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HIT: So, What’s Happening?Or…Getting Comfortable With Ambiguity

State Network Council December 7, 2009

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HITECH Act Statuswww.kha-net.org – FAQs

• HITECH Act 2009– FFY2011 Incentives … October 1, 2010 ? – FFY 2015 Penalties … October 1, 2014 ?

• Meaningful Use – matrix is “very close”• Standards - More guidance expected• Certification -Released in September• State Grants – Kansas $9m (Jan 15, 2010)• Privacy and Security - Breach rules out• Medicaid Incentives – General guidance to

states September 2009 • Regional Center – Kansas app in $9m over 4 yrs• December 2009 – Regs and guidance

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Hospital Based Provider

• Background: • ARRA language is broadly worded to exclude physicians who do

a “substantial” amount of their work using the hospital resources. – Prevent double dipping– who exactly qualify for the incentive has been uncertain.

• ARRA also discusses in a number of ways the intent to coordinate care from different settings and providers to both reduce duplication and improve quality.

• In addition, ARRA articulates the intent to promote the use of electronic records to better assist consumers and patients in receiving primary and preventive services as well as managing chronic conditions. Many of the Meaningful Use measures set forth to date address care rendered for those purposes.

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Recommendations

• Providers who are on staff of a Rural Health Clinic should be eligible to receive ARRA incentives for all services regardless of the source of the billing of those services (1500 or Uniform Bill) or the location the service is provided.– These providers and services should not be included in any

ARRA related definition of Hospital-Based Physicians.• All primary care providers should be eligible to receive

ARRA incentives for all services regardless of the source of the billing of those services (1500 or Uniform Bill).

• Hospitals who purchase electronic record systems for office-based or ambulatory services on behalf of physicians should receive the incentive payments associated with those physicians.

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State Activity

EHR Adoption

Access to SecureInternet

Health InformationExchange

HIT WorkforceDevelopment

CommunityHospitals

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• Renewed and Reappointed by KDHE• Providers, Payers, Consumers, Government, Business – about 30 plus

consultants• Address Required Domains

– Governance– Legal and Policy– Business and Technical Operations– Technical Infrastructure– Finance and Sustainability

• State grant due October 16, 2009– $9 mil– Plan to Plan – Chronic Disease Electronic Management Systems (CDEMS) Development as

an HIE• KHPA – State Medicaid HIE Planning Grant

– $2 million– Not duplicative– Coordination with state planning efforts– Medicaid specific policy and infrastructure for Medicaid Incentive

eHealth Advisory Council

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Regulatory Spectrum for Models of State Regulatory Spectrum for Models of State Government Oversight Government Oversight

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ONC Guidance from State Cooperative ONC Guidance from State Cooperative AgreementAgreement

• What proportion of the governing organization do public What proportion of the governing organization do public stakeholders represent?stakeholders represent?

• What proportion of the governing organization do private What proportion of the governing organization do private sector stakeholders represent?sector stakeholders represent?

• Does the governing organization represent government, Does the governing organization represent government, public health, hospitals, employers, providers, payers and public health, hospitals, employers, providers, payers and consumers?consumers?

• Does the state Medicaid agency have a designated Does the state Medicaid agency have a designated governance role in the organization?governance role in the organization?

• Does the state Medicaid agency have a designated Does the state Medicaid agency have a designated governance role in the organization?governance role in the organization?

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• Regional Extension Center– KFMC – Statewide 1st round application– 90/10 2 years 10/90 2 years– Technical Assistance for Priority Providers

• Vendor Selection & Group Purchasing

• Implementation/Project Management

• Practice/Workflow Redesign

• Progress toward meaningful use

– Focus on small physician practices– CAHs only related to physician practices

EHR Adoption

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Regional Centers - Changes

• Cooperative Agreement• Funding Available in FY2010 Up $640m –

From $598m• Average Award Amount $8.5• Award Floor $1m• Award Ceiling $30m• Number of Awards 70• Four-year project period

– two,two-year budget periods• Start Date pushed back to March 31, 2010

EHR Adoption

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Health Information Exchange Health Information Exchange

• eHAC ProcesseHAC Process– VisionVision– Strategic and Operational PlanStrategic and Operational Plan– Utilize eHAC CommitteesUtilize eHAC Committees– Establish a Public Private PartnershipEstablish a Public Private Partnership

• Determine actual strategyDetermine actual strategy– BuildBuild– FranchiseFranchise– PurchasePurchase

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Health InformationExchange

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• Proposed “Skunk Works”Proposed “Skunk Works”– Small, agile focused on rapid deployment Small, agile focused on rapid deployment

• KHA, KMS, Payers, GovKHA, KMS, Payers, Gov

– Target reusable workTarget reusable work– Maintain alignment Maintain alignment

• with emerging state legal frameworkwith emerging state legal framework

• Accountable to eHACAccountable to eHAC

– Allow providers to meet MUAllow providers to meet MU• Early adoptersEarly adopters

Health InformationExchange

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• eHAC Legal and Policy Domain– Harmonizing state laws Kansas Legislative

Package for 2010– Codifying electronic record– Privacy and Security Requirements (Breach) – Governance Structure of HIE?????

• eHAC Technical Infrastructure Domain– Ks Department of Commerce Broadband Working

Group– ConnectKansas– Kan-ed

Access to SecureInternet

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HIT Workforce Development

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That’s a Good Question!

• How will incentives actually be paid for Medicare?– Rural Health Clinics?– Services with separate provider numbers?

• How will the Kansas Medicaid incentive be structures?• What exactly will be required for MU?• How will MU be verified?• When will standards for full interoperability be

available?• Will KFMC be the Kansas HIT REC? When?• What pieces and parts of the state application will be

funded?• And on and on and on…..