American Recovery and
Reinvestment Act
What’s in it for MN Rural Health?
Rural Health Advisory Committee
May 19, 2009
Karen Welle, Asst Director, Office of Rural Health and
Primary Care
Liz Carpenter, Deputy Director, Center for Health Informatics
Minnesota E-Health and
Telehealth Update
Minnesota e-Health Initiative
“… accelerate the
adoption and effective use
of Health Information
Technology to improve
healthcare quality,
increase patient safety,
reduce healthcare costs,
and enable individuals and
communities to make the
best possible health
decisions.”
State Mandates to Advance e-Health
2011 MN e-Prescribing Mandate
• All providers, group purchasers, prescribers, and
dispensers establish and maintain an electronic
prescription drug program by January 2011
2015 MN Interoperable EHR Mandate:
• All healthcare providers and hospitals have interoperable
EHRs. MDH: statewide plan to meet the mandate
• Establish uniform health data standards by January 2009
• All EHRs must be certified by CCHIT if a certified EHR
product available for the provider’s particular setting
Minnesota Model for Adopting
Interoperable Electronic Health Records
• Breaks achieving the 2015 Mandate into
manageable steps
• Applies across organizational settings
Continuum
of EHR
Adoption
Achievement of
2015 Mandate
Adopt
Assess
Plan
Utilize
Select
Implement
Exchange
Effective Use
Readiness
Interoperate
MN EHR Adoption Rural-Urban
Implementation Stage
All
Rural
Urban
2005 2007 2005 2007 2005 2007
Fully implemented
17% 42%
13% 20%
Implementation in process
29% 20%
23% 28%
20%
58%
34% 13%
Implementation in next 12 months
11% 11%
13% 15%
10%
9%
Implementation in next 13-24 months
16% 13%
22% 21%
11%
8%
Implementation beyond 25 months
**%
9%
**% 11%
**%
7%
No plans for implementation
**%
5*%
**%
**%
4%
In 2007 next two years, 86.7% of Minnesota’s primary care clinics with be fully implemented.
* 47.6% of those who have no plans for implementation have done some exploration in the possibility of using EHR.
50.0% are clinics with 1 physician, compared to 16.7% of all respondents having 1 physician.
76.2% are free standing, independent clinics, compared to 26.7% of all respondents being free standing, independent clinics.
**In 2005, “No plans for implementation in next 24 months was 27% for All, 29% for Rural, and 25% for Urban.
5%
Supporting Rapid Adoption: MN Funding
$14.6 million in grants and loans to support
adoption of interoperable EHRs and targeted
funds to rural and safety net providers.
e-Health Grant Program: $ 8.3 million
2006 - $1.3 million
2007 - $3.5 million
2008 - $3.5 million
EHR Loan Program: $ 6.3 million
Greater MN Telehealth Broadband
Initiative
• Consortium of five health care networks
representing 120 hospitals and mental
health clinics
• FCC Rural Health Care Pilot Program
• Awarded ~$5.4M over 3 years in potential
reimbursements for installation and
support of rural broadband networks for
health care
Greater MN Telehealth Broadband
Initiative
• SISU Medical Systems, Duluth (16
hospitals primarily in NE), Lead Organization
• Medi-sota, Inc. (31 hospitals in SW)
• Minnesota Telehealth Network and North
Region Health Alliance (38 hospitals in
NW MN and NE ND)
• MN Assn of Community Mental Health
Programs (78 clinics)
American Recovery and
Reinvestment Act of 2009
ARRA Key Provisions
ƒ Health Information Technology (HITECH Act) ($2 B)
ƒ Medicaid and Medicare HIT Incentives for hospitals and
providers ($29 B)
ƒ Community Health Center Grants ($2.5 B) ($500M for
operations and $1.5B for capital projects, including HIT)
ƒ Health Workforce Shortages – scholarships, loan repayment,
grants to training programs, and NHSC ($500 M)
ƒ Broadband
ƒ USDA: Distance Learning, Telemedicine and Broadband
Program ($2.5 B)
ƒ NTIA: Broadband Technology Opportunities Program
($4.7 B)
ƒ USDA Rural Community Facilities Program grants and loans
(additional $130M)
Health Information Technology for
Economic and Clinical Health Act
(HITECH)
• Office of National Coordinator for HIT (ONCHIT)
• Grants to states to promote HIT
• Competitive grants to states and tribes to establish
EHR loan programs for providers
• Regional HIT extension and research centers
• Grants to health professions programs to
incorporate HIT into curriculum
• Grants to higher education to expand programs in
health informatics and IT
Office of the National Coordinator
for HIT: Coordinate funds to HRSA,
AHRQ, CMS, CDC, IHS ($300M)
•
•
•
•
•
HIT architecture to support exchange
Training and best practices
Telemedicine infrastructure and tools
Promote interoperability of clinical data
Improve/expand public health HIT
Grants to states to promote HIT:
Minnesota e-Health Initiative
•
•
•
•
•
•
•
•
•
Enhance HIT adoption and effective use
Identify state and local resources
Provide technical assistance
Promote HIT for underserved areas
Assist patients to use HIT
Support use of regional extension centers
Support public health HIT
Promote quality measurement
Match: $1 to $10 (2011), $1 to $7 (2012),
$1 to $3 (2013)
Competitive grants to states and
tribes for loan programs
• To assist providers with:
–
–
–
–
•
•
•
•
Purchase of EHR technology
Enhanced use of EHR
Train personnel
Improve secure health information exchange
Up to market rate
Repayment begins after 1 year
10 year amortization
$1/$5 match
Medicare HIT Incentives: 2011-2015
• Available for hospitals and individual
providers
• Must be “meaningful user” of HIT
– Using certified EHR technology
– Demonstrates information exchange
– Reports clinical quality measures
• Incentives become penalties in 2015
Medicare Hospital HIT Incentives:
2011-2015
• PPS Hospitals = Base of $2M plus a prorated amount of the total based on # of
discharges x Medicare share
– Could receive up to $8 million over 4 years.
• Critical Access Hospitals = Depreciation
value of HIT costs x Medicare share plus
20% points
More about Critical Access Hospital Incentives
• Depreciation value of HIT costs x Medicare share
plus 20% points
• “Certified EHR” definition will ultimately determine
value incentive. What will be included?
• Can only depreciate EHR capital costs, not time
costs
• Incentives don’t begin until after the investments
made; issue of need for capital financing left
unaddressed
• Maximizing incentive bonus: strategy to leave as
much “Certified EHR” investments undepreciated at
time of reaching meaningful user designation
Medicare Incentive Payments:
Professionals
• Qualified EHR user in 2011/2012 can receive up to
$44,000 (or up to $48,400 if practicing in HPSA)
• Applies to all physicians who can prove use of a
qualified EHR, regardless of purchase date
• Must be meaningful EHR User. Includes:
– Using certified EHR technology
– Demonstrates information exchange
– Reports clinical quality measures
Medicaid HIT Incentive Payments
• For providers with high Medicaid volumes to cover the
providers costs for acquiring, using and maintaining certified
EHR technology.
– Up to 85% of the providers’ costs
– Minnesota’s costs to administer matched at 90%
• Eligible providers:
–
–
–
–
–
Children’s hospitals (regardless of Medicaid patient volume)
Acute care hospitals with at least 10% Medicaid patient volume
Professionals in FQHCs or RHCs with at least 30% needy individuals
Other non-hospital based professionals with 30% Medicaid volume
Pediatricians with at least 20% Medicaid volume
MDH priorities under ARRA
• Position providers to pull down maximum
incentive $$$s under Medicare and/or
Medicaid
• Address two largest barriers to
implementing electronic health records:
– Help finance the capital costs of purchasing
and adopting EHRs
– Assist health care providers in using EHRs
effectively
MDH Activities to Prepare MN
• Secure state matching funds and make policy
changes to position MN for funding
• Apply for state grant to continue promoting HIT
• Apply for competitive grants to states for HIT loan
programs to help Minnesota providers purchase
EHR systems
• Inform Minnesota providers and stakeholders
• Collaborate with DHS on Medicaid HIT incentives
• Support statewide partner applications for
exchange, education and technical assistance,
telehealth, and broadband funding
Preparing MN for ARRA:
2009 Policy Legislation
• Assigns new duties to coordinate with national
activities
• Allows collection of data for assessment &
incentive eligibility determination
• Identifies the Commissioner of Health as the
lead applicant or designating authority for HIT
funding
• Aligns current Minnesota EHR loan program with
competitive state grant requirements
Securing matching funds
to seize ARRA opportunities
• Governor’s Budget:
– $350,000 Base Funding for e-Health (1:5 Match)
– $4 Million Funds for EHR Loans (1:5 Match)
– $128,000+ State Loan Repayment for Health
Professionals (1:1Match)
• House Proposal:
– Identical to Governor’s Recommendation
• Senate Proposal:
– $175,000/year Base Funding for e-Health
– $2.8 Million Funds for EHR Loans
– $128,000+ State Loan Repayment for Health
Professionals (1:1Match)
What health care providers can do now
• If no EHR: begin a thorough planning
process now
• If EHR in place, ensure effective use
• Adopt and use e-prescribing
• Reach out to community partners to begin
exchange of information, improve broadband
access, explore telehealth opportunities
For more information
MN e-Health Initiative/HITECH page
http://www.health.state.mn.us/e-health/hitech.html
Office of Rural Health and Primary Care
http://www.health.state.mn.us/divs/orhpc/
Liz Carpenter, Center for Health Informatics,
[email protected], 651-201-5979
Karen Welle, Office of Rural Health & Primary Care,
[email protected], 651-201-3865