EHR Incentive Program Final Rule:  How Clinicians  Can Qualify for  Meaningful Use  & Federal Incentives Prepared by the T...
<ul><li>An Overview of the Final Rule </li></ul>Support for the Tri-State REC is provided under cooperative agreement 90RC...
<ul><li>The ARRA/HITECH Act authorizes incentive funding for health care providers who demonstrate  “meaningful use of hea...
MU Definition <ul><li>Meaningful use (MU) is defined as:  </li></ul><ul><li>Use of a certified  Electronic Health Record (...
MU = Health Care Transformation  Quality reporting Clinical Decision Support Improving care coordination Engaging patients...
Meaningful Use –  Who is eligible for incentives?  * Hospital-based professionals excluded from incentives Eligible Provid...
MU Final Rule  <ul><li>Move away from “all or nothing approach.”  </li></ul><ul><li>There are 15 core requirements for Eli...
Meaningful Use (MU) Final Rule – EPs – Core Set **  <ul><li>Core </li></ul><ul><li>Use computerized order entry for medica...
<ul><li>Menu:  </li></ul><ul><li>Implement drug-formulary checks. </li></ul><ul><li>Incorporate clinical lab-test results ...
MU Final Rule  <ul><li>Other changes: </li></ul><ul><li>Thresholds reduced on many requirements (e.g., reduced from 80% do...
MU Final Rule  <ul><li>Other changes: </li></ul><ul><li>Clinical quality measurements for specialists eliminated in Stage ...
Timeline for  Medicare*  Incentive Payments   <ul><li>Fall 2010 - Certification of EHR vendors will start </li></ul><ul><l...
Medicare Incentives  MEDICARE EP Incentive Payment -  Based on First Calendar Year EP receives Calendar Year CY 2011 CY 20...
Medicaid Incentives MEDICAID EP Incentive Payment -  Based on First Calendar Year EP receives Calendar Year CY 2011 CY 201...
Medicaid MU Thresholds To qualify for Medicaid incentives, EPs and Hospitals must meet certain patient volume thresholds: ...
The Challenges  <ul><li>The final government regulations are  complex (864 pages long) .  </li></ul><ul><li>As many as 30%...
<ul><li>Additional Information </li></ul><ul><li>HealthBridge Tri-State Regional Extension Center  </li></ul><ul><li>www.h...
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Meaningful Use Overview Presentation

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  • So, why are we doing this? Technology is absolutely necessary for change…but it is not sufficient. Collaboration is necessary to achieve the promise of higher quality, lower cost health care.
  • Meaningful Use Overview Presentation

    1. 1. EHR Incentive Program Final Rule: How Clinicians Can Qualify for Meaningful Use & Federal Incentives Prepared by the Tri-State REC Team Support for the Tri-State REC is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services .
    2. 2. <ul><li>An Overview of the Final Rule </li></ul>Support for the Tri-State REC is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services .
    3. 3. <ul><li>The ARRA/HITECH Act authorizes incentive funding for health care providers who demonstrate “meaningful use of health information technology.” </li></ul><ul><li>The federal government will pay physicians who meet meaningful use (MU): </li></ul><ul><ul><li>Up to $44K under Medicare or </li></ul></ul><ul><ul><li>Up to $63,750 under Medicaid </li></ul></ul><ul><li>Eligible hospitals can receive millions. </li></ul><ul><li>MU Final Rule was published on July 13, 2010. </li></ul>Meaningful Use & Incentives
    4. 4. MU Definition <ul><li>Meaningful use (MU) is defined as: </li></ul><ul><li>Use of a certified Electronic Health Record (EHR) </li></ul><ul><li>Electronic exchange of health information </li></ul><ul><li>Quality reporting </li></ul>
    5. 5. MU = Health Care Transformation Quality reporting Clinical Decision Support Improving care coordination Engaging patients Managing Population Health Meaningful Use Quality Improvement Technology Practice Redesign Exchange
    6. 6. Meaningful Use – Who is eligible for incentives? * Hospital-based professionals excluded from incentives Eligible Providers - Medicare Eligible Providers - Medicaid Eligible Professionals (EPs)* Eligible Professionals (EPs) Doctor of Medicine or Osteopathy Physicians (Pediatricians have special eligibility & payment rules) Doctor of Dental Surgery or Dental Medicine Nurse Practitioners (NPs) Doctor of Podiatric Medicine Certified Nurse-Midwives (CNMs) Doctor of Optometry Dentists Chiropractor Physician Assistants (PAs) who lead a FQHC)or rural health clinic Eligible Hospitals* Eligible Hospitals Acute Care Hospitals Acute Care Hospitals, Critical Access Hospitals Critical Access Hospitals (CAHs) Children’s Hospitals
    7. 7. MU Final Rule <ul><li>Move away from “all or nothing approach.” </li></ul><ul><li>There are 15 core requirements for Eligible Professionals </li></ul><ul><li>There are 14 core requirements for Hospitals. </li></ul><ul><li>There are also a “menu” of 10 additional requirements from which 5 must be chosen. </li></ul>Eligible Professionals Eligible Hospitals Must meet 15 core + 5 menu Must meet 14 core + 5 menu
    8. 8. Meaningful Use (MU) Final Rule – EPs – Core Set ** <ul><li>Core </li></ul><ul><li>Use computerized order entry for medication orders. </li></ul><ul><li>Implement drug-drug, drug-allergy checks. </li></ul><ul><li>Generate and transmit permissible prescriptions electronically. </li></ul><ul><li>Record demographics. </li></ul><ul><li>Maintain an up-to-date problem list of current and active diagnoses. </li></ul><ul><li>Maintain active medication list. </li></ul><ul><li>Maintain active medication allergy list. </li></ul><ul><li>Record and chart changes in vital signs. </li></ul><ul><li>Record smoking status for patients 13 years old or older. </li></ul><ul><li>Implement one clinical decision support rule. </li></ul><ul><li>Report ambulatory quality measures to CMS or the States. </li></ul><ul><li>Provide patients with an electronic copy of their health information upon request. </li></ul><ul><li>Provide clinical summaries to patients for each office visit. </li></ul><ul><li>Capability to exchange key clinical information electronically among providers and patient authorized entities. </li></ul><ul><li>Protect electronic health information (privacy & security) </li></ul>
    9. 9. <ul><li>Menu: </li></ul><ul><li>Implement drug-formulary checks. </li></ul><ul><li>Incorporate clinical lab-test results into certified EHR as structured data. </li></ul><ul><li>Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach. </li></ul><ul><li>Send reminders to patients per patient preference for preventive/ follow-up care </li></ul><ul><li>Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies) </li></ul><ul><li>Use certified EHR to identify patient-specific education resources and provide to patient if appropriate. </li></ul><ul><li>Perform medication reconciliation as relevant </li></ul><ul><li>Provide summary care record for transitions in care or referrals. </li></ul><ul><li>Capability to submit electronic data to immunization registries and actual submission. </li></ul><ul><li>Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission. </li></ul><ul><ul><ul><li>*Language from the final rule has been changed in places for brevity. </li></ul></ul></ul><ul><ul><ul><li>** These requirements are for eligible professionals (EPs). A table that includes hospital requirements is available at www.healthbridge.org . </li></ul></ul></ul>Meaningful Use (MU) Final Rule – EP – Menu Set
    10. 10. MU Final Rule <ul><li>Other changes: </li></ul><ul><li>Thresholds reduced on many requirements (e.g., reduced from 80% down to 30-50% of pts) </li></ul><ul><li>Administrative simplification delayed to Stage 2 </li></ul><ul><li>Recording advanced directives and providing patient educational materials added to “menu” </li></ul><ul><li>Quality measures required for reporting reduced </li></ul><ul><ul><li>6 for EPs – 3 core* + 3 menu </li></ul></ul><ul><ul><li>15 measures for hospitals </li></ul></ul>*3 alternative core measures available for those EPs that cannot report on 3 core measures.
    11. 11. MU Final Rule <ul><li>Other changes: </li></ul><ul><li>Clinical quality measurements for specialists eliminated in Stage 1. </li></ul><ul><li>Critical Access Hospitals (CAH) are included in the definition of acute care hospital for the purpose of incentive program eligibility. </li></ul><ul><li>Reporting by attestation required in 2011, electronic reporting to CMS required in 2012. </li></ul>
    12. 12. Timeline for Medicare* Incentive Payments <ul><li>Fall 2010 - Certification of EHR vendors will start </li></ul><ul><li>2011-2012 - Clinicians can begin using a certified EHR in a meaningful manner (must use for 90 days) </li></ul><ul><li>Jan. 2011 – Registration with CMS can begin </li></ul><ul><li>April 2011 - Attestation of meaningful use begins </li></ul><ul><li>May 2011 - CMS payments will begin </li></ul><ul><li>*Medicaid EHR incentives will be managed by states. </li></ul>
    13. 13. Medicare Incentives MEDICARE EP Incentive Payment - Based on First Calendar Year EP receives Calendar Year CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 and later 2011 $18,000 2012 $12,000 $18,000 2013 $8,000 $12,000 $15,000 2014 $4,000 $8,000 $12,000 $12,000 2015 $2,000 $4,000 $8,000 $8,000 0 2016 $2,000 $4,000 $4,000 0 TOTAL $44,000 $44,000 $39,000 $24,000 0
    14. 14. Medicaid Incentives MEDICAID EP Incentive Payment - Based on First Calendar Year EP receives Calendar Year CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY2016 2011 $21,250 2012 $8,500 $21,250 2013 $8,500 $8,500 $21,250 2014 $8,500 $8,500 $8,500 $21,250 2015 $8,500 $8,500 $8,500 $8,500 $21,250 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250 2017 $8,500 $8,500 $8,500 $8,500 $8,500 2018 $8,500 $8,500 $8,500 $8,500 2019 $8,500 $8,500 $8,500 2020 $8,500 $8,500 2021 $8,500 TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750
    15. 15. Medicaid MU Thresholds To qualify for Medicaid incentives, EPs and Hospitals must meet certain patient volume thresholds: Entity Minimum Medicaid Patient Volume Threshold For Eligible Professionals (EPs) Physicians 30% -Pediatricians 20% Dentists 30% CNMs 30% PAs when practicing at an FQHC/RHC that is so led by a PA 30% NPs 30% **Or the Medicaid EP practices predominantly in an FQHC or RHC—30% needy individual patient volume threshold For Eligible Hospitals Acute care hospitals 10% Children’s hospitals No requirement
    16. 16. The Challenges <ul><li>The final government regulations are complex (864 pages long) . </li></ul><ul><li>As many as 30% of all EHR implementations fail. </li></ul><ul><li>To date, there is no evidence that EHRs alone improve quality or cost. </li></ul><ul><li>Regional Extension Centers will be meaningful use clearinghouse and assistance hub for EPs and hospitals. </li></ul>
    17. 17. <ul><li>Additional Information </li></ul><ul><li>HealthBridge Tri-State Regional Extension Center </li></ul><ul><li>www.healthbridge.org </li></ul><ul><li>CMS EHR Incentive Program Home Page </li></ul><ul><li>http://www.cms.gov/EHRIncentivePrograms/ </li></ul><ul><li>Office of National Coordinator for Health IT </li></ul><ul><li>http://healthit.hhs.gov/ </li></ul>

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