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Kareo - The Ins & Outs of Meaningful Use Stage 2

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Watch recorded webinar: http://www.kareo.com/resources/webinars …

Watch recorded webinar: http://www.kareo.com/resources/webinars

Listen. Learn. Implement.
The Ins & Outs of Meaningful Use Stage 2


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  • 1. PAGE 1 KAREO | CONFIDENTIALListen. Learn. Implement.The Ins & Outs of Meaningful UseStage 2
  • 2. PAGE 2 KAREO | CONFIDENTIALYour Hosts Today…Elizabeth WoodcockMBA, FACMPE, CPCLea ChathamContent Marketing Manager, Kareo
  • 3. PAGE 3 KAREO | CONFIDENTIALDiscover Kareo … www.kareo.comOver 17,000 providers use Kareo to improve operations andpatient care.When your practice runs better, your patients feel it. Electronic Health Records Practice management Billing Services
  • 4. PAGE 4 KAREO | CONFIDENTIALElizabeth Woodcock, MBA, FACMPE, CPC Professional Speaker, Trainer, & Author Specializing in Medical PracticeManagement Author of 12 Best-Selling PracticeManagement Books Fellow in the American College ofMedical Practice Executives Certified Professional Coder MBA in Healthcare Management fromThe Wharton School of Business BA from Duke UniversityElizabeth W. Woodcock, MBA, FACMPE, CPCWoodcock & AssociatesSpeaker, Trainer, AuthorAtlanta, Georgia404.373.6195elizabeth@elizabethwoodcock.comwww.elizabethwoodcock.com
  • 5. PAGE 5 KAREO | CONFIDENTIALBackgroundFebruary 2009American Recovery and Reinvestment Act“TITLE XIII—HEALTH INFORMATION TECHNOLOGY”HITECH Act“Eligible professionals” will be paid for “demonstrating use of a qualified electronic health record in a meaningful manner.”Logo: CMS.gov
  • 6. PAGE 6 KAREO | CONFIDENTIALBackgroundMeaningfulUseStage OneStage TwoStage ThreeSeptember 4, 2012 Federal Register 21050Final Rule: Medicare and Medicaid Programs; Electronic Health Record Incentive Program – Stage 2
  • 7. PAGE 7 KAREO | CONFIDENTIALBackgroundVendors received the “Final Rule” on theconstitution of CEHRT systemsCertified EHR Technology (CEHRT)Photo: Teenspeak.org
  • 8. PAGE 8 KAREO | CONFIDENTIALBackgroundIn order to allow time for vendors to createand physicians to implement…Stage Two 2014
  • 9. PAGE 9 KAREO | CONFIDENTIALBackground1st YearStages of Meaningful Use2011 2012 2013 2014 2015 2016 20172011 1 1 1 2 2 3 32012 1 1 2 2 3 32013 1 1 2 2 32014 1 1 2 22015 1 1 22016 1 12017 1Year One: 90 DaysSubsequent Years: 365 Days
  • 10. PAGE 10 KAREO | CONFIDENTIALBackground1st YearMeaningful Use Annual Incentive Payments2011 2012 2013 2014 2015 2016 [….] TOTAL2011 MCR $18,000  $12,000  $8,000  $4,000  $2,000  $0    $0    $44,000 MCD $21,250  $8,500  $8,500  $8,500  $8,500  $8,500  $0    $63,750 2012 MCR $18,000  $12,000  $8,000  $4,000  $2,000  $0    $44,000 MCD $21,250  $8,500  $8,500  $8,500  $8,500  $8,500  $63,750 2013 MCR $15,000  $12,000  $8,000  $4,000  $0    $39,000 MCD $21,250  $8,500  $8,500  $8,500  $17,000  $63,750 2014 MCR $12,000  $8,000  $4,000  $0    $24,000 MCD $21,250  $8,500  $8,500  $25,500  $63,750 2015 MCR $0 $0    $0   $0   MCD $21,250  $8,500 $34,000 $63,750 2016 MCR $0    $0 $0 MCD $21,250  $  42,500  $63,750 MCR = Medicare; MCD = Medicaid. MCD participants must begin participation by 2016.
  • 11. PAGE 11 KAREO | CONFIDENTIALBackground20143-month reporting periodFirst‐time Stage TwoSecond‐year Stage OneFor Medicare, must correspond with the fiscal quarter  four chances
  • 12. PAGE 12 KAREO | CONFIDENTIALMeaningful Use: Stage OneCoreMeasures15MenuMeasures5CQMs*6 MUMeaningfulUseMeaningful Use: Stage TwoCoreMeasures17MenuMeasures3CQMs9 MUMeaningfulUseStage Two*One of the “core measures”; CQM: clinical quality measure
  • 13. PAGE 13 KAREO | CONFIDENTIAL•Maintain core-menu structure– 17 core objectives– 3 of 6 menu– Retain exclusions, but can’t use them to disqualify•9 clinical quality measures (CQMs)– No longer one of the criteria– Considered part and parcel of MUStage Two
  • 14. PAGE 14 KAREO | CONFIDENTIALStage TwoCriteria Old (MU1)ThresholdNew (MU2) ThresholdCPOE 30% (med) 60% (med); 30% (lab/rad)eRx 40% 50%Demographic info 50% 80%Vitals 50% 80%Smoking status 50% 80%Clinical summaries 50% (3 days) 50% (1 day)Patient education 10% (menu) 10% (core)CPOE: Computerized Physician Order Entry
  • 15. PAGE 15 KAREO | CONFIDENTIALStage TwoIn addition to higher measure thresholds…• Completely new criteria• Stage One menu-based criteria now core• Multi-layer criteriaCartoon: Doug Savage
  • 16. PAGE 16 KAREO | CONFIDENTIALStage Two
  • 17. PAGE 17 KAREO | CONFIDENTIALObjective: Record smoking status for patients 13+years oldMeasure: >80% of all unique patients 13+ yearsold seen by the EP have smoking statusrecorded as structured dataStage Two: Sample MU Core Criteria
  • 18. PAGE 18 KAREO | CONFIDENTIALObjective: Provide clinical summaries for patientsfor each office visitMeasure: Clinical summaries provided topatients or patient-authorized representativesfor >50% of office visitsStage Two: Sample MU Core Criteria
  • 19. PAGE 19 KAREO | CONFIDENTIALObjective: Use clinically relevant information toidentify patients who should receive reminders forpreventive/follow-up care and send these patientsthe reminders, per patient preferenceMeasure: >10% of all unique patients who havehad 2+ office visits with the EP within the past 24months before the beginning of the EHR reportingperiod were sent a reminder, per patientpreferenceStage Two: Sample MU Core Criteria
  • 20. PAGE 20 KAREO | CONFIDENTIALStage Two: Sample MU Core CriteriaObjective: Provide patients the ability to viewonline, download and transmit their healthinformation with 4 business days of the informationbeing available to the EP*for both measures, only patients seen by the eligible professional (EP) during thereporting periodMeasure: (1) >50% of all unique patients areprovided timely online access (4 business days) totheir health information; and (2) >5% of all uniquepatients (or authorized representative) view,download or transmit to a third party their healthinformation*
  • 21. PAGE 21 KAREO | CONFIDENTIALObjective: Use electronic messaging tocommunicate with patients on relevant healthinformationCEHRT: certified electronic health record technologyMeasure: A secure message was sent usingthe electronic messaging function of CEHRT by>5% of unique patients (or their authorizedrepresentatives) seen by the EP during theEHR reporting periodStage Two: Sample MU Core CriteriaAppendix
  • 22. PAGE 22 KAREO | CONFIDENTIALStage Two: Menu-based Criteria•Capability to submit electronic syndromicsurveillance data to public health agencies•Record electronic notes in patient records•Imaging results accessible through CEHRT•Record patient family health history•Identify and report cancer cases to a public healthcentral cancer registry•Identify and report specific cases to a specializedregistry (other than a cancer registry)CEHRT: Certified Electronic Health Record Technology
  • 23. PAGE 23 KAREO | CONFIDENTIALMeaningful Use: Stage TwoCoreMeasures17MenuMeasures3CQMs9 MUMeaningfulUseStage Two*One of the “core measures”; CQM: clinical quality measureOut of 6
  • 24. PAGE 24 KAREO | CONFIDENTIALClinical quality measures– 9 measures out of 64– None are “required” but some are recommended– Electronic submission as of 2014, in Year Two+– Alignment with existing quality programs▪PQRS▪Shared Savings Program (ACOs)▪NCQA Patient-Centered Medical Home RecognitionPQRS: Physician Quality Reporting System; ACO: accountable care organization; NCQA: National Committee for Quality AssuranceCMS: Centers for Medicare & Medicaid ServicesStage Two: Clinical Quality Measures
  • 25. PAGE 25 KAREO | CONFIDENTIALStage Two: Clinical Quality MeasuresCQM domains• Patient and family engagement• Patient safety• Care coordination• Population and public health• Efficient use of healthcare resources• Clinical processes/effectiveness9 required measures must come from atleast three different domains
  • 26. PAGE 26 KAREO | CONFIDENTIAL Confirmation that penalties begin in 2015 Avoidance of penalties1. Ineligible for program2. Successful participant in 20133. At minimum, successful participant by October 1,2014▪ Register by July 1, 2014▪ Attest by the end of September 2014…or meet one of the criteria for exclusionMedicare Payment Adjustments
  • 27. PAGE 27 KAREO | CONFIDENTIALMedicare Payment AdjustmentsCriteria for Exclusion▪ Infrastructure: Lack Internet availability/barriers toobtaining IT infrastructure▪ New eligible professional (2 years)▪ Unforeseen circumstances (e.g., natural disasters)▪ Particular specialty/physician▪ Limited interaction with patients▪ Lack of control of EHR access▪ Taxonomy codes: 30 (Diagnostic Rad); 36 (Nuclear Med); 94 (Interventional Rad*);30 (Anesthesiology); and 22 (Pathology)*Exclusion under review by CMS (1/2/13)
  • 28. PAGE 28 KAREO | CONFIDENTIAL•Important– Adjustments will be applied to all Medicarereimbursement– Medicaid reimbursement will not be affected– Medicaid participants need to demonstratemeaningful use to avoid Medicare adjustments– Must continue to demonstrate meaningful useMedicare Payment Adjustments
  • 29. PAGE 29 KAREO | CONFIDENTIALMedicare Payment AdjustmentsYear eRx PQRS EHR Total2012 -1.0% - - -1.0%2013 -1.5% - - -1.5%2014 -2.0% - - -2.0%2015 -2.0% -1.5% -1.0% -4.5%2016 -2.0% -2.0% -4.0%2017 -2.0% -3.0% -5.0%2018 -2.0% up to -5% up to -7%2019 -2.0% up to -5% up to -7%
  • 30. PAGE 30 KAREO | CONFIDENTIALQuestion & Answer Session
  • 31. Listen. Learn. Implement.The Ins & Outs ofMeaningful UseStage 2Your Questions… 
  • 32. PAGE 32 KAREO | CONFIDENTIALSourceSeptember 4, 2012 Federal Register 21050Final Rule: Medicare and Medicaid Programs;Electronic Health Record Incentive Program –Stage 2http://www.gpo.gov/fdsys/pkg/FR-2012-09-04/pdf/2012-21050.pdf
  • 33. PAGE 33 KAREO | CONFIDENTIALAppendix: Remaining MU Core Criteria• Incorporate clinical lab-test results into CEHRT asstructured data• Generate lists of patients by specific conditions to use forquality improvement, reduction of disparities, research oroutreach• Use clinically relevant information from CEHRT to identifypatient-specific education resources and provide thoseresources to the patient• The EP who receives a patient from another setting of careor provider of care or believes an encounter is relevantshould perform medication reconciliation
  • 34. PAGE 34 KAREO | CONFIDENTIALAppendix : Remaining MU Core Criteria• The EP who transitions their patient to another setting of careor provider of care or refers their patient to another provider ofcare should provide summary care record for each transitionof care or referral• Capability to submit electronic data to immunization registriesor immunization information systems except where prohibited,and in accordance with application law and practice• Use CPOE for medication, laboratory and radiology ordersdirectly entered by any licensed healthcare professional whocan enter orders into the medical record per state, local andprofessional guidelines• Generate and transmit permissible prescriptions electronically(eRx)
  • 35. PAGE 35 KAREO | CONFIDENTIALAppendix : Remaining MU Core Criteria• Record the following demographics: preferred language,sex, race, ethnicity, date of birth• Record and chart changes in vital signs• Use clinical decision support to improve performance onhigh priority health conditions• Protect electronic health information created or maintainedby the CEHRT through the implementation of appropriatetechnical capabilities
  • 36. PAGE 36 KAREO | CONFIDENTIALElizabeth W. Woodcock, MBA, FACMPE, CPCWoodcock & AssociatesSpeaker, Trainer, AuthorAtlanta, Georgia404.373.6195elizabeth@elizabethwoodcock.comwww.elizabethwoodcock.comYour Speaker

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