Regulatory Environment: Other Regulations

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HI-FIVE: Health Informatics For Innovation, Value & Enrichment (Clinical Perspective)

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Columbia University

HI-FIVE: Health Informatics For Innovation, Value & Enrichment (Clinical Perspective)

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HI-FIVE (Health Informatics For Innovation, Value & Enrichment) Training is a 12-hour online course designed by Columbia University in 2016, with sponsorship from the Office of the National Coordinator for Health Information Technology (ONC). The training is role-based and uses case scenarios. Also, it has additional, optional modules on other topics of interest or relevance. Although we suggest to complete the course within a month's timeframe, the course is self-paced and so you can start and finish the course at anytime during a month's time period. No additional hardware or software are required for this course. Our nation’s healthcare system is changing at a rapid pace. Transformative health care delivery programs depend heavily on health information technology to improve and coordinate care, maintain patient registries, support patient engagement, develop and sustain data infrastructure necessary for multi-payer value-based payment, and enable analytical capacities to inform decision making and streamline reporting. The accelerated pace of change from new and expanding technology will continue to be a challenge for preparing a skilled workforce so taking this training will help you to stay current in the dynamic landscape of health care. This course is one of three related courses in the HI-FIVE training program, which has topics on population health, care coordination and interoperability, value-based care, healthcare data analytics, and patient-centered care. Each of the three courses is designed from a different perspective based on various healthcare roles. This first course is from a clinical perspective, geared towards physicians, nurse practitioners, physician assistants, nurses, clinical executives and managers, medical assistants, and other clinical support roles. However, we encourage anyone working in healthcare, health IT, public health, and population health to participate in any of the three trainings. If you would like to obtain continuing medical education (CME) or continuing nursing education (CNE) credits, you will need to have eligible credentials, complete the entire course, and complete the evaluation survey at the end. The HI-FIVE team verifies after each month that these requirements have been met and then a separate certificate (fee may apply) is distributed to you from our accreditation office. Please allow time for processing. If you have any further questions about continuing education, please see our website at www.hi-fivetraining.org. Accreditation Statement The College of Physicians and Surgeons of Columbia University is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. AMA Credit Designation Statement The College of Physcians and Surgeons designates this enduring material for 12.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The planning committee members are: Rita Kukafka, DrPH, MA, FACMI; Bruce Forman, MD; Gil Kuperman, MD, PhD; Virginia Lorenzi, MS, CPHIMS, FHL7, and Victoria Tiase, MSN, BN. None of the members of the committee, who planned this CME Activity, have any relevant financial relationships to disclose. The release date is 2/1/17 and the expiration date is 1/31/18. This activity is eligible for 12 continuing nursing education (CNE) credits. Columbia University School of Nursing, Continuing Nursing Education Program is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

从本节课中

Role-Based Content (OPTIONAL) - Physicians / Nurse Practitioners / Physician Assistants / Clinical Executives / Clinical Managers / Public Health Professionals

This module is optional, but has additional topics that you may be interested based on your role. We encourage you to explore any of these topics and there are also quizzes to test your learning.

Regulatory Environment: Rationale for Reform0:00

Regulatory Environment: The Affordable Care Act0:00

Regulatory Environment: Other Regulations0:00

Value-Based Quality and Safety: Overview17:30

Value-Based Quality and Safety: Measurement of Value-Based Care20:41

Value-Based Quality and Safety: Reporting Quality Performance Measures14:18

Value-Based Quality and Safety: Patient Experience14:25

Value-Based Quality and Safety: Process Improvement16:38

Outcomes and Reimbursements: Foundations31:41

Outcomes and Reimbursements: Consumer Understanding of Quality and Cost31:47

Contracts and Payments: Overview29:03

与讲师见面

Rita Kukafka
Associate Professor
Biomedical Informatics

Welcome to Value-Based Care, Regulatory Environment.

This is lecture c.

In this lecture, we will discuss other key pieces of legislation,

the Health Information Technology for Economic and Clinical Health or

HITECH Act, the Medicare Access and CHIP Reauthorization Act or

MACRA, and the Physician Quality Reporting System.

The objectives for this lecture, other regulations are to describe

the Health Information Technology for Economic and Clinical Health Act or

HITECH Act, describe the Medicare Access and CHIP Reauthorization Act or

MACRA, and describe the Physician Quality Reporting System, PQRS.

Strategies for improving the healthcare delivery system emphasize increased

coordination across providers and the continuum of care,

including transfer of information about patients across these providers.

The availability of clinical decision support tools, so

that clinicians can make informed decisions on behalf of their patients, and

payment approaches that incentivize providers to improve the quality of

care and produce good health outcomes.

The glue or mechanism for delivery system redesign is the availability and

use of health information technology or HIT.

HIT can improve the flow of information.

However, for a long time, the United States was behind other

countries in adopting HIT within the delivery system.

For example, in this chart produced by the Commonwealth Fund,

in 2006, only 28% of US primary care physicians had electronic medical records

To address the slow pace of adoption of health information technology, Congress

passed the Health Information Technology for Economic and Clinical Health, or

HITECH Act, as a part of the American Recovery and Reinvestment Act of 2009.

The act authorized the spending of nearly $44.7 billion to support providers

becoming meaningful users of electronic health records specifically,

and health information technology more broadly.

Qualifying physicians and institutions received incentives not just for

purchasing HIT systems and EMRs, but

also by demonstrating that they were using the systems in a meaningful way.

The Centers for Medicare and Medicaid Services developed the regulations

governing requirements for meaningful use.

Using EHR in a meaningful way means that the technology is being used in

the manner for which it was intended, such as e-prescribing, the electronic

exchange of health information and to submit quality measures.

Goals for meaningful use are to improve quality, engage patients in their

healthcare, improve care coordination and to improve population health,

while maintaining the privacy and security of the patient's information.

The HITECH Act has been successful at speeding the adoption of information

technology in hospitals.

This study by Julia Adler-Milstein and her colleagues using data from

the American Hospital Association charts the growth in electronic health

record adoption among general acute care hospitals in the US.

The researchers found that 75% of hospitals had at least a basic

system in 2014, up from 59% in 2013.

In 2014, 34% of hospitals had comprehensive

systems compared to 25% of hospitals in 2013.

Despite this progress, small and

rural hospitals were less likely to have at least a basic system.

Among hospitals that did not meet the threshold for

having a basic EHR, most had adopted some functionality with about

75% of this group with eight or more basic EHR functions in place.

The requirements for

receiving incentives were designed to become more stringent over time in stages.

For instance, the percentage of patients for

whom e-prescribing was used increased in stage two compared to stage one.

And stage two also required hospitals to develop systems to exchange

clinical information using a certified EHR in order to receive monthly payments.

By 2014, 76% of hospitals reported being able to

exchange information with providers outside the system,

an improvement from 41% in 2008.

HITECH not only encouraged the adoption of electronic health records in hospitals,

but in physician offices as well.

By 2013, 78% of office-based physicians

reported adopting some type of EHR system with 48%,

having a basic system defined as having seven electronic capabilities.

Recording patient history and demographic information,

maintaining patient problem lists, recording clinical notes,

recording medication and allergy lists, viewing lab results,

viewing imaging reports and using computerized prescription ordering.

Despite the fairly rapid adoption of EHRs,

post-implementation of HITECH, only 39% of office-based physicians

reported having any health information exchange with other providers.

So in terms of promoting adoption of EHRs, HITECH was fairly successful, but

many of the changes leading to increased quality of care that were envisioned and

had begun, but were not yet widespread in 2015.

The Physician Quality Reporting System was started in 2006,

as part of the Tax Relief and Health Care Act.

Providers who participated in the program would transmit quality metrics for

their Medicare patients to the Centers for Medicare and Medicaid Services.

As a result of the Affordable Care Act, beginning in 2015,

physicians' providers will now receive penalties if they do not satisfactorily

report their quality measures for Medicare Part B, physician component services.

Additional legislation, known by the acronym MACRA, increased the pressure to

focus not just on adoption of EHRs, but on using them to improve the quality of care.

Medicare fee for service reimbursement to doctors has long

been based on what is known as the sustainable growth rate formula or SGR.

The SGR formula sought to limit spending growth in the Medicare fee for service

model that rewarded physicians for the number and intensity of services provided.

It reduced fees paid to physicians, if overall physician spending

exceeded some target based on overall economic growth.

That is if physician expenditures, for a previous year, were greater than expected,

reimbursement to physicians, in the subsequent year, would be reduced.

A study published by the Commonwealth Fund described a number of

criticisms of the SGR including that it cuts fees for every service, and

for every provider under the Medicare fee schedule,

regardless of the provider's contribution to spending growth.

Lacks incentives for improving quality, fails to address volume and

intensity which are significant drivers of Medicare spending growth and

penalizes providers who do control their costs.

The Medicare Access and CHIP Reauthorization Act or MACRA,

authorized in 2015, is intended to not only reduce

uncertainty associated with physician payments, but

also to reduce the emphasis on volume based fee-for-service reimbursement.

Under MACRA, physician fees will increase by .5% until 2019,

and then will remain level through 2025.

MACRA also supports alternative payment models,

such as Accountable Care Organizations and Patient-Centered Medical Homes.

To encourage high quality performance among physicians,

the Merit-Based Incentive program or MIPS will be established in 2019.

MIPS consolidates and replaces three existing payment programs.

The physician quality reporting system that encourages practices to

report on the quality of care provided to Medicare beneficiaries,

the EHR Incentive Program that we discussed in the previous slides, and

the physician value-based modifier that adjust payments based on performance.

Providers that participate in alternative payment models or,

example, Accountable Care Organizations or

Patient-Centered Medical Homes, can receive additional payments.

Or, if eligible, those in alternative payment arrangements can choose

to opt out of the MIPS, but they are required to use certified EHR technology.

MACRA creates four categories of measures that are weighted to create

an overall MIPS score.

These include quality, resource use,

clinical improvement activities and meaningful use of EHR technology.

Under MACRA, the previous incentive programs are changing from standalone

programs with often conflicting requirements to better aligned and

coordinated programs.

CMS is currently in the rule-making stage,

which will better define how the merit-based performance program will work.

This concludes lecture c on Regulatory Environment.

In this lecture, we discussed two additional pieces of legislation

that will have substantial impact on how care is provided.

The HITECH Act provided incentives to encourage the meaningful use of

electronic health records.

Since the Act's passage, the US has seen significant growth in

the use of EHRs in hospitals and in physicians' offices.

MACRA changes how physicians are reimbursed within Medicare.

The new reimbursement mechanism is intended to incentivize

doctors to improve the quality of care.

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