Disclosure. From the London Times... What Is Meaningful Use? 11/7/2011. Overview. The Road to Meaningful Use and Beyond

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1 Disclosure The Road to and Beyond A Simple Overview of a Complex Topic I have no relevant financial relationships to disclose. HIT Subcommittee Dr. Charles King II, Chair Dr. Robert Warren Itara Barnes, Staff Liaison From the London Times... Eggs, Butter, Milk, Flour, Sugar, Salt, Cocoa, Baking Soda That it will ever come into general use, notwithstanding its value, is extremely doubtful; because its beneficial application requires much time and gives a good bit of trouble both to the patient and the practitioner; because its hue and character are foreign and opposed to all our habits and associations of Eggs, Butter, Milk, Flour, Sugar, Salt, Cocoa, Baking Soda Written about the STETHOSCOPE in 1834 Overview What Is the CMS EHR Incentive Program (a.k.a., )? What Is The Value Proposition? Am I An Eligible Provider? Is My EHR Eligible? How Do I Find A Qualified EHR? What Do I Measure? How Do I Measure? How Do I Register and/or Attest? How Do I Get Paid and When? What Do I Do Next? Tips for Success Summary What Is? 1

2 Five Goals Fueling MU improve quality, safety, efficiency, and reduce health disparities privacy and security protections for personal health information Health Outcomes Policy Priorities engage patients and families ARRA Title XIII (HITECH) 2009 (36.3billion) improve population and public health improve care coordination ARRA specifies three components of Use of certified EHR in a meaningful way Use of a certified EHR technology for electronic exchange of health information to improve the quality of health care Use of certified EHR technology to submit clinical quality measures CMS EHR Incentive Program Overview Three Stages of Implementation I. Data Capture and Sharing (2011 and 2012) Collecting structured clinical information electronically II. Advanced Clinical Processes (2013 and 2014) The data follows the patients III. Improved Outcomes (2015 and beyond) Population health improvement What is the Value Proposition? 2

3 The Rest of the Story CMS Medicare Payment Adjustments beginning in 2015 Accountable Care Organization Market Impact: ONC/CMS will publish lists of rs (providers and hospitals) Chronic Care Programs Personal Health Record Platforms Multiple private insurers have declared that future contracting will reflect demonstrated Board certification, MOC, state licensing may include status in the future Patient Centered Medical Home Meaningful Use of EHR Systems Payer Disease / Care Management Health Information Exchange Who is Considered an Eligible Provider? Is my EHR Certified for? Medicare Dr. of Medicine or Osteopathy Dr. of Dental Surgery or Dentistry Dr. of Podiatric Medicine Dr. of Optometry Dr. of Chiropractic Medicine Excludes all NP s Excludes all CNM s Excludes all PA s Medicaid Nurse Practitioners Certified Nurse Midwives PA in FHCQ or in PA led RHC Certification Criteria Assure providers that EHR can support Define key functionalities that can be tested objectively Minimal set supports innovation Both programs exclude hospital based providers Defined as those who submit >90% services billed during the CMS fiscal year (Oct Sept) with place of service codes 21 (inpatient hospital) and/or 23 (emergency room). Both exclude social workers and clinical psychologists Provider Registration Requirements Enroll as a Medicare FFS, MC or MD Provider Use a certified EHR technology o You do not have to provide information on the certified EHR you are using when you register. However, your system must be certified for meaningful use before you can submit attestation and receive an EHR incentive payment. You must register for the EHR Incentive Program o rationuserguide.pdf o NPPES User ID and Password Have an EP NPI and TIN What Do I Measure? 3

4 Stage 1 Criteria Report on EHR Functionality and Interoperability Objectives Core Measures Collect Structured Data Use Computerized Provider Order Entry (CPOE) for medication orders directly entered by any licensed health care professional > 30% who can enter orders into the medical record per state, local, and professional guidelines Generate and transmit permissible prescriptions electronically (Note: only non-controlled substances are permissible) > 40% Maintain an up-to-date problem list of current and active diagnoses > 80% Maintain active medication list > 80% Maintain active medication allergy list >80% Report on 15 Core Functionality and Interoperability Measures Report on Clinical Quality Measures Report on 5/10 Menu Functionality and Interoperability Measures Record and chart changes in vital signs including height, weight, and blood pressure > 50% Record smoking status for patients 13 years old or older > 50% Record demographics including preferred language, gender, race, ethnicity, and date of birth > 50% Practice and Decision Support Implement drug-drug and drug-allergy checks Enabled for full period Implement one clinical decision support rule relevant to specialty or high clinical priority with the ability to track compliance to Implement 1 that rule rule Report Clinical Quality Measures Report ambulatory quality measures to CMS or the States Patient Engagement Provide clinical summaries for patients for each office visit > 50% Provide patients with an electronic copy of their health information > 50% Report on 3 Core/Alternative Core Measures Report on 3/38 Menu Clinical Quality Measures Information Exchange and Care Coordination Capability to exchange key clinical information among providers of care and patient authorized entities electronically Privacy and Security 1 test Protect electronic health information or maintained by the certified EHR technology through the implementation of appropriate technical capabilities Security risk analysis Collect Structured Data Incorporate clinical lab-test results into EHR as structured data Practice and Decision Support Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach 40% of test results Implement drug-formulary checks Implement 1 formulary Patient Engagement Send reminders to patients per patient preference for preventive/follow up care > 20% of pt.s < 5 yoa or > 65 yoa Provide patients with timely electronic access to their health information within 4 business days of the information being available to the EP Information Exchange and Care Coordination Menu Measures The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation The EP who transitions their patient to another setting of care or refers their patient to another provider of care should provide summary care record for each transition of care and referral Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice 1 list >10% > 50% of care transitions > 50% of instances 1 test 1 test CORE EHR Core Clinical Quality Measures (CQM) (3/6 Required) Blood pressure measurement Tobacco use assessment and cessation intervention Adult weight screening and follow-up ALTERNATE Weight assessment and counseling for children and adolescents Influenza immunization for patients >= 50y Childhood immunization status EHR Additional Clinical Quality Measures (CQM) (3/38 Required) (inadequate measures for most subspecialties, including rheumatology) Diabetes: Hemoglobin A1c Poor Control Diabetes: Low Density Lipoprotein (LDL) Management and Control Diabetes: Blood Pressure Management Diabetes: Eye Exam Diabetes: Urine Screening Diabetes: Foot Exam Diabetes: Hemoglobin A1c Control (<8.0%) Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol Coronary Artery Disease (CAD): Oral Anti-platelet Therapy Prescribed for Patients with CAD Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) Pneumonia Vaccination Status for Older Adults Breast Cancer Screening Colorectal Cancer Screening Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients EHR Additional Clinical Quality Measures (CQM) (3/38 Required) (inadequate measures for most subspecialties, including rheumatology) Ischemic Vascular Disease (IVD): Blood Pressure Management Ischemic Vascular Disease (IVD): Use of Aspirin or Another Anti-thrombotic Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) Prenatal Care: Anti-D Immune Globulin Controlling High Blood Pressure Cervical Cancer Screening Chlamydia Screening for Women Use of Appropriate Medications for Asthma Low Back Pain: Use of Imaging Studies Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies 4

5 Medicaid vs. Medicare How Do I Measure? Medicaid Year 1: What does it mean to Adopt, Implement, or Upgrade Adopt: To acquire, purchase, or secure access to certified EHR technology. Implementation: To install or commence utilization of certified EHR technology. Upgrade: To expand the available functionality of certified EHR technology. Medicare Year 1: Attest to 90 days of Meaningful Use Year 2 and beyond: Attest to full year of Year 2: Attest to 90 days of Meaningful Use Year 3 and beyond: Attest to full year of Measuring Up The measures supporting the objectives are reported directly from a certified EHR and will need to be entered in the web-based attestation system to receive an incentive payment. Measures are based on reporting numerators and denominators, and in some cases attesting that a functionality has been enabled and/or tested. Measure denominators are based on o All patients o Patients in the EHR o Patients in specific groups Measure Numerators can be based on actions performed: o For unique patients o For each patient visit As you evaluate your performance on the measures, pay close attention to the data elements that go into the numerator and denominator counts to ensure that you re actions are captured and counted by the EHR system How Do I Get Paid and When? Must choose between Medicare and Medicaid incentives o Allowed one switch o For Medicare based on cap of MAC (75%) o For Medicaid tied to encounter volume Existing EHR users are eligible for incentives Payment goes to provider designated billing Tax ID The entire group does not need to qualify at once CMS anticipates that the incentive payment will be issued to the providers TIN within 15 to 46 days from the time of successful attestation or reporting What Do I Do Next? Tips for success 1)Decide whether to pursue Medicare or Medicaid incentives. 2)Each physician should have a good understanding of. 3)Be patient! 4)Having a certified EHR doesn t guarantee. 5)It s about workflow. 6)Work with your vendor. 7)Pursue stage 1 with stage 2 in mind. 8)Be part of the process! It s not just about the EHR and a list of objectives and measures, it s about better care! 5

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