPES Use Account and PECOS Enrollment: All Medicare eligible professionals must have a National Provider Identifier (NPI) & be enrolled in the CMS Provider Enrollment, Chain and Ownership System (PECOS) to participate in the EHR incentive program.

Most will also need an active user account in the National Plan and Provider Enumeration System (NPPES).

CMS will use these systems' records to register for the program and verify Medicare enrollment prior to making Medicare EHR incentive program payments.

If you are a Medicare EP that does not have an NPI and/or an NPPES web user account., use the following website to apply for an NPI and/or create a NPPES user account:

https://nppes.cms.hhs.gov/NPPES/welcome.do

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How to Qualify for EHR Incentives? • To qualify for incentive payments in 2011 and 2012, EP To qualify for incentive payments in 2011 and 2012, EP

must achieve: must achieve: Specifics of Stage 1 Specifics of Stage 1 meaningful usemeaningful use and clinical quality and clinical quality

measure (CQM) reporting measure (CQM) reporting

• The Recovery Act specifies 3 main components of The Recovery Act specifies 3 main components of Meaningful Use. Meaningful Use. The use of a certified EHR: The use of a certified EHR:

In a meaningful manner (e.g., e-Prescribing);In a meaningful manner (e.g., e-Prescribing);

For electronic exchange of health information to improve For electronic exchange of health information to improve quality of health care; quality of health care;

To submit clinical quality and other measures.To submit clinical quality and other measures.

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Specifics of Stage 1 Meaningful Use (2011 & 2012)• For Stage 1, which begins in 2011, the criteria for meaningful use is based on a series of

specific objectives that allows EPs to demonstrate meaningful users of certified EHR technology.

For EPs, there are total of 25 meaningful use (MU) objectives: 15 Core Set Objectives (mandatory), 5 Menu Set Objectives (optional, out of 10) For details see: http://suitemed.com/MU_measures.pdf

In 2011, EPs seeking to demonstrate Meaningful Use are required to submit aggregate clinical quality measures (CQM) and MU numerator, denominator, and exclusion data to CMS (or the States) by attestation.

In 2012, seeking to demonstrate meaningful use must electronically submit clinical quality measures selected by CMS directly to CMS (or the States) through certified EHR technology.

By using certified EHR technology to report information on clinical quality measures electronically to a health information network, a State, CMS, or a registry, the burden on providers that are gathering the data and transmitting them will be greatly reduced.

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Beyond the Stage 1 Criteria for Meaningful Use

CMS intends to propose through future rulemaking two additional stages of the criteria for meaningful use.

Stage 2 would expand upon the Stage 1 criteria in the areas of disease management, clinical decision support, medication management support for patient access to their health information, transitions in care, quality measurement and research, and bi-directional communication with public health agencies. These changes will be reflected by a larger number of core objective requirements for Stage 2.

Stage 3 would focus on achieving improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data, and improving population health outcomes.

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III. Why SuiteMed Intelligent Medical

Software (IMS)?

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III.2. Meaningful Use Made Easy with SuiteMed IMS Meaningful Dashboard

You can gather real-time indications of your current Meaningful Use levels.

Monitoring of countless CMS-required data elements.

Quick exporting of the data for delivery to Regional Health Information Exchanges

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Guide to Meaningful Use: Core Set (Mandatory) Objectives

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Guide to Meaningful Use: Menu Set (Optional) Objectives

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Source: CMS

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III. Why SuiteMed IMS?

III.3. EMR Systems, Authorized Partner of SuiteMed IMS You Will Experience Peace of Mind

Exceptional long-term support (customized CPSP forms) Local experts, sales and support Maximize the effectiveness to you Seamless implementation Hands-on consultative approach to training Saas & Client-Server Models

III.4. Proven Positive Return on Investment (ROI)* Cost savings Revenue enhancements Data accuracy, patient security and safety

* ROI – for details, see Appendix (1)

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Appendix (1): Proven Return on Investment

Data Accuracy & Patient Safety• Reduced risk of transcription errors• Reduced risk of missing critical information• Regulatory compliance & reduced professional liability rate

Cost Savings• Eliminates soaring dictation & transcription costs • Minimizes paper costs (storage rooms, copying, printing, staff time)• Eliminates out sourcing billing costs • Substantial cost savings through qualifying for the Gov’t Financial Stimulus

Revenue Enhancements• Accuracy of coding• Built-in protocols & reminders including health maintenance • Improved quality of charting & documentation• Ease of integration with specialists, labs, pharmacies, insurance companies, etc. • Increasing number of patient visits per day

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Appendix (2): About SuiteMed LLC

• Financially secure company • Founded 1998 – privately held and self funded• Headquartered in Oakland, CA with offices nationwide• Integrated PM / EMR/ Patient Portal & more• Over 26 different medical specialties• Local technology experts, sales, service & support• Multiple sister companies, community health, plastic surgery,

pharmacy automation, allergy, pain management and more• Over 3000 physician users nationwide