Meaningful Use Attestation                                                     January 11, 2012©2012 The HIT Community, LL...
Welcome!©2012 The HIT Community, LLC. All Rights Reserved.   2
Michael Levinger • President, CEO and Cofounder of The HIT   Community • 30+ years of experience in the successful   use o...
Agenda      • Overview of Federal EHR Incentive Program      • Three Steps to get Federal Incentives               1. Regi...
Poll Question # 1?                                Where are attendees in the                                 implementatio...
Federal EHR Program Summary                                                     One Hundred Eleventh      • The Federal go...
Government ARRA Incentives for EHR         As much as $44,000 per provider              As much as $63,750 per provider   ...
Who is Eligible for Payment?      Medicaid                                       Medicare      • Professionals            ...
Meaningful Use Goals      The use of Health IT to:      • Improve quality, safety, efficiency, and reduce health dispariti...
Three Stages of Meaningful Use                                                                                            ...
Certification      • A defined process to ensure that EHR technologies meet        the technical requirements to achieve m...
Poll Question # 2?                             Where are attendees in the                                attestation proce...
What do I need to do to receive my        Medicare /Medicaid Incentive Payment?                                  1. Regist...
Registration                                                     2. Decide whether                 1. See if your state is...
Information Needed to Register      Eligible Professionals      • National Provider Identifier (NPI).      • National Plan...
Achieve Meaningful Use                   Stage 11 Criteriafor MeaningfulUse Focus On:                    Stage Criteria fo...
Meaningful Use Stage 1 Summary                                                 Eligible Professionals                     ...
Example Quality Measure©2012 The HIT Community, LLC. All Rights Reserved.   18
Poll Question # 3?       Have attendees defined the meaningful           use measures they are using?©2012 The HIT Communi...
Medicaid Attestation – Varies by State   Register using the CMS system described earlier. Use CMS web-based   Registration...
Critical Success Factors      • Issue: Need the right information to attest               –     What measures?            ...
Critical Success Factors      • Issue: Your EHR system must support tracking the        information for attestation       ...
Critical Success Factors      • Issue: Can get ―caught‖ by attestation details               – The CMS Medicare attestatio...
Critical Success Factors      • Issue: Timing is important to maximizing payment               – When you attest will affe...
What do I need to do to receive my      Medicare/Medicaid EHR incentive payment?                                          ...
Detailed Attestation Information           Meaningful Use Objectives           Quality Measures           APPENDIX©2012 Th...
Information Needed to Register      Eligible Professionals      • National Provider Identifier (NPI).      • National Plan...
Medicare Attestation Details      1. Use CMS web-based Registration and Attestation System at https://ehrincentives.cms.go...
Eligible Professional Core Objectives   1.     Use CPOE for medication orders                    11. Implement one clinica...
Eligible Professional Menu Objectives      1.     Implement drug formulary checks.                                        ...
Eligible Professional Quality Measures      Must report on 6 total measures:      •    3 required core measures (substitut...
Eligible Professional Quality Measures          Measure                                                                   ...
Detailed Information & Help      • htttp://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAtt        estation.asp     ...
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HITC Attestation Webinar 1.11.12

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HITC Attestation Webinar 1.11.12

  1. 1. Meaningful Use Attestation January 11, 2012©2012 The HIT Community, LLC. All Rights Reserved. 1
  2. 2. Welcome!©2012 The HIT Community, LLC. All Rights Reserved. 2
  3. 3. Michael Levinger • President, CEO and Cofounder of The HIT Community • 30+ years of experience in the successful use of mission-critical software including EHRs and Health Information Technology • On the faculty of Boston University teaching a masters degree course on Electronic Health Records • Serves as the Health IT ―Ask the Expert‖ for Pri-Med • Member of Massachusetts REC workgroup on Health IT Workforce Development©2012 The HIT Community, LLC. All Rights Reserved. 3
  4. 4. Agenda • Overview of Federal EHR Incentive Program • Three Steps to get Federal Incentives 1. Registration 2. Meaningful Use 3. Attestation • Critical Success Factors for Attestation©2012 The HIT Community, LLC. All Rights Reserved. 4
  5. 5. Poll Question # 1? Where are attendees in the implementation process?©2012 The HIT Community, LLC. All Rights Reserved. 5
  6. 6. Federal EHR Program Summary One Hundred Eleventh • The Federal government will pay for Congress of the – Meaningful Use United States of – Of a Certified EHR America • What is Meaningful Use? AT THE FIRST SESSION – A set of government definitions Begun and held at the City of Washington on Tuesday, of how to use an EHR the sixth day of January, two thousand and nine – Defines the impact of EHRs on An Act Healthcare Delivery and Quality • What is Certification? – Government specifications – Indicate whether an HER can support Meaningful Use • Certification and Meaningful Use work together©2012 The HIT Community, LLC. All Rights Reserved. 6
  7. 7. Government ARRA Incentives for EHR As much as $44,000 per provider As much as $63,750 per provider • Must be eligible professionals (NOT • Eligible professionals (NOT hospital- hospital-based) that are meaningful based) that are meaningful EHR users EHR users • Must meet Medicaid volume levels • Paid over five years • Payment for up to six years • Disincentives if don’t deploy EHR • Up to 85% of the costs for certified EHR system, payments will be cut technology and support services – 1% in 2015 • Pediatricians can receive up to $42,500 at – 2% in 2016 lower thresholds – 3% in 2017 • Maximum of $21,250 in the first year, $8,500 in subsequent years, up to a total Lots of “fine print” of $63,750 over total time frame • No payments after 2021©2012 The HIT Community, LLC. All Rights Reserved. 7
  8. 8. Who is Eligible for Payment? Medicaid Medicare • Professionals • Professionals – Physicians (non-hospital – Doctor of Medicine affiliated) – Osteopathy – Nurse Practitioners – Dental Surgery, Dental – Physician Assistants (PA) in Medicine FQHC or rural health clinic – Podiatric Medicine led by PA – Optometry • Hospitals – Chiropractor – Acute Care Hospitals • Hospitals – Critical Access Hospitals – Acute Care Hospitals – Children’s Hospitals – Critical Access Hospitals©2012 The HIT Community, LLC. All Rights Reserved. 8
  9. 9. Meaningful Use Goals The use of Health IT to: • Improve quality, safety, efficiency, and reduce health disparities • Engage patients and families • Improve care coordination • Improve population and public health • Further the goal of information exchange among health professionals • Ensure adequate privacy and security protections for personal health information Defined by Centers for Medicare and Medicaid Services (CMS)©2012 The HIT Community, LLC. All Rights Reserved. 9
  10. 10. Three Stages of Meaningful Use Stage 3 – 2015 • Final Stage Stage 2 - 2013 • Focus is data use to impact outcomes • Advanced Clinical • Providers will demonstrate Processes improvement in • Builds upon Stage 1 quality, safety and • Focused on data efficiency Stage 1 - 2011-2012 aggregation and quality • Clinical decision support improvement at the point • Data Capture & Sharing. • Patient management tools of care and electronic • Concentration on exchange of information electronic capture and sharing of health information in a structured format©2012 The HIT Community, LLC. All Rights Reserved. 10
  11. 11. Certification • A defined process to ensure that EHR technologies meet the technical requirements to achieve meaningful use. • Includes: – Security – Data confidentiality – Can work with other systems to share information – Can perform a set of well-defined functions needed for Meaningful Use • Administered by the Federal Office of the National Coordinator of HIT (ONCHIT)©2012 The HIT Community, LLC. All Rights Reserved. 11
  12. 12. Poll Question # 2? Where are attendees in the attestation process?©2012 The HIT Community, LLC. All Rights Reserved. 12
  13. 13. What do I need to do to receive my Medicare /Medicaid Incentive Payment? 1. Register for the EHR Incentive Program; 2. Meet Meaningful Use criteria using certified EHR technology; and 3. Attest that have met meaningful use.©2012 The HIT Community, LLC. All Rights Reserved. 13
  14. 14. Registration 2. Decide whether 1. See if your state is to participate in 3. Register ready to participate the Medicare or Medicaid program State must be Register at: EPs can switch once ready to register for https://ehrincentives.c before 2015 Medicaid program ms.gov/ Most states are If eligible, Medicaid Requires Standard ready by Jan. 2012 provides a higher CMS Registration potential payment Information Some hospitals are See Appendix for dually-eligible for Details of Information both Programs Required©2012 The HIT Community, LLC. All Rights Reserved. 14
  15. 15. Information Needed to Register Eligible Professionals • National Provider Identifier (NPI). • National Plan and Provider Enumeration System (NPPES) User ID and Password. • Payee Tax Identification Number (if you are reassigning your benefits). • Payee National Provider Identifier (NPI) (if you are reassigning your benefits). • An EP can designate a third party to register and attest on their behalf Eligible Hospitals and Critical Access Hospitals (CAHs) • CMS Identity and Access Management (I&A) User ID and Password. • CMS Certification Number (CCN). • National Provider Identifier (NPI). • Hospital Tax Identification Number©2012 The HIT Community, LLC. All Rights Reserved. 15
  16. 16. Achieve Meaningful Use Stage 11 Criteriafor MeaningfulUse Focus On: Stage Criteria for Meaningful Use Focus On: Using that Communicating Reporting of Electronically information to that information clinical quality capturing track key for care measures and health clinical coordination public health information conditions purposes information©2012 The HIT Community, LLC. All Rights Reserved. 16
  17. 17. Meaningful Use Stage 1 Summary Eligible Professionals Meet 20 of 25 objectives plus 6-9 quality measures 6 total Clinical Quality 15 required core 5 objectives chosen Measures (3 core or objectives. from a list of 10 menu alternate core, and 3 out set objectives. of 44 from alternate set) Eligible Hospitals and Critical Access Hospitals Meet 19 of 24 objectives plus 15 quality measures 5 objectives chosen 14 required core 15 clinical quality from a list of 10 menu objectives. measures set objectives.©2012 The HIT Community, LLC. All Rights Reserved. 17
  18. 18. Example Quality Measure©2012 The HIT Community, LLC. All Rights Reserved. 18
  19. 19. Poll Question # 3? Have attendees defined the meaningful use measures they are using?©2012 The HIT Community, LLC. All Rights Reserved. 19
  20. 20. Medicaid Attestation – Varies by State Register using the CMS system described earlier. Use CMS web-based Registration and Attestation System at https://ehrincentives.cms.gov/ Illinois Attestation is via MEDI https://secure.myhfs.illinois.gov/login/Authen ticateUserRoamingEPF.html For more on Illinois Medicaid payments see: http://hfs.illinois.gov/ehr/path.html©2012 The HIT Community, LLC. All Rights Reserved. 20
  21. 21. Critical Success Factors • Issue: Need the right information to attest – What measures? – How computed? – Where does the information come from? – GIGO • Action Recommendation – Define which measures you are using – Understand the calculations for each measure - CMS has detailed definitions – Insure revised workflow captures this information – Must train staff to know what information you need and that they must capture it©2012 The HIT Community, LLC. All Rights Reserved. 21
  22. 22. Critical Success Factors • Issue: Your EHR system must support tracking the information for attestation – EHR must have the right fields – Not all vendors have all the MU measures in place – especially quality measures – Must be easy to enter the right information into those fields – Must be able to get reports with the right information • Action Recommendation – Meaningful Use information requirements must be part of EHR selection – Meaningful Use information requirements must be part of EHR implementation – Work with vendor or any consultants or REC to make sure the correct reports are available – Train users on how to enter and access information in your EHR©2012 The HIT Community, LLC. All Rights Reserved. 22
  23. 23. Critical Success Factors • Issue: Can get ―caught‖ by attestation details – The CMS Medicare attestation rules have some tricky details. – Some examples • You are asked to provide an EHR Certification number - which is not the same as the Certified Health IT Product List (CHPL) Product number assigned during the certification process, EHR Provider Number • A hospital must decide if it is using the observation services method for calculating emergency department (ED) visits or if all visits were counted • Computing the core and quality measures can be tricky • Action Recommendation – Clearly define your Meaningful Use information requirements – Define a process to access, compute and review the information – Have the information ready and completed before going online – Use the CMS Attestation User Guides and Worksheets©2012 The HIT Community, LLC. All Rights Reserved. 23
  24. 24. Critical Success Factors • Issue: Timing is important to maximizing payment – When you attest will affect the timing of incentive payments… – … and could also impact when you must attest for stage 2 – Medicare schedule – the schedule is subject to change • Action Recommendation – Understand when you can realistically start implementing an EHR – Don’t underestimate how long and complex implementation can be – Start by 2013 to assure full payment – Keep informed about rule changes©2012 The HIT Community, LLC. All Rights Reserved. 24
  25. 25. What do I need to do to receive my Medicare/Medicaid EHR incentive payment? Successfully register for the EHR Incentive Program Meet meaningful use criteria using certified EHR technology Successfully attest that you have met meaningful use criteria using certified EHR technology©2012 The HIT Community, LLC. All Rights Reserved. 25
  26. 26. Detailed Attestation Information Meaningful Use Objectives Quality Measures APPENDIX©2012 The HIT Community, LLC. All Rights Reserved. 26
  27. 27. Information Needed to Register Eligible Professionals • National Provider Identifier (NPI). • National Plan and Provider Enumeration System (NPPES) User ID and Password. • Payee Tax Identification Number (if you are reassigning your benefits). • Payee National Provider Identifier (NPI) (if you are reassigning your benefits). • An EP can designate a third party to register and attest on their behalf Eligible Hospitals and Critical Access Hospitals (CAHs) • CMS Identity and Access Management (I&A) User ID and Password. • CMS Certification Number (CCN). • National Provider Identifier (NPI). • Hospital Tax Identification Number©2012 The HIT Community, LLC. All Rights Reserved. 27
  28. 28. Medicare Attestation Details 1. Use CMS web-based Registration and Attestation System at https://ehrincentives.cms.gov/ 2. Currently you attest for the Medicare EHR Incentive Program in your first year of participation • Need to have met meaningful use for a consecutive 90-day reporting period • If initial attestation fails, you can select a different 90-day reporting period that may partially overlap with a previously reported 90-day period. • To attest for the Medicare EHR Incentive Program in subsequent years, you will need to have met meaningful use for a full year. • The reporting period for eligible professionals must fall within the calendar year, • The reporting period for eligible hospitals and critical access hospitals must fall during the Federal fiscal year. • At some point (likely in 2012), submission will be directly from an EHR system 3. To attest • Fill in numerators and denominators for the meaningful use objectives and clinical quality measures, Note: EHR system will provide a report of the numerators, denominators and other information to enter that data into our online Attestation System. • indicate if they qualify for exclusions to specific objectives, and • legally attest that they have successfully demonstrated meaningful use. • Provide a CMS EHR Certification ID that identifies the certified EHR technology being used to demonstrate meaningful use. This can be obtained by entering the certified EHR technology product information at the Certified Health IT Product List (CHPL) on the ONC website: http://healthit.hhs.gov/chpl • Providers will qualify for a Medicare EHR incentive payment upon completing a successful online submission through the Attestation System—immediately after submitting results you will see a summary of your attestation, and whether or not it was successful. 4. Payment • Payments for the Medicare EHR Incentive Program will be made approximately four to eight weeks after successfully attesting. • Payments will be held for eligible professionals until eligible professionals meet the $24,000 threshold in allowed charges. • Payments to Medicare providers will be made to the taxpayer identification number (TIN) selected at registration • Payment will be check or electronic funds transfer the same as Medicare payments • CMS will deposit payment in the first bank account on file. It will appear on your bank statement as "EHR Incentive Payment‖ • Medicare Administrative Contractors (MACs), carriers and fiscal intermediaries will not be making these payments. CMS has contracted with a Payment File Development Contractor to make these payments. • Payments can be for taxes or nontax offsets • Payments are subject to audit©2012 The HIT Community, LLC. All Rights Reserved. 28
  29. 29. Eligible Professional Core Objectives 1. Use CPOE for medication orders 11. Implement one clinical decision support rule 2. Implement drug-drug and drug-allergy relevant to specialty or high clinical priority interaction checks. along with the ability to track compliance with 3. Maintain an up-to-date problem list of current that rule. and active diagnoses. 12. Provide patients with an electronic copy of 4. Generate and transmit permissible prescriptions their health information (including diagnostics electronically (eRx). test results, problem list, medication lists, medication allergies) upon request. 5. Maintain active medication list. 13. Provide clinical summaries for patients for 6. Maintain active medication allergy list. each office visit. 7. Record specified demographics 14. Capability to exchange key clinical information 8. Record specified vital signs among providers of care and patient authorized entities electronically. 9. Record smoking status for patients 13 years old or older. 15. Protect electronic health information created or maintained by the certified EHR technology 10. Report ambulatory clinical quality measures to through the implementation of appropriate CMS or, in the case of Medicaid EPs, the technical capabilities. States.©2012 The HIT Community, LLC. All Rights Reserved. 29
  30. 30. Eligible Professional Menu Objectives 1. Implement drug formulary checks. Must Achieve Five! 2. Incorporate clinical lab-test results into EHR as structured data. 3. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. 4. Send patient reminders per patient preference for preventive/follow-up care. 5. Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP. 6. Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. 7. 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. 8. The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral. 9. Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice. 10. Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice.©2012 The HIT Community, LLC. All Rights Reserved. 30
  31. 31. Eligible Professional Quality Measures Must report on 6 total measures: • 3 required core measures (substituting alternate core measures where necessary) and • 3 additional measures. • A maximum of 9 measures would be reported if the Eligible Provider needed to attest to the 3 required core, the three alternate core, and the 3 additional measures. Core Measures: • Hypertension: Blood Pressure Measurement • Tobacco Use Assessment and Tobacco Cessation Intervention • Adult Weight Screening and Follow-up (BMI) Alternative Core Measures: • If the denominator for one or more of the Core Measures is zero, Eligible Providers will be required to report results for up to three Alternate Core Measures. • The Measures are Weight Assessment and Counseling for Children and Adolescents (BMI) • Preventive Care and Screening: Influenza Immunization for Patients ≥ 50 Years Old • Childhood Immunization Status Clinical Quality Measures - Eligible Providers must choose 3 of 44. Next slide summarizes the 44.©2012 The HIT Community, LLC. All Rights Reserved. 31
  32. 32. Eligible Professional Quality Measures Measure Recommended Measure TitleMeasure Developer Title0001 AMA Asthma Assessment0002 NCQA Appropriate Testing for Children with Pharyngitis0004 NCQA Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: (a) Initiation, (b) Engagement0012 AMA Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)0013 AMA Hypertension: Blood Pressure Measurement0014 AMA Prenatal Care: Anti-D Immune Globulin0018 NCQA Controlling High Blood Pressure0024 NCQA Weight Assessment and Counseling for Children and Adolescents0027 NCQA 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 Strategies0028a AMA Preventive Care and Screening Measure Pair: a.Tobacco Use Assessment0028b AMA Preventive Care and Screening Measure Pair: b.Tobacco Cessation Intervention0031 NCQA Breast Cancer Screening0032 NCQA Cervical Cancer Screening0033 NCQA Chlamydia Screening for Women0034 NCQA Colorectal Cancer Screening0036 NCQA Use of Appropriate Medications for Asthma0038 NCQA Childhood immunization Status0041 AMA Preventive Care and Screening: Influenza Immunization for Patients ≥ 50 Years Old0043 NCQA Pneumonia Vaccination Status for Older Adults0047 AMA Asthma Pharmacologic Therapy0052 NCQA Low Back Pain: Use of Imaging Studies0055 NCQA Diabetes: Eye Exam0056 NCQA Diabetes: Foot Exam0059 NCQA Diabetes: HbA1c Poor Control0061 NCQA Diabetes: Blood Pressure Management0062 NCQA Diabetes: Urine Screening0064 NCQA Diabetes: LDL Management & Control0067 AMA Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD0068 NCQA Ischemic Vascular Disease (IVD): Use of Aspirin or another Antithrombotic0070 AMA Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)0073 NCQA Ischemic Vascular Disease (IVD): Blood Pressure Management0074 AMA Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol0075 NCQA Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control0081 AMA Heart Failure (HF) : Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)0083 AMA Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)0084 AMA Heart Failure (HF) : Warfarin Therapy Patients with Atrial Fibrillation0086 AMA Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation0088 AMA Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy0089 AMA Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care0105 NCQA Anti‐depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment0385 AMA Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients0387 AMA Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer0389 AMA Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients0421 QIP Adult Weight Screening and Follow-Up0575 NCQA Diabetes: HbA1c Control (<8%)
  33. 33. Detailed Information & Help • htttp://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAtt estation.asp • Contact: EHR Information Center Hours of Operation: 7:30 a.m. – 6:30 p.m. (CT) Monday through Friday, except federal holidays. 888-734-6433 (primary number) 888-734-6563 (TTY Number) • Contact your HIT Regional Extension Center©2012 The HIT Community, LLC. All Rights Reserved. 33

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