6 report from washington fitzmaurice
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Report from WashingtonmHealth Initiative
J. Michael Fitzmaurice, Ph.D.
Agency for Healthcare Research and Quality
June 4, 2009
2
Agenda
Health Reform
AHRQ
ARRA-Comparative Effectiveness
ARRA-HITECH
3
Health Reform Issues
Medicare Trust Fund
Medicaid and State Budgets
Employer financing of employee health benefits
– International competition on price and quality
Piecework payments for health care
Patient Safety/Medical Errors
17 % of GDP20, 25, 30 % in my lifetime
Are we getting value for our dollar?
4
Patient Involvement Campaign
AHRQ‟s campaign with The Advertising Council uses a
series of TV, radio, and print public service announcements
Web site features a “Question Builder” for patients to
enhance their medical appointments
– www.ahrq.gov/questionsaretheanswer
5
Agency for Healthcare Research and Quality (AHRQ)
Mission
Improve the quality, safety, efficiency and effectiveness
of health care for all Americans
6
Research At HHS
What is AHRQ’s “Space?”
NIH
Biomedical
research to prevent,
diagnose, and treat
diseases
CDC
Population health
and the role of
community-based
interventions to
improve health
AHRQ
Long-term and
system-wide
improvement of
health care quality
and effectiveness
8
AHRQ FY 2009 Funding
$372 million
– $37 million more than FY 2008
– $46 million more than the president‟s request
FY 2009 appropriation includes:
– $50 million for comparative effectiveness
research, $20 million more than FY 2008
– $49 million for patient safety activities
– $45 million for health IT
9
AHRQ Priorities
Effective Health
Care Program
Medical Expenditure
Panel Surveys
Ambulatory
Patient Safety
Patient Safety
Health IT
Patient Safety
Organizations
New Patient
Safety Grants Comparative
Effectiveness Reviews
Comparative Effectiveness Research
Clear Findings for
Multiple Audiences
Quality & Cost-Effectiveness, e.g.
Prevention and Pharmaceutical
Outcomes
U.S. Preventive Services
Task Force
MRSA/HAIs
Visit-Level Information on
Medical Expenditures
Annual Quality &
Disparities Reports
Safety & Quality Measures,
Drug Management and
Patient-Centered Care
Patient Safety Improvement
Corps
Other Research &
Dissemination Activities
10
Comparative Effectiveness and ARRA
The American Recovery and Reinvestment Act of
2009 includes $1.1 billion for comparative
effectiveness research:
– AHRQ: $300 million
– NIH: $400 million (appropriated to AHRQ and
transferred to NIH)
– Office of the Secretary: $400 million (allocated at the
Secretary‟s discretion)
Compare alternative treatments for common
health conditions and make the findings public
11
Recovery Act Timeline: AHRQ
2009
March 19: Due date
for establishment of
Federal Coordinating
Council for
Comparative
Effectiveness
Research
February 17: The
American
Recovery and
Reinvestment Act
of 2009 is signed
into law
January April July
June 30: Due date
for IOM submission
of a list of national
priority conditions*
May 1: Due date
for Agency wide
and program-
specific Recovery
Act plans
October
November 1:
AHRQ FY
„10 operations
plan due
July 30:
AHRQ to
submit FY
‟09
Operations
Plan
2010
December 31,
2010: All
Recovery Act
funding to be
obligated
* Stakeholder input required
12
Questions for Setting Clinical Policy:A Systematic Process
1. What is the outcome I care most about?
2. How good is the evidence that the interventions can
improve those outcomes?
3. How sure am I that it will work in “real world”?
4. How do the potential benefits compare to possible
harms and costs?
5. What constitutes “good enough” evidence?
6. What other considerations are relevant?
13
ARRA
American Recovery
and Reinvestment Act
of 2009 (Public Law
111-5, February 17,
2009)
“Economic Stimulus
Package”
– Health Information
Technology for
Economic and Clinical
Health (HITECH) Act
14
ARRA Purposes
(1) To preserve and create jobs and promote economic recovery.
(2) To assist those most impacted by the recession.
(3) To provide investments needed to increase economic efficiency by spurring technological advances in science and health.
(4) To invest in transportation, environmental protection, and other infrastructure that will provide long-term economic benefits.
(5) To stabilize State and local government budgets, in order to minimize and avoid reductions in essential services and counterproductive state and local tax increases.
15
Goals of ARRA
Improve Health Care
– Quality
– Safety
– Efficiency
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ARRA of 2009
American Reinvestment and Recovery Act of 2009
HITECH portion
– Codifies ONC
– Creates 2 Federal Advisory Committee Act committees
– Provides for incentive payments to health providers for
meaningful use of EHRs
– Provides for $2B of HIT investment funds for ONC
– Adds to privacy protections, such as found in HIPAA
– Mandates publication of designated standards by 12-31-09
17
ARRA Creates Two HIT FACA’s
To advise the National
Coordinator for HIT
HIT Policy Committee
HIT Standards
Committee
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HIT Policy Committee
Formed: May 11, 2009
Charge: Make recommendations on– A policy framework for the development and adoption of a nationwide
health information infrastructure, including standards for the exchange of patient medical information
– Standards, implementation specifications, and certifications criteria in eight specific areas.
Chair: David Blumenthal, MD, National Coordinator for HIT
Working Groups– Meaningful use of EHRs
– Certification and adoption of electronic records
– Information exchange
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8 Areas of Policy Focus
1. Technologies that protect the privacy of health information
2. A nationwide health information technology infrastructure
3. The utilization of a certified electronic record for each person in the US by 2014
4. Technologies that support accounting of disclosures made by a covered entity
5. The use of electronic records to improve quality
6. Technologies that enable identifiable health information to be rendered unusable/unreadable
7. Demographic data collection including race, ethnicity, primary language, and gender
8. Technologies that address the needs of children and other vulnerable populations
20
Other Areas to Consider: HIT &
– Self-service -- Diverse populations
– Telemedicine -- Patient‟s own access to PHI
– Public health -- Quality and Efficiency of HC
– Home health care
21
HIT Policy Committee
David Bates, Brigham and Women‟s Hospital
Christine Bechtel, National Partnership for Women & Families
Neil Calman, The Institute for Family Health
Richard Chapman, Kindred Healthcare
Adam Clark, Lance Armstrong Foundation
Arthur Davidson, Denver Public Health Department
Connie White Delaney, University of Minnesota/School of Nursing
Paul Egerman, Businessman/Entrepreneur
Judith Faulkner, Epic Systems Corporation
Gayle Harrell, Former Florida State Legislator
Charles Kennedy, WellPoint, Inc.
Michael Klag, Johns Hopkins University, Bloomberg School of Public Health
David Lansky, Pacific Business Group on Health
Deven McGraw, Center for Democracy & Technology
Frank Nemec, Gastroenterology Associates, Inc.
Marc Probst, Intermountain Healthcare
Latanya Sweeney, Carnegie Mellon University
Paul Tang, Palo Alto Medical Foundation
Scott White, 1199 SEIU Training and Employment Fund
22
HIT Standards Committee
Formed: May 15, 2009
Charge: Make recommendations on – Standards, implementation specifications, and certification criteria for
the electronic exchange and use of health information
– Focus on areas developed by the HIT Policy Committee
– Provide for testing standards and IS‟s by NIST
Chair: Jonathon Perlin, MD– Vice Chair: John Halamka, MD
Working Groups– Clinical quality
– Clinical operations
– Privacy and security
23
HIT Standards Committee
Dixie Baker, Science Applications International Corporation
Anne Castro, BlueCross BlueShield of South Carolina
Christopher Chute, Mayo Clinic College of Medicine
Janet Corrigan, National Quality Forum
John Derr, Golden Living, LLC
Linda Dillman, Wal-Mart Stores, Inc.
James Ferguson, Kaiser Permanente
Steven Findlay, Consumers Union
Douglas Fridsma, Arizona State University
C. Martin Harris, Cleveland Clinic Foundation
Stanley M. Huff, Intermountain Healthcare
Kevin Hutchinson, Prematics, Inc.
Elizabeth O. Johnson, Tenet Healthcare Corporation
John Klimek, National Council for Prescription Drug Programs
David McCallie, Jr., Cerner Corporation
Judy Murphy, Aurora Health Care
J. Marc Overhage, Regenstrief Institute
Gina Perez, Delaware Health Information Network
Wes Rishel, Gartner, Inc.
Sharon Terry, Genetic Alliance
James Walker, Geisinger Health System
24
Incentive Payments
Beginning 2011-2014 to providers who
meaningfully use EHRs
– A total of $29B [12B in savings expected]
Disincentives from 2015 onward
Under development are
– The definition of meaningful use
– The structure of these incentive payments, and
– Any reporting measures (Quality, Use, other)
25
HIT Investments
$2B appropriated to Office of the National Coordinator for HIT– No-year funds (FACAs, workforce training, HIT extension
centers, grant programs, other)
– $20M for NIST
– Investment areas are guided by many sections of ARRA Studies, technology implementation assistance, state grants,
facilitate loan programs, demonstration projects
Privacy Officer for ONC
HIPAA Privacy Rule applies to business associates of CE‟s
26
Publication of Standards
Standards, interoperability specifications,
certification criteria--Annually
Publish the initial set as an Interim Final Rule
by 12-31-09, in the Federal Register
– As opposed to a Notice of Proposed Rule Making
(NPRM)
– May use standards previously
accepted/recognized by the HHS Secretary in
this initial set
27
The Path to Incentive Payments
Define meaningful use for 2011
Find the standards that support meaningful uses of
EHRs
Specify the certification criteria for EHRs to enable
meaningful uses by providers
Reward providers who meaningfully use EHRS with
increases in their Medicare and Medicaid payments
Continue for 2013 and 2015
Then the beatings begin
– We know where we are going
28
According to Yogi Berra
“If you don't know
where you are going,
you might wind up
someplace else.”
Report from WashingtonmHealth Initiative
J. Michael Fitzmaurice, Ph.D.
Agency for Healthcare Research and Quality
June 4, 2009
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