1. CMS Vision of Meaningful Use of HIT
Georgia Partnership for TeleHealth Conference
Reynolds Plantation, Ga.
March 16, 2012
Richard E. Wild, MD,JD,MBA, FACEP
Chief Medical Officer
CMS -Atlanta
3. HIT Overview
HIT and Congressional Initiatives
ARRA of 2009, HITECH ACT, established CMS
E.HR incentive program for Meaningful Use of HIT
Recent Studies: Archives of Internal Medicine,
Jan. 26 2009, Amarasingham, et.al,“Clinical
Information Technologies and Inpatient
Outcomes, a Multiple Hospital Study”
-Hospitals with automated notes and records, order
entry and clinical decision support had fewer
complications, lower mortality rates, and lower costs.
4. What is Meaningful Use?
• 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
• All the while maintaining privacy and security
• Meaningful Use mandated in law to receive
incentives
4
5. The Triple Aim Goals of CMS
Better Care
• Patient Safety
• Quality
• Patient Experience
More Efficient Care: (Reduce Per Capita Cost through
improvement in care)
• Reduce unnecessary and unjustified medical cost
• Reduce administrative cost thru process simplification
Improve Population Health
• Decrease health disparities
• Improve chronic care management and outcome
• Improve community health status
6. What’s Wrong with US Healthcare
Today?
Too Costly?
Inefficient?
Disparities in Access and Quality?
Evidence Base foundation often lacking?
Lack of Prevention focus?
Fragmentation of care, between providers and sites of
care? (Silos, care transitions)
Poor information and data sharing and transfer?
Patient safety and quality ? (Compare to aviation industry?)
A payment system that rewards providing services rather
than outcomes?
Coordinated, accountable or Uncoordinated, Unaccountable
care?
9. Why E-Prescribing?
98,000 die from medical errors annually
• More than breast cancer, AIDS, or motor
vehicle accidents
1.5 million preventable adverse drug
events annually
• Hospitals, long-term care, outpatient
encounters
• 530,000 among Medicare beneficiaries
• $877 million per year for Medicare
beneficiaries
Source Institute of Medicine 1999, 2000, 2003, 2006
10.
11. •
•
• Potential to save up to $35 billion dollars over three years.
12. How to Get Involved!
Join the Partnership for Patients – Sign the Pledge!
Go to www.healthcare.gov/center/programs/partnership
13. Health Care Delivery System
Transformation
Adoption of Enhancing
Health Health System Performance Transformation
Information Competencies Barrier
Technology
Clinical Care
Knowledge
Infrastructure Barrier
Barrier Integrated
Care
Accountable
Care
Personalized
Episodic/ Health Care
Uncoordinated Management
14. Timeline for Delivery System
Reform and Transformation
2011-2019
MU
Stage
MU Stage 3
2
MU Healthcare
Stage Delivery System
Program and
Reform and
1 Policy Redesign
Transformation
Successful 2014-2019
Payment and
Service Model 2012-2019
Innovation
2011-2019
15. A Strategic System Approach to Healthcare
Delivery Transformation
Strategic HIT HIT Strategic Quality and Cost
Focus Areas Performance Metrics Performance Outcomes
Meaningful Use of Reduced Unnecessary
Cost EHR to reduce Cost/Utilization &
Duplication, Errors Lower % Admin Cost
Containment
Strategic Planning Logic Map
and improve care
Cost Effectiveness
Meaningful Use of Improved Quality
Quality EHR to better & Patient Wellness
Improvement coordinate care and Benchmarks
Quality Performance
Meaningful use of Higher Provider
Administrative EHR to Reduce Satisfaction &
Efficiency Admin. Process Reduction in Admin.
Cycle Times Cost
Population Meaningful Use of
EHR to build Improve health status
Health & Reduction in
Population
Research Health Mgmt. & Health Disparities
Research
Meaningful USE PERFORMANCE Management
Barrier Barrier
16. Medical Home 1.0
E-
Prescribing
Electronic Medical Individual
Health Home Patient Care
Record 1.0 Plans
Care
Coordination
Capable
17. Medical Home 2.0
Advance
Chronic
Disease
Integrate Management
Patient
e-prescribing Registries
and COEs
E-Clinical
HIE
Connected Medical Decision
Making
Home
2.0
Electronic
Population
Patient Access
Health Bio
and
Surveillance
Communication
Electronic
Two Way Eligibility
Quality System
Report Interface
18. Medical Home 3.0
Advanced Care
Management
Fully e-Health Capable
Capable Clinical Practice
Translational
Research
Remote Bio
Metrics Connected to
Monitoring and Community
Tele health Medical Resource
Capable Databases
Home
3..0
Integrated
Electronic Clinical Patient E-Learning
Network Center
Interfaces
Community
Psycho/Social
Health
Evaluation and
Surveillance Intervention
Network
19. HITECH: How the Pieces
Fit Together
Regional Extension Centers
Improved Individual &
Medicaid EHR Program 1st Year Incentive ADOPTION Population Health
Workforce Training Outcomes
Increased
Transparency &
Efficiency
Medicare and Medicaid EHR
Incentive Programs MEANINGFUL USE
Improved
Ability to Study &
Improve Care Delivery
State Grants for
Health Information Exchange
Medicaid Administrative Funding for HIE EXCHANGE
Standards & Certification Framework
Privacy & Security Framework
Health IT Practice Research
19
19
20. What are the Three Main
Components of Meaningful Use?
• The Recovery Act specifies the following 3
components of Meaningful Use:
1. Use of certified EHR in a meaningful manner
(e.g., e-prescribing)
2. Use of certified EHR technology for electronic
exchange of health information to improve
quality of health care
3. Use of certified EHR technology to submit
clinical quality measures (CQM) and other such
measures selected by the Secretary
20
21. What are the Requirements of
Stage 1 Meaningful Use?
• Stage 1 Objectives and Measures Reporting
• Eligible 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 additional set)
• Hospitals must complete:
• 14 core objectives
• 5 objectives out of 10 from menu set
• 15 Clinical Quality Measures
21
22. What do the objectives and measures really
mean?
22
23. Meaningful Use: Core
Objectives
• Eligible Professionals – 15 Core Objectives
1. Computerized provider order entry (CPOE)
2. E-Prescribing (eRx)
3. Report ambulatory clinical quality measures to CMS/States
4. Implement one clinical decision support rule
5. Provide patients with an electronic copy of their health information, upon request
6. Provide clinical summaries for patients for each office visit
7. Drug-drug and drug-allergy interaction checks
8. Record demographics
9. Maintain an up-to-date problem list of current and active diagnoses
10. Maintain active medication list
11. Maintain active medication allergy list
12. Record and chart changes in vital signs
13. Record smoking status for patients 13 years or older
14. Capability to exchange key clinical information among providers of care and
patient-authorized entities electronically
15. Protect electronic health information
23
25. Proposed Rule
This presentation is part of a notice of proposed
rulemaking (NPRM).
We encourage anyone interested in Stage 2 of
meaningful use to review the NPRM for Stage 2
of meaningful use and the NPRM for the 2014
certification of EHR technology at
CMS Rule: http://www.ofr.gov/OFRUpload/OFRData/2012-04443_PI.pdf
ONC Rule: http://www.ofr.gov/OFRUpload/OFRData/2012-04430_PI.pdf
Comments can be made starting March 7 through
May 6 at www.regulations.gov
26. What is in the Proposed Rule
• Minor changes to Stage 1 of meaningful use
• Stage 2 of meaningful use
• New clinical quality measures
• New clinical quality measure reporting
mechanisms
• Appeals
• Details on the Medicare payment adjustments
• Minor Medicare Advantage program changes
• Minor Medicaid program changes
26
27. Stage 2 Timeline
June 2011
HITPC
Recommendations Summer 2012
on Stage 2 Stage 2 Final Rule
Feb 2012 Oct 1, 2013/ Jan 1, 2014
Stage 2 Proposed Proposed Stage 2 Start
Rule Dates
27
28. Stage 1 to Stage 2 Meaningful Use
Eligible Professionals Eligible Professionals
15 core objectives 17 core objectives
5 of 10 menu objectives 3 of 5 menu objectives
20 total objectives 20 total objectives
Eligible Hospitals & CAHs Eligible Hospitals & CAHs
14 core objectives 16 core objectives
5 of 10 menu objectives 2 of 4 menu objectives
19 total objectives 18 total objectives
28
29. Medicare Shared Savings Program
Accountable Care Organizations (ACOs)
Program
For more information:
www.cms.gov/sharedsavingsprogram/
Shared Savings Program
http://www.cms.gov/savingsprogram http://www.cms.gov/savingsprogram/
http://www.cms.gov/savingspr
30. Medicare Shared Savings Program
Goals
The Shared Savings Program is a new
approach to the delivery of health care
aimed at reducing fragmentation,
improving population health, and
lowering overall growth in
expenditures by:
• Promoting accountability for the care of
Medicare fee-for-service beneficiaries
• Improving coordination of care for
services provided under Medicare Parts A
and B
• Encouraging investment in infrastructure
and redesigned care processes
31. What entities could form an ACO?
Existing or newly formed organizations may form an ACO:
• ACO professionals in group practice arrangements
• Networks of individual practices of ACO professionals
• Joint ventures/partnerships of hospitals and ACO
professionals
• Hospitals employing ACO professionals
• Federal Qualified Health Centers (FQHCs) and Rural Health
Clinics (RHCs)
• Critical Access Hospitals (CAHs) that bill under method II
Secretarial discretion for other providers and suppliers of
services
• Other Medicare-enrolled entities may join the groups above
as ACO participants.
33. ACO Quality Measurement &
Performance
Quality measures are separated into the
following four key domains that will
serve as the basis for assessing,
benchmarking, rewarding and improving
ACO quality performance:
• Better Care
1. Patient/Caregiver Experience
2. Care Coordination/Patient Safety
• Better Health
3. Preventative Health
4. At-Risk Population
34. ACO Quality Measurement &
Performance Continued
ACO Quality Performance Standard made up of 33
measures intended to do the following:
Improve individual health and the health of populations
Address quality aims such as prevention, care of chronic
illness, high prevalence conditions, patient safety,
patient and caregiver engagement and care
coordination
Support the Shared Savings Program goals of better care,
better health and lower growth in expenditures
Align with other incentive programs like PQRS and EHR
35. ACO Quality Data Reporting
Quality data collected three ways:
• Claims and other internal data
• ACO-GPRO tool
• Survey
Complete and accurate reporting in the first year qualifies
the ACO to share in the maximum available quality
sharing rate
Pay for reporting is phased in for the remaining
performance years
Shared savings payments are linked to quality performance
based on a sliding scale that rewards attainment
• High performing ACOs receive a higher sharing rate
36. Return on Investment from HIT
Wide Spread Adoption of Electronic Health Information
(EHI) Technologies for Better Outcomes , Lower Cost ,
Improve Population Health
Improving Health Care Quality,
Cost Performance, Population Health
Better
ROI of EHI at Point of Care: Outcomes
• Improved Patient Safety
• Reduced Complications Rates Lower
• Reduced Cost per Patient Episode of Costs
Care
• Enhanced cost & quality performance
accountability
• Improved Quality Performance Population
• Improve Community Health
Health
Surveillance
When Congress first adopted the phrase meaningful use, our first instinct was to just reach for the dictionary. However, the definition for meaningful use as we use it today isn’t in Webster’s or Oxford. Rather meaningful use is the phrase we use to describe why we even care if providers use EHRs, paper or stone tablets. Meaningful use is the key to three things: Use of EHRs in a way that we believe will (five points in the slide)A structure to advance the use of EHRs from today to where we believe it needs to be in order to generate these outcomesThe gateway to billions of dollars of incentives that the American people provided through Congress because they believe that using EHRs is going to make a difference in their health care and therefore in their lives.The nearly $30 billion dollars allocated for both meaningful use and support to make it happen represents a $100 investment from every American to this effort.
Unfortunately, in spite of heroic advocacy by clinicians and families like Sorrel’s, Josie’s story is still not rare. How does this happen?Numerous inputsComplex ScienceChaotic SystemHuman factors
Achieving these two goals will not only save lives and greatly reduce injuries to millions of Americans, it will also result in savings of billions of dollars that help put the nation on the path to having a more sustainable health care system.We already have XXX# hospitals, etc that have joined the partnerships.
The Partnership for Patients is truly a partnership. In order to achieve our ambitious goals we’ll need a broad coalition of hospitals, clinicians, employers, labor unions, advocacy organizations and states to join with us. So please join the Partnership by signing the pledge. To learn more about the Partnership, to sign the pledge, and for additional resources please visit our website.
