• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Meaningful use and cpoe cme presentation
 

Meaningful use and cpoe cme presentation

on

  • 2,100 views

 

Statistics

Views

Total Views
2,100
Views on SlideShare
1,975
Embed Views
125

Actions

Likes
0
Downloads
0
Comments
0

2 Embeds 125

http://www.surveymonkey.com 124
http://www.mefeedia.com 1

Accessibility

Categories

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Meaningful use and cpoe cme presentation Meaningful use and cpoe cme presentation Presentation Transcript

    • Saint Lukes Care presents "Meaningful Use" and CPOE 1 credit hour of Category 1 CME Free CME for Saint Lukes Care physicians Upon completion of the online learning module, the participant will  List three required portions of the Electronic Health Record that must be completed for a hospital to reach “Meaningful Use”.  List the three required areas for electronic quality measure documentation and reporting by hospitals.  Know that 30% of unique hospitalized patients must have more than one medication entered via CPOE  Know that only physicians working primarily in the outpatient environment are eligible for incentives to use an Electronic Health Record.  List the three stages of the HI-TECH Act  Know that hospitals will begin incurring penalties if they are not meeting Meaningful Use goals by 2015. Target Audience: All SL Care physicians Content: The federal EHR incentive program: Achieving ‘meaningful use’, Robert Tennant, MA, Senior Policy Advisor, Medical Group Management Association (MGMA), Washington, D.C. & Healthcare IT and Stimulus Readiness: The American Recovery and Reinvestment Act of 2009, Melody Kolb, MBA, Director, Business Analysis-McKesson Corp, Alpharetta, GA Planning Committee: Brent W. Beasley, MD, FACP - Medical Director, Saint Lukes Care, Saint Luke’s Health System, Kansas City, MO John Yeast, MD – Vice President of Medical Affairs, Saint Luke’s Health System, Kansas City, MO Carl Dirks, MD – Chief Medical Information Officer, Saint Luke’s Health System, Kansas City, MO Shauna Todd, RN, BSN - Quality and Implementation System Analyst, Saint Luke’s Care, Kansas City, MO Sharon Hoffarth, MD, MPH, FACPM – Medical Director, Primaris, Columbia, MO This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Primaris and Saint Lukes Care. Primaris is accredited by the Missouri State Medical Association to provide continuing medical education for physicians.Primaris designates this educational activity for a maximum of 1 hours AMA PRA Category 1 Credit™. Physicians should claim credit commensurate with the extent of their participation in the activity. For questions please contact Shauna Todd (stodd@saint-lukes.org) or Brent Beasley (bbeasley@saint-lukes.org)
    • WASHINGTON LINK Advocacy and informationThe federal EHR incentive program:Achieving ‘meaningful use’ By the MGMA Government Affairs Department, govaff@mgma.com O n July 13, 2010, the Centers for Medicare & Medicaid Services (CMS) published the final rule outlining specifica- • Increasing compliance flexibility through exclusions for criteria that fall outside the scope of practice; tions for the “meaningful use” of EHR tech- • Removing the criteria that require nology. Mandated as part of the American manual chart review to calculate specific Recovery and Reinvestment Act of 2009 measure thresholds; and (ARRA), the EHR incentive program will mgma.com provide payments to eligible professionals • Removing administrative transactions, • mgma.com/ (EPs) who meet certain qualifications using including electronic claim submission medicarepaymentpolicies certified software. and electronic eligibility verification • Contact Congress to voice your opinions at As a result of advocacy by MGMA and criteria. mgma.com/policy other groups, the final rule significantly re- duced the requirements that were originally proposed. Change to hospital-based EP Modifications to the final rule include: ARRA outlined that hospital-based EPs who • Eliminating the requirement that all 25 furnish substantially all their services in a meaningful-use criteria had to be met to hospital setting are not eligible for incentive qualify for the incentives; payments. The Continuing Extension Act of • Reducing the number of required criteria 2010 modified the definition of a hospital- from 25 to 20; based EP as “a practitioner who performs substantially all of [his or her] services in an • Requiring 15 core criteria and five add ‘inpatient hospital setting or emergency criteria that EPs choose from a menu room.’” The final rule on meaningful use re- of 10; flects this change. Hospital-based EPs are • Decreasing the threshold for now defined as EPs who furnish 90 percent meaningful-use measures (i.e., the or more of their allowed services in hospital percentage of prescriptions sent inpatient settings or hospital emergency de- electronically was reduced from 75 partments. percent to 40 percent); Payments and reporting periods Who is eligible? Those EPs who qualify to receive EHR in- Medicare Medicaid centive payments via the Medicare program can receive up to $44,000 over five years Doctors of medicine or osteopathy Physicians with payments beginning as early as 2011. EPs will receive an incentive payment for Doctors of dental surgery or dental medicine Dentists up to 75 percent of Medicare allowable Doctors of podiatric medicine Certified nurse midwives charges for covered professional services furnished in a payment year. An EP who Doctors of optometry Nurse practitioners predominantly furnishes services in a geo- graphic Health Professional Shortage Area is Chiropractors who are legally authorized to Physician assistants who practice in a feder- practice under state law ally qualified health center or rural health eligible for a 10 percent increase in the clinic led by a physician assistant maximum incentive payment amount.p a g e 1 4 • MGMA Connexion • September 2010 ©2010 Medical Group Management Association. All rights reserved.
    • First calendar year that the EP receives an incentive payment Calendar year 2011 2012 2013 2015 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 The total maximum EHR incentive demonstrate meaningful use of certi- Health & Human Services secretary payment amounts for Medicare EPs fied EHR technology will be subject to to decrease payments by as much as are outlined on page 15. payment adjustments for their 5 percent. Under the Medicaid program, EPs Medicare-covered professional services EPs participating in the Medicaid are eligible for up to $63,750 over six in 2015. The penalties include the fol- incentive program are not subject to years if at least 30 percent of their pa- lowing reduced payment amounts: penalties. tients are Medicaid patients. Pediatri- cians are eligible for two-thirds of the • 2015 – 1 percent decrease; Medicaid incentives if 20 percent to • 2016 – 2 percent decrease; Meaningful-use criteria 29 percent of their patients are on • 2017 and beyond – 3 percent To qualify for the incentives, EPs must Medicaid and 100 percent of the in- decrease; and meet all 15 of the core objectives and centive if they reach the 30 percent select five additional objectives from threshold. • In 2019 and beyond – ARRA the menu objectives list. If an EP quali- Payments under this Medicare in- permits the U.S. Department of centive program will be disbursed see Washington Link, page 16 through a single payment contractor Core objectives (all required) Menu objectives (must select five) to the tax identification number pro- vided by the qualifying EP. And then, 1. Implement computerized physician order entry 1. Use drug-formulary checks provided EPs meet certain conditions, 2. Use e-prescribing (eRx) 2. Incorporate clinical lab test results as structured they can reassign their incentive pay- data ment to one employer or entity. 3. Report ambulatory clinical quality measures to 3. Generate lists of patients by specific conditions CMS/states For the first year an EP receives an 4. Implement one clinical decision support rule 4. Send reminders to patients per patient incentive payment, the EHR reporting preference for preventive/follow-up care period is any continuous 90 days be- 5. Provide patients with an electronic copy of their 5. Provide patients with timely electronic access health information upon request to their health information ginning and ending within the year. 6. Provide clinical summaries for patients for each 6. Use certified EHR technology to identify For every year after the first payment office visit patient-specific education resources and provide to patient, if appropriate year, the EHR reporting period in- 7. Use drug-drug and drug-allergy interaction checks 7. Perform medication reconciliation cludes the entire year. Note: For the first year of participa- 8. Record demographics 8. Provide summary of care record for each transition of care/referrals tion, EPs in the Medicaid incentive 9. Maintain an up-to-date problem list of current 9. Submit electronic data to immunization program are not required to prove and active diagnoses registries/systems they have attained meaningful use, 10. Maintain active medication list 10. Provide electronic syndromic surveillance data to public health agencies only that they have been “adopting, 11. Maintain active medication allergy list implementing or upgrading to certi- fied EHR technology … .” 12. Record and chart changes in vital signs 13. Record smoking status for patients 13 years or older Penalties 14. Exchange key clinical information among providers of care and patient-authorized While the EHR incentive program is entities electronically voluntary, EPs who do not successfully 15. Protect electronic health information©2010 Medical Group Management Association. All rights reserved. MGMA Connexion • September 2010 • p a g e 1 5
    • from page 15 WASHINGTON LINK fies for an exclusion, he or she may select lect three additional CQM from a set of 38 four menu objectives. One of the menu ob- CQM (other than the core/alternative core jectives must be a public health measures). objective (No. 9 or 10 from the list on EPs must report on six total measures: page 15). three required core measures (substituting alternative core measures where necessary) and three additional measures. Meaningful use for EPs who work at multiple sites Product certification An EP who works at multiple locations but does not have certified EHR technology The Office of the National Coordinator for available at all of them would need to indi- Health Information Technology (ONC) pub- cate that at least 50 percent of his or her lished a final rule outlining the “temporary” total patient encounters were at locations EHR software certification process. ONC that use certified EHR technology. In addi- permits any organization to apply to be- tion, the EP would need to base all mean- come an Authorized Certification and Test- ingful-use measures only on encounters ing Body (ACTB). It is anticipated that that occurred at locations that use certified multiple organizations will be designated as technology. ACTBs and that product testing and certifi- cation will begin this year. Clinical quality measures overview Registration EPs seeking to demonstrate meaningful use in 2011 must submit aggregate clinical qual- To register for the program, EPs must be en- ity measures (CQM) numerator, denomina- rolled in Medicare Fee for Service (FFS), tor and exclusion data to CMS or the states Medicare Advantage or Medicaid (FFS or by attestation. In other words, they must managed care). In addition, participants certify to the government that they have must have a national provider identifier met all the requirements. In 2012, EPs will and be enrolled in Provider Enrollment, be required to electronically submit aggre- Chain and Ownership System. gate CQM numerator, denominator and ex- Go to mgma.com for additional informa- clusion data to CMS or the states. tion on these Medicare and Medicaid EHR EPs must report on three required core incentive programs. CQM. If the denominator of one or more of For program information and to register the required core measures is zero, then EPs for the program, go to cms.gov/EHRIncen- are required to report results for up to three tivePrograms. alternative core measures. EPs also must se- Required clinical quality core criteria Alternative core criteria Hypertension: blood pressure management Influenza immunization for patients 50 years of age or older Tobacco use assessment and cessation Weight assessment and counseling for intervention children and adolescents Adult weight screening and follow-up Childhood immunization status p a g e 1 6 • MGMA Connexion • September 2010 ©2010 Medical Group Management Association. All rights reserved.
    • Copyright of MGMA Connexion is the property of Medical Group Management Association and its contentmay not be copied or emailed to multiple sites or posted to a listserv without the copyright holders expresswritten permission. However, users may print, download, or email articles for individual use.Reprinted with permission from the Medical Group Management Association, 104 Inverness Terrace East,Englewood, Colorado 80112. 877.275.6462. www.mgma.com. Copyright 2010.
    • Healthcare IT and Stimulus Readiness The American Recovery and Reinvestment Act of 2009 September 21, 2010 Melody Kolb, MBA Director, Business AnalysisCopyright © 2010 McKesson Corporation. All Rights Reserved. DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • HITECH Overview Estimated Payments from Stimulus $30.0  $27.4  $25.0  $20.0  $19.0  $15.0  $9.7  $10.0  $5.0  $‐ Low Scenario Low Scenario Approved High Scenario High Scenario CMS estimated payouts (billions) for both Medicare and Medicaid, less penalties from 2011 – 2019 MedicaidCopyright © 2010 McKesson Corporation. All Rights Reserved. 3 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • HITECH Overview Estimated Timeline 2015 – Medicare penalties begin for EPs and eligible hospitals that are not meaningful users of EHR technology July 28, 2010 y ,Federal Register Publication 2016 – Last yr to receive a Medicare EHR incentive payment; Last yr to apply for Medicaid EHR incentives Final Rule for Stage 1 Meaningful Use 2021 – Last year to receive Medicaid EHR incentive payment January 2011 Registration for EHR Incentive Programs begins December 31, 2011 December 31, 2013 States may launch programs Stage 2 criteria available Stage 3 criteria available for Medicaid providers January 1, 2011 May 2011 February 29, 2012 Medicare / Medicaid EHR incentive Last day for EPs to incentive program f i ti for payments b i begin register/attest f CY11 i / for physicians begins incentive payment October 1, 2010 April 2011 November 30, 2011 Medicare / Medicaid Attestation for Last day for eligible hospitals / incentive program for Medicare incentive CAHs to register/attest for hospitals begins program begins FY11 incentive paymentCopyright © 2010 McKesson Corporation. All Rights Reserved. 4 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • Stage 1 Meaningful Use Final Rule Significant Changes  14 Core objectives; all required for Stage 1 ─ Ten additional Menu objectives; select/meet 5 of the 10 for Stage 1 • Must choose at least 1 of the population and public health objectives (pg 44328) • Proposing to require all Stage 1 Menu objectives in Stage 2 ─ Previously 23 hospital objectives  Emergency Department ( g y p (POS 23) included in measures for ) 12 objectives  Clinical quality measures reduced from 35 to 15 measures  Clinical decision support rules decreased from 5 to 1  Electronic copy of health information provided within 3 business days (previously 48 hrs)Source: U.S. Department of Health & Human Services. Medicare and Medicaid Programs; Electronic Health Record Incentive Program. Vol. 75, No. 144. / Federal Register /July 28, 2010 / Final Rule. Retrieved from http://federalregister.gov/a/2010-17207Copyright © 2010 McKesson Corporation. All Rights Reserved. 5 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • Stage 1 Meaningful Use Final Rule Significant Changes (Continued)  Electronic insurance eligibility & claims submission objectives expected for Stage 2 ((pg 44353)  Advance directives and patient-specific education resources Menu objectives added  Measure threshold changes include: ─ CPOE increased from 10% to 30% but for Med orders only ─ Demographics, Vital Signs, smoking status, electronic copy of health information, Med Reconciliation and Summary Care Record all decreased from 80% to 50% ─ Incorporating structured Lab results decreased from 50% to 40%  Eligibility still based on CCN (CMS Certification Number) ─ Potential for legislative changeSource: U.S. Department of Health & Human Services. Medicare and Medicaid Programs; Electronic Health Record Incentive Program. Vol. 75, No. 144. / Federal Register /July 28, 2010 / Final Rule. Retrieved from http://federalregister.gov/a/2010-17207Copyright © 2010 McKesson Corporation. All Rights Reserved. 6 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • Stage 1 Meaningful Use Methods of Measure Calculation  Mandates certified EHR technology must include ability to calculate measures (pg 44334) ─ Clinical Performance Analytics™ (15.0 ARRA SP) meets requirement for the 14 threshold calculations  5 measures with a denominator of unique patients regardless of whether the patient’s records are maintained using certified EHR technology ─ Patients seen more than once during the EHR reporting period are only counted once in the denominator for the measure ─ All measures relying on the term “unique patient” relate to what is contained in the patient’s medical record (pg 44334) ─ Includes the objectives for problems, medications, allergies, j g demographics and patient-specific educationSource: TABLE 3: Stage 1 Meaningful Use Objectives and Associated Measures Sorted by Method of Measure Calculation. U.S. Department of Health & Human Services.Medicare and Medicaid Programs; Electronic Health Record Incentive Program. Vol. 75, No. 144. / page 44376 / Federal Register / July 28, 2010 / Final Rule. Retrieved fromhttp://federalregister.gov/a/2010-17207Copyright © 2010 McKesson Corporation. All Rights Reserved. 7 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • Stage 1 Meaningful Use Methods of Measure Calculation (Continued)  9 measures with a denominator based on counting actions for patients whose records are maintained using certified EHR technology ─ Subset of unique patients based on objectives criteria ─ Intent is to ensure a minimum of 80% of records are maintained, e.g., problems, allergies & medication measures (pg 44330)  9 measures requiring only a Yes/No attestation  15 hospital clinical q p quality measures to CMS or the States y ─ Detailed electronic specifications available on the CMS website at: http://www.cms.gov/QualityMeasures/03_ElectronicSpecifications.asp#TopOfPageSource: TABLE 3: Stage 1 Meaningful Use Objectives and Associated Measures Sorted by Method of Measure Calculation. U.S. Department of Health & Human Services.Medicare and Medicaid Programs; Electronic Health Record Incentive Program. Vol. 75, No. 144. / page 44376 / Federal Register / July 28, 2010 / Final Rule. Retrieved fromhttp://federalregister.gov/a/2010-17207Copyright © 2010 McKesson Corporation. All Rights Reserved. 8 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • Stage 1 Meaningful Use Computerized Physician Order Entry  Requires 30% of unique patients with ≥1 medication listed in med list must have ≥1 med order entered via CPOE  Expands objective/measure to include Emergency Department (POS 23)  Finalizes a Stage 1 threshold for CPOE of 30% for EPs and hospitals (pg 44333) h it l ─ Finalizes a Stage 2 threshold for CPOE of 60% EPs and hospitals ─ Considering adding measures related to CPOE orders for services beyond medication orders in Stage 2 and beyond (pg 44322)Source: U.S. Department of Health & Human Services. Medicare and Medicaid Programs; Electronic Health Record Incentive Program. Vol. 75, No. 144. / Federal Register /July 28, 2010 / Final Rule. Retrieved from http://federalregister.gov/a/2010-17207Copyright © 2010 McKesson Corporation. All Rights Reserved. 9 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • Stage 1 Meaningful Use Computerized Physician Order Entry (Cont’d) (Cont d)  Recommends any licensed healthcare professional can enter orders into the medical record per state local and professional state, guidelines (pg 44332) ─ Decreases opportunities for clinical decision support and adverse pp pp interaction ─ Balances potential workflow implications of requiring the ordering provider to enter every order directly especially in the hospital setting directly, ─ Removes possibility of presenting alerts to someone without clinical judgment; excludes clerical staff from entering orders in CPOESource: U.S. Department of Health & Human Services. Medicare and Medicaid Programs; Electronic Health Record Incentive Program. Vol. 75, No. 144. / Federal Register /July 28, 2010 / Final Rule. Retrieved from http://federalregister.gov/a/2010-17207Copyright © 2010 McKesson Corporation. All Rights Reserved. 10 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • Stage 1 Meaningful Use Clinical Quality Measures  Ability to report on 15 hospital quality measures to CMS or State ─ ED throughput (2) ─ Ischemic or hemorrhagic stroke (7) ─ VTE (6)  Required to attest results are automatically calculated by certified EHR in 2011 ─ Electronically submit requirements beginning in 2012 (pg 44432)  Electronic med admin record (eMAR) required to calculate 7 ( ) q of the 15 measures  Required to maintain evidence of incentive qualification for 6 or 10 years (pg 44439 / 44468)Source: Excerpt from TABLE 10: Clinical Quality Measures for Submission by Eligible Hospitals and CAHs for Payment Year 2011-20125. U.S. Department of Health & HumanServices. Medicare and Medicaid Programs; Electronic Health Record Incentive Program. Vol. 75, No. 144. / page 44418 / Federal Register / July 28, 2010 / Final Rule.Retrieved from http://federalregister.gov/a/2010-17207Copyright © 2010 McKesson Corporation. All Rights Reserved. 11 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • Stage 1 Meaningful Use Clinical Quality Measures (Cont’d) (Cont d) 15 hospital quality measures: 1. 1 ED Throughput – admitted patients (Median time from ED arrival to ED departure) ED 1 ED-1 2. ED Throughput – admitted patients (Admission decision time to ED departure time) ED-2 3. Ischemic stroke – Discharge on anti-thrombotics STROKE-2 4. Ischemic stroke – Anticoagulation for A-fib/flutter STROKE-3 g 5. Ischemic stroke – Thrombolytic therapy for pts arriving within 2 hrs of symptom onset STROKE-4* 6. Ischemic or hemorrhagic stroke – Antithrombotic therapy by day 2 STROKE-5* 7. Ischemic stroke – Discharge on statins STROKE-6 8. Ischemic or hemorrhagic stroke – Stroke education STROKE-8 9. Ischemic or hemorrhagic stroke – Rehabilitation assessment STROKE-10 10. VTE prophylaxis within 24 hours of arrival VTE-1* 11 Intensive Care Unit VTE prophylaxis VTE-2* 11. VTE 2 12. Anticoagulation overlap therapy VTE-3* 13. Platelet monitoring on unfractionated heparin VTE-4* 14. VTE discharge instructions VTE-5 15. Incidence of potentially preventable VTE VTE-6* Asterisk indicates eMAR required.Source: Excerpt from TABLE 10: Clinical Quality Measures for Submission by Eligible Hospitals and CAHs for Payment Year 2011-20125. U.S. Department of Health & HumanServices. Medicare and Medicaid Programs; Electronic Health Record Incentive Program. Vol. 75, No. 144. / page 44418 / Federal Register / July 28, 2010 / Final Rule.Retrieved from http://federalregister.gov/a/2010-17207Copyright © 2010 McKesson Corporation. All Rights Reserved. 12 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • Meaningful Use Measurement McKesson s McKesson’s Comprehensive Solution McKesson provides a comprehensive strategy for measuring meaningful use  that supports immediate and long term objectives. Analytics Strategic Components IT Functionality Measures • Calculation of IT adoption rates Calculation of IT adoption rates  • Installed as Clinical 10.3 is installed • Measures process of care Software and content must be implemented for Quality Benchmarks Collaborative Quality Benchmarks Collaborative™ Stage 1 Meaningful Use g g measurement • Calculation and submission of quality measures • 10.3 and design guide dependency • Measures quality of care delivery Clinical Outcomes  Measures Software and content • Measures  patient outcomes pre and post adoption must be implemented for • Supports nursing and  physician alignment Stage 2 Meaningful Use measurement • Measures outcomes of care Measures outcomes of careCopyright © 2010 McKesson Corporation. All Rights Reserved. 13 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • Stage 1 Meaningful Use Hospital Based Hospital-Based Eligible Professionals (EP)  Legislative Change: The Continuing Extension Act of 2010 (HR 4851) ─ Only hospital-based physicians, who provide more than 90% of Medicare/Medicaid services in a hospital inpatient or emergency room setting (POS 21 & 23), are excluded from receiving Medicare/Medicaid incentives ─ Physicians, who provide Medicare/Medicaid services p y , p primarily at y hospital outpatient centers and clinics, are eligible for EHR incentives (pgs 44439–44440)Source: U.S. Department of Health & Human Services. Medicare and Medicaid Programs; Electronic Health Record Incentive Program. Vol. 75, No. 144. / Federal Register /July 28, 2010 / Final Rule. Retrieved from http://federalregister.gov/a/2010-17207Copyright © 2010 McKesson Corporation. All Rights Reserved. 14 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • Meaningful Use HITECH Program Stages Stage Goal Stage 1 Electronic Capture of Patient Data Stage 2 g Improved Clinical Processes p Stage 3 Quality Measurement & Improvement  Proposed updating meaningful use criteria on a biennial basis (pg 44321):  Stage 2 proposed by end of calendar year 2011  Stage 3 proposed by end of calendar year 2013  Clear indication that Stage 3 will not be last year of requirements ( 44323) (pgCopyright © 2010 McKesson Corporation. All Rights Reserved. 15 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • Stage 1 Meaningful Use “Reporting Period” Defined Reporting Period  For the First Year Incentive Qualifications ─ 90 consecutive day reporting period to prove MU through required measures ─ Provider determines reporting period within payment year Eligible Hospitals Eligible Professionals First Payment Year Earliest Earliest Last Date Last Date Date Date 2011 10/1/2010 7/1/2011 1/1/2011 10/1/2011 2012 10/1/2011 7/1/2012 1/1/2012 10/1/2012 2013 10/1/2012 7/1/2013 1/1/2013 10/1/2013 ─ “Attestation methodology” proposed in 2011, with selected compliance reviews • Electronic reporting of quality measures to CMS starts in 2012 • Other measures remains through attestation until further testing and advancement made in HIT (pg 44436)  Subsequent Years ─ Entire 12 months of the respective year • Eligible Hospitals: Federal Fiscal Year (October 1 – September 30) • Eligible Professionals: Calendar YearCopyright © 2010 McKesson Corporation. All Rights Reserved. 16 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • Stage 1 Meaningful Use Respective Criteria per Payment Year First Payment Year Payment Year 2011 2012 2013 2014 2015 2011 Stage 1 Stage 1 Stage 2 Stage 2 TBD 2012 Stage 1 Stage 1 Stage 2 TBD 2013 Stage 1 Stage 1/2* TBD 2014 Stage 1 TBD * Discrepancy between TABLE 1: Stage of Meaningful Use Criteria by Payment Year which states “Stage 1” and page 44322 which states “anticipate updating the criteria of meaningful use to Stage 2 in time for the 2013 payment year and therefore anticipate for their second payment year (2014), an EP, eligible hospital, or CAH whose first payment year is 2013 would have to satisfy the Stage 2 criteria of meaningful use to receive the incentive payments” Retrieved July 28, 2010, from http://federalregister.gov/a/2010-17207  Signifies when payment is reported/earned, not necessarily paid Source: TABLE 1: Stage of Meaningful Use Criteria by Payment Year. U.S. Department of Health & Human Services. Medicare and Medicaid Programs; Electronic Health Record Incentive Program. Vol. 75, No. 144. / page 44323 / Federal Register / July 28, 2010 / Final Rule. Retrieved from http://federalregister.gov/a/2010-17207Copyright © 2010 McKesson Corporation. All Rights Reserved. 17 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • Meaningful Use Application Criteria  Register at the EHR Incentive Program website beginning January, 2011 (http://www.cms.gov/EHRIncentivePrograms)  Must be enrolled in Medicare FFS, MA or Medicaid (FFS or managed care)  Need a National Provider Identifier (NPI)  Use certified EHR technology to demonstrate Meaningful Use  Medicare providers and Medicaid eligible hospitals must be enrolled in PECOS (Provider Enrollment, Chain and Ownership System)  Attestations can be submitted beginning in April, 2011 for Medicare; Medicaid determined based on CMS approval of State HIT plan Source: http://www.cms.gov/EHRIncentivePrograms/Downloads/EHR_Incentive_Program_Agency_Training_v8-20.pdfCopyright © 2010 McKesson Corporation. All Rights Reserved. 18 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • Meaningful Use Incentive Payment Detail  First payments anticipated May 2011  Payments to be made within 15 – 46 days after application approved  Eligible Hospitals may be able to “skip” a year, but will lose that year’s payment for Medicare  Medicaid payment years need not be consecutive prior to FY 2016  No restrictions on EHR incentive payment; treated similar to bonus payment  Payments will be based on most recently submitted Cost Report and calculated by the FIs/MACs  Payments to be paid through single p y y p g g payment contractorSource: U.S. Department of Health & Human Services. Medicare and Medicaid Programs; Electronic Health Record Incentive Program. Vol. 75, No. 144. / Federal Register /January 28, 2010 / Final Rule. Retrieved from http://federalregister.gov/a/2010-17207Copyright © 2010 McKesson Corporation. All Rights Reserved. 19 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • Meaningful Use Certification  Final Rule published in Federal Register June 24, 2010  Timeline ─ Applications open July 1; expected to “open doors” by end of August ─ First certified systems expected “Fall 2010”  Remote testing required by Accredited Testing & Certification Bodies (ATCB) ─ Testing on developers systems or at operational site  Must strictly adhere to requirements established by HHS ─ May offer other programs, but cannot add requirements to HHS certification ─ No grandfathering of previous certifications supported by HHS  Certification attestation required with service packs/subsequent code releases ─ Attest to no changes to applications that would affect certification criteria  Horizon Clinicals 10.3 ─ September: Apply for certification ─ October: targeted Generally Available (GA)Copyright © 2010 McKesson Corporation. All Rights Reserved. DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • Hospital Stimulus Program Medicare Based Medicare-Based Incentives  Requires “meaningful use” of certified Potential Medicare Incentive for Electronic Health Record (EHR) Saint Lukes Health System ─ Stage 1 final requirements posted to Federal (thousands) Register July 28, 2010 (official 60 days later) $12,000 Potential for ~ $20.9 million over 4 years  Formula based primarily on acute inpatient Based on 42,646 discharges; discharges and Medicare share $10,000 46.7% Medicare Days; 3.0% Charity ─ Initial A t I iti l Amt = $2M + $200 per di h discharge $8,307 for discharges between 1,150 and 23,000 $8,000 ─ Medicare Share based on inpatient bed days, excluding those not paid under IPPS, $6,265 with an adjustment for charity care $6,000 $ Stage ─ 100% yr 1, 75% yr 2, 50% yr 3, 25% yr 4 1 90 days $4,201  Must qualify initially between FY 2011 – FY $4,000 1 2013 to receive max 12 mo ─ Reduced i R d d incentives f FY 2014 – FY 2015 ti for 2 $2,112 12 mo ─ No payments to providers after FY 2016 $2,000 TBD ─ May miss a year, but lose that year’s payment 12 mo $0 $0 ─ Estimate first payment year paid out within 15 – $0 46 d days (if applying after M 2011) l i ft May, 2011 2012 2013 2014 2015 2016  Hospitals are permitted to participate in Federal Fiscal Year (begins October 1) Medicaid incentives as well (min 10%)Copyright © 2010 McKesson Corporation. All Rights Reserved. 22 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • Hospital Stimulus Program Medicare Based Medicare-Based Penalties  Non-compliance of EHR requirements Potential Medicare Penalties for results in penalties Saint Lukes Health System (thousands) ─ Penalties begin in FY 2015 $0 $0 ─ Impacts Medicare only – not Medicaid  Penalized through reductions in market ($2,000) ( ($1,956) ) basket adjustments ─ FY 2015 – 25% cut in applicable increase ($4,000) ($3,982) ─ FY 2016 – 50% cut ─ FY 2017 and beyond – 75% cut y ($6,000) ($6 000) ($6,031) ($6,100) ($6,172)  Projections based on historical national average market basket adjustment of 3.1% ($8,000) ─ FY 2015: 3.1% X 25% = 0.775% penalty Potential for ~ $24.2 million penalty ─ FY 2016: 3.1% X 50% = 1.550% penalty between 2015 - 2019 ($10,000) Based on $247.0 million current ─ FY 2017+: 3.1% X 75% = 2.325% penalty annual Medicare reimbursement ($12,000) 2014 2015 2016 2017 2018 2019 Federal Fiscal Year (begins October 1)Copyright © 2010 McKesson Corporation. All Rights Reserved. 23 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • Hospital Stimulus Program Medicaid Based Medicaid-Based Incentives  Requires “meaningful use” of certified EHR Potential Medicaid Incentive for by second year Saint Lukes Health System ─ State administered – and optional (thousands) $5,000 ─ State may not add to federal MU objectives, but can require certain menu objectives  Formula based primarily on inpatient Potential for ~ $5.0 million over 3-6 years $ , $4,000 Based on 42,646 discharges; discharges and Medicaid share 11.0% Medicaid Days; 3.0% Charity ─ Use the 4-yr total based on Medicare formula assuming 100% Medicare $3,000 ─ Cap based on Medicaid share $2,479 ─ Potential to transition over 3 – 6 years Can not exceed 50% in any year; 90% in 2 yrs $1,983 $2,000 ─ Payment years need not be consecutive ─ First year payment for Implementation, Adoption or U Upgrading di $1,000  Must qualify by FY 2016 to receive max $497 ─ No payments to providers after FY 2021 $0 $0 $0 $0  Must have at least 10% of patient volume 2011 2012 2013 2014 2015 2016 as Medicaid or be a children’s hospital Federal Fiscal Year (begins October 1)  Unlike Medicare, no penaltiesCopyright © 2010 McKesson Corporation. All Rights Reserved. 24 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • Appendix B Clinical Quality Measures for HospitalsSource: TABLE 10: Clinical Quality Measures for Submission by Eligible Hospitals and CAHs for Payment Year 2011-20125. U.S. Department of Health & Human Services.Medicare and Medicaid Programs; Electronic Health Record Incentive Program. Vol. 75, No. 144. / page 44418 – 44420 / Federal Register / January 28, 2010 / Final Rule.Retrieved from http://federalregister.gov/a/2010-17207 p g gFootnote: In the event that new clinical quality measures are not adopted by 2013, the clinical quality measures in this Table would continue to apply. Copyright © 2010 McKesson Corporation. All Rights Reserved.
    • TABLE 10: Clinical Quality Measures for Submission by Elig. Hospitals/CAHs for Payment Year 2011 2012 2011-2012Measure No.Identifier Measure Title, Description & Measure StewardEmergency Title: Emergency Department Throughput – admitted patients Median time from ED arrival to ED departureDepartment (ED)-1 for admitted patients Description: Median time from emergency department arrival to time of departure from the emergency roomNQF 0495 for patients admitted to the facility from the emergency department Measure Developer: CMS/Oklahoma Foundation for Medical Quality (OFMQ)ED-2ED 2 Title: Emergency Department Throughput – admitted patients Admission decision time to ED departure time for admitted patientsNQF 0497 Description: Median time from admit decision time to time of departure from the emergency department of emergency department patients admitted to inpatient status Measure Developer: CMS/OFMQStroke-2St k 2 Title: Ischemic t k Titl I h i stroke – Di h Discharge on anti-thrombotics ti th b ti Description: Ischemic stroke patients prescribed antithrombotic therapy at hospital dischargeNQF 0435 Measure Developer: The Joint CommissionStroke-3 Title: Ischemic stroke – Anticoagulation for A-fib/flutter Description: Ischemic stroke patients with atrial fibrillation/flutter who are prescribed anticoagulation therapyNQF 0436 at hospital discharge. Measure Developer: The Joint CommissionStroke-4 Title: Ischemic stroke – Thrombolytic therapy for patients arriving within 2 hours of symptom onset Description: Acute ischemic stroke patients who arrive at this hospital within 2 hours of time last known wellNQF 0437 and for whom IV t-PA was initiated at this hospital within 3 hours of time last known well. p Measure Developer: The Joint CommissionAccess detailed electronic specifications of the clinical quality measures for EPs, eligible hospitals, and CAHs on the CMS website athttp://www.cms.gov/QualityMeasures/03_ElectronicSpecifications.asp#TopOfPageCopyright © 2010 McKesson Corporation. All Rights Reserved. 56 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • TABLE 10: Clinical Quality Measures for Submission by Elig. Hospitals/CAHs for Payment Year 2011 2012 2011-2012Measure No.Identifier Measure Title, Description & Measure StewardStroke-5Stroke 5 Title: Ischemic or hemorrhagic stroke – Antithrombotic therapy by day 2 Description: Ischemic stroke patients administeredNQF 0438 antithrombotic therapy by the end of hospital day 2. Measure Developer: The Joint CommissionStroke-6 Title: Ischemic stroke – Discharge on statins Description: Ischemic stroke patients with LDL ≥ 100 mg/dL, or LDL not measured, or who were on a lipid mg/dL measured or, lipid-NQF 0439 lowering medication prior to hospital arrival are prescribed statin medication at hospital discharge. Measure Developer: The Joint CommissionStroke-8 Title: Ischemic or hemorrhagic stroke – Stroke education Description: Ischemic or hemorrhagic stroke patients or their caregivers who were given educationalNQF 0440 materials d i th h t i l during the hospital stay addressing all of the following: activation of emergency medical system, it l t dd i ll f th f ll i ti ti f di l t need for follow-up after discharge, medications prescribed at discharge, risk factors for stroke, and warning signs and symptoms of stroke. Measure Developer: The Joint CommissionStroke-10 Title: Ischemic or hemorrhagic stroke – Rehabilitation assessment Description: Ischemic or hemorrhagic stroke patients who were assessed for rehabilitation services.NQF 0441 Measure Developer: The Joint CommissionVenous Title: VTE prophylaxis within 24 hours of arrivalThromboembolism Description: This measure assesses the number of patients who received VTE prophylaxis or have((VTE)-1 ) documentation why no VTE prophylaxis was g y p p y given the day of or the day after hospital admission or surgery y y p g y end date for surgeries that start the day of or the day after hospital admission.NQF 0371 Measure Developer: The Joint CommissionAccess detailed electronic specifications of the clinical quality measures for EPs, eligible hospitals, and CAHs on the CMS website athttp://www.cms.gov/QualityMeasures/03_ElectronicSpecifications.asp#TopOfPageCopyright © 2010 McKesson Corporation. All Rights Reserved. 57 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • TABLE 10: Clinical Quality Measures for Submission by Elig. Hospitals/CAHs for Payment Year 2011 2012 2011-2012Measure No.Identifier Measure Title, Description & Measure StewardVTE-2VTE 2 Title: Intensive Care Unit VTE prophylaxis Description: This measure assesses the number of patients who received VTE prophylaxis or haveNQF 0372 documentation why no VTE prophylaxis was given the day of or the day after the initial admission (or transfer) to the Intensive Care Unit (ICU) or surgery end date for surgeries that start the day of or the day after ICU admission (or transfer). Measure Developer: The Joint Commission pVTE-3 Title: Anticoagulation overlap therapy Description: This measure assesses the number of patients diagnosed with confirmed VTE who received anNQF 0373 overlap of parenteral (intravenous [IV] or subcutaneous [subcu]) anticoagulation and warfarin therapy. For patients who received less than five days of overlap therapy, they must be discharged on both medications. Overlap therapy must be administered for at least five days with an international normalized ratio (INR) ≥ 2 prior to discontinuation of the parenteral anticoagulation therapy or the patient must be discharged on both meds. Measure Developer: The Joint CommissionVTE-4 Title: Platelet monitoring on unfractionated heparin Description: This measure assesses the number of patients diagnosed with confirmed VTE who receivedNQF 0374 intravenous (IV) UFH therapy dosages AND had their platelet counts monitored using defined parameters such as a nomogram or protocol. Measure Developer: The Joint CommissionAccess detailed electronic specifications of the clinical quality measures for EPs, eligible hospitals, and CAHs on the CMS website athttp://www.cms.gov/QualityMeasures/03_ElectronicSpecifications.asp#TopOfPageCopyright © 2010 McKesson Corporation. All Rights Reserved. 58 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION
    • TABLE 10: Clinical Quality Measures for Submission by Elig. Hospitals/CAHs for Payment Year 2011 2012 2011-2012Measure No.Identifier Measure Title, Description & Measure StewardVTE-5VTE 5 Title: VTE discharge instructions Description: This measure assesses the number of patients diagnosed with confirmed VTE that areNQF 0375 discharged to home, to home with home health, home hospice or discharged/ transferred to court/law enforcement on warfarin with written discharge instructions that address all four criteria: compliance issues, dietary advice, follow-up monitoring, and information about the potential for adverse drug reactions/interactions. Measure Developer: The Joint CommissionVTE-6 Title: Incidence of potentially preventable VTE Description: This measure assesses the number of patients diagnosed with confirmed VTE duringNQF 0376 hospitalization (not present on arrival) who did not receive VTE prophylaxis between hospital admission and the day before the VTE diagnostic testing order date. Measure Developer: The Joint CommissionAccess detailed electronic specifications of the clinical quality measures for EPs, eligible hospitals, and CAHs on the CMS website athttp://www.cms.gov/QualityMeasures/03_ElectronicSpecifications.asp#TopOfPageCopyright © 2010 McKesson Corporation. All Rights Reserved. 59 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION