SCG's Meaningful Use White Paper

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White Paper Discussing Meaningful Use Incentives

White Paper Discussing Meaningful Use Incentives

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  • 1. SUCCOR CONSULTING GROUP Help has arrived.__________________________________________ Medicare & Medicaid Meaningful Use Incentives Program Specifics May 2011 Copyright 2011 © Succor Consulting Group, Inc
  • 2. TABLE OF CONTENTSEHR INCENTIVE PROGRAM - OVERVIEW 1MEDICARE/MEDICAID ELIGIBLE PROFESSIONALS (EPs) 3ELIGIBILITY REQUIREMENTS FOR PHYSICIANS 4MEDICAID INCENTIVES OVERVIEW 6ELIGIBLE PROFESSIONAL SHORTAGE BONUSES 7PROFESSIONALS ELIGIBLE FOR BOTH PROGRAMS 8MEDICARE VS MEDICAID 9PENDING EXPANDED MEDICARE & MEDICAID ELIGIBLE PROFESSIONALS & FACILITIES 10MEDICARE EHR INCENTIVES BASICS OVERVIEW FOR ELIGIBLE PROFESSIONALS 11MEDICAID EHR INCENTIVES BASICS OVERVIEW FOR ELIGIBLE PROFESSIONALS 12MEDICARE ADVANTAGE ELIGIBLE PROFESSIONALS 13MEDICARE ELIGIBLE HOSPITALS 14MEDICAID ELIGIBLE HOSPITALS 19MEDICARE & MEDICAID DUALLY ELIGIBLE HOSPITALS 22E-PRESCRIBING INCENTIVES PROGRAM OVERVIEW 23E-PRESCRIPTION – ELIGIBLE PROFESSIONALS 26E-PRESCRIBING INCENTIVES PAYMENT DETAILS 28WHAT IS MEANINGFUL USE (MU)? 29BASIC OVERVIEW OF STAGE 1 MU OBJECTIVES AND MEASURES REPORTING 32ELIGIBLE PROFESSIONALS 15 CORE/10 MENU OBJECTIVES 33ELIGIBLE PROFESSIONALS & MEANINGFUL USE 34WHAT ARE CLINICAL QUALITY MEASURES? 35WHAT ARE QUALITY MEASURES? 35EP REQUIREMENTS FOR CLINICAL QUALITY MEASURES 36EP REQUIREMENTS FOR CLINICAL QUALITY MEASURES REPORTING 36EP REPORTING PERIOD 37CLINICAL QUALITY MEASURES CORE SET 38ALTERNATE CORE SET 38ADDITIONAL SET CQM 39REGISTRATION REQUIREMENTS 41PROGRAM TIMELINE 42ACRONYMS 43
  • 3. EHR INCENTIVES PROGRAM OVERVIEWEHR Incentive Programs were established by law through the AmericanRecovery & Reinvestment Act (ARRA) of 2009.The Medicare and Medicaid EHR Incentive Programs will provide incentivepayments to eligible professionals (EPs), eligible hospitals and critical accesshospitals (CAHs), Integrated Delivery Networks (IDNs) and other MedicalEstablishments as they adopt, implement, upgrade or demonstrate MeaningfulUse (MU) of CCHIT certified EHR technology.We have been preparing to cross this threshold for many decades. Thepotential for information technology to support and improve health care wasrecognized early. Government and private support for development andassessment of health informatics began in the 1960s. Yet, even as computerstransformed almost every other sector of the economy, health care remainedmostly paper-based.In 2009, Congress and President Obama took a definitive new step when theyenacted the Health Information Technology Economic and Clinical Heath Act(HITECH), part of ARRA. HITECH authorized up to $27 billion in incentivepayments for providers and $2 billion to build a national infrastructure for theadoption of EHRs. Most importantly, HITECH established the goal of themeaningful use of electronic health records. However cryptic this term mayhave seemed at first, it holds the key to unlocking the power of information totransform health care for the better.Put plainly, “meaningful use” is a shorthand for three things:An incentive program, rewarding not only deployment of EHRs, but also theireffective use for patient benefit;A new national infrastructure to support deployment and beneficial use ofEHRs; andA vision for the evolving, dynamic and optimal uses of information to supporthealth and health care improvement – the tip of the spear for an information-powered leap in the quality, safety and effectiveness (including costeffectiveness) of our health care system. 1
  • 4. As an incentive program, meaningful use went live January 1, 2011. That waswhen registration opened for eligible providers and hospitals to take part in theMedicare and Medicaid incentive payments programs. Surveys in the latter partof 2010 by the American Hospital Association (AHA) and CDC’s National Centerfor Health Statistics indicated that 81 percent of hospitals and 41 percent ofoffice-based physicians were already planning to achieve meaningful use andqualify for incentive payments. In January alone, 21,300 providers initiated theregistration process. 2
  • 5. MEDICARE ELIGIBLE PROFESSIONALSEligible professionals under the Medicare EHR Incentive Program include:• Doctor of medicine or osteopathy• Doctor of dental surgery or dental medicine• Doctor of podiatry• Doctor of optometry• ChiropractorEPs may not be hospital-based.MEDICAID ELIGIBLE PROFESSIONALSEligible professionals under the Medicaid EHR Incentive Program include:• Physicians (primarily doctors of medicine and doctors of osteopathy)• Nurse practitioner• Certified nurse-midwife• Dentist• Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant.EPs may not be hospital-based.To qualify for an incentive payment under the Medicaid EHR Incentive Program,an eligible professional must meet one of the following criteria:1. Have a minimum of 30% Medicaid patient volume*2. Have a minimum of 20% Medicaid patient volume and is a pediatrician*3. Practice predominantly in a Federally Qualified Health Center or Rural HealthCenter and have a minimum of 30% patient volume attributable to needyindividuals*Note - Childrens Health Insurance Program (CHIP) patients do not count toward theMedicaid patient volume criteria. 3
  • 6. ELIGIBILITY REQUIREMENTS FOR PROFESSIONALS• Incentive payments for eligible professionals are based on individual practitioners.• If you are part of a practice, each eligible professional may qualify for an incentive payment if each eligible professional successfully demonstrates meaningful use of certified EHR technology.• Each eligible professional is only eligible for one incentive payment per year, regardless of how many practices or locations at which he or she provides services.Hospital-based eligible professionals are not eligible for incentivepayments. An eligible professional is considered hospital-based if 90% or moreof his or her services are performed in a hospital inpatient (Place Of Servicecode 21) or emergency room (Place Of Service code 23) setting. 4
  • 7. Medicare EP Incentive Payments amounts are based on:• Fee-for-Service (FFS) allowable charges• Maximum incentives are $44,000 over 5 years• Incentives decrease if starting after 2012• Must begin by 2014 to receive incentive payments• Last payment year is 2016• Extra bonus amount available for practicing predominantly in a Health Professional Shortage Area• Receive one (1) incentive payment per year Payment First Year you First Year you First Year you First Year you Amount for Qualify to Qualify to Qualify to Qualify to Year: Receive Payment Receive Payment Receive Payment Receive Payment 2011 2012 2013 2014 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 2016 - $2,000 $4,000 $4,000 TOTAL Possible $44,000 $44,000 $39,000 $24,000 Incentive Payments 5
  • 8. Medicaid Incentives Payments Overview• Maximum incentives are $63,750 over six years• Incentives are the same regardless of start year• The first year payment is $21,250• Must begin by 2016 to receive incentive payments• Incentives are available through 2021• Pays one (1) incentive payment per year*NOTE: No extra bonus for health professional shortage area Payment First Year you First Year you First Year you First Year you First Year you First Year you Amount for Qualify to Qualify to Qualify to Qualify to Qualify to Qualify to Year: Receive Payment Receive Payment Receive Payment Receive Payment Receive Payment Receive Payment 2011 2012 2013 2014 2015 2016 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 Possible $63,750 $63,750 $63,750 $63,750 $63,750 $63,750 Incentive Payments 6
  • 9. ELIGIBLE PROFESSIONAL SHORTAGE BONUSESYou may qualify for more!Practices with 30% or more of their patient population paying with Medicaid(20% for pediatricians) are eligible for stimulus incentive payments of up to$65,000.Practices operating in a "health provider shortage area" (HPSA) can qualifyfor bonus incentives, e-prescribing, Medicares physician quality reportinginitiative (PQRI) and Medicare Care Manage Performance (MCMP) can alsoincrease your bonuses. Private Practice Non-FQHC Safety NetClinics FQHC ClinicsMedicare HITECHIncentive $44,000 per provider $44,000 per provider $44,000 per providerMedicare PlusHSPA $48,400 per provider $48,400 per provider $48,400 per providerMedicaid HITECHIncentive - $65,000 per provider $65,000 per providerBonusE-Prescribe 2% bonus 2% bonus 2% bonusMedicare PQRI 2% bonus 2% bonus -Medicare MCMP $12,500 per provider $12,500 per provider - 7
  • 10. PROFESSIONALS ELIGIBLE FOR BOTH PROGRAMSEPs eligible for both the Medicare and Medicaid EHR Incentive Programsmust choose which incentive program they wish to participate in when theyregister.Before 2015, an EP may switch programs only once after the first incentivepayment is initiated. Medicare EPs who also qualify as a Medicaid EP mustchoose between the Medicare and Medicaid incentive programs when theyregister.Medicaid EPs and providers who are not eligible to participate in the Medicareand Medicaid EHR Incentive Programs will not be subject to paymentadjustments. However, Medicaid EPs who also treat Medicare patients willhave a payment adjustment to Medicare reimbursements, starting in 2015 ifthey do not successfully demonstrate meaningful use. Eligible for both Doctors or Medicine Doctors of Osteopathy Doctors of Dental Medicine or Surgery Nurse Practitioners Doctors of Optometry Certified Nurse-Midwives Doctors of Podiatric Physician Assistants Medicine (when working at an Chiropractor FQHC or RHA that is led by a PA) Medicare only Medicaid only*Most eligible professionals will maximize their incentive payments byparticipating in the Medicaid EHR Incentive Program. 8
  • 11. MEDICARE VS MEDICAIDMedicare MedicaidFederal Government will implement Voluntary for States to implement -starting January 2011 Most expected to start late summer 2011Payment reductions begin in 2015 for No Medicaid payment reductionsproviders that do not demonstrate MUMust demonstrate MU in Year 1 A/I/U option for 1st participation yearMaximum incentive is $44,000 for EPs Maximum incentive is $63,750 for EPs(bonus for Eps in HPSAs)MU definition is common for Medicare States can adopt certain additional requirements for MULast year a provider may initiate program Last year a provider may register for &is 2014; Last year to register is 2016; initiate program is 2016; Last paymentPayment adjustments begin in 2015 year is 2021Only physicians, subsection (d) 5 types of EPs, acute care hospitalshospitals and CAHs (including CAHs) & childrens hospitals 9
  • 12. PENDING EXPANDED MEDICARE & MEDICAID ELIGIBLEPROFESSIONALS & FACILITIESLegislation introduced in the U.S. Senate would extend eligibility for electronichealth records meaningful use incentive payments to:• Behavioral health professionals and facilities• Mental health professionals and facilities• Substance abuse professionals and facilitiesSen. Sheldon Whitehouse (D-RI) introduced S. 539, which has been referred tothe Finance Committee. Facilities eligible under the bill include:• Community mental health centers• Psychiatric hospitals• Residential mental health treatment facilities• Outpatient mental health treatment facilities• Substance abuse treatment facilities• Including facilities operated by countiesThe legislation also would make these professionals and facilities eligible forservices from health information technology extension centers. Text of S. 529 isavailable at congress.gov. Please check back for updates. 10
  • 13. MEDICARE EHR INCENTIVES BASICS OVERVIEW FORELIGIBLE PROFESSIONALSThe Medicare EHR Incentive Program for EPs starts in 2011 and will continuethrough 2016. Depending on the first year they participate, EPs can participatefor up to 5 years throughout the duration of the program. The last year to beginparticipation in the Medicare EHR Incentive Program is 2014.• To qualify for Medicare EHR incentive payments, Medicare EPs mustsuccessfully demonstrate meaningful use for each year of participation in the program.• Incentive payments are made based on the calendar year. The reportingperiod for the first year is any 90 continuous days during the calendar year. Thereporting period for all subsequent years is the entire calendar year.• For calendar years 2011–2016, EPs who demonstrate meaningful use ofcertified EHR technology can receive up to $44,000 over 5 years under theMedicare EHR Incentive Program.To receive the maximum EHR incentive payment, Medicare EPs must begin participation by 2012. Important! For 2015 and later, Medicare EPs who do not successfullydemonstrate meaningful use will have a payment adjustment to their Medicarereimbursement. The payment reduction starts at 1% and increases each yearthat a Medicare EP does not demonstrate meaningful use, to a maximum of 5%. 11
  • 14. MEDICAID EHR INCENTIVES BASICS OVERVIEW FORELIGIBLE PROFESSIONALSThe Medicaid EHR Incentive Program is offered and administered voluntarily bystates and territories. States can start offering their program to EPs as early as2011. The program continues through 2021. EPs can participate for 6 yearsthroughout the duration of the program. The last year to begin participationin the Medicaid EHR Incentive Program is 2016.• To qualify for Medicaid incentive payments, Medicaid EPs must adopt,implement, upgrade or demonstrate meaningful use of certified EHR technologyin the first year of participation and successfully demonstrate meaningful use insubsequent participation years.• For calendar years 2011–2021, participants can receive up to $63,750 over 6years under the Medicaid EHR incentive program. EHR incentive payments aremade by the state based on the calendar year.• Medicaid EPs who also qualify as Medicare EPs must choose between theMedicare and Medicaid EHR Incentive Programs when they register.• Medicaid EPs and providers who are not eligible to participate in the Medicareand Medicaid EHR Incentive Programs will not be subject to paymentadjustments. However, Medicaid EPs who also treat Medicare patients will havea payment adjustment to Medicare reimbursements starting in 2015 if they donot successfully demonstrate meaningful use. 12
  • 15. MEDICARE ADVANTAGE ELIGIBLE PROFESSIONALS?Medicare Advantage (MA) EPs are physicians that are either:• Employed by the Medicare Advantage organization OR• Employed by, or partner of, an entity through a contract with the Medicare Advantage organization, that furnishes at least 80% of that entitys Medicare patient care services to enrollees of the MA organization.Also, Medicare Advantage EPs must furnish at least 80% of their Medicare-related professional services to enrollees of the MA organization and mustfurnish, on average, at least 20 hours per week of patient care services.Medicare Advantage (MA) organizations may also qualify to receive EHRincentive payments. Under the Medicare Advantage EHR Incentive Program,payments are made only to Medicare Advantage organizations that are licensedas HMOs, or in the same manner as HMOs, by a State. These MedicareAdvantage organizations may receive incentive payments by way of MedicareAdvantage affiliated hospitals (MA-affiliated hospitals) and Medicare AdvantageEPs.What is a Medicare Advantage affiliated hospital?Medicare Advantage affiliated hospitals are hospitals that:• Are under a common corporate governance with the Medicare Advantage organization AND• Serve individuals enrolled under Medicare Advantage plans offered by the Medicare Advantage organization, where less than one-third are Medicare individuals covered under Medicare Part A.*For additional information regarding the Medicare Advantage EHR incentive payment,please review section 4101(c) of subtitle D of the HITECH ACT. 13
  • 16. MEDICARE ELIGIBLE HOSPITALSEligible hospitals and Critical Access Hospitals (CAHs) will qualify for incentivepayments under the Medicare EHR Incentive Program if they successfullydemonstrate meaningful use of certified EHR technology.What is an Eligible Hospital under the Medicare EHR Incentive Program?• "Subsection (d) hospitals" in the 50 states or DC that are paid under theInpatient Prospective Payment System (IPPS)• Critical Access Hospitals (CAHs)• Medicare Advantage (MA-Affiliated) Hospitals• Eligible hospitals and CAHs that adopt and successfully demonstratemeaningful use of certified EHR technology can begin receiving incentivepayments for any year from federal fiscal year (FY) 2011 to FY 2015.• Incentive payments to eligible hospitals and CAHs may begin as early as2011 and are based on a number of factors, beginning with a $2 million basepayment.• The law defines a payment year for eligible hospitals and CAHs in terms offederal fiscal year (FY) beginning with FY 2011. However, a hospital does nothave to begin receiving incentive payments in FY 2011.• Hospitals can begin receiving EHR incentive payments in any year from FY2011 to FY 2015, but payments will decrease for hospitals that start receivingpayments in 2014 and later.• Hospitals that do not successfully demonstrate meaningful use of certifiedEHR technology beginning in FY 2015 will be subject to payment adjustments. 14
  • 17. Eligible acute care inpatient hospitals are defined as “subsection (d) hospitals”in section 1886(d)(1)(B) of the Act—which are hospitals that are paid under thehospital inpatient prospective payment system (IPPS) and are located in one ofthe 50 states or the District of Columbia. Section 1853(m)(2) of the Act alsospecifies that qualifying Medicare Advantage (MA) organizations will be eligiblefor incentive payments by way of their MA-affiliated eligible hospitals. An MA-affiliated eligible hospital is a “subsection (d)” hospital that operates undercommon corporate governance with a qualifying MA organization and servesprimarily individuals enrolled under MA plans offered by such organizations.Medicare hospitals and MA-affiliated eligible hospitals that adopt a certifiedEHR system and are meaningful users can begin receiving incentive paymentsin any year from FY 2011 to FY 2015.Medicare Incentive Payment CalculationRegardless of the payment year, the Medicare incentive payment is the productof three factors:1. An Initial Amount2. The Medicare Share3. A Transition Factor applicable to the payment year This paymentmethodology will be utilized to calculate Medicare hospital-based EHR incentivepayments for eligible hospitals participating under both the Medicare fee forservice and MA incentive programs.Initial Amount = a base amount of $2,000,000 + discharge-related amountThe Initial Amount is the sum of a base amount and a discharge-relatedamount. The base amount is $2,000,000, and the discharge-related amountprovides an additional $200 for each acute care hospital discharge during apayment year, beginning with a hospital’s 1,150th discharge of the year andending with a hospital’s 23,000th discharge of the year. No additional paymentis made for discharges prior to the 1,150th discharge or for those dischargesafter the 23,000th discharge.Data on acute care hospital discharges from the hospital’s most recently filed12-month cost report at the time of the calculation will be used as the basis formaking preliminary incentive payments. Final payments will be determined atthe time of settling the first 12-month cost report for the hospital FY that beginsafter the beginning of the payment year and settled on the basis of the hospitaldischarge data from that cost reporting period. 15
  • 18. For example, for an eligible hospital with a cost reporting period running from July 1, 2010 through June 30, 2011, CMS would employ the relevant data from the hospital’s most recently filed 12-month cost report at the time of the calculation (most likely the June 30, 2010 cost report) to determine the preliminary incentive payment for the hospital during FY 2011. However, the final incentive payment would probably be based on hospital discharge data from the cost report beginning July 1, 2011 (fiscal year ending June 30, 2012) and determined at the time of settlement for that cost reporting period. If that cost report is not filed for a 12-month period, the next full 12-month cost report would be employed. For purposes of determining the Initial Amount, three (3) classes of hospitals are distinguished on the basis of the number of discharges as shown in Table 1. Table 1: Initial Amount Calculation Type of Hospital with 1,149 or fewer with at least 1,150 but no with 23,001 or more discharges during the more than 23,000 discharges during payment year discharges during payment payment year year Base Amount $2,000,000 $2,000,000 $2,000,000 Discharge $0 $200 x (n-1,149) $200 x (23,001- Related Amount (n=number of discharges 1,149) during the payment year) Total Initial $2,000,000 Between $2M & $6,370,400 Limited by law to Amount depending on number of $6,370,400 DischargesMedicare Share Calculation is as follows:# of IP Part A Bed Days + # of IP Part C Days________________________Total IP Bed Days x Total Charges - Charges Attributable to Charity Care IP=inpatient Total ChargesThe second step in determining the hospital payment for a meaningful user ofcertified EHR technology is to calculate the Medicare Share. 16
  • 19. As in calculating the Initial Amount, the time period used to determine theMedicare Share fraction is based on data from the latest filed 12-month costreport at the time the calculation is made and that is later update when the first12-month cost report for the hospital fiscal year that begins after the beginning ofthe payment year is settled.The numerator of the Medicare Share is the sum of:• The estimated number of acute care inpatient-bed-days attributable toindividuals for whom payment may be made under Part A; and• The estimated number of acute care inpatient-bed-days attributable toindividuals who are enrolled with a Medicare Advantage organization under PartC.The denominator of the Medicare Share is the product of:• The estimated total number of acute care inpatient-bed-days for the eligiblehospital during such a period; and• The estimated total amount of the eligible hospital’s charges during suchperiod, not including any charges that are attributable to charity care, divided bythe estimated total amount of the hospitals charges during such period.Note: The removal of charges attributable to charity care in the formula, in effect,increases the Medicare Share resulting in higher incentive payments forhospitals that provide a greater proportion of charity care. The amount comesfrom the Medicare Cost Report, Worksheet S-10.Transition FactorThe third (3rd) factor in the formula to determine the incentive payment to aneligible hospital for a payment year is the Transition Factor. As seen in Table 2 onthe following page, this element phases down the incentive payments over time.Hospitals that demonstrate that they are meaningful users of certified EHRtechnology in FYs 2011, 2012 or 2013, could receive up to four (4) years offinancial incentive payments. Hospitals that begin receiving incentive paymentslater than FY 2013 will receive no more than three (3) years of incentivepayments. Specifically, if a hospital were to begin to demonstrate meaningful useof certified EHR technology in FY 2014, it would receive incentive payments forFY 2014, FY 2015, and FY 2016. 17
  • 20. Similarly, if a hospital were to begin meaningful use of certified EHRtechnology in FY 2015, it would receive incentive payments for FYs 2015 and2016. Table 2 shows the possible years an eligible hospital could receive anincentive payment and the Transition Factor applicable to each year.Table 2: Fiscal Year That Eligible Hospital First Receives the IncentivePayment Fiscal Year 2011 2012 2013 2014 2015 2011 1.00 2012 0.75 1.00 2013 0.50 0.75 1.00 2014 0.25 0.50 0.75 0.75 2015 0.25 0.50 0.50 0.50 2016 0.25 0.25 0.25 18
  • 21. MEDICAID ELIGIBLE HOSPITALSEligible hospitals will qualify for incentive payments if they adopt, implement,upgrade or demonstrate meaningful use of certified EHR technology duringthe first participation year or successfully demonstrate meaningful use ofcertified EHR technology in subsequent participation years.What is an Eligible Hospital under the Medicaid EHR IncentiveProgram?• Acute care hospitals (including CAHs and cancer hospitals) with at least10% Medicaid patient volume Childrens hospitals (no Medicaid patientvolume requirements)• Medicaid hospitals that qualify for EHR incentive payments may beginreceiving incentive payments in any year from fiscal year (FY) 2011 to FY2016.• While the law defines a payment year in terms of a FY beginning with FY2011, a hospital does not have to begin receiving incentive payments in FY 2011. An eligible acute care inpatient hospital is defined as a health care facilitywith an average length of patient stay of 25 days or fewer and with a ClaimControl Number that has the last four digits in the series 0001-0879 or 1300-1399. This includes the 11 cancer hospitals and all Critical Access Hospitals(CAHs) in the United States. In addition, to be eligible to receive a MedicaidEHR incentive payment, acute care hospitals must also meet a 10 percent(10%) Medicaid patient volume threshold. There is no Medicaid patientvolume requirement for children’s hospitals.The method for estimating Medicaid patient volume will be designated by theState Medicaid Agency and approved by CMS, but CMS provided States withacceptable alternatives for making such estimates in the final rule.Provided the state where the hospital is located is ready and participating inthe Medicaid EHR Incentive Program, acute care and children’s hospitals thatadopt a certified EHR system and are meaningful users can begin receivingincentive payments in any year from fiscal year (FY) 2011 to FY 2016. 19
  • 22. While the law defines a payment year in terms of a federal fiscal year, a hospitaldoes not have to begin receiving incentive payments in FY 2011. Hospitals canbegin receiving payments in any year from FY 2011 to FY 2016; however, the lastyear a hospital can first receive a Medicaid incentive program payment is 2016.Acute care hospitals may receive EHR Incentive Program payments from bothMedicare and Medicaid if eligible for both programs.Medicaid Incentive Payment Calculation States may pay children’s hospitals andacute care hospitals up to 100 percent (100%) of an aggregate EHR hospitalincentive amount provided over a minimum of a three-year period and amaximum of a six-year period. The aggregate EHR incentive amount is the totalamount the hospital could receive in Medicaid payments over a theoretical four(4) years of the program. It is the product of two factors:1. The overall EHR amount.2. The Medicaid Share.The overall EHR amount is based upon the sum over a theoretical four years ofpayment where the amount for each year is the product of three (3) factors:1. An Initial Amount2. The Medicare Share3. A Transition Factor applicable to each of a theoretical four (4) years.Initial AmountInitial Amount = a base amount of $2,000,000 + a discharge-related amountThe Initial Amount is the sum of a base amount and a discharge-related amount.The base amount is $2,000,000, and the discharge-related amount provides anadditional $200 for estimated discharges between 1,150 and 23,000 discharges.No payment is made for discharges prior to the 1,150th discharge or fordischarges after the 23,000th discharge.For the first payment year, data on hospital discharges from the hospital fiscalyear that ends during the federal fiscal year prior to the hospital fiscal year thatserves as the first payment year will be used as the basis for determining thedischarge-related amount. To determine the discharge-related amount for thethree subsequent payment years that are included in determining the overallEHR amount, the number of discharges will be based on the average annualgrowth rate for the hospital over the most recent three years of available data.Note: If a hospital’s average annual rate of growth is negative over the three-yearperiod, the rate should be applied as such. 20
  • 23. This factor in the formula determines the Medicaid incentive payment to an eligible hospital. For each of the four (4) years of theoretical payment, a different transition factor applies, as demonstrated in Table 1. Note that for the Medicaid Program, an aggregate EHR amount is calculated only once, and this amount is then spread over all years of a hospital’s payments. Therefore, the transition factors in Table 1 are used to calculate the aggregate EHR amount but do not indicate that the hospital’s payment will be calculated anew on a yearly basis. The second step in determining the aggregate EHR amount for a meaningful user of certified EHR technology is to calculate the Medicaid Share. The Medicaid Share is essentially the percentage of a hospital’s inpatient, non-charity care days that are attributable to Medicaid inpatients. Table 1: Transition Factor by Year TRANSITION FACTOR Year 1 1.00 Year 2 0.75 Year 3 0.50 Year 4 0.25The Medicaid ShareThe numerator of the Medicaid Share is the sum of:1. The estimated number of Medicaid inpatient-bed-days2. The estimated number of Medicaid managed care inpatient-bed-daysThe denominator of the Medicaid Share is the product of:1. The estimated total number of inpatient-bed-days for the eligible hospitalduring that period2. The estimated total amount of the eligible hospital’s charges during that period,not including any charges that are attributable to charity care divided by theestimated total amount of the hospital’s charges during that period. The hospital’sfinal payments would be based on the State Health Information Technology planfor incentive payments.Note: The removal of charges attributable to charity care in the formula, in effect, increases theMedicaid Share resulting in higher incentive payments for hospitals that provide a greater proportionof charity care. 21
  • 24. MEDICARE & MEDICAID DUALLY ELIGIBLE HOSPITALSSome hospitals may receive incentive payments from both Medicare andMedicaid if they meet all eligibility criteria.Hospitals that are eligible for EHR incentive payments under both Medicare andMedicaid should select "Both Medicare and Medicaid" during theregistration process, even if they plan to apply ONLY for a Medicaid EHRincentive payment by adopting, implementing or upgrading certified EHRtechnology.Dually-eligible hospitals can then attest through CMS for their Medicare EHRincentive payment at a later date, if they so desire. It is important for a dually-eligible hospital to select "Both Medicare and Medicaid" from the start ofregistration in order to maintain this option.Hospitals that register only for the Medicaid program (or only the Medicareprogram) will not be able to manually change their registration (i.e., change to"Both Medicare and Medicaid" or from one program to the other) after apayment is initiated and this may cause significant delays in receiving aMedicare EHR incentive payment. 22
  • 25. E-PRESCRIBING INCENTIVES PROGRAM OVERVIEWEligible Professionals who participate in the eRx Incentive Program byreporting on their adoption and use of a qualified eRx system that has thefunctionalities required by CMS may qualify for an incentive payment.E-prescribing is the transmission of prescription or prescription-relatedinformation through electronic media. The Medicare Improvements for Patientsand Providers Act of 2008 (known as MIPPA) authorized the MedicareElectronic Prescribing Incentive Program to promote adoption and use ofelectronic-prescribing systems.With eRx, health care professionals can electronically transmit both newprescriptions and responses to renewal requests to a pharmacy without havingto write or fax the prescription.The eRx incentive payment is similar to the Physician Quality ReportingInitiative, or PQRI incentive in that it is based on the Medicare Part BPhysician Fee Schedule (PFS) covered professional services furnished by theEPs during a reporting period. To be eligible for the incentive, you must meetthe criteria for being a successful electronic prescriber. The criteria used todetermine whether an EP is a successful electronic prescriber are establishedfor each program year through rulemaking.Beginning 2012, CMS will apply payment adjustments to EPs who are notsuccessful electronic prescribers under the eRx Incentive Program. To becomesuccessful e-prescribers for purposes of avoiding the 2012 eRx paymentadjustment, EPs must report the electronic prescribing measure for a requiredminimum number of unique electronic prescribing events via claims betweenJanuary 1, 2011 and June 30, 2011EPs may begin reporting the eRx measure at any time throughout the 2011program year of January 1-December 31, 2011 to be incentive eligible, butmust do so prior to June 30, 2011 to be exempt from the 2012 eRx paymentadjustment. 23
  • 26. EPs must have adopted a "qualified" e-prescribing system in order to be able toreport the e-prescribing measure. There are two (2) types of systems.1) a system for eRx only (stand-alone).2) an EHR system with eRx functionality.Regardless of the type of system used, to be considered "qualified" it must bebased on ALL of the following capabilities:• Generating a complete active medication list incorporating electronic datareceived from applicable pharmacies and pharmacy benefit managers (PBMs) ifavailable.• Selecting medications, printing prescriptions, electronically transmittingprescriptions and conducting all alerts.• Providing information related to lower cost, therapeutically appropriatealternatives (if any). (The availability of an eRx system to receive tiered formularyinformation, if available, would meet this requirement for 2011)• Providing information on formulary or tiered formulary medications, patienteligibility and authorization requirements received electronically from the patientsdrug plan, if available.EPs can begin by reporting e-prescribing data for January 1-December 31, 2011.Beginning in 2012, EPs who are not successful e-prescribers may be subject toa payment adjustment. Section 132 of the Medicare Improvements for Patientsand Providers Act of 2008 (MIPPA) authorizes CMS to apply this paymentadjustment whether or not the EP is planning to participate in the eRx IncentiveProgram.The payment adjustment in 2012, with regard to all of the EP’s Part B-coveredprofessional services, will result in the EP’s or group practice receiving 99% ofthe Physician Fee Schedule (PFS) amount that would otherwise apply to suchservices. In 2013, the EPs will receive 98.5% of their covered Part B-eligiblecharges if they aren’t a successful e-prescriber. In 2014, the penalty for not beinga successful e-prescriber is 2% resulting in EPs receiving 98% of their coveredPart B charges. 24
  • 27. For purposes of determining which EPs or group practices are subject to thepayment adjustment in 2012, CMS will analyze claims data from January 1,2011- June 30, 2011 to determine if the EP has submitted at least ten (10)electronic prescriptions during the first six months of calendar year 2011. Grouppractices reporting as a GPRO I or GPRO II in 2011must report all of theirrequired e-prescribing events in the first six months of 2011 to avoid thepayment adjustment in 2012.If an EP or selected group practice wishes to request an exemption to the eRxIncentive Program and the payment adjustment, there are two “hardship codes”that can be reported via claims should one of the following situations apply:• G8642 - The EP practices in a rural area without sufficient high speed internetaccess and requests a hardship exemption from the application of the paymentadjustment under section 1848(a)(5)(A) of the Social Security Act.• G8643 - The eligible professional practices in an area without sufficientavailable pharmacies for electronic prescribing and requests a hardshipexemption from the application of the payment adjustment under section1848(a)(5)(A) of the Social Security ActAdditionally, there will be a G code which can be used by EPs to indicate thatthey do not have prescribing privileges. Reporting this G code will prevent theEP from being subjected to a payment adjustment in 2012 . 25
  • 28. EPRESCRIPTION – ELIGIBLE PROFESSIONALSEligible professionals do not need to participate in the Physician QualityReporting System to participate in the Electronic Prescribing (eRx) IncentiveProgram.Under the eRx Incentive Program, covered professional services are those paidunder the Medicare Physician Fee Schedule (PFS). To the extent that eligibleprofessionals are providing services which are paid under the PFS, thoseservices are eligible for eRx Incentive Program.Eligible and Able to ParticipateThe following professionals are eligible to participate in eRx Incentive Program:Eligible professionals must have prescribing authority in order to participate inthis program.1. Medicare physicians • Doctor of Medicine • Doctor of Osteopathy • Doctor of Podiatric Medicine • Doctor of Optometry • Doctor of Oral Surgery • Doctor of Dental Medicine • Doctor of Chiropractic2. Practitioners • Physician Assistant • Nurse Practitioner • Clinical Nurse Specialist • Certified Registered Nurse Anesthetist (and Anesthesiologist Assistant) • Certified Nurse Midwife • Clinical Social Worker • Clinical Psychologist • Registered Dietician • Nutrition Professional • Audiologists3. Therapists • Physical Therapist • Occupational Therapist • Qualified Speech-Language Therapist 26
  • 29. Eligible But Not Able to ParticipateThe following professionals are eligible to participate but are not able toparticipate for one or more reasons:1. Professionals paid under or based upon the PFS billing Medicare Carriers/Medicare Administrative Contractors (MACs) who do not bill directly.2. Professionals paid under the PFS billing Medicare fiscal intermediaries(FIs) or MACs. The FI/MAC claims processing systems currently cannotaccommodate billing at the individual physician or practitioner level:• Critical access hospital (CAH), method II payment, where the physician orpractitioner has reassigned his or her benefits to the CAH. In this situation,the CAH bills the regular FI for the professional services provided by thephysician or practitioner.• All institutional providers that bill for outpatient therapy provided by physicaland occupational therapists and speech language pathologists (for example,hospital, skilled nursing facility Part B, home health agency, comprehensiveoutpatient rehabilitation facility, or outpatient rehabilitation facility). This doesnot apply to skilled nursing facilities under Part A.Services payable under fee schedules or methodologies other than the PFSare not included in Physician Quality Reporting (for example, servicesprovided in federally qualified health centers, independent diagnostic testingfacilities, independent laboratories, hospitals [including method I criticalaccess hospitals], rural health clinics, ambulance providers, and ambulatorysurgery center facilities). 27
  • 30. EPRESCRIBING INCENTIVES PAYMENT DETAILSBeginning 2012, Section 132 of the Medicare Improvements for Patients andProviders Act of 2008 (P.L.110-275) (MIPPA) requires CMS to subject eligibleprofessionals who are not successful electronic prescribers under the eRxIncentive Program to a payment adjustment.This payment adjustment applies to all of the eligible professionals Part B-covered professional services under the Medicare Physician Fee Schedule(MPFS). From 2012 through 2014, the payment adjustment will increase witheach new reporting period. Accordingly, for 2012, eligible professionalsreceiving a payment adjustment will be paid 1.0% less than the MPFSamount for that service. In 2013 and 2014, the payment adjustment increasesto 1.5% and 2.0% respectively.Significant Hardship Exception: Eligible professionals may be exempt fromthe application of the payment adjustment if CMS determines that compliancewith the requirement for being a successful electronic prescriber would resultin a significant hardship. This hardship exception is subject to annualrenewal. 28
  • 31. WHAT IS MEANINGFUL USE (MU)?The Medicare and Medicaid EHR Incentive Programs provide a financialincentive for the "meaningful use" (MU) of certified EHR technology toachieve health and efficiency goals. By putting into action and meaningfullyusing an EHR system, providers will reap benefits beyond financialincentives–such as reduction in errors, availability of records and data,reminders and alerts, clinical decision support, and e-prescribing/refillautomation.The American Recovery and Reinvestment Act (ARRA) specifies three (3)main components of Meaningful Use:1. The use of a certified EHR in a meaningful manner, such as e-Prescribing.2. The use of certified EHR technology for electronic exchange of healthinformation to improve quality of health care.3. The use of certified EHR technology to submit clinical quality and othermeasures.Simply put, "meaningful use" means providers need to show they are usingcertified EHR technology in ways that can be measured significantly in qualityand in quantity.Meaningful Use is using certified EHR technology to:• Improve quality, safety, efficiency and reduce health disparities• Engage patients and families in their health care• Improve care coordination• Improve population and public health• Maintaining privacy and securityThe criteria for meaningful use will be staged in three (3) steps over thecourse of the next five (5) years. 29
  • 32. Stage 1 (2011 and 2012) sets the baseline for electronic data capture andinformation sharing.Stage 2 (expected to be implemented in 2013)Stage 3 (expected to be implemented in 2015) and will continue to expandon this baseline and be developed through future rule making.To qualify for incentive payments, meaningful use requirements must be met inthe following ways:Medicare EHR Incentive Program—Eligible professionals, eligible hospitals,and critical access hospitals (CAHs) must successfully demonstrate meaningfuluse of certified electronic health record technology every year they participate inthe program.Medicaid EHR Incentive Program—Eligible professionals and eligiblehospitals may qualify for incentive payments if they adopt, implement, upgradeor demonstrate meaningful use in their first year of participation. They mustsuccessfully demonstrate meaningful use for subsequent participation years.Adopted: Acquired and installed certified EHR technology. (For example, canshow evidence of installation.)Implemented: Began using certified EHR technology. (For example, providestaff training or data entry of patient demographic information into EHR.)Upgraded: Expanded existing technology to meet certification requirements.(For example, upgrade to certified EHR technology or add new functionality tomeet the definition of certified EHR technology.)What are the requirements for Stage 1 of Meaningful Use (2011 and 2012)?Meaningful use includes both a core set and a menu set of objectives that arespecific to eligible professionals or eligible hospitals and CAHs.• 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. 30
  • 33. • For eligible hospitals and CAHs, there are a total of 24 meaningful useobjectives. To qualify for an incentive payment, 19 of these 24 objectives must be met. -There are 14 required core objectives. -The remaining 5 objectives may be chosen from the list of 10 menu set objectives.How do I meet the Requirements?To qualify for incentive payments, meaningful use requirements must be met in thefollowing ways:Medicare EHR Incentive Program—Eligible professionals, eligible hospitals andcritical access hospitals (CAHs) must successfully demonstrate meaningful use ofcertified electronic health record technology every year they participate in theprogram.Medicaid EHR Incentive Program—Eligible professionals and eligible hospitalsmay qualify for incentive payments if they adopt, implement, upgrade ordemonstrate meaningful use in their first year of participation. They mustsuccessfully demonstrate meaningful use for subsequent participation years.Adopted: Acquired and installed certified EHR technology. (For example, canshow evidence of installation.)Implemented: Began using certified EHR technology. (For example, provide stafftraining or data entry of patient demographic information into EHR.)Upgraded: Expanded existing technology to meet certification requirements. (Forexample, upgrade to certified EHR technology or add new functionality to meet thedefinition of certified EHR technology.) 31
  • 34. BASIC OVERVIEW OF STAGE 1 MEANINGFUL USE• Reporting period is 90 days for first year and one (1) year subsequently• Reporting through “attestation”• Objectives and Clinical Quality Measures• Reporting may be yes/no or numerator/denominator attestation• To meet certain objectives/measures, 80% of patients must have records inthe certified EHR technology *SCG assists with the registration and Attestation Processes – see related white paperSTAGE 1 OBJECTIVES AND MEASURES REPORTINGEligible Professionals must complete:• 15 core objectives• 5 objectives out of 10 from menu set• 6 total Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from menu set)NOTE: Some MU objectives are not applicable to every provider’s clinicalpractice, thus they would not have any eligible patients or actions for themeasure denominator. Exclusions do not count against the five (5) deferredmeasures. In these cases, the eligible professional would be excluded fromhaving to meet that measure.IE: Dentists who do not perform immunizations; Chiropractors do not e-PrescribeThere are two types of percentage-based measures for denominator:1. All patients seen during EHR reporting period2. Patients or actions taken for patients who’s records are kept in thecertified EHR technology 32
  • 35. ELIGIBLE PROFESSIONALS 15 CORE OBJECTIVES1. Computerized physician order entry (CPOE)2. E-Prescribing (eRx)3. Report ambulatory clinical quality measures to CMS/States4. Implement one clinical decision support rule5. Provide patients with an electronic copy of their health information, upon request6. Provide clinical summaries for patients for each office visit7. Drug-drug and drug-allergy interaction checks8. Record demographics9. Maintain an up-to-date problem list of current and active diagnoses10. Maintain active medication list11. Maintain active medication allergy list12. Record and chart changes in vital signs13. Record smoking status for patients 13 years or older14. Capability to exchange key clinical information among providers of care and patient-authorized entities electronically15. Protect electronic health information ELIGIBLE PROFESSIONALS 10 MENU OBJECTIVES EPs must complete 5 of 10, listed below 1. Drug-formulary checks 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 syndromic surveillance data to public health agencies* 33
  • 36. ELIGIBLE PROFESSIONALS & MEANINGFUL USEAn Eligible Professional who works at multiple locations, but does not havecertified EHR technology available at all of them would:• Have to have 50% of their total patient encounters at locations wherecertified EHR technology is available• Would base all meaningful use measures only on encounters that occurredat locations where certified EHR technology is availableA Medicare Eligible Professional who does NOT demonstrate meaningful useby 2015 will be subject to payment adjustments in their Medicarereimbursement schedule.• Medicaid-only EPs are not subject to payment adjustments• Payment adjustments may apply for any EP who accepts Medicare anddoes not demonstrate meaningful use in 2015 34
  • 37. WHAT ARE CLINICAL QUALITY MEASURES?Quality health care is a high priority for the President, the Department of Healthand Human Services (HHS) and the Centers for Medicare & Medicaid Services(CMS). CMS implements quality initiatives to assure quality health care forMedicare Beneficiaries through accountability and public disclosure. CMS usesquality measures in its various quality initiatives that include qualityimprovement, pay for reporting, and public reporting.WHAT ARE QUALITY MEASURES?Quality measures are tools that help us measure or quantify healthcareprocesses, outcomes, patient perceptions, and organizational structure and/orsystems that are associated with the ability to provide high-quality health careand/or that relate to one or more quality goals for health care. These goalsinclude: effective, safe, efficient, patient-centered, equitable and timely care.To demonstrate meaningful use successfully, eligible professionals, eligiblehospitals and CAHs are required also to report clinical quality measuresspecific to eligible professionals or eligible hospitals and CAHs.Eligible professionals must report on six (6) total clinical quality measures:Three (3) required core measures (substituting alternate core measureswhere necessary) and three (3) additional measures (selected from a set of 38clinical quality measures).Eligible hospitals and CAHs must report on all 15 of their clinical qualitymeasures. 35
  • 38. ELIGIBLE PROFESSIONALS REQUIREMENTS FORCLINICAL QUALITY MEASURESDetails of Clinical Quality Measures2011 –Eligible Professionals seeking to demonstrate Meaningful Use arerequired to submit aggregate CQM numerator, denominator, and exclusiondata to CMS or the States by “ATTESTATION”.2012 –Eligible Professionals seeking to demonstrate Meaningful Use arerequired to electronically submit aggregate CQM numerator, denominator, andexclusion data to CMS or the States.ELIGIBLE PROFESSIONALS REQUIREMENTS FORCLINICAL QUALITY MEASURES REPORTING EHR Incentive Program Electronic Specifications Introduction: In order to report quality measures from an EHR, electronic specifications must be developed that include the data elements, logic and definitions for that measure in a format that can be captured or stored in the EHR so that the data can be sent or shared electronically with other entities in a structured, standardized format and unaltered. These electronic specifications are derived from certified EHRs. As part of the criteria for satisfying meaningful use, clinical quality measures results (numerators, denominators, and exclusions) must be reported to CMS. 36
  • 39. ELIGIBLE PROFESSIONALS REPORTING PERIODThe reporting period for the EHR Incentive program using a certified EHR isany continuous 90 day period during the first payment year. Please notethat although the measure specifications assume a full calendar year, youshould only calculate the denominator and numerator from the first day of the90 day reporting period to the last day of the 90 day reporting period.Eligible professionals must report from the table of 44 clinical quality measureswhich includes, 3 Core, 3 Alternate Core, and 38 additional CQMs.• Core CQMs - EPs must report on 3 required core CQMs, and if thedenominator of 1 or more of the required core measures is 0, then EPs arerequired to report results for up to 3 alternate core measures.• EPs must also select 3 additional CQMs from a set of 38 CQMs (excludingthe core/alternate core measures). It is acceptable to have a 0 denominator,provided the EP does not have an applicable population.In sum, EPs must report on six (6) total measures: 3 required core measures(substituting alternate core measures where necessary) and 3 additionalmeasures. A maximum of 9 measures would be reported if the EP needed toattest to the 3 required core, the three alternate core and the 3 additionalmeasures. 37
  • 40. CLINICAL QUALITY MEASURES CORE SETNQF Measure Number & PQRI Clinical Quality Measure TitleImplementation NumberNQF 0013 Hypertension: Blood Pressure MeasurementNQF 0028 Preventive Care & Screening Measure Pair: a) Tobacco Use Assessment, b) Tobacco Cessation InterventionNQF 0421 Adult Weight Screening & Follow-upPQRI 128ALTERNATE CORE SETNQF Measure Number & PQRI Clinical Quality Measure TitleImplementation NumberNQF 0024 Weight Assessment & Counseling for Children & AdolescentsNQF 0041 Preventive Care & Screening:PQRI 110 Influenza Immunization for Patients 50 Years Old or OlderNQF 0038 Childhood Immunization Status 38
  • 41. ADDITIONAL SET CQMMust Complete 3 of 381. Diabetes: Hemoglobin A1c Poor Control2. Diabetes: Low Density Lipoprotein (LDL) Management and Control3. Diabetes: Blood Pressure Management4. Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor 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 Adults7. Breast Cancer Screening8. Colorectal Cancer Screening9. Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD10. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic11. Dysfunction (LVSD) Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment12. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation13. Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy14. Diabetic Retinopathy: Communication with the15. Physician Managing Ongoing Diabetes Care16. Asthma Pharmacologic Therapy17. Asthma Assessment18. Appropriate Testing for Children with Pharyngitis Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer19. Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients20. Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients 21.Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies 39
  • 42. 22. Diabetes: Eye Exam23. Diabetes: Urine Screening24. Diabetes: Foot Exam25. Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL- Cholesterol26. Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation27. Ischemic Vascular Disease (IVD): Blood Pressure Management28. Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic29. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement30. Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)31. Prenatal Care: Anti-D Immune Globulin32. Controlling High Blood Pressure33. Cervical Cancer Screening34. Chlamydia Screening for Women35. Use of Appropriate Medications for Asthma36. Low Back Pain: Use of Imaging Studies37. Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control38. Diabetes: Hemoglobin A1c Control (<8.0%)• Clinical Quality Measures align with Physicians Clinical Quality reporting(PQRI)• Alignment between 4 HITECH CQM and the CHIPRA initial core set thatproviders report to States 40
  • 43. REGISTRATION REQUIREMENTS INCLUDE:• Name of the eligible professional• National Provider Identifier (NPI)• Business address and business phone• Taxpayer Identification Number (TIN) to which the provider would like theirincentive payment made• Medicare or Medicaid program selection (may only switch once afterreceiving an incentive payment before 2015) for EPs• State selection for Medicaid providers 41
  • 44. PROGRAM TIMELINE January 2011 –Registration for the EHR Incentive Programs begins January 2011 –For Medicaid providers. States may launch their programs if they choose April 2011 –Attestation for the Medicare EHR Incentive Program begins May 2011 –Medicare EHR incentive payments begin February 29, 2012 –Last day for EPs to register and attest to receive an incentive payment for CY 2011 2015–Medicare payment adjustments begin for EPs and eligible hospitals that are not meaningful users of EHR technology 2016–Last year to receive a Medicare EHR incentive payment; Last year to initiate participation in Medicaid EHR Incentive Program 2021–Last year to receive Medicaid EHR incentive payment**for details on how SCG assists with the registration & MU process, see our“procedure for assistance” white paper. 42
  • 45. ACRONYMSACA –Patient Protection and Affordable Care ActA/I/U –Adopt, implement, or upgradeCAH –Critical Access HospitalCCN –CMS Certification NumberCHIPRA –Childrens Health Insurance Program Reauthorization Act of 2009CMS –Centers for Medicare & Medicaid ServicesCNM –Certified Nurse MidwifeCPOE –Computerized Physician Order EntryCQM –Clinical Quality MeasuresCY –Calendar YearEHR –Electronic Health RecordEP –Eligible ProfessionaleRx–E-PrescribingFFS –Fee-for-serviceFQHC –Federally Qualified Health CenterFFY –Federal Fiscal YearHHS –U.S. Department of Health and Human ServicesHIT –Health Information TechnologyHITECH –Health Information Technology for Economic and Clinical Health ActHITPC –Health Information Technology Policy CommitteeHPSA –Health Professional Shortage AreaMA –Medicare AdvantageMCMP –Medicare Care Management Performance DemonstrationMU –Meaningful UseNCVHS –National Committee on Vital and Health StatisticsNP –Nurse PractitionerNPI –National Provider IdentifierNPRM –Notice of Proposed RulemakingOMB –Office of Management and BudgetONC –Office of the National Coordinator of Health Information TechnologyATCB –Authorized Testing and Certification BodyCCHIT –Certification Commission for Health Information TechnologyEMR –Electronic Medical Records 43
  • 46. HIPAA –Health Insurance Portability and Accountability Act of 1996PA –Physician AssistantPECOS –Provider Enrollment, Chain, and Ownership SystemPPS –Prospective Payment System (Part A)PQRI –Medicare Physician Quality Reporting InitiativeARRA –American Reinvestment & Recovery Act of 2009RHC –Rural Health ClinicRHQDAPU –Reporting Hospital Quality Data for Annual Payment UpdateTIN –Taxpayer Identification Number 44
  • 47. Questions or Comments? 1-888-803-9431 1-704-405-3085Email: help@mysuccor.com www.mysuccor.com