Purpose of the IncentiveThe HITECH Act established the $17.2 billion fund for EHR incentives. Its purpose is two fold: Move physicians and hospitals toward the meaningful use of a certified EHR, Establish a mechanism to actively exchange patient information among providers
Meaningful Use is driven by five principles• Improving quality, safety and efficiency• Engaging patients in their care• Increasing coordination of care• Improving the health status of the population• Ensuring privacy and security
Who Is Eligible Doctors of medicine or osteopathy Doctors of dental surgery or dental medicine Doctors of podiatric medicine Doctors of optometry ChiropractorsNOTE: Hospital based practitioners are NOT eligible
Physicians wrestle with technical details of meaningful use www.NHINWatch.com Thursday, January 20, 2011Healthcare providers have discovered that identifyingthe technologies to perform some meaningful usemeasures is not as easy as federal rules might suggest.
How much is paid? Medicare – 75% of the allowed charges for professional services provided by physicians up to a total of $44,000 over five years Medicaid – Must have minimum of 30% of Medicaid patient volume unless Pediatrician then only 20% Medicaid volume (Only 2/3) Can receive up to $63,750 over 6 years
Must Choose Medicare or Medicaid For obvious reasons, you must choose to participate under one program or the other. Cannot participate in both. You will receive one payment per year regardless of which program you choose.
Why Medicaid is EasierMEDICAID –Only for first participation year• Adopted –Acquired and Installed Eg: Evidence of installation prior to incentive• Implemented –Commenced Utilization of Eg: Staff training, data entry of patient demographic information into EHR• Upgraded –Expanded Upgraded to certified EHR technology or added new functionality to meet the definition of certified EHR technology• Must be certified EHR technology capable of meeting meaningful use• No EHR reporting period28
Medicare Reporting Period: The reporting period for the EHR Incentive program using a certified EHR is any continuous 90 day period during the first payment year. Note that although the measure specifications assume a full calendar year you should only calculate the denominator and numerator from the first day of the 90 day reporting period to the last day of the 90 day reporting period.
Must Start by 2014 to get Must Start by 2012 to get payments at all Medicare Payment Details full payment CY 2011 CY 2012 CY 2013 CY 2014 CY 2015CY 2011 $18,000CY 2012 $12,000 $18,000CY 2013 $8,000 $12,000 $15,000 Last payment in 2016CY 2014 $4,000 $8,000 $12,000 $12,000CY 2015 $2,000 $4,000 $8,000 $8,000CY 2016 $2,000 $4,000 $4,000 $0TOTAL $44,000 $44,000 $39,000 $24,000 $0
What are the requirements for “meaningful use”?1. Use certified EHR in a meaningfulmanner2. Use certified EHR to exchangepatient health data electronically3. Use certified EHR to submit clinicalquality measures
What is a certified EHR? Must include a clinical data repository and Computerized Physician Order Entry (CPOE) supported by CDS. ePrescribing technology to electronically • transmit prescriptions to pharmacies. Exchange health information electronically with external entities. E-submission of claims complying with HIPAA Claims Attachment regulations Quality reporting metrics.
Certified EHRs Must be certified by an ONC-Authorized Testing and Certification Bodies (ONC- ATCBs). You must get the certification number in order to register for incentive payments Approximately 260 certified ambulatory care EHRs (number is growing every day)
Two Types of CriteriaEHR Functionality Clinical Quality Measures
Functionality Meaningful Use Criteria Defined For eligible professionals, there are a total of 25 meaningful use objectives. To qualify for an incentive payment, 20 of these 25 objectives must be met. There are 15 required core objectives. The remaining 5 objectives may be chosen from the list of 10 menu set objectives. 80% of patients in EHR
EHR Functionality CriteriaCore Set 15 Menu Set 10Mandatory Select 5 20 Criteria Needed
15 Required MU Criteria• 1. Computerized provider order entry (CPOE)• 2. E-Prescribing (eRx)• 3. Report ambulatory clinical quality measures to CMS/States• 4. Implement one clinical decision support rule• 5. Provide patients with an electronic copy of their health information, upon request• 6. Provide clinical summaries for patients for each office visit• 7. Drug-drug and drug-allergy interaction checks• 8. Record demographics• 9. Maintain an up-to-date problem list of current and active diagnoses• 10. Maintain active medication list• 11. Maintain active medication allergy list• 12. Record and chart changes in vital signs• 13. Record smoking status for patients13 years or older• 14. Capability to exchange key clinical information among providers of care and patient-authorized entities electronically• 15. Protect electronic health information
Menu Objectives• 1. Drug-formulary checks (Choose 5)• 2. Incorporate clinical lab test results as structured data• 3. Generate lists of patients by specific conditions• 4. Send reminders to patients per patient preference for preventive/follow up care• 5. Provide patients with timely electronic access to their health information• 6. Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate• 7. Medication reconciliation• 8. Summary of care record for each transition of care/referrals• 9. Capability to submit electronic data to immunization registries/systems*• 10. Capability to provide electronic syndromicsurveillance data to public health agencies*• * At least 1 public health objective must be selected.
Clinical Quality Measures 6 total Clinical Quality Measures 3 core or alternate core, and 3 out of 38 from additional set 2011 –Eligible Professionals are required to submit aggregate CQM numerator, denominator, and exclusion data to CMS or the States by ATTESTATION. 2012 –Eligible Professionals are required to electronically submit aggregate CQM numerator, denominator, and exclusion data to CMS or the States.
Clinical Quality Measures CoreHypertension: Blood Pressure MeasurementPreventive Care and Screening Measure Pair: − a) Tobacco Use Assessment, − b) Tobacco Cessation InterventionAdult Weight Screening andFollow-up
Clinical Quality Measures Alternate Core Weight Assessment and Counseling for Children and Adolescents Preventive Care and Screening: Influenza Immunization for Patients 50 years and older Childhood Immunization Status
Additional Set CQM–EPs must complete 3 of 38• 1. Diabetes: Hemoglobin A1c Poor Control• 2. Diabetes: Low Density Lipoprotein (LDL) Management and Control• 3. Diabetes: Blood Pressure Management• 4. Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or AngiotensinReceptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)• 5. Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)• 6 Pneumonia Vaccination Status for Older Adults• 7. Breast Cancer Screening• 8. Colorectal Cancer Screening• 9. Coronary Artery Disease (CAD): Oral AntiplateletTherapy Prescribed for Patients with CAD• 10. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)• 11. Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment• 12. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation• 13. Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy• 14. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care• 15. Asthma Pharmacologic Therapy• 16. Asthma Assessment• 17. Appropriate Testing for Children with Pharyngitis• 18. Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR)
Best Practices Decide if you want to go for the Medicare or Medicaid incentive program by looking at your numbers. Medicaid is best. Determine the MU and CQM you want to report on. Give this one some thought – big brother is watching. Create a “Meaningful Use” folder on your computer and in your filing cabinet. Document everything. Capture and save/print screen shots of registration. Copy/scan agreements. Seek help.
What Next??Step 1: Familiarize yourself with theCMS EHR Incentive Program websiteStep 2: Contact us for help with registration and attestation.Step 3: Collect EHR Incentive Payments
Frequently Asked Questions• Who is responsible for demonstrating meaningful use of certified EHR technology, the provider or the vendor?• “To receive an EHR incentive payment, the provider (eligible professional (EP), eligible hospital or critical access hospital (CAH)) is responsible for demonstrating meaningful use of certified EHR technology under both the Medicare and Medicaid EHR incentive programs.” CMS Website• In plain English, you are.•
Frequently Asked Questions• What if my electronic health record (EHR) system costs much more than the incentive the government will pay? May I request additional funds?• “The Medicare and Medicaid EHR Incentive Programs provide incentives for the meaningful use of certified EHR technology. The incentives are not a reimbursement of costs, and maximum payments have been set.” CMS Website•
Frequently Asked Questions• Is the physician the only person who can enter information in the EHR in order to qualify for the Medicare and Medicaid EHR Incentive Programs?• “No. Any licensed healthcare professional can enter orders into the medical record per state, local, and professional guidelines. The remaining meaningful use objectives do not specify any requirement for who must enter information.” CMS Website•
Frequently Asked Questions• Are payments from the Medicare and Medicaid EHR Incentive Programs subject to federal income tax?• “We note that nothing in the Act excludes such payments from taxation or as tax-free income. Therefore, it is our belief that incentive payments would be treated like any other income. Providers should consult with a tax advisor or the Internal Revenue Service regarding how to properly report this income on their filings.”• CMS Website•
Frequently Asked Questions• In a group practice, will each provider need to demonstrate meaningful use in order to get Medicare and Medicaid electronic health record (EHR) incentive payments or can meaningful use be calculated or averaged at the group level?• “Yes. Medicare and Medicaid incentive payments are made on a per EP basis, not by practice. Each EP will need to demonstrate the full requirements of meaningful use in order to qualify for the EHR incentive payments”. CMS Website•
We will provide you with a free consultationto help you with Meaningful Use issue and todocument your clinical and financial goals as they relate to EHR technology, develop aroadmap for success and help you to get the most out of your EHR investment. We can help you. Contact us at (800) 431-3454. www.healthinfotexas.com email@example.com