Meaningful Use Overview PresentationPresentation Transcript
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 .
An Overview of the Final Rule
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 .
The ARRA/HITECH Act authorizes incentive funding for health care providers who demonstrate “meaningful use of health information technology.”
The federal government will pay physicians who meet meaningful use (MU):
Up to $44K under Medicare or
Up to $63,750 under Medicaid
Eligible hospitals can receive millions.
MU Final Rule was published on July 13, 2010.
Meaningful Use & Incentives
Meaningful use (MU) is defined as:
Use of a certified Electronic Health Record (EHR)
Electronic exchange of health information
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
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
MU Final Rule
Move away from “all or nothing approach.”
There are 15 core requirements for Eligible Professionals
There are 14 core requirements for Hospitals.
There are also a “menu” of 10 additional requirements from which 5 must be chosen.
Eligible Professionals Eligible Hospitals Must meet 15 core + 5 menu Must meet 14 core + 5 menu
Meaningful Use (MU) Final Rule – EPs – Core Set **
Use computerized order entry for medication orders.
Implement drug-drug, drug-allergy checks.
Generate and transmit permissible prescriptions electronically.
Maintain an up-to-date problem list of current and active diagnoses.
Maintain active medication list.
Maintain active medication allergy list.
Record and chart changes in vital signs.
Record smoking status for patients 13 years old or older.
Implement one clinical decision support rule.
Report ambulatory quality measures to CMS or the States.
Provide patients with an electronic copy of their health information upon request.
Provide clinical summaries to patients for each office visit.
Capability to exchange key clinical information electronically among providers and patient authorized entities.
Protect electronic health information (privacy & security)
Implement drug-formulary checks.
Incorporate clinical lab-test results into certified EHR as structured data.
Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach.
Send reminders to patients per patient preference for preventive/ follow-up care
Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies)
Use certified EHR to identify patient-specific education resources and provide to patient if appropriate.
Perform medication reconciliation as relevant
Provide summary care record for transitions in care or referrals.
Capability to submit electronic data to immunization registries and actual submission.
Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission.
*Language from the final rule has been changed in places for brevity.
** These requirements are for eligible professionals (EPs). A table that includes hospital requirements is available at www.healthbridge.org .
Meaningful Use (MU) Final Rule – EP – Menu Set
MU Final Rule
Thresholds reduced on many requirements (e.g., reduced from 80% down to 30-50% of pts)
Administrative simplification delayed to Stage 2
Recording advanced directives and providing patient educational materials added to “menu”
Quality measures required for reporting reduced
6 for EPs – 3 core* + 3 menu
15 measures for hospitals
*3 alternative core measures available for those EPs that cannot report on 3 core measures.
MU Final Rule
Clinical quality measurements for specialists eliminated in Stage 1.
Critical Access Hospitals (CAH) are included in the definition of acute care hospital for the purpose of incentive program eligibility.
Reporting by attestation required in 2011, electronic reporting to CMS required in 2012.
Timeline for Medicare* Incentive Payments
Fall 2010 - Certification of EHR vendors will start
2011-2012 - Clinicians can begin using a certified EHR in a meaningful manner (must use for 90 days)
Jan. 2011 – Registration with CMS can begin
April 2011 - Attestation of meaningful use begins
May 2011 - CMS payments will begin
*Medicaid EHR incentives will be managed by states.
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
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
The final government regulations are complex (864 pages long) .
As many as 30% of all EHR implementations fail.
To date, there is no evidence that EHRs alone improve quality or cost.
Regional Extension Centers will be meaningful use clearinghouse and assistance hub for EPs and hospitals.