Facts about the
government’s healthcare
stimulus package
For informational purposes only.
Use this as a starting point to
gather additional knowledge on this
fast evolving opportunity.
• • • • • • • • • • • ARRA
– American Recovery & Reinvestment Act
Hitech
– Health Information Technology for Economic and Clinical Health Act
EMR
– Electronic Medical Records (Local)
EHR
– Electronic Health Records (Global)
PHR
– Patient Health Record
HHS
– United States Department of Health & Human Services
CCHIT Certified® product
– Commission for Healthcare Information Technology
CMS
– Center for Medicare/Medicaid Services
HCIS
– MEDITECH's Health Care Information System
EDM
– Electronic Document Management
– Electronic Data Management
OSA
– Open Systems Architecture
• $787 billion Stimulus Package
– $2 billion available immediately for loans and grants
to help health care providers implement electronic
health record systems and to fund research into the
use of various health systems
– $17+ billion for new programs rewarding doctors and
hospitals over the next 5 years for the “Meaningful”
use of e-health record systems.
• Beginning 2011, health care providers who use
electronic medical records and other health IT
systems in “meaningful” ways will be eligible for
government rewards ranging from tens of
thousands of dollars for doctors to millions for
hospitals.
• After 2014, laggards will be penalized with
reduced payments from Medicare.
• To get reimbursement, a physician or hospital has to
demonstrate that the EHR is certified and:
1. “Used in a meaningful manner”, and they reference eRx (eprescriptions)
2. Demonstrates that the certified EHR can also provide reporting
on “clinical quality measures.”
• Clinical Quality Measures use information and other technology to identify those patients who may
qualify for treatment, to confirm their eligibility, to notify clinicians caring for them and to work with
their physicians to institute the treatment.
3. Able to demonstrate the certified EHR “is connected in a manner
that provides for electronic exchange of health information to
improve quality of care such as care coordination.”
No one knows for sure how HHS will ultimately define “meaningful
use” or what “certified EHR” may mean.
• CMS will distribute on a tiered basis
– First year, physician gets $18k, 2nd, $12k,
etc.
• If physician gets started quickly (by 2010)
they can reap some $44K.
• If they drag their feet and start a couple of
years later, they’ll get a total of $24k.
• A similar tiered model is also established
for hospitals.
Ref: http://www.mdsmedicalsoftware.com/emr-software-stimulus.php
* HITECH ACT PHYSICIAN REIMBURSEMENT PLAN:
ELECTRONIC HEALTH RECORDS SOFTWARE
EHR Adoption
2011
EHR Adoption
2012
EHR Adoption
2013
EHR Adoption
2014
EHR Adoption
2015
2011 ($)
$18,000
0
0
0
0
2012 ($)
$12,000
$18,000
0
0
0
2013 ($)
$8,000
$12,000
$15,000
0
0
2014 ($)
$4,000
$8,000
$12,000
$15,000
0
2015 ($)
$2,000
$4,000
$8,000
$12,000
0
2016 ($)
0
$2,000
$4,000
$8,000
0
TOTAL
$44,000
$44,000
$39,000
$35,000
0
• Reduction by 1% of Medicare/
Medicaid reimbursements from
2015-2018
• Additional 1% reduction per year up
to 5%
• Managed at the State level and will institute the guidelines provided by HHS.
• Basic qualifications are similar, e.g., “meaningful use of certified EHR”
– Significantly more complicated process to receive reimbursement.
– Total reimbursement amounts up to $65,000/physician over five years.
– First year costs applied to purchase, install and training. Follow-on years,
reimbursement for operations and maintenance.
– Reimbursement is for a percentage of total expenditures by physician for certified
EHR.
– Extended time horizon, payments through 2021.
– Physician must demonstrate that a certain percentage of patients (20-30%) are
covered by Medicaid.
– Table below provides physician payment schedule under Medicaid.
Ref: http://chilmarkresearch.com/2009/02/17/hitech-act-medicaid-reimbursement-plan/
• EHR is an individual patient's medical record in digital
format that allows for storage and retrieval of this
information
• It may be made up of electronic medical records (EMRs)
from many locations and/or sources.
– Patient demographics, medical history, medicine and allergy lists
(including immunization status), laboratory test results, radiology
images, billing records and advanced directives.
• EHR systems can increase physician efficiency and reduce
costs, as well as promote standardization of care.
– Even though EMR systems with computerized provider order entry
(CPOE) have existed for more than 30 years, less than 10 percent
of hospitals as of 2006 have a fully integrated system
• Can cost upwards of $30,000-$50,000 per doctor
• Prior to the stimulus package the financial rewards of implementing an EHR
traditionally went to insurance companies, health plans, and government
programs as Medicare/Medicaid; not necessarily to the doctors or hospitals that
pay them.
• Doctors & Hospital Benefits
– – – – – – – – – Reduce medical errors
Reduce paperwork
Reduce redundancy
Automat medical claims processing
Improve Workflow that delivers decision-making data from multiple systems to one
screen
Enable faster check deposits while eliminating courier trips
Match medical record requests with receipts
Improve Help Desk Services with centralized EDM
Save money in paper, shipping costs
• Stimulus Funds can now give Doctors/Hospitals direct payout
• A qualified e-prescribing system includes the following:
1. Formulary and benefit transactions: gives prescribers information
about which drugs are covered by a Medicare beneficiary's
prescription drug benefit plan.
2. Medication history transactions: provides prescribers with
information about medications a beneficiary is already taking,
including those prescribed by other providers, to help reduce the
number of adverse drug events.
3. Fill Status notifications: allows prescribers to receive an electronic
notice from the pharmacy telling them that a patient's prescription has
been picked up, not picked up, or has been partially filled, to help
monitor medication adherence in patients with chronic conditions.
Ref: http://www.cms.hhs.gov/EPrescribing/
• Medicare recently announced a new rule, saying that by
2012, doctors participating in Medicare programs would be
required to prescribe prescriptions electronically.
– Blue Cross Blue Shield of Massachusetts announced it was
following Medicare's lead, beginning on Jan. 1, 2011, it was
requiring doctors to electronically prescribe medications in order to
qualify for bonus programs.
– BCBSMA says 99% of primary care doctors and 78% of specialists
in the company's network currently participate in the insurer's
incentive plans. So, that means there will likely be lots more
Massachusetts doctors trading in their paper prescription pads for eprescribing systems in the next couple of years.
• Cut costs
• Improve patient safety by automatically
flagging potential drug allergies and
interactions
• Reducing errors related to illegible
handwriting
• Bettering adherence to benefit formularies
• Stemming the number of callbacks
between pharmacy and doctors office
• 2007 - 120 million e-P written
• 2008 - 240 million e-P written
• 2009 (1st Q) - 134 million e-P messages sent
1. Doctors confirming patients prescription plan benefits
with payers
2. Checking patients prescription history
3. Sending e-prescriptions to pharmacies
• 80% of e-Prescriptions are being generated by doctors
using stand alone prescribing software, as opposed to more
comprehensive, integrated EMR systems
• 2007, only 19,000 doctors were prescribing prescriptions
electronically
• Today; 103,000 doctors
– These numbers represent doctors, physician assistance and nurse
practitioners mostly in physicians practices, not clinicians in hospitals that use
computerized order-entry systems
• Congressional Budget Office estimates that stimulus
provisions could drive adoption of EHR systems to
nearly 90% of U.S doctor offices and hospitals in a few
years.
• More realistic goal may be 60-70% by 2014
– John Glaser, CIO Partners HealthCare
• Right now less than 10% of US doctors have adapted
the systems, low double digits for hospitals
• Stimulus money will cover a good part, but the money
won’t be available up front. This makes the investment
a challenge
• Draft guidelines to be released no later than mid-June to allow for sufficient
public comment and re-work. Final guidelines must be in place by end of
calendar year 2009.
• Meaningful use guidelines will be tiered, less onerous in early years but
slowly ratcheting up to meet broader healthcare goals.
• EHRs in use today that are CCHIT certified will be grandfathered in.
Certification criteria for EHR vendors will be kept to a minimum in support of
meaningful use, specific features/functions will by and large be left alone.
• CCHIT will not be the only certifying body, others will be created to insure
CCHIT does not become a choke point.
• EHRs will not directly equate to EMRs. ONC will provide a structure that
supports an overarching range of apps that when combined, like building
blocks in support of meaningful use, are deemed certified.
• There is currently no information on regulation of implementations or how
audits of the system use might be performed.
Chilmark Research
• A doctor can wait to implement an EDM,EMR or EHR for
scanning, archiving and retrieving medical records until the
stimulus package is finalized, the penalty for not administering
a program is about to kick in and what if at that time the
necessary up front funds are not available
OR…
• They can begin the process today by taking advantage of our
document filing capabilities using our Content Central EDM
Software by Ademero designed for the healthcare industry. It
may not be an all out EHR, but it’s an important first step. One
that can then be integrated at a later date.
• The benefit will be immediate in that with
Content Central EDM Software by
Ademero they will be able to reap the
rewards of instant access to critical records
and the ability to increase efficiencies.
• The only difference is that they are realizing
the benefit today instead of later.
State
Number Hospitals
Staffed Beds
Total Discharges
Patient Days
Revenue ($000)
AK - Alaska
16
1,107
37,093
242,283
$2,070,824
AL - Alabama
101
15,822
629,880
3,536,925
$28,566,823
AR - Arkansas
57
7,936
324,439
1,698,892
$12,318,308
AZ - Arizona
73
12,096
693,381
3,048,397
$32,946,787
CA - California
358
74,752
3,213,697
18,420,975
$217,322,432
CO - Colorado
56
8,227
406,185
1,986,542
$22,991,644
CT - Connecticut
34
8,372
386,807
2,422,563
$19,066,097
DC - Washington D.C.
9
2,803
118,093
820,392
$6,419,435
DE - Delaware
8
2,143
97,666
594,031
$3,302,034
FL - Florida
213
52,225
2,338,606
12,163,514
$125,971,326
GA - Georgia
116
23,188
907,609
5,977,533
$41,952,793
GU - Guam
2
179
11,280
58,097
$123,027
HI - Hawaii
15
2,721
91,034
751,127
$4,417,911
IA - Iowa
38
7,158
283,574
1,621,187
$11,731,272
ID - Idaho
19
2,331
110,218
479,151
$3,932,446
IL - Illinois
143
32,108
1,436,546
7,746,825
$73,318,631
IN - Indiana
92
16,712
674,920
3,617,716
$30,750,752
KS - Kansas
59
6,659
289,178
1,416,873
$13,512,025
KY - Kentucky
75
13,075
553,506
3,127,161
$23,771,708
LA - Louisiana
114
15,416
581,496
3,207,097
$24,170,323
MA - Massachusetts
82
15,083
759,287
4,095,826
$37,921,394
MD - Maryland
51
11,814
734,159
3,368,006
$14,409,954
ME - Maine
23
3,100
129,064
742,479
$5,610,929
MI - Michigan
116
23,799
1,115,693
5,965,341
$51,775,334
State
Number Hospitals
Number Beds
Discharges
Patient Days
Gross Patient Revenue
($000)
MN - Minnesota
55
10,618
520,490
2,716,872
$22,087,887
MO - Missouri
91
17,981
717,423
3,989,932
$35,288,857
MS - Mississippi
74
11,131
375,922
2,270,909
$16,191,435
MT - Montana
19
2,319
80,297
547,671
$3,138,060
22,892
991,909
5,983,391
$39,673,186
72,839
484,052
$2,887,658
174,926
1,122,996
$8,166,792
NC - North Carolina
109
ND - North Dakota
14
2,072
NE - Nebraska
24
4,382
NH - New Hampshire
14
2,200
108,674
539,771
$5,833,516
NJ - New Jersey
73
21,131
1,036,616
5,809,572
$70,052,481
NM - New Mexico
40
3,956
169,972
845,255
$7,685,257
NV - Nevada
29
4,916
269,286
1,305,230
$15,239,915
NY - New York
213
67,899
2,210,323
18,233,211
$105,519,318
OH - Ohio
151
30,421
1,386,512
7,296,750
$67,850,346
OK - Oklahoma
99
10,747
451,125
2,412,030
$18,223,316
OR - Oregon
36
5,854
310,184
1,451,263
$12,727,451
PA - Pennsylvania
36,950
1,687,627
9,614,855
$108,733,142
PR - Puerto Rico
53
8,017
390,960
2,241,605
$3,775,746
RI - Rhode Island
12
2,511
131,075
696,377
$6,545,416
SC - South Carolina
62
11,807
502,493
2,988,853
$25,334,067
SD - South Dakota
180
2,664
86,549
653,801
$3,637,705
TN - Tennessee
122
20,255
816,675
4,639,454
$36,915,144
TX - Texas
367
55,733
2,536,072
12,601,186
$125,054,604
UT - Utah
34
3,994
202,028
960,878
$7,030,298
VA - Virginia
92
19,249
752,629
4,747,505
$34,814,303
VT - Vermont
29
821
37,174
204,681
$2,306,342
WA - Washington
61
9,326
525,149
2,370,625
$25,628,263
WI - Wisconsin
71
11,084
524,107
2,537,418
$21,999,086
WV - West Virginia
40
6,304
244,948
1,489,205
$8,522,973
WY - Wyoming
15
1,220
40,060
248,595
$1,411,818
767,280
33,277,455
188,112,876
$1,650,648,592
Totals
7
4,056
• Definition EHR
– • Research Firm
– • http://www.impac.com/hitech-act.html#BMwhatdoes
Information Week – Search “Hitech”
– • http://www.kryptiq.com/about
About Hitech
– • http://www.cchit.org/choose/index.asp
Kryptiq – (in discussions with Sharp)
– • http://www.medipro.com/stimulus/index.html#faq
CCHIT – certified applications
– • http://www.mdsmedicalsoftware.com/emr-software-stimulus.php
FAQ
– • http://chilmarkresearch.com/2009/02/13/sweet-rewards-for-hit-vendors-with-final-stimulus-package/
EHR payout example
– • http://en.wikipedia.org/wiki/Electronic_health_record
http://www.informationweek.com/TechSearch/Search.jhtml?
site_id=InformationWeek&personality=category&cid=header-search&queryText=hitech&search=Go
Hitech background
– http://news.avancehealth.com/2009/02/20-billion-hitech-stimulus-senate.html