Medi-Cal EHR Incentive Program

1. Medi-Cal EHR Incentive Program Larry Dickey, MD, MPH Medical Director Office of Health Information Technology California Department of HealthCare Services

2. Medi-Cal EHR Incentive Program • Cornerstone of ARRA Hi-Tech Program • Companion to the Medicare EHR Incentive Program administered by CMS • Medi-Cal EHR Incentive Program administered by DHCS with CMS funding • $1.4 billion dollars to California providers (practitioners and hospitals) over 10 year period beginning in 2011 • EHR Incentive programs complement HIE and REC programs funded by ONC

3. Medi-Cal EHR Incentive Program • Purpose: to incentive providers to: • adopt, install, or upgrade high quality EHRs certified by ONC • use EHRs to meaningfully improve clinical practice and public health • Incentives: • Practitioners: $63,750 over 6 years • Hospitals: $2-6 million over 4 years • Timeline • Enrollment: January, 2011 • First payments: April, 2011

4. Potential Medicaid Provider Incentives • Year 1 payment for adoption of certified EHR—demonstration of actual installation, not efforts to install. • Year 2-6 payments contingent on provider demonstrating “meaningful use” of the EHR • Year 1 payment does not need to be in 2011, but cannot be later than 2016. • Years need not be consecutive. • Cannot receive both Medicaid and Medicare incentives, but an can switch once between programs by 2015.

5. Medi-Cal EHR Incentive Payments • Will incentive payments be enough? • No—only about 50% according to CMS projections for providers currently without EHRs • However—providers can assign incentive payments to practice site or employer. Pooled payments may be enough • There is a “stick.” Medicare providers will begin to experience payment withholds in 2015 if they do not use a certified EHR.

6. Medi-Cal EHR Incentive Program Practitioner Eligibility • Physicians • Dentists • Nurse Practitioners • Midwifes • Optometrists • Physicians assistants practicing in a PA-led FQHC or Rural Health Clinic

7. Medi-Cal EHR Incentive Program Practitioner Eligibility • Patient Volume Requirement • 30% Medi-Cal patient volume, except for pediatricians who can qualify with 20% but receive 2/3 of incentive payments • Practitioners in FQHCs or RHCs are eligible with 30% “needy” volume—Medi-Cal, Healthy Families, uninsured and partial-pay patients • Clinics and groups can qualify providers using group/clinic-wide patient volume

11. Hospital Eligibility • Hospitals are eligible to receive incentive payments under both Medicare and Medicaid programs.

12. How Many Hospitals will be Eligible? • Of the state’s 435 hospitals • Approximately 242 (56%) will be eligible for the incentive payments • These 242 hospitals cover 93% of all Medi-Cal discharges and 72% of all acute hospital beds. All children’s hospitals are eligible

13. Critical Access Hospitals • Originally not include in the incentive program by CMS, but included in the final regulations • DHCS is partnering with CSRHA to assess their needs. • 23 of 31 CAHs will qualify for Medi-Cal EHR Incentive Program funds. • 8 mayl not be eligible due to average length of stays over 25 days. All but one of these will qualify for Medicare incentive funds. • $72 million in incentive payments for CAHs

14. How Many Practitioners and Hospitals Currently Use EHRs? • Practitioners—14% of outpatient providers in 2005 with providers in larger practices having higher rates. No good recent data. DHCS is partnering with the Medical Board and UCSF to conduct an annual survey. • Hospitals—13% fully implemented, 42% partially implemented and 45% not implemented at all. CA ranks 32nd in hospital EHR implementation.

15. Further Information Provider enrollment open January 1 through a national registry and a state website. Watch for the details. DHCS http://www.dhcs.ca.gov/Pages/DHCSOHIT.aspx Questions to: Medi-Cal_Incentive@dhcs.ca.gov Federal http://healthit.hhs.gov/portal/server.pt http://www.cms.gov/EHRIncentivePrograms