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EHR Contracts and Regulations A Outline I. About Rural Health Care II. Regulatory Framework EHR Contracts and Regulations A. HITECH Act What Rural Health Care Providers Must Know B. Meaningful Use Regulations III. Purchasing Software Health IT Vendor Fair Mt. Pleasant, MI A. Initial Considerations August 26 - 27, 2011 B. Types of Software Models Brian Balow Tatiana Melnik C. Key Provisions and Negotiation Techniques Partner Associate Outline Why is Rural Health Care Different? I. About Rural Health Care Rural Urban Percentage of USA Population nearly 25% 75% + II. Regulatory Framework Percentage of USA Physicians 10% 90% No. of Specialists per 100,000 40.1 134.1 A. HITECH Act population B. Meaningful Use Regulations Population aged 65 and older 18% 15% Population below the poverty level 14% 11% III. Purchasing Software Average per capita income $19K $26K A. Initial Considerations Adults who describe health status as 28% 21% B. Types of Software Models fair/poor C. Key Provisions and Negotiation Techniques Why is Rural Health Care Different? Primary Issues Affecting Providers • Unique combination of factors that create disparities • Lack of Resources: Lack of Money in health care not generally found in urban areas o Medicaid reimbursement rate disparities o Economic o Low income population – High rates of poverty – High percentage of subsidized patients – No transportation – High percentage of uninsured patients o Cultural and social differences o Education BUT, have the same fixed overhead expenses as o Lack of recognition by legislators because less health care providers in urban areas. people to represent 1 Primary Issues Affecting Providers Primary Issues Affecting Providers • Lack of Resources: Lack of Money • Lack of Resources: Workforce Shortage o Fewer and fewer doctors become generalists and of On August 16, 2011, Agriculture Secretary Tom those that do, fewer still practice in the rural area Vilsack announced that he and HHS Secretary – Find urban practice more attractive Sebelius will sign a memorandum of understanding to – Medicaid reimbursement disparities (same costs as make it easier for rural hospitals to make use of urban doctors but fewer patients) existing capital loan programs to buy high-tech o Nursing shortage information technology software and hardware. o Specialists shortage Primary Issues Affecting Providers How Can Information Technology Help? • Lack of Resources: Workforce Shortage • Provide better care (enhance patient safety) o Telemedicine On Aug. 16, 2011, HHS announced that it will soon o Remote home monitoring issue guidance expanding eligibility under the • Coordinate care National Health Service Corps program, which provides $60,000 in student loan repayments for • Improve disease surveillance primary physicians, family nurse practitioners, • Target health education den ists and other qualifying health providers who • Compile regional data agree to work for two years in medically underserved • Help practitioners be more efficient areas. • Make care more cost efficient How Can Information Technology Help? Outline • 2011 ONC literature review of HIT research found I. About Rural Health Care that 92% of HIT articles between 2007 - 2010 came II. Regulatory Framework to positive conclusions about HIT A. HITECH Act o 3 NYC dialysis centers - 3 yrs after implementing EHRs, patient mortality ↓ by as much as 48% and nurse staffing ↓ B. Meaningful Use Regulations by 25% o 41 Texas hospitals - hospitals with more advanced HIT III. Purchasing Software had fewer complications, lower mortality and lower costs A. Initial Considerations than hospitals with less advanced HIT B. Types of Software Models C. Key Provisions and Negotiation Techniques 2 Regulatory Framework: HITECH Regulatory Framework: MU • Health Information Technology for Economic • HITECH Act enacted “to promote the adoption and Clinical Health (HITECH) Act and meaningful use of health information o Enacted as part of the American Reinvestment and technology” Recovery Act of 2009 • To be eligible for EHR incentive payments, eligible o Gives HHS authority to establish programs to improve hospitals and elig ble professionals must use health care quality, safety, and efficiency hrough HIT “certified” EHR technology and be “meaningful EHR o Certain specified health care providers and hospitals users” must adopt electronic health records by 2015 • Three stages (the panel developing Stage 2 clinical o Provides incentive payments from Medicare and and process measures has endorsed a 1 year delay Medicaid for those that adopt EHR systems - stay tuned!) Regulatory Framework: HITECH Regulatory Framework: HITECH • Eligible Professionals • Eligible Hospitals & Critical Access Hospitals o Medicare - as much as $44,000 over five years o Medicare and Medicaid - both have complicated o Medicaid - as much as $63,750 over six years calculations but amounts to millions of dollars in o Can receive their 1st year’s payment for adopting, payments implementing and upgrading certified EHR technology o Unlike eligible professionals, eligible hospitals but must demonstrate meaningful use in subsequent (including CAH) may be able to receive payments years to qualify for additional payments under both Medicare and Medicaid o Can only participate in Medicare or Medicaid • Payments already started - Beth Israel Deaconess Medical Center was first hospital nationally to receive the federal MU payment ($2.57 million) Outline Initial Considerations: Organization I. About Rural Health Care • Develop a work plan What are your organization’s needs? II. Regulatory Framework o o How do you see your organization growing in 5, 10, A. HITECH Act 15 years? B. Meaningful Use Regulations o What are the HIT objectives? III. Purchasing Software o What are the legal requirements - federal, state A. Initial Considerations B. Types of Software Models C. Key Provisions and Negotiation Techniques 3 Initial Considerations: Organization Initial Considerations: Organization • Assess the current infrastructure - environment is • What is the current workflow? generally a complex combination of IT applications • What are the functional requirements? o Clinical decision support system • Interview the stakeholders o Clinical data repository o Are they open to new technology? o Medical vocabulary o How will they be impacted? o Pharmacy o Are the users part of the process? o Computerized provider order entry o Reference lab o Electronic health record Initial Considerations: Vendor Initial Considerations: Vendor • Select your vendor based on your needs • Verifiable history of meeting deadlines and pricing (i.e., avoiding “change orders”)? o Are they certified? (HealthIT.HHS.gov) • Verifiable history of producing products that WORK? o New to health care? New to rural health care? • Ask for current references o Adaptability of “standard” product “Certified” EHR technology DOES NOT MEAN o Integration wi h existing technology? working EHR technology Initial Considerations: Process Initial Considerations: Process • Define roles: Technical, Practical, Procurement, • Large providers should develop an RFP; smaller Legal providers might simply interview potential vendors • Gather data (use questionnaires) • Review proposals, and obtain clarifications • Create a functional specification • Develop a clear term sheet with fully defined • Consider the use of template agreements deliverables, pricing, and support terms • Negotiate final agreements • Implement and administer (including internal training) 4 Types of Software Models Types of Software Models • Open Source • Open Source o Has worked well in other industries (Internet!) o Examples in health care o But, may not be right for your organization – VistaA Office EHR - version of the VA Hospital records system adapted for small and medium sized practices – May not be supported in the same manner as a proprietary system but still requires installation, maintenance, – Open Dental - record management, patient scheduling and upgrades and training dental office management – Must be willing to work with software not backed by a large – ClearHealth - practice management software including company (although some companies do offer support for scheduling, billing, EMR, H PAA Security and accounts open source systems) receivable – Licensing terms are non-negotiable (public licenses) – OpenEMR -EMR software – OpenMRS - enterprise EMR framework Types of Software Models Types of Software Models • Proprietary • Software Licensing Metrics o Developed by a company and the software is “secret” o Hosted (internally or 3rd party) to that company Enterprise license – Allscripts Site license – GE Healthcare IT (Centricity) Per user/client – eClinicalWorks o Subscription (SaaS) – Practice Fusion – See InformationWeek, 17 Leading EHR Vendors (Dec. 2010) for The “Cloud” informative review http://www.informationweek.com/news/galleries/healthcare/EMR/228800 771?pgno=4 Critical Contract Terms Critical Contract Terms o Warranty Rights: This must cover not only the scope and o Functional Specification: Something against which to duration of the performance warranty, but also remedies measure performance, and should include elements for nonconformance. Beware of the refund pushback necessary for HIPAA/HITECH compliance and (revenue recognition issues), and be prepared to get this meaningful use certifica ion criteria issue on the table early. Additionally, in the MU context he vendor should warrant that it will, through its o License Scope: Includes (i) who (will need access to maintenance obligations, keep the product
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