Health IT EHR Opportunity September 22, 2009 Paul M. Lee John M. - - PowerPoint PPT Presentation

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Health IT EHR Opportunity September 22, 2009 Paul M. Lee John M. - - PowerPoint PPT Presentation

Dec 21, 2022 440 likes •739 views

Health IT EHR Opportunity September 22, 2009 Paul M. Lee John M. Kirsner, Esq. Strategic Health Care Squire, Sanders & Dempsey L.L.P. Senior Partner Partner, Health Care and Life Sciences (202) 266-2600 (614) 365-2722

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Health IT EHR Opportunity September 22, 2009

John M. Kirsner, Esq. Squire, Sanders & Dempsey L.L.P. Partner, Health Care and Life Sciences (614) 365-2722 jkirsner@ssd.com Scott A. Edelstein Squire, Sanders & Dempsey L.L.P. Partner, Health Care and Life Sciences (202) 626-6602 sedelstein@ssd.com Paul M. Lee Strategic Health Care Senior Partner (202) 266-2600 paul.lee@shcare.net

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Overview

  • Purpose of Today’s Presentation
  • Proposal for Hospital/Physician collaboration:

– Creation of Health IT MSO/Association

  • HITECH Act
  • Legal Issues
  • Next Steps
  • Questions
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Purpose of Today’s Presentation

  • Determine hospitals’ interest in

developing a not-for-profit

  • rganization to help them

implement an EHR physician alignment strategy.

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New HIT MSO/Association

  • Not-for-Profit
  • Financed by Government
  • NOT a “one size fits all!”
  • Board members comprised of hospital CIOs

– Hospital CIO committees created to:

  • Advise MSO staff/attorneys on direction
  • Advise on the creation of legal documents
  • Negotiate with vendors (hardware, software, etc…)
  • Advocate for regulatory changes to “meaningful use.”

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New HIT MSO/Association

– MSO would:

  • Create all documents establishing MSO as legal entity
  • Manage all Committees – like association
  • Be a resource (legal, marketing, etc…) to each hospital

member

  • Recommend solutions to group and individual

implementation issues

  • Advise Board and members on all issues regarding the

successful management of the MSO

  • Under the direction of the Board, adjust MSO mission

based on member needs

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Benefits

  • Leverages buying power of multiple physicians

at a national level for better pricing from vendors – hardware & software

  • Better pricing may result in pool of additional

funds to meet future EHR needs

  • Helps physicians maximize eligibility for

incentive payments

  • Brings together hospitals and physicians

through an integrated, seamless EHR system

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Benefits

  • “Free” to physicians – funded through HIT payments
  • Turnkey solution for physicians
  • One-stop shop for technology acquisition,

implementation, maintenance and related support

  • Manages complex regulations regarding meaningful use

and other legal requirements, and monitors compliance

  • Potential for Hospital/Hospital alignment through
  • utsourcing of CIO/IT expertise of larger

hosptals/systems to smaller hospitals/systems.

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Benefits

  • Ensures consistency in implementation
  • Can be a step in a clinical integration program
  • r accountable care organization program or

medical home program

  • Seasoned legal advice for physicians and

hospitals

  • Ability to obtain federal and state grant funding

in which all participants can benefit

  • Provides peer-to-peer opportunities for CIOs
  • Organization “owned” by hospitals

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Advantages

  • COMPETITIVE ADVANGE FOR MEMBERS

– Only one hospital/system in each community

  • NOT a Health IT Regional Extension Center

– Will use the services of the RECs to provide further advantages to member hospitals – Not entangled with same government limitations

  • NOT vendor-centric

– Hospitals/physicians can select own vendor

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National HIT MSO/Association Example

10 10 Medicare Customer Hospitals (20) IT Vendor Physicians (10,000)

$440 Million EHR Services $300 Million

EHR Software, Hardware, etc.

Hospital Group retains $140 Million to fund enhancements to EHR, support National HIT Assn., local MSO, etc.

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Advisory Committee

  • Mike Bundy, CIO, Wellmont Health System (TN)
  • Tom Gregorio, CIO, Newark Beth Israel MC (NJ)
  • Arlo Jennings, CIO, Mission Hospitals (NC)
  • Tom Johnson, CIO, DuBois Regional MC (PA)
  • George Morris, CIO, Northwest Community (IL)
  • Dana Moore, CIO, Centura Health, (CO)
  • Dave Selman, CIO, ProMedica, (OH)
  • Martin Tursky, CIO, Aultman Hospital (OH)
  • Will Weider, CIO, Ministry Health Care (WI)
  • Bernie Clement, CIO, East Jefferson General (LA)

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Operational Flow Chart

Medicare Medicaid Physician MSO/ Association Vendor

Equity Return

Hospital Physicians Nat’l HIT Assn.

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Creating the National HIT Association

  • Budget under development

– Needs CIO input – Dues and vendor support – Government payments through physicians reimburse all members

  • Not-for-Profit entity would contract with Strategic Health

Care for staff support services. ED, hired by Board, would run organization day to day.

  • NFP entity would contract with Squire Sanders for legal,

regulatory, compliance services.

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Facilitator MSO Structure – Option 1 Hospital/Physician JV

National MSO/ Association

Local MSO/ Facilitator Hospital Physicians

Equity Return Management and Purchasing Contract

Medical Staff Members

HIT Management Contracts

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Facilitator MSO Structure – Option 2 Hospital Subsidiary

National MSO/ Association

Local MSO/ Facilitator Hospital

Equity Return Management and Purchasing Contract HIT Management Contracts

Medical Staff Members

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Facilitator MSO Structure – Option 3 National MSO/Assn./Physician JV

National MSO/ Association

Local Facilitator/ MSO Physicians

Equity Return Management and Purchasing Contract

Physicians

HIT Management Contracts

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HITECH Act

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HITECH Act

  • American Recovery and Reinvestment Act of

2009 (Stimulus Law) provides $36 billion in funding for health information technology (HIT) and health information exchange (HIE) development

  • Incentive payments to encourage hospitals and

eligible professionals to adopt and use certified EHR systems

  • Successful implementation of the HITECH Act

would transform the healthcare system

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Incentives for Physician Participation

  • Additional health program payments to eligible professionals

demonstrating “meaningful use” of EHR

  • Penalties:

– Phased-in reduction of Medicare payments for eligible professionals not implementing “meaningful use” of EHR – Medicare payment reductions will begin in 2015 for an eligible professional who is not a meaningful EHR user – Reductions to the otherwise-payable fee schedule for covered professional services shall equal:

  • 2015: 1%; 2016: 2%; 2017 and thereafter: 3%
  • 2018 and beyond – Secretary can further reduce payments by

up to 5% if less than 75% of eligible professionals are meaningful EHR users

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Medicare Incentive Payment Schedule

Year First Year Payment 2011 First Year Payment 2012 First Year Payment 2013 First Year Payment 2014 2011 $18,000

  • 2012

12,000 $18,000

  • 2013

8,000 12,000 $15,000

  • 2014

4,000 8,000 12,000 $15,000 2015 2,000 4,000 8,000 12,000 2016 2,000 4,000 8,000 2017 Total $44,000 $44,000 $39,000 $35,000 Total with HPSA 10% $48,400 $48,400 $42,900 $38,500

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Meaningful EHR User - Definition

To demonstrate meaningful use of EHR, an eligible professional must satisfy three requirements: 1. Demonstrate use of certified EHR technology in a meaningful manner, including use for electronic prescribing 2. Demonstrate that certified EHR technology provides for electronic exchange of health information 3. Report on clinical quality measures using the EHR technology

  • Refer to advisory committee recommendations. Final HHS regs

by Spring 2010.

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Legal Issues

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Legal Issues to Consider

  • Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b) and 42

C.F.R. §§ 1001.951 et seq. – Group Purchasing Safe Harbor protects the National HIT Association – Personal Services Safe Harbor and adherence to fair market value principles protects the MSO Facilitator structure

  • Stark Law, 42 U.S.C. § 1395nn and 42 C.F.R. §§ 411.351 et

seq. – No physician participation and no physician referrals at national level means no Stark issue for the National HIT Association – MSO Facilitator implicates Stark law but several exceptions exist to immunize structure

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Legal Issues to Consider

  • Tax-Exempt Implications

– Only applies to non profit tax exempt hospitals, not to for profit hospitals – Established legal principles provide comfort in joint venture setting for MSO Facilitator

  • Control considerations
  • Revenue sharing considerations
  • Antitrust Implications

– Antitrust “safety zone” protects group purchasing aspects of National HIT Association and related purchasing structure

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Legal Issues to Consider

  • The Health Insurance Portability and

Accountability Act of 1996, 42 U.S.C. §§ 1320d et

  • seq. and 45 C.F.R. §§ 160 & 164 (HIPAA)
  • Securities Law Implications
  • State Regulatory Considerations

– State “Stark” Law – State Anti-Kickback Statute – State health and medical records laws

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Next Steps

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  • Call participants will be emailed a

questionnaire and advisory. We want feedback!

  • Interested Board members: please email Paul

Lee at Strategic Health Care

– Paul.Lee@shcare.net – First Board conference call is scheduled for next week – No financial obligation at this time

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Questions?

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Health IT EHR Opportunity September 22, 2009

John M. Kirsner, Esq. Squire, Sanders & Dempsey L.L.P. Partner, Health Care and Life Sciences (614) 365-2722 jkirsner@ssd.com Scott A. Edelstein Squire, Sanders & Dempsey L.L.P. Partner, Health Care and Life Sciences (202) 626-6602 sedelstein@ssd.com Paul M. Lee Strategic Health Care Senior Partner (202) 266-2600 paul.lee@shcare.net