Grec Program Overview

Dominic H. Mack MD, MBA Project Director, GREC Deputy Director, National Center for Primary Care Morehouse School of Medicine [email_address] 404-756-8960 www.primarycareforall .org Georgia Regional Extension Center (GREC)

HITECH Act Re-Establish ONC for HIT to develop rules by 2010 Savings -quality, care coordination & error reduction Strengthening Federal privacy and security law $20 billion Health information technology infrastructure 60-70 Regional Extension Centers 32 centers have been awarded Medicare and Medicaid incentives

Meaningful Use Definition & Rules The Recovery Act specifies the following 3 components of Meaningful Use: Use of certified EHR in a meaningful manner (ex: e-prescribing) Use of certified EHR technology for electronic exchange of health information to improve quality of health care Use of certified EHR technology to submit clinical quality and other measures 14

Stage 1- Health Outcome Initiatives Improving quality, safety, efficiency, and reducing health disparities • Engage patients and families in their health care • Improve care coordination • Improve population and public health • Ensure adequate privacy and security protections for personal health information

GREC Mission GREC’s mission is to furnish assistance to help Georgia’s providers select, successfully implement, and meaningfully use certified EHR technology to improve clinical outcomes and the quality of care provided to their patients. Vision: GREC will work collaboratively with valued partners to assure the adoption of certified EHR technology to improve the quality of health for the community while eliminating the disparate gap of healthcare throughout Georgia.

GREC Goals and Services To use a community oriented approach to provide outreach and education to facilitate the adoption and meaningful use of EHR. To work collaboratively with statewide partners across the 18 public health districts of GA to develop and implement programs to meet GREC objectives. To select HIT products that meet provider’s needs and helps them to meet patient centered medical home standards . To provide equitable group purchasing agreements for Georgia’s priority primary care providers. To build up competent technical teams to obtain meaningful use of EHR throughout the state and grow Georgia’s HIT workforce. To work collaboratively with State HIE (GA. DCH) to meet all meaningful use criteria. To provide excellent quality service to our customers in order to build a national reputation as a reliable HIT resource for providers.

The following organizations, serving over 9,000 PCPs, submitted letters of partnership AmeriChoice Andrew Young School of Policy Studies GA Academy of Family Physicians GA Association for Primary Health Care GA Hospital Association GA Institute of Technology GA Chapter of the of Pediatrics GA Department of Community Health (DCH) GA DCH Office of Health Information Technology and Transparency GA State Medical Association GA State Office of Rural Health GA State Policy Institute GMCF (QIO) Greenway Medical Technologies Hispanic Health Coalition of GA Governor’s Office of Workforce Investment Kibbe Group, Founding Director of the Center for HIT for the of Family Physicians Morehouse School of Medicine Office of Sponsored Research Administration Kids Health First Pediatric , Independent Practice Association Statewide Area Health Education Centers Network The Center for Pan Asian Community Services, inc. Medical College of GA N.W. GA Healthcare Partnership Technical College System of GA (TCSG) University System of GA WellCare of GA Macon State College

Key Statewide Statistics Map of Georgia PCP: 15,563 Priority PCP: 8040 Total Number Served: 1608 (Yr 1) 5225 (Yr 5) Georgia Population: 9,965,744 Total patients served (projected) : 2.8 million

Georgia Healthcare Coverage Kaiser Family State Health Facts 2007-2008 Medicaid 12.2% 1,150,800 Medicare 10.1% 958,200 Employer 54.8% 5,185,900 Individual 3.4% 325,400 Other Public 1.7% 164,300 Uninsured 17.8% 1,682,400 Total 9,467,100

Meaningful Use Summary EPs 25 Objectives and Measures 8 Measures require ‘Yes’ or ‘No’ as structured data 17 Measures require numerator and denominator Eligible Hospitals and CAHs 23 Objectives and Measures 10 Measures require ‘Yes’ or ‘No’ as structured data 13 Measures require numerator and denominator Reporting Period –90 days for first year; one year subsequently

Examples of Meaningful Use EHR criteria Use CPOE Implement drug-drug, drug-allergy, drug-formulary checks Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT® Check Insurance eligibility & submit claims electronically Maintain active medication allergy list Record demographics Record and chart changes in vital signs Record smoking status for 13 and old Provide electronic syndromic surveillance data

Eligible Providers Medicare FFS Eligible professionals (EPs) Eligible hospitals and critical access hospitals (CAHs) Medicare Advantage (MA)MA EPs MA-affiliated eligible hospital Medicaid EPs Eligible hospitals 7

Medicaid Eligible Providers Eligible Professionals (EPs) Physicians (Peds have special eligibility & payment rules) Nurse Practitioners (NPs) Certified Nurse-Midwives (CNMs) Dentists Physician Assistants (FQHC or RHC that is directed by a PA) Eligible Hospitals Acute Care Hospitals Children’s Hospitals

Medicare Eligible Providers Eligible Professionals (EPs) Doctor of Medicine or Osteopathy Doctor of Dental Surgery or Dental Medicine Doctor of Podiatric Medicine Doctor of Optometry Chiropractor Eligible Hospitals Acute Care Hospitals Critical Access Hospitals (CAHs)

Hospital-based Eligible Providers Hospital-based EPs do not qualify for Medicare EHR incentive payments Most hospital-based EPs will not qualify for Medicaid EHR incentive payments (FQHCs will qualify) Defined as an EP who furnishes 90% or more of their services in a hospital setting (inpatient, outpatient, or emergency room)

Eligible Providers in Medicare Advantage MA Eligible Professionals (EPs) Must furnish, on average, at least 20 hours/week of patient-care services and be employed by the qualifying MA organization -or- Must be employed by, or be a partner of, an entity that through contract with the qualifying MA organization furnishes at least 80 percent of the entity’s Medicare patient care services to enrollees of the qualifying MA organization Qualifying MA-Affiliated Eligible Hospitals Will be paid under the Medicare Fee-for-service EHR incentive program

Minimum Medicaid pt volume threshold 30%-Physicians, Dentist, CNMs, NPs, Pas 20%-Pediatricians 10%Acute care hospitals 0%-Children’s hospitals Or the Medicaid EP practices predominantly in an FQHC or RHC—30% needy individual patient volume threshold

Medicare Providers-Meaningful Use Meet requirements in 2011 or 2012 $15,000 - $18,000 payments yr 1, $44,000 total by yr4 Declining payments through year 5 The later you meet requirements, the less you get No incentives after 2016 or for first adopters after 2014 Provider payments increase 10% in HPSA Payment reduction if not adopted by 2015 Excludes hospital based “eligible professionals” Special rules for Medicare Advantage

Medicare First Calendar Year in which the EP receives an Incentive Payment Calendar Year 2011 2012 2013 2014 2015 & later 2011 $18,000 2012 $12,000 $18,000 2013 $8,000 $12,000 $15,000 2014 $4,000 $8,000 $12,000 $12,000 2015 $2,000 $4,000 $8,000 8,000 $0 2016 $2000 $4,000 $4,000 $0 Total $44,000 $44,000 $39,000 $24,000 $0

Medicaid Providers-Meaningful Use The Medicaid EHR Incentive Program starts in 2011 and ends in 2021  The latest that a Medicaid provider can initiate the program is 2016  A Medicaid provider can initiate the program under the Adopt, Implement and Upgrade bar but in their 2ndand subsequent years, they must meet MU at the stage that is in place, per rule-making (Stage 3 by 2015).

Medicaid First Calendar Year in which the EP receives an Incentive Payment Calendar Year 2011 2012 2013 2014 2015 2016 2011 $21,250 2012 $8,500 $21,250 2013 $8,500 $8,500 $21,500 2014 $8,500 $8,500 $8,500 $21,500 2015 $8,500 $8,500 $8,500 $8,500 $21,500 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,000 2017 $8,500 $8,500 $8,500 $8,500 $8,500 2018 $8,500 $8,500 $8,500 $8,500 2019 $8,500 $8,500 $8,500 2020 $8,500 $8,500 2021 $8,500 Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750

Medicare Hospitals-Meaningful Use “ Eligible hospitals” meet requirements in 2011 $2,000,000 base + discharge related payment Payments reduced over 4 year period Non-adopters received reduced payments in 2015 Critical access hospital have more generous formula

Medicaid Hospitals-Meaningful Use Eligible hospitals, unlike EPs, may receive incentives from Medicare and Medicaid Subsection(d) hospitals, also acute care Hospitals meeting Medicare MU requirements may be deemed for Medicaid , even if the State has an expanded (approved) definition of meaningful use 31

Workforce development Insufficient Technical Workforce Not much education capacity around HIT Education budget cut $1 billion GA Economy – 10% unemployment rate Low broadband access in rural areas Challenges

Scaling capabilities of education system HIT is a growing industry in GA HIT intellectual capital in Atlanta Large lab space Enthusiasm of the state Workforce development Strengths

Workforce Development Cost of Education and training is rising Decreasing funds for education programs Education level in underserved communities Threats

Workforce Development Low technical capabilities leaves room for growth Development of new partnerships GA Board or Regents Technical college System of GA (TCSG) GAFP GA Partnership for TeleHealth New certification programs in education system Growth of degreed programs Opportunities

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