hipaamippatrhcaarrappaca era: connecting the health care legislation dots

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HIPAAMIPPATRHCAARRAPPACA Era Connecting the Health Care Legislation Dots

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Are you having trouble navigating through the murky waters of health care legislation? Fear not! We have broken down the complexities of the HIPAAMIPPATRHCAARRAPPACA Era, provided an illustration of each initiative in action, and explained what your IT vendor should be doing to help you comply with today's health care legislation.

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Page 1: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

HIPAAMIPPATRHCAARRAPPACA EraConnecting the Health Care Legislation Dots

Page 2: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

Wait… What?

Page 3: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

A Legislation Smorgasbord • HIPAA– Health Insurance Portability & Accountability Act

• MIPAA– Medicare Improvements for Patients & Providers Act

• TRHCA– Tax Relief & Health Care Act

• ARRA– American Recovery & Reinvestment Act

• PPACA– Patient Protection & Affordable Care Act

Page 4: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

HIPAA• 1996

• In short, electronic transactions: 5010/ICD-10

• The “5010 Rules” requiring the changeover from 4010 to 5010 transactions and from ICD-9 to ICD-10, fall under the administrative simplification portion of HIPAA

Page 5: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

MIPPA• 2008

• In short, Medicare ePrescribing Program

• Established the Medicare ePrescribing program that requires eligible professionals with prescriptive privileges to eRx permissible medications for Medicare Part B fee-for-service patients or suffer a payment adjustment

Page 6: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

TRHCA• 2006

• In short, Physician Quality Reporting System (PQRS)

• Established the Physician Quality Reporting Initiative (now known as PQRS) to collect clinical data so that the government could define value and purchase value

Page 7: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

ARRA• 2009

• In short, Meaningful Use of certified EHRs

• HITECH, which is 60 pages of ARRA, establishes the MU programs to accelerate and reward adoption of interoperable certified electronic health record technology

Page 8: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

PPACA• 2010

• In short, defining and purchasing value for affordable care

• Seeks to reduce the number of uninsured Americans and make care affordable by defining value and purchasing value

Page 9: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

What do they have in common?

• All of these pieces of legislation have an increased focus on process and technology

• The two major laws enacted under our current administration (ARRA and PPACA) accelerate transformation through the use of health IT

Page 10: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

Is it time to retire?• Providers are utterly overwhelmed trying to

figure out what systems are impacted, how to align disparate dates of compliance, design roadmaps, or even figuring out how close to retirement they are

• It is nearly impossible to put all the pieces together and translate them into usable health IT workflows without a strong technology partner

Page 11: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

HIPAAMIPPATRHCAARRAPPACA in Action

Page 12: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

Health & Human

Services Factory

Page 13: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

Health & Human

Services Factory

Status QuoPay-for-Service

Provider CEHRTData

Page 14: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

Status QuoPay-for-Service

Provider CEHRT

Data

Health & Human

Services Factory

Page 15: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

Status QuoPay-for-Service

Provider CEHRT

Data

Health & Human

Services Factory

Comparative Effectiveness

Research

Page 16: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

Status QuoPay-for-Service

Provider CEHRT

Data

Health & Human

Services Factory

Comparative Effectiveness

Research Guidelines

Page 17: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

Status QuoPay-for-Service

Provider CEHRT

Data

Health & Human

Services Factory

Comparative Effectiveness

Research Guidelines

Page 18: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

Status QuoPay-for-Service

Provider CEHRT

Data

Health & Human

Services Factory

Comparative Effectiveness

Research

GuidelinesEducate Measures

Page 19: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

Status QuoPay-for-Service

Provider CEHRT

Data

Health & Human

Services Factory

Comparative Effectiveness

Research

Educate GuidelinesMeasures

Clinical Decision Support

Page 20: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

Status QuoPay-for-Service

Provider CEHRT

Data

Health & Human

Services Factory

Comparative Effectiveness

Research

Educate GuidelinesMeasures

Clinical Decision Support

CEHRTProviderPerformance

Data

Page 21: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

Status QuoPay-for-Service

Provider CEHRT

Data

Health & Human

Services Factory

Comparative Effectiveness

Research

Educate GuidelinesMeasures

Clinical Decision Support

CEHRTProvider

New Status QuoPay-for-Value

PerformanceData

Page 22: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

Status QuoPay-for-Service

Provider CEHRT

Data

Health & Human

Services Factory

Comparative Effectiveness

Research

Educate GuidelinesMeasures

Clinical Decision Support

CEHRTProvider

New Status QuoPay-for-Value

PerformanceData

All together now!

Page 23: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

Status QuoPay-for-Service

Provider CEHRT

Data

Health & Human

Services Factory

Comparative Effectiveness

Research

Educate GuidelinesMeasures

Clinical Decision Support

CEHRTProvider

New Status QuoPay-for-Value

PerformanceData

MIPPA - eRx

Page 24: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

Status QuoPay-for-Service

Provider CEHRT

Data

Health & Human

Services Factory

Comparative Effectiveness

Research

Educate GuidelinesMeasures

Clinical Decision Support

CEHRTProvider

New Status QuoPay-for-Value

PerformanceData

MIPPA - eRxARRA – Meaningful Use

Page 25: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

Status QuoPay-for-Service

Provider CEHRT

Data

Health & Human

Services Factory

Comparative Effectiveness

Research

Educate GuidelinesMeasures

Clinical Decision Support

CEHRTProvider

New Status QuoPay-for-Value

PerformanceData

MIPPA - eRxARRA – Meaningful Use

TRHCA – PQRS

Page 26: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

Status QuoPay-for-Service

Provider CEHRT

Data

Health & Human

Services Factory

Comparative Effectiveness

Research

Educate GuidelinesMeasures

Clinical Decision Support

CEHRTProvider

New Status QuoPay-for-Value

PerformanceData

MIPPA - eRxARRA – Meaningful Use

TRHCA – PQRS

PPACA – Define “Value”

Page 27: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

Status QuoPay-for-Service

Provider CEHRT

Data

Health & Human

Services Factory

Comparative Effectiveness

Research

Educate GuidelinesMeasures

Clinical Decision Support

CEHRTProvider

New Status QuoPay-for-Value

PerformanceData

MIPPA - eRxARRA – Meaningful Use

TRHCA – PQRS

PPACA – Define “Value”

PPACA – VBM

Page 28: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

Status QuoPay-for-Service

Provider CEHRT

Data

Health & Human

Services Factory

Comparative Effectiveness

Research

Educate GuidelinesMeasures

Clinical Decision Support

CEHRTProvider

New Status QuoPay-for-Value

PerformanceData

MIPPA - eRxARRA – Meaningful Use

TRHCA – PQRS

PPACA – Define “Value”

PPACA – VBM

HIPAA – ICD-10

Page 29: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

What can my IT vendor do to help?

Page 30: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

How your IT Vendor Should Help

• Meaningful Use and other Dashboards– MU and PQRS metrics with analytics on each

provider– Facilitates quick numerators / denominators for

Meaningful Use attestation– Analytics on your practice with drill-through

details

Page 31: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

How your IT Vendor Should Help

• Patient Portal Inherent with System– If your vendor outsources its Patient Portal, you

could be paying additional license or support fees– If your vendor is not equipped with a Patient

Portal, you could face an additional Portal vendor and all the integration considerations that go with it

Page 32: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

How your IT Vendor Should Help

• Single database solution– Always use a certified, complete EHR, meaning

the practice management and electronic health record are part of the same solution

– A certified, quality vendor can seamlessly provide both

Page 33: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

How your IT Vendor Should Help

• EHR Direct PQRS– Must be certified to do EHR Direct PQRS, not beta

testing

Page 34: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

How your IT Vendor Should Help

• Support that’s more than just a phone call (and two continents) away– Initiative toolkits for Meaningful Use, PCMH,

PQRS, etc.– Consulting support with domain experts– U.S.-based staff that is well-trained, friendly and

considerate of your time and needs

Page 35: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

How your IT Vendor Should Help

• Ongoing Client Educational Offerings– Provides free educational webinars– Offers a wealth of articles, white papers, case

studies, tips and tricks to help you become more knowledgeable about the industry and your specialty

– Provides CEU-approved opportunities– Consistently communicates about new features

Page 36: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

How your IT Vendor Should Help

• Quality Improvement Organization Alignment

Page 37: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots

Are you getting enough from your vendor during this

HIPAAMIPPATRHCAARRAPPACAEra of Health Care?

Page 38: HIPAAMIPPATRHCAARRAPPACA Era: Connecting the Health Care Legislation Dots