Economic Stimulus Presentation August 2010

Economic Stimulus Overview We will begin the presentation shortly.

The Obama Stimulus

• The American Recovery & Reinvestment Act (ARRA) is a $787 billion stimulus package that became law in February 2009.

• The stimulus is not related to healthcare reform legislation.

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The Obama Stimulus

• $20 billion in incentives for meaningful use of certified EMR technology:

– Medicare: $44,000 per doctor

– Medicaid: $63,750 per doctor

• Incentive money is per Doctor; not per Practice. – Incentive money goes directly to the Doctor; there is no

aggregator.

• There are penalties: – Beginning in 2015, Medicare Physicians not demonstrating meaningful use of

EMR technology will have their Medicare fee schedule reduced:

• 2015: -1%

• 2016: -2%

• 2017 and beyond: -3%

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Medicare/Medicaid Incentive Overview

• Providers must select either the Medicare or Medicaid program, they cannot select both.

• Providers are allowed to change their program election…but only once.

– If changing programs, doctors start at the payment year level that you would have had in your original program.

– Can’t change programs after 2014.

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Medicare/Medicaid Incentive Overview Meaningful Use 2011-2012

• Functional measures have been replaced by Core Objectives and a Menu Set.

– Doctors must abide by all Core Objectives.

– Doctors must abide by 5 of 10 Menu items.

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Medicare/Medicaid: “Meaningful Use” Core Objectives

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Medicare/Medicaid: “Meaningful Use” Menu Set

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Demonstrating “Meaningful Use”

• Medicare

– Year 1 – 90 days of continuous, meaningful use

– Year 2 – Meaningful use for the entire calendar year

• Medicaid

– Year 1 – Doctor need only adopt, implement or upgrade

– Year 2 – 90 days of continuous, meaningful use

– Year 3 – Meaningful use for the entire calendar year

• Eligible Professionals must provide an attestation (witness statement) – mechanism TBD.

– Doctors must identify which certified EMR they are using.

– Doctors must describe their performance on all Core Objectives and Menu Items.

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Payment

• Doctor’s will need to provide:

– National Provider Identifier (NPI), business address, phone etc.

– Taxpayer identification

• The doctor’s participation in the incentive program will be made public.

• Payment will come in a single, annual payment from CMS or the State Medicaid agency.

• Payments can be re-assigned.

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Clinical Quality Measures

• Part of meaningful use is submitting information on clinical quality measures (reports on care and care outcomes).

– Reports on clinical quality measures help the government identify trends and patterns of care, and provide guidance for improving care.

• There are now 44 measures

– Three measures required of everyone

– Choice of 3 others, chosen from a subset

• Reporting

– 2011: via attestation

– 2012: through an electronic means

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Medicare

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Medicare: Eligible Professionals

• Doctors of medicine

• Doctors of osteopathy

• Doctors of dental surgery

• Doctors of dental medicine

• Doctors of podiatric medicine

• Doctors of optometry

• Chiropractors

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Medicare Payment Schedule

Incen 2011

Incen 2012

Incen 2013

Incen 2014

Incent 2015

Incen 2016

Incen 2017

Total

2011 $18,000 $12,000 $8,000 $4,000 $2,000 - - $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 -1% -1% MFS

2016 -1% -2% -3% MFS

2017 -1% -2% -3% -6% MFS

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-Medicare providers who practice in health professional shortage areas (HPSA’s) will have their incentive payments increased 10%.

Medicare Payment Schedule

• Medicare incentive payments are based on 75% of submitted allowable charges (look to the physicians Medicare fee schedule).

– Clinic that charges $24,000 or more is eligible for $18,000 incentive (75% of 24k = $18k).

– Clinic that charges $13,300 is eligible for $9,975 (75% of $13,3000 = $9,975).

– Only for services furnished by the EP.

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Medicaid

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Medicaid: Eligible Professionals

• Physicians

• Nurse Practitioners

• Dentists

• Certified Nurse Midwifes

• Physician Assistants practicing in federally qualified health centers led by a PA

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Medicaid: Payment Structure

Year Incentive

Year 1 $21,250 (25k)

Year 2 $8,500 (10k)

Year 3 $8,500 (10k)

Year 4 $8,500 (10k)

Year 5 $8,500 (10k)

Year 6 $8,500 (10k)

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85% of “Net Average Allowable Costs”

Maximum Incentive Payment is $63,750

Medicaid Incentives

• Year 1 incentive payments are provided to eligible providers who are adopters / meaningful users of certified EMR technology:

– Eligible providers receive up to 85% of net average allowable costs for their EMR (software, implementation, training, etc.).

– Last “first” year is 2015 and no payments after 2021.

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Medicaid: Eligible Professionals

• A non-hospital-based professional with at least 30% of their patient volume coming from Medicaid patients.

• A non-hospital-based pediatrician with at least 20% of his/her patient volume coming from Medicaid patients.

• A professional who practices predominately in a Federally-qualified health center or rural health clinic with at least 30% of the professional’s patient volume coming from Medicaid patients.

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Pediatrician Incentive

• The pediatrician incentive is lower, because the threshold is lower.

• Maximum cumulative incentive = $42,500.

– $14,167 in Year 1

• ($16,667 x 85% = $14,167).

– $5,667 in Years 2-6

• ($6,667 x 85% = $5,667).

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How is Patient Volume Defined?

• “at least 30% of patient volume” means that the physician must be able to attribute 30% of his/her patient encounters over a 90-day period to Medicaid patients.

– Numerator: amount of Medicaid patients

– Denominator: total amount of all patients

• “practice predominantly in a federally qualified health centers” means more than 50% of the time.

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What Should I Do Today?

• Start researching your options.

• Consider your technology, maintenance and support options.

• Don’t wait!

– With nearly 1 million providers going electronic there will be a line.

– The plans are front loaded, most of the money is available in the first few years.

• The requirements ramp up over time.

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Questions and Answers

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Contact

• Todd Krieger

– Cell: 248-227-9167

– Email: [email protected]

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