Overcoming Obstacles to HIT Adoption: Financial Incentives and Internal ROI Strategies

1. Provider Incentives for HIT Adoption Gerard P. Filicko, MHA, CMPE Sr. VP, Physician Services

2. Otherwise known as…

3. Obstacles to Implementation:Show me the Money! • Internal ROI Forecast • ASP vs Client-Server EMRs • New Funding Opportunity? • CMS EMR Demonstration

4. ROI Forecast • “Benefits Portfolio” of an EMR: • Quantifiable vs Anecdotal • Financial vs Qualitative • The entire portfolio is important, although only quantifiable, financial benefits form basis for ROI • Financial benefits are almost entirely based on Operational Improvements

5. Improved physician workflow OV time reduced due to faster pre-encounter chart review & post-encounter documentation Fractional FTE savings: Reduction in clinical messaging Staff time to process 1 med request typically reduced by 80% (12 min) Elimination of business office outsourcing expenses through an interfaced PMS Eliminate paper chart supplies (up to $3/chart) Reduce clerical (medical records) personnel Reduce or eliminate transcription costs Operational Improvements Profit Contribution Productivity Improved Revenue Cost Savings Cost Avoidance ROI Forecast Productivity Cost Savings

6. Records storage Liability reduction: Orders/results matching and patient follow-up Enhanced legibility of chart reduces potential for errors E-rx reduces multiple requests for same refill Accurate coding & billing from interfaced PMS Improved patient tracking & charge capture ROI Forecast Cost Avoidance Revenue/Profit Operational Improvements Profit Contribution Productivity Improved Revenue Cost Savings Cost Avoidance

7. Internal ROI Measures • Non-quantifiable Benefits • Quality improvements • Continuity of care • Patient satisfaction • Improved access

8. ASP vs Client-Server EMRs • Application Service Provider model • “Subscription based” EMR • Optional offering by various national vendors • May also include local collaborations: • Shared services among practices • “Server farm”

9. Is the ASP Alternative right for you? • CCHIT certified vendors • Evaluate Pros & Cons: • Remote support by IT professionals • Less costly start-up, reduced ongoing expenses • Worldwide accessibility thru Internet • Data is controlled by a third party • No direct oversight of maintenance, backups • Internet dependent

10. Case Study: ASP support for Safety Net Providers • 4 Richmond Free Clinics needed access to an integrated data platform • Hospital & clinic results • Labs & medications • Sought a common eligibility screening process • Did not have capital and needed to keep operating costs low • Governor’s HIT Council Grant

11. Reporting, Grant Writing Free Clinic Pharmacy E-Scripts Community Pharmacy Updated Meds MedVirginia Health Information Exchange Demographics Schedule MEDfx Practice Management System Results Discharge Meds Hospitals & Eligibility Screening Tool Referrals Eligibility Data Clinicals Specialists Referral Back to Medical Home Care Coordination Monitoring of Sentinel Events

15. MedVirginia - Health Information Exchange Physician View • e-Chart • Meds/Allergies List • Ancillaries • IP / OP • Secure Messaging Data Flowing to Solution Clinical Results from Hospitals and Providers Discharge Summaries Reference Lab Results Physician Suite of Services Physician e-Prescribing • PM Integration • Practice Notes • e- RX • Electronic Health Record • Interface with EMRs Medications Allergies

17. Current Clinical inbox Clinical messaging Community e-chart Demographic summary Clinical summary Electronic prescribing Integrated practice notes 3Q08 PACS interface E-signatures Rounds list Medication histories Free Clinic EMR: Features and Functions

18. CMS EMR Demonstration Project

19. Project Overview • Purpose: Drive adoption of EHRs in primary care • MedVirginia selected as “convener” for Virginia • Only 12 sites awarded in U.S. • Small-medium PCP practices <20 MDs • 200 practices in VA (100 control, 100 study) • Incentives (additional Medicare reimbursement) provided for: Year 1: Adoption of CCHIT-certified EHR Year 2: Reporting of quality measures Year 3-5: Clinical improvements (P4P)

20. Practice Requirements • Size • Small to medium-sized practices (<= 20) • NPs / PAs as well as MDs / DOs • At least 50 Medicare FFS beneficiaries • Specialty • Primary care (IM, FP, GP, gerontology) • Medical sub-specialists only if practice is predominantly primary care • Must adopt CCHIT-certified* EHR by end of Year 2 • Must bill OVs electronically * CCHIT = Certification Commission for Healthcare Information Technology

21. Minimum Required EHR Functionalities • Demonstration Practices must be utilizing EHR to perform minimum functionalities: • Patient visit notes • Recording of lab/diagnostic tests orders & results • Recording of prescriptions • More sophisticated users get higher payment • Based on OSS score

22. Incentive Payments • HIT incentive payment based on performance on Office Systems Survey (OSS) • Quality incentive payment for reporting/performance on 26 clinical measures related to: • Diabetes • Congestive Heart Failure • Coronary Artery Disease • Preventive Services • Both paid on a per-beneficiary basis (increased Medicare reimbursement)

23. Incentives Vary by Year • Year 1: • Payment for use of HIT core functionalities • Year 2 • Payment for reporting quality measures • Payment for use of HIT • Practice terminated from Demonstration if it has not adopted CCHIT EHR and is using minimum core functionalities • Years 3 -5 • Payment for performance on quality measures • Payment for use of HIT • Minimum quality performance required to receive HIT payment

24. Maximum Potential Payment

25. Next Steps for Virginia • Virginia is a Phase II Site (1 of 8) • Kick off expected by Summer 2009 • MedVirginia, as convener, will help direct CMS recruitment efforts

26. More Information • MedVirginia website • www.medvirginia.net • CMS website • http://www.cms.hhs.gov/ • Medicare > Demonstration Projects