PYA Looks Beyond Meaningful Use at AHIMA


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PYA Consulting Manager Linda ClenDening helped connect the dots between the data at the 2013 AHIMA Convention and Exhibit in Atlanta. She spoke during the Innovation educational track on the topic: “Beyond Meaningful Use: Connecting Quality Data Requirements to Business Operational Improvements.”

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  • most important is dedicated network system uninterupted communication system,conferecing hall from to conferencing commissioned ,readiness dedicated commitment to coment discuss for a patient insurance of all medicine patient even doctors advices money will come no doubt but service with honesty is the vital requirement.
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  • PYA Looks Beyond Meaningful Use at AHIMA

    1. 1. Beyond Meaningful Use: Connecting quality data requirements to business operational improvements Linda ClenDening, MS, CMPE PYA
    2. 2. Agenda • Data and quality clinical outcomes • Regulatory information highlights and audits • Meaningful Use (MU) implications for – Staffing/Roles – Alliances/Referrals – Meaningful data
    3. 3. Quality Outcomes
    4. 4. Quality Data in the Exam Room xx% of my patients over 18 who have their tonsils removed experience post-surgical hemorrhaging. These outcomes are less than the national average of yy% of patients over 18.
    5. 5. Quality Data What’s the source of the data?
    6. 6. Communicating About Quality If he’s using clinical outcomes statistics in the exam room, where else is he using them?
    7. 7. Doctor’s Lounge Communicating with referring physicians?
    8. 8. Board Table Quality contractual requirements between hospitals and physicians – Employment arrangements – Clinical co-management – ACOs – Other partnerships
    9. 9. Negotiating Table Once quality metrics are operationalized for one payor, the provider can build on that strength to discuss quality with other contracting payors.
    10. 10. Website How is he attracting patients to his practice based on quality outcomes?
    11. 11. Take Away #1 • What story are you telling about the physicians in your practice using the quality data collected in the MU process? • Focus on a core measure metric or clinical quality metrics and develop the story.
    12. 12. MU Statistics as of June 2013 Medicare EP.s Medicaid EP.s $3,000,000,000 $2,500,000,000 Almost 6 billion dollars to EP.s todate $2,000,000,000 $1,500,000,000 $1,000,000,000 $500,000,000 $2011 2012 2013 YTD
    13. 13. Real World Impact of MU • More than 458 million test results were entered into the EHR by 111,954 Eligible Providers (EP.s). • Medication reconciliation was performed on over 40 million patient transitions of care by 83,035 EP.s. More than 4.3 million patient transitions of care summaries were generated by 24,827 EP.s. • By Robert Tagalicod, Director, Office of E-health Standards and Services
    14. 14. Meaningful Use Headlines • July 30, 2013 – AHA and AMA, as well as CHIME (College of Healthcare Information Management Executives), request more time for Stage 2. • July 30, 2013 –AHA report calls for a delay of Eligible Hospital Stage 2 deadline of October 1, 2013. • September 24, 2013 – Senators call for one-year Stage 2 Meaningful Use extension. As reported in HealthLeaders Media and EHRIntelligence.
    15. 15. Meaningful Use Current Details • Stage 2 Meaningful Use (MU) Attestation begins in calendar year 2014 for Eligible Providers (EP.s). – If a provider began MU in 2011, he/she will meet three consecutive years of MU before beginning Stage 2 in 2014. – All other providers meet two years of MU before advancing to Stage 2 in their third reporting year. • For 2014 only, all providers – regardless of MU stage – are only required to demonstrate MU for a 3 month reporting period. • Beginning in 2015, Medicare eligible professionals who do not successfully demonstrate meaningful use will be subject to a payment adjustment.
    16. 16. Penalty Scenarios Requirement to Avoid Penalty First Year of MU 2015 2016 2017 2011 Achieve MU in 2013 (365 days) Achieve MU in 2014 (One 3-month quarter) Achieve MU in 2015 (365 days) 2012 Achieve MU in 2013 (365 days) Achieve MU in 2014 (One 3-month quarter) Achieve MU in 2015 (365 days) 2013 Achieve MU in 2013 (Any 90-consecutive-day period) Achieve MU in 2014 (One 3-month quarter) Achieve MU in 2015 (365 days) 2014 Achieve MU in 2014 (Any 90-consecutive-day period ending no later than 3 months before the end of the reporting period) Achieve MU in 2014 (One 3-month quarter) Achieve MU in 2015 (365 days)
    17. 17. MU Role in New Care Model Development • • • • Consolidation/M&A ACOs Clinically Integrated Networks Private Payor Network Development/Contracting • Others
    18. 18. MU & Consolidation • Weathering the storm with a bigger ship: – From 2000 to 2010, hospital physician employment rose 32%. – Hospitals directly employ about a quarter of all U.S. physicians. – By 2013, two-thirds of physicians will work for hospitals or large groups. • Strategic Consideration: – Affiliate or merge with an organization without an MU plan or at risk of a penalty?
    19. 19. MU & Consolidation • Transaction Due Diligence Consideration: – Meaningful Use due diligence now occurs in most healthcare transactions. – Organizational readiness for Meaningful Use Attestation requires detailed supporting documentation.
    20. 20. MU & ACOs • Public Payor • Medicare • Medicaid • Private Payor • Private Payors (Blue Cross, United, Cigna, Aetna) • ACOs with private insurers in effect or development at four times the rate of Medicare ACOs • Large Employers • Self-Insured Hospitals and Health Systems
    21. 21. MU & ACOs • ACO 33 Quality Measures include: – Percent of PCPs who Successfully Qualify for MU Payment – CQMs overlap with ACO measures
    22. 22. Clinical Quality Measure (CQM) Overlap with ACO and Other Programs Stage 2 2014 CQM Measure Other CMS Program Controlling High Blood Pressure Percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period. ACO; EHR PQRS; Group Reporting PQRS Use of High-Risk Medications in the Elderly PQRS Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention ACO; EHR PQRS Group Reporting PQRS Use of Imaging Studies for Low Back Pain Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan EHR PQRS; ACO; Group Reporting PQRS Documentation of Current Medications in the Medical Record PQRS; EHR PQRS Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up EHR PQRS; ACO; Group Reporting PQRS
    23. 23. 2013 PQRS • If you have EPs that meet MU, don’t leave money on the table: – 2013: 0.5% incentive – 2015: 1.5% penalty • Assess crosswalk opportunities for quality reporting across programs.
    24. 24. MU & Private Payor Contracting • A growing number of private payers have added the MU requirements to their P4P programs: – Aetna, United and WellPoint – Highmark modified "Quality Blue" program to include MU: • Require copy of attestation • Incorporate CQM for physician practice best practice indicator program • Payors not setting up proprietary mini-MU programs – Rather use developed MU system – Similar to using DRGs as a reference price for rates
    25. 25. Take Away #2 • Incorporate MU into Compliance Program. – Compliance Officer involvement in attestation and annual review. • Ensure attestation documentation is consistent with CMS’s recommendations. • Prepare for more oversight – not just from CMS. • Maximize MU attestation benefits with other payors and alliances.
    26. 26. Operationalizing to imperfect users. Adapting a perfect program…
    27. 27. Operationalizing Much more about the people, than the systems.
    28. 28. Meaningful Use Progression As Meaningful Use requirements progress there will be a higher volume of data requirements and more complexity. The systems need to carry the burden to prompt users to do the right thing.
    29. 29. We can only do so much.
    30. 30. MU Staffing Changes Other No staffing changes made Group 2 Group 1 Increased clinical staff Increased clerical staff 0% 10% 20% 30% 40% 50% 60%
    31. 31. MU Staffing Changes? • Increased data input demands on current staff. • Hired dedicated quality manager. • Shift in resources in IT department to focus on MU readiness. • We used outside consultants for MU attestation.
    32. 32. MU Staffing Changes Increased duties and responsibilities of current staff, including Administrator/Director. Use of consultants for MU implementation and attestation process. New IT team members: Quality staff, EMR analysts, and EMR trainers
    33. 33. New IT Staff Positions No Group 2 Group 1 Yes 0% 20% 40% 60% 80%
    34. 34. New IT Staff Positions for MU? • Not yet, but we are discussing these. • Hired a portal manager.
    35. 35. IT Staff Positions Added 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Group 1 Group 2 Report/data specialist Clinical data analyst Training Other
    36. 36. IT Functional Roles Changing 40% 35% 30% 25% 20% 15% Group 1 10% Group 2 5% 0% Increase in support/ help desk Increase in liaison/ networking support Increase in leadership/ management Other
    37. 37. Staffing Changes EMR Build Specialists Healthcare Analytics Project Management Program Management Application Development Data Architecture Quality Assurance Source: 7 Hottest IT Healthcare Skills October 18, 2012
    38. 38. IT Functional Roles Changing • Anticipate increased need of support for – New hardware – Networking – Remote access – Interoperability issues 2012 HIMSS Leadership Survey
    39. 39. Strategic Partnerships based on Quality? 45% 40% 35% 30% 25% Group 1 20% Group 2 15% 10% 5% 0% Yes No Unknown
    40. 40. MU effect on Alliance Decisions Other (please specify) MU not considered Group 2 Referral partners MU attested Group 1 Referral partners asked about MU 0% 20% 40% 60% 80% 100%
    41. 41. Take Away #3 • Re-assess staff skills and training for EHR usage. • Determine possible staff duty changes. • Document process and workflow redesign for EHR/MU implementation. • Update all affected policies and procedures. • Redesign monthly reports and dashboards to include key MU metrics.
    42. 42. The Meaningful Use Goal ❝Language is the road map of a culture. It tells you where its people come from and where they are going.❞ ‒Rita Mae Brown Healthcare providers, executives, and staff are engaged in developing a new language.
    43. 43. Thank you! Linda ClenDening, MS, CMPE Manager PYA 615-305-5218 865-684-2735