Wk 3 Individual: Technology Trends Proposal Part 2

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Implementation of Health Information Technology

Jodie Curtis, Government Relations Director, Drinker Biddle Reath, Washington, DC

Many practices already use some form of health infor- mation technology (HIT) or electronic health records (EHRs). If your practice does not use this technology now, you probably have had conversations about what it would take to implement an HIT or EHR system. Many believe that the proliferation and comprehensive use of HIT across all health care provider groups will significantly increase the quality of health care deliv- ered in this country. In fact, in its analysis of budget options for Congress, the Congressional Budget Office (CBO) suggested that health IT would “improve the information available to clinicians at the time of treatment by encouraging the use of evidence-based medicine and by helping physicians manage patients with complex, chronic conditions.” The report also states that HIT can reduce costs by “reducing the number of inappropriate tests and procedures, reduc- ing paperwork and administrative overhead, and decreasing the number of adverse events resulting from medical errors” (Budget Options. Health Care Congressional Budget Office. Vol. 1, option 46, p. 88). But did you know that Congress and others in the fed- eral government may play a role in helping you to have access to HIT?

The Office of the National Coordinator for Health Information Technology (ONC) was established in the Department of Health and Human Services in 2004. Since that time, HIT has assumed a prominent role in health care policy discussions. This past year, Congress passed the American Recovery and Reinvestment Act of 2009 (ARRA), also known as the stimulus package. The stimulus package contained approximately $36 bil- lion in funds intended to help develop the infrastructure necessary for meaningful implementation of HIT. That funding includes $17.2 million in incentives for Medicare and Medicaid health care providers who can prove that they are using “certified health information technology” in a “meaningful way.”

There are many differences between the ARRA HIT incentive programs for Medicare providers and Medicaid providers. Unfortunately, nurse practition- ers (NPs) are not eligible for Medicare funds for meaningful use of HIT under the ARRA provisions. Still, a hospital or provider may not receive funds from both the Medicare and Medicaid grants, so NPs who practice in hospital settings or are employed by

a hospital may have access to some Medicare funds under this provision. Medicare providers who are eligible to participate in the HIT incentive program are subject to a penalty if they are not able to successfully implement HIT into their practices by 2015.

The stimulus package instructs the Health and Human Services secretary to conduct a study to determine the extent to which, and manner in which, payment incentives should be made avail- able to health care providers who are receiving minimal or no payment incentives or funding under this act. The NP Roundtable will continue to monitor the implementation of this provision as it pertains to NPs, who were excluded from the initial Medicare incentive funds.

MEDICAID Unlike the Medicare incentives, Medicaid incentives do not include a penalty and, in fact, while the Medicare provisions require that providers be “meaningful users” to obtain the funding, Medicaid providers can use the implementation funding to acquire HIT sys- tems. The Medicaid HIT implementation funds apply to physicians, dentists, certified nurse-midwives, NPs, and physician assistants (in rural health clinics and fed- erally qualified health centers run by a physician).

To receive Medicaid funds, nonhospital providers must have a 30% Medicaid patient volume (20% if they are nonhospital pediatric providers). Medicaid providers and certain qualifying hospitals can receive up to $25,000 in year 1 to defray the cost of HIT acquisition.

These providers can earn up to $10,000 annually for 4 additional years if they can prove “meaningful use” of HIT. Still, because Medicaid is a state-run pro- gram, states will have more control over how the Medicaid incentive program is implemented. The only qualification is that providers cannot receive more than 85% of their net average “allowable costs” (a billing calculation that is adjusted to reflect the Medicaid payer mix of the provider) or $63,750 to purchase and maintain certified EHRs.

MEDICARE The stimulus package also allows for hospitals to qualify for incentives to adopt HIT through Medicare and Medicaid. The Medicare incentives

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ACNP Past President Susan Apold, PhD, ANP, testi- fied to the Institute of Medicine (IOM) on behalf of NPs and their role addressing the nation’s primary care needs. In collaboration with the National Organization of Nurse Practitioner Faculties (NONPF), ACNP provided the IOM with evidence that NPs are well trained and qualified to tackle the increasing need for primary care.

“In the early days of his administration, President Obama proposed that every American should have a primary care provider. Health reform proposals have highlighted the significant need for primary care and an increased number of primary care providers. Yet the nation faces a projected health care workforce short- age of over a quarter-million registered nurses and over 200,000 primary care providers by 2025. It is clear that traditional models of primary care delivery no longer meet the health care needs of our nation’s citi-

zens. The American College of Physicians (2006) reports that only 27% of medical residents list primary care as a career goal, compared to 54% in 1996. With the low percentage return to primary care physician training1, medical students will continue to seek spe- cialization over primary care. The future of health care in this nation is dependent upon full integration of all health care professionals, practicing at the full scope of their licenses, and providing primary care that saves lives and dollars. The nation’s nurse practitioners stand ready to participate in the solution to the looming pri- mary care delivery crisis.”

The written testimony submitted to the IOM by ACNP and NONPF can be found by visiting bit.ly/4VE3aE.

Reference

1. Glied S, Prabhu AG, Edelman N. The cost of primary care doctors. Forum Health Economics Policy. 2009;12, article 4.

for hospitals are similar to incentives for eligible individuals, in that incentive payments are made for the first payment years, and penalties in the form of market basket reductions will apply for hospital providers that are not “meaningful EHR users” by 2016. The specific payment formula for hospitals is based on the number of hospital dis- charges in a payment year, the hospital’s Medicare share (a calculation that takes the number of Medicare inpatient bed days for Medicare Part A and Medicare Part C patients), and a transition fac- tor that weights incentives to provide more money in the first years of adoption.

GRANTS In addition to the incentives that go directly to health care providers, the stimulus package contained provi- sions for grants to states to build infrastructure, pro- mote planning activities, and expand the use of health

information. For more information on these grant pro- grams, visit bit.ly/5cgH6S.

IMPLEMENTATION The most crucial element of the implementation of these programs will be the definition of “meaningful use,” which is a requirement of the Medicare HIT adop- tion incentives. ONC expects that the Centers for Medicare and Medicaid Services will release meaning- ful use criteria this year. ONC has also announced that it is prepared to start to unveil other portions of the stim- ulus act provisions that will provide regional technical assistance and support to providers who are imple- menting HIT systems. Although many had hoped that the health care reform proposal debated in Congress late last year would include an expansion of the Medicare incentive program to include NPs, the latest drafts of the bill when this column was written did not include this expansion.

ACNP Testifies Before IOM Hearings on the Future of Nursing

Visit the ACNP Online Learning Center for New Online CE sessions from the 2009 National Clinical Conference

www.ACNPweb.org and click on Online CE Portal

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New information for health care providers adopting health information technology (HIT) systems is now available on the Agency for Healthcare Research and Quality’s (AHRQ) National Resource Center on Health Information Technology’s website at healthit.ahrq.gov.

The new topic areas, found on the NRC’s HIT bibliography, include disease registries, personal health records, usability testing, education and training, privacy and security, quality measure- ment and improvement, and transitions in care. The HIT bibliography represents both peer- reviewed articles from professional journals and web-based resources from highly respected health care and HIT organizations. The bibliogra-

phy’s articles and resources provide knowledge and insight that may help clinicians and organiza- tions implement systems and models related to the American Recovery and Reinvestment Act and the Health Information Technology for Economic and Clinical Health Act, enacted as part of the American Recovery and Reinvestment Act of 2009 (PL 111-5). For example, these resources can be used to:

• Track and manage patients with chronic con- ditions and engage them in better self-man- agement and care coordination

• Support nursing practice and long-term care of older adults

• Establish medical homes for patients • Improve transitions in care

AHRQ Releases New Resources for Health IT

System Adoption

Experts agree that the way health care is paid for in the United States—especially in the traditional, fee-for-service Medicare program—does not support high-quality and cost-efficient coordinated care. In an attempt to identify a better way to deliver well-coordinated care that results in good outcomes and that consumers consider good value, policymakers are taking a close look at accountable care organizations (ACOs).

A new policy brief supported by the Robert Wood Johnson Foundation and prepared by researchers at the Urban Institute provides a comprehensive look at ACOs. Authors Robert Berenson, MD, and Kelly Devers, PhD, look at the definition of an ACO, design and implementa- tion issues, and opportunities and challenges with the concept.

According to the authors, ACOs will not be real game changers, at least in the short term, but are nevertheless worth concerted study. Given the current health care culture—along with exist- ing legal requirements, political realities, and the legacy of previous payment reform efforts— important questions remain about ACOs. But lessons from previous efforts can also provide use- ful insight into the trade-offs among program options. Current legislative proposals include pilot tests of the ACO concept, ensuring that policymakers will be able to learn from experience and make program modifications as necessary.

Can ACOs Effectively Address Concerns About Healthcare Cost, Quality, and Value?

1555-4155/10/$ see front matter © 2010 American College of Nurse Practitioners DOI:10.1016/j.nurpra.2010.01.010