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www.bakerdaniels.com
What the Stimulus Bill Means for the Future of
Health Information Technology March 16, 20091:30 PM EDT
Please dial 1-866-642-1665Passcode 342441
to listen to the audio portion of the webinar
You will not be able to listen to the audio over the web
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David Zook and Vince VentimigliaDavid Zook and Vince Ventimiglia
David Zook
Vincent J. Ventimiglia, Jr.
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Agenda Agenda Introductions Overview of ARRA HIT provisions Office of National Coordinator:
– Policy & Standards HIT grants and loans Medicare & Medicaid incentives Privacy provisions Telemedicine overview Impact & Engagement
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Call for StimulusCall for Stimulus
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Stimulus overviewStimulus overview ARRA signed into law February 17, 2009
– $787 billion in new spending and tax cuts– Congressional Budget Office estimates that
the bill will add $185 billion to the economy in 2009 and $399 billion next year
Federal agencies and states involved in implementation
Exceptional requirements for speed, duration, transparency, and accountability
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“Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy, and save lives.”
President ObamaAddress to Joint Session of Congress
February 24, 2009
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ARRA Health IT ComponentsARRA Health IT Components
Office of the National Coordinator of HIT Funding to support infrastructure and EHR
adoption Incentives to providers through Medicare
& Medicaid Significant privacy and security
components
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Office of National CoordinatorOffice of National Coordinator Codified through ARRA
Standards– Review federal health IT investments to ensure they are meeting objectives of
federal health IT strategic plan– Establish HIT Standards Committee (consider role of National eHealth
Collaborative)– Review and determine within 45 days whether to endorse standards,
implementation specifications, and certification criteria for electronic exchange and use of health information recommended by HIT Standards Committee
Policy– Coordinate policy and programs– Establish HIT Policy Committee (consider role of National eHealth Collaborative)
ONC chief privacy officer appointed by HHS Secretary within 12 months to advise National Coordinator and assist states, regions, and other nations
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Office of National CoordinatorOffice of National Coordinator Federal Health IT Strategic Plan
– Update the plan with other federal agencies to address several key components (electronic exchange, overall utilization, privacy and security, specifications, public engagement, continuous improvements)
– Update through public and private sector collaboration
– Measurable outcome goals– Published and accessible
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Office of National CoordinatorOffice of National Coordinator HIT Policy Committee
– Recommend policy framework for nationwide health information technology infrastructure
– Recommend and prioritize areas in which standards, implementation specifications, and certification criteria are needed
– Consider recommendations for appropriate use such as quality, care coordination, vulnerable populations
– Encourage broad stakeholder input– Members appointed by Secretary, Senate, House,
President, Comptroller General (specific expertise)– Letters of nomination for GAO positions were due
March 6; appointments by the end of the month– Letters of nomination for HHS position due to ONC on
March 16
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Office of National CoordinatorOffice of National Coordinator HIT Policy Committee
– Areas for review:• Appropriate use of nationwide health IT infrastructure for
collection of quality data, biosurveillance, public health, medical and clinical research, and drug safety
• Self-service technologies for exchange of patient information• Telemedicine technologies• Home health care• Reduce medical errors• Promote continuity of care• Meet needs of diverse populations• Facilitate secure access to PHI
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Office of National CoordinatorOffice of National Coordinator HIT Standards Committee
– Recommend standards, implementations specifications, and certification criteria
– Provide for NIST testing– Within 90 days, develop schedule for assessment of
recommendations for HIT Policy Committee– Open public meetings– Membership to include providers, ancillary healthcare
workers, consumers, purchasers, health plans, technology vendors, researchers, federal agencies, expert individuals
– Specific stakeholder input with sector balance– Letters of nomination due to ONC on March 16
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Federal Adoption of StandardsFederal Adoption of Standards Within 90 days, Secretary will determine
whether or not to propose adoption of current standards
By 12/31/09, Secretary shall adopt, by rulemaking process, an initial set of standards, implementation specifications, and certification criteria
As each agency implements IT systems, it will use systems meeting the standards
Voluntary adoption by private sector
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Federal Health ITFederal Health IT National Coordinator will support development
and updating of quality HIT technology unless Secretary determines that the needs of providers are being met through marketplace
Pilot testing of standards and specifications by NIST with HIT Standards Committee
NIST to support establishment of conformance testing infrastructure and may accredit independent, non-federal labs to perform testing
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HIT $HIT $
$2 billion total through the Office of the National Coordinator (HHS)– $300 million to support regional health
information exchanges– $20 million for NIST work on health care
information enterprise integration– the balance spread among the new grant
programs in unspecified amounts and at largely unspecified times
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HIT $HIT $
Other Health IT funding outside ONC– $85 million for Indian Health Service for HIT– $1.5 billion for community health centers,
which can be used for IT acquisition– $500 million for Social Security
Administration, of which $40 million may be used for health IT research and adoption
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HIT $HIT $ Funding to strengthen infrastructure
– Health IT architecture to support nationwide exchange and use of health information
– Development and adoption of certified electronic health records for providers not eligible for support under Medicare/Medicaid
– Training and dissemination on best practices to integrate health IT and EHRs
– Acquisition of health IT that meets standards adopted by HHS– Funded through ONC and administered by agencies with
relevant expertise (such as HRSA, AHRQ, CMS, CDC and Indian Health Service), grants will be made available for health information exchanges (HIEs), federal agencies, providers, community health centers, 340B entities, telemedicine providers, holders of health information and public health departments
– HHS is required to invest $300 million to "support regional or sub-national efforts toward health information exchange."
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HIT $HIT $ Implementation assistance
– State grants to promote HIT• Planning or implementation grants to states or state-designated
qualified entities to expand electronic health information exchange• States must provide matching funds on sliding scale (discretionary
in FY09 and 10; 1:10 in FY11, 1:7 in FY12, 1:3 in FY13)– Competitive grants to states and Indian tribes for loan
programs• Funded through ONC, these grants will be made available to states
or Indian tribes to establish loan funds for health care providers to acquire EHR technology (private contributions allowed)
– Programs to integrate HIT into education • Competitive awards to health professions schools to develop
curricula to integrate EHR technology into education• HHS, with NIST, provide funding to higher education for medical
health informatics education programs at undergrad and grad levels
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HIT $HIT $ Implementation assistance (cont.)
– Health Care Information Enterprise Integration Research Centers• NIST grants to higher ed institutions or consortia to establish multidsciplinary centers• Generate innovative approaches to health care information enterprise integration; and• Pursue development of health information technologies and other complementary fields.
– Health Information Technology Extension Program• ONC will establish a health IT extension program to assist providers to adopt, implement, and use
certified EHR technology• Collaborate with other agencies such as NIST in implementing the program
– Health Information Technology Research Center• HHS will create a HIT Research Center to provide technical assistance and develop best practices to
support effective use of health IT
– Health Information Technology Regional Extension Centers• HHS will assist with creation of regional centers to provide technical assistance and disseminate best
practices from the national Research Center• Regional centers will be affiliated with US-based nonprofit institutions• Up to four years of federal assistance, capped at 50% of the capital and annual operating costs
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HIT Medicare and MedicaidHIT Medicare and MedicaidIncentivesIncentives
Medicare incentives for providers– Up to $18k if in 2011, then, 12k, 8k, 4k, 2k in subsequent years– Payment reduction begins in 2015-- 1%, 2%, 3%– Must meet standards
Medicare incentives for hospitals– Up to $16 million over 4 years if using HIT in 2011– Additional penalties if not adopted– Must meet standards
Medicaid incentives – Pays states incentive payments to support costs incurred for
adoption
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Next stepsNext steps ARRA provisions direct funding at high level
– Specific details, including funding targets and processes for disbursement under development
How does this fit into your strategic plan?– Health provisions, but others that could impact you
(research, construction, energy, etc.) Are you communicating with Agency officials
and congressional representatives about your interests/needs?
Are you monitoring implementation?
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Additional ARRA details Additional ARRA details available available
www.recovery.gov www.HHS.gov/recovery
www.AHRQ.gov www.CDC.gov www.CMS.gov www.HRSA.gov www.NIH.gov
www.bakerdconsulting.com www.bakerdaniels.com
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B&D ConsultingB&D Consulting National advisory and advocacy consulting group
based in Washington, DC– 50+ professionals with deep sector
concentrations; www.bakerdconsulting.com– Division of Baker & Daniels LLP
Health & Life Sciences consulting practice focused on technical and political aspects of the U.S. healthcare system
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Remember Your HIPAA Headache??Remember Your HIPAA Headache??
What is the impact on Covered Entities?
What are the new requirements for
Business Associates?
How has ARRA changed the security
breach reporting obligations?
How has ARRA expanded HIPAA in terms of
additional entities that must now comply?
How has ARRA affected enforcement?
What new rights do patients have under the
ARRA?
What is the impact, if any, How has ARRA changed the security
breach reporting obligations?
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The Evolving Privacy and Security LandscapeThe Evolving Privacy and Security Landscape
70+ countries have passed sweeping laws
More on the way
US is considered to be less strict than the EU, Canada, Switzerland
Impact of ARRA goes far beyond the US
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ARRA OverviewARRA Overview
Security breaches – what has changed
HIPAA – expansion and new requirements
Enforcement – federal and state
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Security BreachesSecurity Breaches
Overview of existing state law obligations
ARRA obligations
– Who must comply?– What must you do to comply?– What has changed from prior state law obligations?– Do the state laws still apply too?– What enforcement can occur if you fail to comply?– What is the impact on patients?
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HIPAA--Before and After ARRAHIPAA--Before and After ARRA
Expanded scope of coverage
Limitation on permissible activities
Expanded patient access rights
Additional administrative responsibilities
Additional risks (enforcement, litigation)
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HIPAA – Examples of ImpactHIPAA – Examples of Impact
Third party management process
Internal management and documentation
Changes to procedures, training
Changes to auditing
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EnforcementEnforcement
New tiered penalties
Expanded public notification
Additional pressure on HHS to enforce
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Moving ForwardMoving Forward
Next B&D webinar on privacy and security: April 10, 2009, 1:30-3 pm
More detailed discussion of these issues
Call or email me at any time:
(317) 569-4665
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What Is Telemedicine?What Is Telemedicine?
• Telemedicine is not new.
• Definition of telemedicine varies.
• “Generally refers to the use of technology for the delivery
of healthcare when the healthcare practitioner and
patient are not in the same physical location.”
Telemedicine: Survey and Analysis of Federal and State
laws, Mayo & Kepler (AHLA).
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Who Is Practicing Telemedicine?Who Is Practicing Telemedicine?• Numerous healthcare providers: Family physicians,
radiologists, dermatologists, psychiatrists, hospitals, rural health clinics and many, many others.
• Consultation with Specialist: Telemedicine consultations with a specialist physician is one of the more common types of telemedicine.
• Wide variety of services: Telephone consultations, telephone cross-coverage, live video patient assessments, store and forward image analysis, etc.
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Brief History of Telemedicine Brief History of Telemedicine Legal IssuesLegal Issues
• Technology has continued to advance, but the law has not kept up.
• Providers, lawmakers, payors, patients and other interested parties have repeatedly attempted to address telemedicine’s legal issues and expand telemedicine.
• Examples
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Major Legal ObstaclesMajor Legal Obstacles
1. Licensure and credentialing
2. Liability for patient injuries
3. Federal and State regulations
4. Security of patient health information
5. Reimbursement
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Recent DevelopmentsRecent Developments ABA addressed state licensure issue during
August 2008 annual meeting
Number of “originating sites” for Medicare reimbursement was expanded effective Jan. 1, 2009
ARRA/HITECH Act provides additional funding for telemedicine
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Future of TelemedicineFuture of Telemedicine
• Impact of ARRA/HITECH Act
• Key obstacles to overcome
• Is telemedicine important to the future of medicine?
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Questions…?Questions…? David Zook [email protected]
202.589.2809 phone
Vincent J. Ventimiglia, Jr. [email protected]
202.312.7463 phone
Joan S. Antokol [email protected]
317. 569.4665 phone
David D. Storey [email protected]
260.460.1681 phone
