Health IT EHR Opportunity September 22, 2009 John M. Kirsner, Esq. Squire, Sanders & Dempsey L.L.P. Partner, Health Care and Life Sciences (614) 365-2722 [email protected]Scott A. Edelstein Squire, Sanders & Dempsey L.L.P. Partner, Health Care and Life Sciences (202) 626-6602 [email protected]Paul M. Lee Strategic Health Care Senior Partner (202) 266-2600 [email protected]
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Health IT EHR Opportunity September 22, 2009€¦ · Health IT EHR Opportunity September 22, 2009 John M. Kirsner, Esq. Squire, Sanders & Dempsey L.L.P. Partner, Health Care and Life
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Health IT EHR Opportunity September 22, 2009
John M. Kirsner, Esq.Squire, Sanders & Dempsey L.L.P.Partner, Health Care and Life Sciences(614) [email protected]
Scott A. EdelsteinSquire, Sanders & Dempsey L.L.P.Partner, Health Care and Life Sciences(202) [email protected]
Paul M. LeeStrategic Health CareSenior Partner(202) [email protected]
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Overview
• Purpose of Today’s Presentation
• Proposal for Hospital/Physician collaboration:
– Creation of Health IT MSO/Association
• HITECH Act
• Legal Issues
• Next Steps
• Questions
Purpose of Today’s Presentation
• Determine hospitals’ interest in developing a not-for-profit organization to help them implement an EHR physician alignment strategy.
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New HIT MSO/Association• Not-for-Profit
• Financed by Government
• NOT a “one size fits all!”
• Board members comprised of hospital CIOs
– Hospital CIO committees created to:
• Advise MSO staff/attorneys on direction
• Advise on the creation of legal documents
• Negotiate with vendors (hardware, software, etc…)
• Advocate for regulatory changes to “meaningful use.”
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New HIT MSO/Association– MSO would:
• Create all documents establishing MSO as legal entity
• Manage all Committees – like association
• Be a resource (legal, marketing, etc…) to each hospital member
• Recommend solutions to group and individual implementation issues
• Advise Board and members on all issues regarding the successful management of the MSO
• Under the direction of the Board, adjust MSO mission based on member needs
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Benefits • Leverages buying power of multiple physicians
at a national level for better pricing from vendors – hardware & software
• Better pricing may result in pool of additional funds to meet future EHR needs
• Helps physicians maximize eligibility for incentive payments
• Brings together hospitals and physicians through an integrated, seamless EHR system
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Benefits• “Free” to physicians – funded through HIT payments
• Turnkey solution for physicians
• One-stop shop for technology acquisition, implementation, maintenance and related support
• Manages complex regulations regarding meaningful use and other legal requirements, and monitors compliance
• Potential for Hospital/Hospital alignment through outsourcing of CIO/IT expertise of larger hosptals/systems to smaller hospitals/systems.
Benefits• Ensures consistency in implementation
• Can be a step in a clinical integration program or accountable care organization program or medical home program
• Seasoned legal advice for physicians and hospitals
• Ability to obtain federal and state grant funding in which all participants can benefit
• Provides peer-to-peer opportunities for CIOs
• Organization “owned” by hospitals
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Advantages• COMPETITIVE ADVANGE FOR MEMBERS
– Only one hospital/system in each community
• NOT a Health IT Regional Extension Center
– Will use the services of the RECs to provide further advantages to member hospitals
– Not entangled with same government limitations
• NOT vendor-centric
– Hospitals/physicians can select own vendor
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National HIT MSO/Association Example
1010
Medicare
Customer
Hospitals
(20)
IT Vendor
Physicians (10,000)
$440 Million EHR Services
$300 Million EHR Software, Hardware, etc.
Hospital Group retains $140 Million to fund enhancements to EHR, support National HIT Assn., local MSO, etc.
Advisory Committee• Mike Bundy, CIO, Wellmont Health System (TN)
• Tom Gregorio, CIO, Newark Beth Israel MC (NJ)
• Arlo Jennings, CIO, Mission Hospitals (NC)
• Tom Johnson, CIO, DuBois Regional MC (PA)
• George Morris, CIO, Northwest Community (IL)
• Dana Moore, CIO, Centura Health, (CO)
• Dave Selman, CIO, ProMedica, (OH)
• Martin Tursky, CIO, Aultman Hospital (OH)
• Will Weider, CIO, Ministry Health Care (WI)
• Bernie Clement, CIO, East Jefferson General (LA)
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Operational Flow Chart
Medicare
Medicaid
Physician MSO/
AssociationVendor
Equity Return
Hospital Physicians
Nat’l
HIT Assn.
Creating the National HIT Association
• Budget under development
– Needs CIO input
– Dues and vendor support
– Government payments through physicians reimburse all members
• Not-for-Profit entity would contract with Strategic Health Care for staff support services. ED, hired by Board, would run organization day to day.
• NFP entity would contract with Squire Sanders for legal, regulatory, compliance services.
Facilitator MSO Structure – Option 3 National MSO/Assn./Physician JV
National MSO/ Association
Local Facilitator/
MSO
Physicians
Equity ReturnManagement and
Purchasing Contract
Physicians
HIT Management Contracts
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HITECH Act
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HITECH Act
• American Recovery and Reinvestment Act of 2009 (Stimulus Law) provides $36 billion in funding for health information technology (HIT) and health information exchange (HIE) development
• Incentive payments to encourage hospitals and eligible professionals to adopt and use certified EHR systems
• Successful implementation of the HITECH Act would transform the healthcare system
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Incentives for Physician Participation
• Additional health program payments to eligible professionals demonstrating “meaningful use” of EHR
• Penalties:
– Phased-in reduction of Medicare payments for eligible professionals not implementing “meaningful use” of EHR
– Medicare payment reductions will begin in 2015 for an eligible professional who is not a meaningful EHR user
– Reductions to the otherwise-payable fee schedule for covered professional services shall equal:
• 2015: 1%; 2016: 2%; 2017 and thereafter: 3%
• 2018 and beyond – Secretary can further reduce payments by up to 5% if less than 75% of eligible professionals are meaningful EHR users