Meaningful Use Stage 2 Changes for Eligible Professionals

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Meaningful Use Stage 2 Changes for Eligible Professionals

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  • There has been a total of $572 M paid to MI providers. Approximately ¾ are Medicare; ¼ are Medicaid.Data from www.dashboard.healthit.gov
  • Meaningful Use Stage 2 Changes for Eligible Professionals

    1. 1. Meaningful Use Stage 2 Changes for Eligible Professionals Michelle Brunsen, Senior HIT Advisor
    2. 2. Today’s Objectives      Stage 2 Meaningful Use Clinical Quality Measures New Clinical Quality Measures Reporting Mechanisms Payment Adjustments and Hardships Medicaid Program Specific Changes 2
    3. 3. EPs Paid By Medicare or Medicaid 3
    4. 4. Payments to Eligible Professionals Michigan Payments as of October 2013  3,365 Medicaid Eligible Professionals have been paid (27.8%)  8,737 Medicare Eligible Professionals have been paid (72.2%)  Total Medicare and Medicaid payments to Michigan of $572M 4
    5. 5. STAGE 2 MEANINGFUL USE 5
    6. 6. What Stage 2 Means to You New Criteria  Starting in 2014, providers participating in the EHR Incentive Programs who have met Stage 1 for two or three years will need to meet meaningful use Stage 2 criteria  Improving Patient Care – Stage 2 includes new objectives to improve patient care through better clinical decision support, care coordination and patient engagement  Saving Money, Time, Lives – With this next stage, EHRs will further save our health care system money, save time for doctors and hospitals and save lives 6
    7. 7. Stages of Meaningful Use Stage 2: Advanced Clinical Processes Advanced Clinical Processes Improved Outcomes Data Capturing and Sharing 7
    8. 8. What is Your Meaningful Use Path? 8
    9. 9. Starting in 2014 Changes  EHRs Meeting ONC 2014 Standards – Starting in 2014, all EHR Incentive Program participants will have to adopt certified EHR technology that meets ONC’s Standards & Certification Criteria 2014 Final Rule 9
    10. 10. What does this mean for EPs?  Pay your annual maintenance/support with your EHR vendor  Speak with a representative from your EHR vendor to get in the queue to receive the 2014 upgrade  Install the 2014 EHR version as soon as possible  Start educating your patients about the patient portal, collecting email addresses 10
    11. 11. 2014 Reporting Period Reporting Period Reduced to Three Months  To allow providers time to adopt 2014 certified EHR technology and prepare for Stage 2  Regardless of Meaningful Use stage or year 11
    12. 12. What does this mean for Michigan EPs?  All participants will have one calendar quarter reporting period in 2014  Medicare and Medicaid = 1 quarter  Jan – Mar, Apr – June, July – Sep, Oct – Dec  Stage 1 Year 1 attesting for first time – MUST attest NO LATER THAN 10/1/14 to avoid a disincentive and use reporting period of Q1, Q2 or Q3 12
    13. 13. Stage 2 EP Core Objectives EPs Must Meet all 17 Core Objectives 13
    14. 14. Stage 2 EP Core Objectives EPs Must Meet all 17 Core Objectives 14
    15. 15. Stage 2 EP Menu Objectives Eligible Professionals Must Select 3 out of the 6 15
    16. 16. Closer Look at Stage 2 Patient Engagement  Patient Engagement is an important focus of Stage 2  Requirements for patient action – More than five percent of patients must send secure messages to their EP – More than five percent of patients must access their health information online  Exclusions – CMS is introducing exclusions based on broadband availability in the provider’s county 16
    17. 17. Closer Look at Stage 2 Electronic Exchange: Stage 2 focuses on actual use cases of electronic information exchange  Stage 2 requires that a provider send a summary of care record for more than 50 percent of transitions of care and referrals  The rule also requires that a provider electronically transmit a summary of care for more than 10 percent of transitions of care and referrals  At least one summary of care document sent electronically to recipient with different EHR vendor or to CMS test EHR 17
    18. 18. CLINICAL QUALITY MEASURES 18
    19. 19. How Do CQMs Relate to the CMS Incentive Programs?  Although reporting CQMs is no longer a core objective of the EHR Incentive Programs, all providers are required to report on CQMs in order to demonstrate meaningful use  In 2014 and beyond, reporting programs (i.e., PQRS, eRx reporting) will be streamlined in order to reduce provider burden 19
    20. 20. CQM Alignment with HHS Priorities All Providers Must Select CQMs from at least 3 of the 6 HHS National Quality Strategy domains       Patient and Family Engagement Patient Safety Care Coordination Population and Public Health Efficient Use of Healthcare Resources Clinical Processes/Effectiveness 20
    21. 21. CQMs in 2014 and Beyond www.cms.gov/EHRIncentivePrograms  A complete list of 2014 CQMs and their associated National Quality Strategy domains is posted on the CMS EHR Incentive Programs website  CMS has posted a recommended core set of CQMs for EPs that focus on high priority health conditions 21
    22. 22. CQMs in 2014 and Beyond CQMs change in 2014 *Regardless of the stage of meaningful use, all providers will complete this number of CQMs in 2014 22
    23. 23. CQMs in 2014 and Beyond Adult Recommended Core Measures  Controlling High Blood Pressure  Use of High-Risk Medications in the Elderly  Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention  Use of Imaging Studies for Low Back Pain  Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan  Documentation of Current Medications in the Medical Record  Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up  Closing the Referral Loop: Receipt of Specialist Report  Functional Status Assessment for Complex Chronic Conditions 23
    24. 24. CQMs in 2014 and Beyond Pediatric Recommended Core Measures  Appropriate Testing for Children with Pharyngitis  Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents  Chlamydia Screening for Women  Use of Appropriate Medications for Asthma  Childhood Immunization Status  Appropriate Treatment for Children with Upper Respiratory Infection (URI)  ADHD: Follow-Up Care for Children Prescribed ADHD Medication  Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan  Children Who Have Dental Decay or Cavities 24
    25. 25. NEW CLINICAL QUALITY MEASURES REPORTING MECHANISMS 25
    26. 26. Reporting CQMs in 2014 and Beyond  Beginning in 2014, all Medicare-eligible providers in their second year and beyond of demonstrating meaningful use must electronically report their CQM data to CMS  Medicaid providers will electronically report their CQM data to their state 26
    27. 27. EP CQM Reporting in 2014 EPs Reporting for the Medicare EHR Incentive Program 27
    28. 28. PAYMENT ADJUSTMENTS AND HARDSHIP EXEMPTIONS (MEDICARE ONLY) 28
    29. 29. EP Payment Adjustments % adjustment below assumes less than 75% of EPs are meaningful users by CY 2018+ 2015 2016 2017 2018 2019 2020+ EP is not subject to the payment adjustment for eRx in 2014 99% 98% 97% 96% 95% 95% EP is subject to the payment adjustment for eRx in 2014 98% 98% 97% 96% 95% 95% % adjustment below assumes more than 75% of EPs are meaningful users by CY 2018+ 2015 2016 2017 2018 2019 2020+ EP is not subject to the payment adjustment for eRx in 2014 99% 98% 97% 97% 97% 97% EP is subject to the payment adjustment for eRx in 2014 98% 98% 97% 97% 97% 97% 29
    30. 30. EP EHR Reporting Period  Payment adjustments are based on prior years' reporting periods  The length of the reporting period depends upon the first year of participation  To avoid payment adjustments: – EPs MUST continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years For an EP who has demonstrated meaningful use in 2011 or 2012 Payment Adjustment Year 2015 2016 2017 2018 2019 2020 Based on full year EHR reporting period 2013 2014* 2015 2016 2017 2018 *Special three month reporting period 30
    31. 31. EP EHR Reporting Period For an EP who demonstrates meaningful use in 2013 for the first time Payment Adjustment Year 2015 Based on 90 day EHR reporting period 2013 Based on full year EHR reporting period 2016 2017 2018 2019 2020 2014* 2015 2016 2017 2018 *Special three month reporting period To avoid payment adjustments: EPs MUST continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years 31
    32. 32. EP EHR Reporting Period EP who demonstrates meaningful use in 2014 for the first time: Payment Adjustment Year 2015 Based on 90 day EHR reporting period 2014* 2014 Based on full year EHR reporting period 2016 2017 2018 2019 2020 2015 2016 2017 2018 * In order to avoid the 2015 payment adjustment, the EP must attest no later than 10/1/14, which means they must begin their 90-day reporting period no later than 7/1/14 32
    33. 33. Payment Adjustments for Providers Eligible for Both Programs  If you are eligible to participate in both the Medicaid and Medicare EHR Incentive Programs, you MUST demonstrate Meaningful Use according to the timelines in the previous slides to avoid the payment adjustments  You may demonstrate meaningful use under either program – NOTE: Congress mandated that an EP must be a meaningful user in order to avoid a payment adjustment; therefore receiving a Medicaid EHR Incentive Payment for adopting, implementing or upgrading your certified EHR Technology would not exempt you from the payment adjustments 33
    34. 34. EP Hardship Exceptions EPs can apply for hardship exceptions in the following categories: 1. Infrastructure EPs must demonstrate they are in an area without sufficient internet access or face insurmountable barriers to obtaining infrastructure. 2. New EPs Newly practicing EPs who would not have time to become a meaningful user can apply for a 2-year limited exception to payment adjustments. 3. Unforeseen circumstances Natural disaster or other unforeseeable barrier. 4. EPs must demonstrate the criteria 1. Lack of face-to-face or telemedicine interaction with patients. 2. Lack of need for follow up with patients. 5. EPs who practice Lack of control of availability of CEHRT for more than 50% of in multiple locations patient encounters. must demonstrate 34
    35. 35. Applying for Hardship Exceptions  Applying: EPs/EHs must apply for hardship exceptions to avoid payment adjustments  Granting Exceptions: CMS will grant hardship exceptions only if they determine that providers have demonstrated that those circumstances pose a significant barrier to them achieving meaningful use  Deadlines: Applications need to be submitted no later than July 1 for EPs of the year before the payment adjustment year, but CMS recommends earlier submission  For More Information: Details on how to apply will be available in the future at www.cms.gov/EHRIncentivePrograms 35
    36. 36. MEDICAID PROGRAM SPECIFIC CHANGES 36
    37. 37. Medicaid Eligibility Expansion Patient Encounters  Definition of patient encounter has changed  The rule includes encounters for anyone enrolled in the Medicaid program, including Medicaid expansion encounters (except stand-alone Title 21) and those with zero-pay claims  The rule adds flexibility in the look-back period for overall patient volume 37
    38. 38. Provider Eligibility: Patient Volume Calculation Medicaid Encounters  Previously under Stage 1 rule: – Service rendered on any one day where Medicaid paid for all or part of the service or Medicaid paid the co-pays, cost-sharing or premiums  Changes in Stage 2 rule (applicable to all stages): – Service rendered on any one day to a Medicaid-enrolled individual, regardless of payment liability – Includes zero-pay claims and encounters with patients in Title-21 funded Medicaid expansions (but not separate CHIPs) 38
    39. 39. Provider Eligibility: Patient Volume Calculation 90 Day Period for Medicaid Patient Volume Calculation  Under Stage 1 rule, Medicaid patient volume for providers calculated across 90-day period in last calendar year  Under Stage 2 rule (applicable to all stages), States also have the option to allow providers to calculate Medicaid patient volume across 90-day period in last 12 months preceding provider’s attestation  Also applies to needy individual patient volume  Applies to patient panel methodology: – With at least one Medicaid encounter taking place in the last 24 months prior to the 90-day period (expanded from 12 months prior) 39
    40. 40. STAGE 2 RESOURCES 40
    41. 41. Stage 2 Resources CMS Website  http://www.cms.gov/Regulations-and Guidance/Legislation/EHRIncentivePrograms/Stage_2.html  Links to the Federal Register  Tip Sheets: – – – – – Stage 2 Overview 2014 Clinical Quality Measures Payment Adjustments & Hardship Exceptions (EPs & Hospitals) Stage 1 Changes Stage 1 vs. Stage 2 Tables (EPs & Hospitals) 41
    42. 42. Contact Us Michelle Brunsen Sr. Health IT Advisor mbrunsen@telligen.org (515) 453-8180 www.telligenhitrec.org @TelligenHITREC In Partnership with: The Office of the National Coordinator for Health Information Technology (ONC) U.S. Department of Health and Human Services grant 90RC0004/01. IA-HITREC-05/13-794 42

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