EHR Incentive Program Analysis

Medicare & Medicaid EHR Incentive Programs Robert Tagalicod, Robert Anthony, and Jessica Kahn HIT Policy Committee January 10, 2012http://www.cms.gov/EHRIncentivePrograms/

Active Registrations – December 2011 December-11 YTD Eligible Professional 8,996 123,923 Hospital 0 168 Total 8,996 124,089 Eligible Professional 9,614 49,051 Hospital 9 75 Total 8,186 39,503 Hospital (registered for both Medicare & Medicaid ) 200 2,834 18,819 176,049 For final CMS reports, please visit: http://www.cms.gov/EHRIncentivePrograms/56_DataAndReports.asphttp://www.cms.gov/EHRIncentivePrograms/

Medicare Incentive Payments – December 2011 Meaningful Use (MU) YTD December 2011 December 2011 Providers YTD Providers Paid Payments Paid Payments Eligible Professional 4,997 $ 86,946,000 15,255 $ 274,590,000 Medicare Only Hospital 4 $ 5,600,870 38 $ 56,782,557 Medicare & Medicaid Hospital (Medicare Payment) 189 $ 369,136,265 566 $ 1,052,839,955 TOTAL 5,190 $ 464,683,136 15,859 $ 1,384,212,512 For final CMS reports, please visit: http://www.cms.gov/EHRIncentivePrograms/56_DataAndReports.asp 3http://www.cms.gov/EHRIncentivePrograms/

Medicaid Incentive Payments – December 2011 (Both MU and AIU) YTD December 2011 December 2011 Providers YTD Providers Paid Payments Paid Payments Eligible Professional 2,794 $ 58,373,535 11,270 $ 295,760,910 Medicare & Medicaid Hospital (Medicaid Payment) + Medicaid Only Hospital 230 $ 165,141,069 1,016 $ 787,466,254 TOTAL 3,024 $ 229,380,747 15,132 $ 1,149,476,633 For final CMS reports, please visit: http://www.cms.gov/EHRIncentivePrograms/56_DataAndReports.asp 4http://www.cms.gov/EHRIncentivePrograms/

EHR Incentive Programs – December 2011 Totals Registrations December-11 YTD Medicare EPs 8,996 123,921 Medicaid EPs 9,614 49,051 Medicaid/Medicare Hospitals 200 2,834 Total 18,819 176,049 Payments December-11 YTD Medicare EPs $95,546,870 $274,590,000 Medicaid EPs $64,239,678 $362,010,379 Medicaid/Medicare Hospitals (Medicare Payment) $369,136,265 $1,052,839,955 Medicaid/Medicare Hospitals (Medicaid Payment) $165,141,069 $787,466,254 Total $694,063,883 $2,533,689,145 For final CMS reports, please visit: 5http://www.cms.gov/EHRIncentivePrograms/ http://www.cms.gov/EHRIncentivePrograms/56_DataAndReports.asp

EHR Incentive Programs – December 2011 Providers Paid by Month Providers Paid 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec 6http://www.cms.gov/EHRIncentivePrograms/

EHR Incentive Programs – December 2011 Incentive Payments by Month $800,000,000 Incentive Payments $700,000,000 $600,000,000 $500,000,000 $400,000,000 $300,000,000 $200,000,000 $100,000,000 $0 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec 7http://www.cms.gov/EHRIncentivePrograms/

Medicaid Implementation Report (1/12) States launched as of January 2012: 42 National Status Map # of States that disbursed incentives: 33 March 2011 June 2011 VT ME WA MT ND NH MN MA OR NY WI ID SD MI RI WY PA CT IA OH NJ NE IL IN DE NV WV MD UT VA CO KY KS MO CA DC NC TN 19 SMHPs approved AZ NM OK AR MS WA AL GA SC August 2011 VT ME TX LA MT ND NH MN MA OR FL NY WI ID Territories SD RI MI AK Planning WY PR PA CT SMHPs Pending USVINE IA OH NJ HI SMHPs Approved GU IL IN DE NV WV MD IAPDs Pending UT CNMI VA IAPDs Approved CA Launched CO AS KS MO TN KY NC DC December 2011 Incentives Disbursed OK SC ME AR VT 17 launched, 12 incentives, $121,958,515 AZ NM MS AL GA WA MT ND NH TX LA MN MA OR NY FL WI ID Territories SD MI RI AK Planning AS WY PA CT SMHPs Pending CNMI IA OH NJ NE HI SMHPs Approved GU NV PR IL IN DE IAPDs Pending WV UT VA MD IAPDs Approved USVI CO KS MO KY Launched DC CA NC Incentives Disbursed TN 23 launched, 16 incentives, $247,000,000 AZ NM OK AR SC GA MS AL TX LA FL AK Planning Territories SMHPs Submitted AS HI SMHPs Final Approval CNMI IAPDs Pending GU IAPDs Approval PR Launched USVI Incentives Disbursedhttp://www.cms.gov/EHRIncentivePrograms/ 43 launched, 33 incentives : $908,955,358 * 8

CMS EHR Incentive Programs Attestation Data 9http://www.cms.gov/EHRIncentivePrograms/

Data Caveats As of December 2011: • Only Medicare EPs are attesting to meaningful use. • Medicaid EPs are attesting to AIU • Acute care/critical access hospitals could be receiving a meaningful use incentive payment from both Medicare and Medicaid • Medicaid-only hospitals are only attesting to AIU • Reports from January onward will include both Medicare and Medicaid MU data, as well as Medicaid AIU data as available 10http://www.cms.gov/EHRIncentivePrograms/ http://www.cms.gov/EHRIncentivePrograms/56_DataAndReports.asp

Highlights • MU data is only for Medicare physicians and for acute care and critical access hospitals. It is not a representative sample of EPs, nor of all eligible hospitals. • Do we have the n? • What we know about early adopters: • On average all thresholds were greatly exceeded, but every threshold had some providers on the borderline • Little difference between EP and hospitals • Little difference among specialties in performance, but differences in exclusions 11http://www.cms.gov/EHRIncentivePrograms/

Providers Included in MU Analysis At the time of the analysis: • 33,595 Medicare EPs had attested • 33,240 Successfully • 355 Unsuccessfully (89 previously unsuccessful resubmitted) • 842 Acute Care and Critical Access Hospitals had attested • All successfully 12http://www.cms.gov/EHRIncentivePrograms/

EP Quality, Safety, Efficiency, and Reduce Health Disparities Objective Performance Exclusion Deferral Recording objectives* 90%+ 9%* N/A CPOE 85% 17% N/A Electronic prescribing 78% 22% N/A Incorporate lab results 91% 4% 36% Drug-formulary checks N/A 14% 17% Patient lists N/A N/A 27% Send reminders to patients 61% 0.5% 77% *Refers to problem, med, allergy lists, vital signs, demographics and smoking status. Exclusion is for vital signs and smoking status. 13http://www.cms.gov/EHRIncentivePrograms/

EP Engage Patients and Their Families Objective Performance Exclusion Deferral E – Copy of Health Information 96% 75% N/A Office visit summaries 78% 2% N/A Patient Education Resources 50% N/A 49% Timely electronic access 75% 1% 62% 14http://www.cms.gov/EHRIncentivePrograms/

EP Improve Care Coordination Objective Performance Exclusion Deferral Medication reconciliation 89% 3% 56% Summary of care at transitions 88% 3% 85% 15http://www.cms.gov/EHRIncentivePrograms/

EP Improve Population and Public Health Objective Performance* Exclusion Deferral Immunizations 34% 45% 20% Syndromic Surveillance 3% 27% 70% *Performance is percentage of attesting providers who conducted test 16http://www.cms.gov/EHRIncentivePrograms/

EH Quality, Safety, Efficiency, and Reduce Health Disparities Objective Performance Exclusion Deferral Recording objectives* +93% 0.5% 0% CPOE 85% N/A N/A Advance directives 95% 0.1% 13% Incorporate lab results 95% N/A 18% Drug-formulary checks N/A N/A 13% Patient lists N/A N/A 34% *Refers to problem, med, allergy lists, vital signs, demographics and smoking status. Exclusion is for vital signs and smoking status. 17http://www.cms.gov/EHRIncentivePrograms/

EH Engage Patients and Their Families Objective Performance Exclusion Deferral E – copy of health information 96% 68% N/A E – copy of discharge 96% 59% N/A Instructions Patient education resources 71% N/A 62% 18http://www.cms.gov/EHRIncentivePrograms/

EH Improve Care Coordination Objective Performance Deferral Medication reconciliation 84% 75% Summary of care at transitions 81% 93% 19http://www.cms.gov/EHRIncentivePrograms/

EH Improve Population and Public Health Objective Performance* Exclusion Deferral Immunizations 48% 15% 37% Reportable Lab Results 16% 7% 77% Syndromic Surveillance 18% 3% 79% *Performance is percentage of attesting providers who conducted test 20http://www.cms.gov/EHRIncentivePrograms/

Specialty Performance •Family practice, internal medicine, and optometry highest for CPOE •Optometry and podiatry had lowest rates of recording vitals •Gastroenterology lowest rate for patient electronic access by almost 10% •For providing patient education resources, optometry was nearly 10% higher than others, podiatry was nearly 20% lower. •All others measures were consistent across specialties. 21http://www.cms.gov/EHRIncentivePrograms/

Concluding Points • Preliminary monthly data is provided to the HITPC for consideration • Official data should be sourced and cited from the CMS website, updated monthly (http://www.cms.gov/EHRIncentivePrograms/56_ DataAndReports.asp) • Some States began accepting meaningful use attestations for Medicaid-only EHs in January • Some States will begin accepting meaningful use attestations from Medicaid EPs in April For final CMS reports, please visit: 22http://www.cms.gov/EHRIncentivePrograms/ http://www.cms.gov/EHRIncentivePrograms/56_DataAndReports.asp

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EHR Incentive Program Analysis

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