MHA Leadership Forum

MHA Leadership Forum

Theresa RogersSenior Vice President of

Data & Information Services

Hospital Industry Data Institute

• Incorporated October 1985• The data company of the Missouri Hospital

Association (MHA)• A comprehensive data organization providing

services to hospitals and hospital association state partners

• Customizes services to meet member hospital needs

MissouriAlaskaGeorgiaKansasOklahomaTennesseeVirginiaWashingtonWyoming

HIDI State Partners

HIDI

• Serves over 900 hospitals across the country

• Processes over 40 million discharges annually

HIDI Core Service Offerings

Data Collection Data Analysis Data Reporting Advocacy Support to MHA Utilization, Management and Other Surveys Mandated Submissions to DHSS AHRQ (Agency Healthcare Research & Quality) HCUP

Partner Submissions AHRQ Indicator Reports AHA Survey Collection & Editing Special Projects

HIDI Data Policy

• Signed HIDI master agreement for release of data on file & must participate• Must sign a data use agreement if requesting

patient level data; HIPAA limited data set for research, public health or healthcare operations

• Must sign a data release policy for hospital-specific reporting of limited data set

HIDI Participating Hospital Use of Data

Strategic Planning/Marketing• Market Share• Service Line Analysis• Physician Loyalty

Health Improvement/Quality• MHA Hospital Performance Project• MHA QualityWorks• Research• Trends

Advocacy/Policy Development• Policy Impact Analysis• Modeling

Report Services Provided by HIDI to Participating Hospitals

• Annual and interim inpatient report series (quarterly available upon request)

• Annual outpatient report series• Annual census data• HIDI drill-down report tool• Monthly Utilization Reporting (MUR)• Quarterly Management Reporting• Focus Series Reports• Data Analytics & Modeling – NEW!• Special Projects/Consulting – optional w/fee• Medpar Data Purchase – optional w/fee

HIDI Data Committee

• Representative committee from Missouri hospitals and health systems

• Provides guidance & recommendations on use and reporting of data

HIDI Discharge Data System

• Secure Web site address provided to authorized users

• Online data submission• Quick turnaround time• Error reporting• Validation reporting

Hospital Inpatient Discharge Reports

• PO reports are patient origin type• Hospital-specific

• DRG, RE, BD, and MDC reports are based on clinical data• Not hospital-specific

Hospital Outpatient Reports

• Includes hospitals and ASCs (if reported)• Patient origin reports are similar to inpatient• RC reports are based on major revenue

categories• Reporting of all outpatient visits is not

mandated• Encourage non-hospital sites to report

HIDI Online

• Interactive drill down cube using remote access to secure Web site – available only to authorized users

• Makes large volumes of multidimensional data easily and quickly accessible

• Inpatient and outpatient data updated quarterly

Focus Reports

• RACs• Readmissions• Present on Admission• Hospital Acquired Conditions

Custom Reports

• Reports available in electronic or printed format

• Reports customized to meet user’s needs • Physician loyalty• Service line, etc.

• HIPAA compliant

Sample Special Report

HIDI Census* Data Report

• Data purchased from Claritas• Contains 2000 census data, current year

estimates and 5-year projections• CD-ROM version contains ZIP codes for

entire HIDI area• Printed version contains ZIP codes for a

hospital’s base county & adjoining counties

*Census reports require additional licensing fee costs

Sample map

Health Information Technology

• Services related to HIT• Leadership through MHA’s HIT Committee• HIDI TechConnect e-newsletter updates (included in

MHA Today as of January 1, 2010)• HITECH activities including webinars, representation

in HIE planning, Meaningful Use Symposium, issue briefs and more

• Regional Extension Center partner for hospital services

• Active participation and monitoring of HIE activities• Visit the HIT Web site at www.mhanet.com

ARRA American Recovery & Reinvestment Act

The American Recovery and Reinvestment Act of 2009 distributes $787 billion

Nearly $20 billion for incentive program to be a “meaningful user of Electronic Health Record (EHR)” through:• Medicare to PPS Hospitals, CAHs and Physicians• Medicaid incentives to Physicians with 30 percent

Medicaid volume, Children’s hospitals and other acute care hospitals with 10 percent Medicaid volume

Otherwise, penalties start 2015

HITECH ACTHealth Information Technology for Economic

and Clinical Health Act

• Incentives/penalties related to Meaningful Use• Certification and Standards• Regional Extension Centers • State designated entity HIE support• State Medicaid support including HIT• Comparative Effectiveness Research• Broadband Expansion and Innovation• Privacy and Security beyond HIPAA

Improve quality,

safety and efficiency,

reduce disparities

Engage patients

and families

Improve care

coordination

Ensure privacy and security for personal

health information

Improve population

health

HITECH Act and Meaningful Use• The Health Information

Technology for Economic and Clinical Health Act (HITECH) was enacted as part of the American Recovery and Reinvestment Act (ARRA) in 2009.

• Under the HITECH Act, eligible professionals (physicians) and hospitals can receive financial incentives based on timely adoption of EHRs and meeting the criteria for “meaningful use” of certified EHR technology

Goals of Meaningful Use of EHR

*Slide designed by Christopher Jackson, D.O., Sisters of Mercy Health System

Meaningful Use Definition Details

1. CPOE for Medications2. Drug-drug/drug-allergy checks3. Record demographics4. Structured problem list5. Structured medication list6. Structured medication allergy list7. Record and chart changes in vital signs8. Record smoking status9. 1 clinical decision support rule 10. Report clinical quality measures11. Electronic health info to patients12. Electronic copy of discharge instructions13. Exchange key clinical information (capability)14. Protect electronic health information

15. Drug-formulary checks16. Record advanced directives17. Incorporate structured clinical-lab data18. Generate patient lists by condition19. Identify patient-specific education resources20. Medication reconciliation21. Summary care record transitioned or referred

patients

22. Submit data to immunization registries23. Submit lab results to public health24. Submit syndromic surveillance data

24 Objectives of Meaningful Use 19 Objectives Required in Stage 11. CPOE for Medications2. Drug-drug/drug-allergy checks3. Record demographics4. Structured problem list5. Structured medication list6. Structured medication allergy list7. Record and chart changes in vital signs8. Record smoking status9. 1 clinical decision support rule 10. Report clinical quality measures11. Electronic health info to patients12. Electronic copy of discharge instructions13. Exchange key clinical information (capability)14. Protect electronic health information

14 Core Objectives Required of All Hospitals

15. Option 116. Option 217. Option 318. Option 419. Option 5

Choose 5 from

Menu Set

Choose at least 1 Public Health Option

19. Public Health reporting option

*Slide designed by American Hospital Association

Possible Exclusions

Can exclude certain objectives if they are not applicable to you• Hospitals can exclude up to

seven objectives • Must meet specific exclusion

criteria detailed in final ruleExclusion reduces total

number of objectives to be met

Examples of Hospital Objectives that can be

excluded as not applicable:

Provide electronic copy of discharge instructions, if NO patients request it

Submit data to immunization registries, if NO immunizations given or NO registry can receive data

Submit reportable lab results, if NO public health agencies can accept data

*Slide designed by American Hospital Association

Required Quality Reporting

Hospitals must report 15 measures (three sets)• Endorsed by National Quality Forum• Not in current quality reporting program (RHQDAPU)• “e-specified” but not field tested

Calculation through the EHR, but submission is through attestation in 2011• Numerators• Denominators• Patient exclusions

Anticipate electronic submission in 2012

Stage 1 Hospital Quality Reporting Measures

Condition Measure Name Emergency Department Throughput

Median time from ED arrival to ED departure for admitted patientsAdmission decision time to ED departure time for admitted patients

Stroke Discharge on anti-thrombotics Anticoagulation for A-fib/flutter Thrombolytic therapy for patients arriving within 2 hours of symptom onset Anti-thrombotic therapy by day 2 Discharge on statins Stroke educationRehabilitation assessment

Venous Thrombo-embolism (VTE)

VTE prophylaxis within 24 hours of arrival Intensive care unit VTE prophylaxisAnticoagulation overlap therapyPlatelet monitoring on unfractionated heparinVTE discharge instructionsIncidence of potentially preventable VTE

2010 2011 2012 2013 2014 2015 2016 2017......2021

Medicare: incentives begin Jan 2011 for EPs

Medicaid: EPs - no payments after 2021 or more than 5 yrs.

Medicare: penalties begin for non-meaningful users

FY15 for hospitalscalendar 2015 for EPs

Medicare: incentives begin Oct. 2010

(FY2011)for hospitals

Medicaid: hospitals that adopt after 2017 not eligible for incentives

Medicaid: EPs 1st yr cost no later than 2016

Medicare: incentivesEnd 2016

Medicare: phase down incentive payments for EPs

Medicare: EPs who 1st paymentis after 2014 receive no incentives

MEDICARE

MEDICAID

ONC Final Rules

Meaningful Use Timeline

Medicaid: incentives begin(Medicaid payment systems

expected to be on-line by Summer 2011)

CMS Final Rule on Incentives

Total Incentive Funding: Approx. $20-$30 billion in outlays/payments• On-going Penalties

for Non-Adopters*Slide designed by Manatt Health Solutions

Incentive PaymentsEligibility Begins

◦For Eligible Hospitals (EHs) any federal fiscal year starting October 2010.

◦For Eligible Professionals (EPs) any calendar year starting January 2011.

Reporting & Payment Period

◦The 1st Payment Year means the 1st year an EH or EP receives an incentive payment (as opposed to the 1st year of the program).

◦For EH’s of EP’s 1st Payment Year only, the reporting period is any continuous 90-day period in which the provider successfully demonstrates meaningful use of a certified EHR. In subsequent years, the reporting period is the entire Payment Year.

Payments Begin

CMS expects to initiate Medicare incentive payments May 2011. ◦For Medicaid, States determine their own deadlines, but are required to make timely payments. CMS expects the majority of States will have launched their programs by Summer 2011.

*Slide designed by Manatt Health Solutions

Stage 3: 2015Improved outcomes

Stage 2: 2013Advanced care processes

with decision support

Stage 1: 2011Capture/share data

Meaningful Use Stages

Leve

l of C

olla

bora

tion

Requ

ired

Regional Extension Centers (REC)

• Created last year under the Health Information Technology Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009

• 62 Regional Extension Centers (RECs) located in 9 regional areas

Purpose

• Purpose of the Regional Extension Centers is to assist providers within their geographic areas on selection, acquisition, meaningful use, and implementation of EHRs and HIEs to improve health care quality and outcomes.

• Serve as resource for all providers in an area; target assistance to eligible primary care providers in smaller practices, small and rural hospitals and public health clinics

Missouri HIT Assistance Center

Partnership of:• University of Missouri’s Department of Health

Management and Informatics; Center for Health Policy; Department of Family and Community Medicine

• Missouri Telehealth Network• Primaris• Missouri Primary Care Association• Kansas City Quality Improvement Organization• Hospital Industry Data Institute

What this means to hospitals

1. REC partners will be offering assistance to primary care physicians & clinics in your trading area

2. Supplemental expansion grant provides opportunity to create service offerings for hospitals

Assistance to Primary Care Providers & Clinics

• Direct assistance support in the form of onsite technical assistance to providers

• Training and support services to assist physicians and other providers in adopting EHRs

• Guidance to help with EHR implementation & meeting meaningful use

• *Contact the AC for physician services pricing schedule

REC Supplemental Expansion Grant

• Expansion supplement to original REC grant awards

• Intended to ensure the provision of services to CAHs and rural hospitals

• HIDI is the REC partner to provide and coordinate REC services to 55 designated small rural hospitals but services can be used by all MHA hospitals

REC Services for Hospitals

EHRConnect™

EHRAssist™

Assistance Center Loan

Services

Web-based interactive toolkit designed to assist hospitals to implement and achieve meaningful use of electronic health records

• Roadmap providing best practices to navigate an EHR implementation

• Mile markers• Preparation• Selection• Implementation • Meaningful Use

• See who uses what EHR in your area• Identify resources to connect to other

hospitals• Phone consultations with experienced users• See vendor products in use through site visits

Group purchasing arrangement for fee-for service consulting

Vendor selection Project management Shoulder to shoulder implementation management

Practice workflow redesign

Assistance with interoperability and HIE

Implementation of privacy & security best practices

Technical infrastructure support

IT staffing Data center hosting

Cooperative Grant Funding – How it Works

The REC is paid for reaching each of the following three milestones1. signed technical assistance contract2. provider “go live” with certified EHR3. provider attains meaningful use

Next Steps

Coordinate GPO fee-based services & deploy EHRAssist™ (April 2011)

Update MHA HIT pages (May 2011)Continue to encourage signed technical

assistance contracts between REC-eligible hospitals and the MU HIT AC (June 2011)

“Meaningful Use” early adopter panel presentation (June 2011)

2011 MHA Meaningful Use Symposium (Aug 2011)

Parting Thoughts to

Do not get yourself in trouble!

Aim High!

Stay focused on your job

Exercise to maintain good health

Practice Team Work

Rely on your trusted partner to watch your back

Save for raining day

Rest and Relax!!!

Always smile when your boss is around

And remember … nothing is impossible!

QUESTIONS

Resources

Website: http://ehrhelp.missouri.eduE-Mail:[email protected]@mail.mhanet.com

Thank you!