Understanding Meaningful Use - 26Feb2010

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Wondering about the meaning of Meaningful use? Pulse offers a brief overview of the forthcoming Meaningful Use requirements and what you need to do as a physician to be eligible to receive ARRA Stimulus money when it becomes available.

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Understanding Meaningful Use - 26Feb2010

  1. 1. ARRA HITECH Meaningful Use Update<br />
  2. 2. What Does it All Mean to You?<br />Two programs with substantial incentive payment programs<br />Medicare offers up to $44,000 per physician<br />Medicaid offers up to $63,750 per physician<br />Non-participation leads to reimbursement penalties<br />1% penalty in 2015<br />2% penalty in 2016<br />3% penalty in 2017<br />5% penalty in 2019<br />Qualification requires:<br />Certified Complete EHR<br />Meaningful Use<br />
  3. 3. What Do Physicians Need to Do?<br /> 2010 2011 <br />2<br />3<br />4<br />5<br />1<br />Choose a Certified Complete EHR<br />Utilize all meaningful use measures for at least 90 consecutive days<br />Choose Medicare or Medicaid incentive program<br />Attest to meaningful use and name of Certified Complete EHR<br />Implement and train usage to all meaningful use measures<br />Receive first payment<br />
  4. 4. Lots of Questions<br />How will I prove I’m meeting Meaningful Use measures?<br />How long do I have to prove Meaningful Use measures?<br />How will I prove I’m using a Certified Complete EHR?<br />Will the incentive payments be made to physicians or practices?<br />How often will payments be made?<br />Which incentive program is best for me…Medicare or Medicaid?<br />What if my local HIE isn’t live yet?<br />Many questions are ready to be answered today, this presentation will address many of the most common questions encountered.<br />
  5. 5. When will it all be finalized?<br />
  6. 6. Where Is It All Leading?<br />2015<br />2013<br />2011<br />Enable significant and measurable improvements in population health through a transformed delivery system.<br />Adapted from Health Information Technology Meaningful EHR Use Workgroup, June 16, 2009<br />
  7. 7. Building An Electronic Healthcare Network<br />Personal Health Records<br />Health Vault/Google Health<br />Electronic Health Records<br />Certified Complete EHR<br />$20 billion Incentive payments available<br />Health Information Exchanges/Regional Health Information Organizations – Connecting Patient Data within Medical Trade Areas<br />$564 million grants issued Feb. 12th, in all 50 states<br />National Health Information Network – A network of networks<br />HIE grants earmarked with NHIN funding<br />SureScripts™ - National clearing-house for prescriptions<br />Regional Centers – Consulting with Primary Care Practices<br />$250 million in grants issued Feb. 12th in 39 regions<br />Community College Consortia to Educate Information Technology Professionals in Health Care<br />$70 million to be awarded March ‘10<br />
  8. 8. What Do Physicians Need to Do?<br /> 2010 2011 <br />2<br />3<br />4<br />5<br />1<br />Choose a Certified Complete EHR<br />Utilize all meaningful use measures for at least 90 consecutive days<br />Choose Medicare or Medicaid incentive program<br />Attest to meaningful use and name of Certified Complete EHR<br />Implement and train usage to all meaningful use measures<br />Receive first payment<br />
  9. 9. Utilize Certified EHR Technology<br />
  10. 10. HHS Certification Process<br />Rules expected in February to define process for how certifying bodies will be named, certified and issue certifications<br />CCHIT will almost certainly be a certifying body<br />Already aligned certification criteria with proposed MU measures<br />Dr. Mark Leavitt, CCHIT Chair: “Unless they pass a law saying that certifying bodies cannot start with the letter C, we will be a certifying body.”<br />
  11. 11. What is a Certified Complete EHR?<br />CCHIT mapped latest proposed requirements to 2011 Comprehensive Certification<br />Pulse EHR first to fully certify for CCHIT 2011 Ambulatory Comprehensive Certification without any restrictions<br />
  12. 12. What Do Physicians Need to Do?<br /> 2010 2011 <br />2<br />3<br />4<br />5<br />1<br />Choose a Certified Complete EHR<br />Utilize all meaningful use measures for at least 90 consecutive days<br />Choose Medicare or Medicaid incentive program<br />Attest to meaningful use and name of Certified Complete EHR<br />Implement and train usage to all meaningful use measures<br />Receive first payment<br />
  13. 13. New: Staged Approach to Meaningful Use<br />First Payment Year<br />
  14. 14. Proposed Meaningful Use Measures: Stage 1<br />
  15. 15. Proposed Meaningful Use Measures: Stage 1<br />
  16. 16. Proposed Meaningful Use Measures: Stage 1<br />
  17. 17. Comments? You Have Until March 15th<br />Federal eRulemaking Portal: http:// www.regulations.gov<br />Identified by RIN 0991-AB58<br />Regular, Express, Overnight Mail, Hand Delivery or Courier<br />Department of Health and Human Services<br />Office of the National Coordinator for Health Information Technology<br />Attention: HITECH Initial Set Interim Final Rule<br />Hubert H. Humphrey Building, Suite 729D<br />200 Independence Ave., SW.<br />Washington, DC 20201<br />All comments received before the close of the comment period will be available for public inspection at http://www.regulations.gov<br />
  18. 18. Comment Sample…Health IT Policy Committee<br />Allow providers to defer up to five proposed measures from 2011-13<br />Providers could not defer all measures from a single priority area<br />No deferrals in the privacy and security priority area<br />Certain meaningful use measures should remain mandatory, such as:<br />Using computerized physician order entry systems<br />Providing patients with electronic copies of discharge instructions<br />Recording patient demographics as structured data<br />Transmitting certain prescriptions electronically<br />
  19. 19. Stage 2 Preview<br />HHS anticipates redefining objectives to include not only the capturing of data in electronic format but also the exchange of that data in increasingly structured formats<br />Stage 2 meaningful use criteria preview:<br />“CPOE use” will include not only the percentage of orders entered directly by providers through CPOEs but also the electronic transmission of those orders<br />“Incorporate clinical lab-test results into EHR as structured data” will be expanded, where feasible<br />Measures that currently require the performance of a capability test will be revised to require the actual submission of that data<br />Measures that currently allow the provision and exchange of unstructured data will require the provision and exchange of electronic and structured data, where feasible<br />
  20. 20. How will Meaningful Use be proven?<br />Attestation to CMS<br />Complete EHR Certification information (supplied by Pulse)<br />Describe performance on all functional measures required for Meaningful Use<br />
  21. 21. Clinical Reporting Measures<br />
  22. 22. Core Clinical Reporting Measures<br />Reports on patient care from administration and medical record data<br />Allows identification of patterns in diagnosis and treatment<br />All reporting must use a Certified Complete EHR to capture and calculate results<br />All Physicians are required to report information on Core measures<br />Proposed Required Core Clinical Reporting Measures<br />Inquiry Regarding Tobacco Use<br />Blood pressure measurement<br />Drugs to be avoided in the elderly<br />
  23. 23. Specialty Specific Proposal Measures<br /><ul><li>Specialty measures will be limited to a required subset of 3 to 5 measures based on the availability of electronic measure specifications and comments received</li></ul>Cardiology<br />Pulmonology<br />Endocrinology<br />Oncology<br />Surgery<br />Primary Care<br />Pediatrics<br />OB GYN<br />Neurology<br />Psychiatry<br />Ophthalmology<br />Podiatry<br />Radiology<br />Gastroenterology<br />Nephrology<br />
  24. 24. How will Clinical Quality Measures be Submitted?<br />For 2011, an attestation methodology will be used to submit summary information to CMS on clinical quality measures as a condition of demonstrating meaningful use of Certified EHR Technology<br />HHS and State CMS Technology is expected to be ready to receive data electronically starting in 2012<br />Many Health Information Exchanges are considering offering physicians the service of packaging and submitting meaningful use data.<br />
  25. 25. What Do Physicians Need to Do?<br /> 2010 2011 <br />2<br />3<br />4<br />5<br />1<br />Choose a Certified Complete EHR<br />Utilize all meaningful use measures for at least 90 consecutive days<br />Choose Medicare or Medicaid incentive program<br />Attest to meaningful use and name of Certified Complete EHR<br />Implement and train usage to all meaningful use measures<br />Receive first payment<br />
  26. 26. Who Qualifies?<br />Medicare<br />Eligible Providers (EP)<br />Doctor of medicine or osteopathy<br />Doctor of dental surgery of medicine<br />Doctor of podiatric medicine<br />Doctor of optometry<br />Chiropractor<br />Medicaid<br />Eligible Providers (EP)<br />Physicians<br />Dentists<br />Certified nurse – midwives<br />Nurse practitioners<br />Physicians assistants in FQHC or RHC led by a Physician assistant<br />
  27. 27. Medicare<br />Up to $44,000 over 5 years<br />75% of submitted allowable charges to Medicare, up to the capped amount for that year<br />Part B claims for the Fee for Service program<br />Items in the Medicare Physician’s Fee Schedule<br />“Professional” components only, no “Technical” components<br />Medicaid<br />Up to $63,750 over 6 years<br />Flat fees to cover 85% cost of purchasing, implementing and maintaining an EHR<br />Average allowable cost for EHR purchase, including implementation and hardware is $54,000<br />Average allowable annual cost for maintenance is $20,610<br />How are the Incentives Calculated?<br />
  28. 28. Payment Calendars<br />Medicare Calendar<br />First Attestation Year<br />Medicaid Calendar<br />Medicaid incentive qualification must start by 2015, no payments beyond 2021<br />
  29. 29. Medicare<br />Full incentive payment in 2011 requires allowable charges of $24,000<br />Lower allowable charges result in lower incentive payments<br />Eligible Providers in a Health provider shortage area (HPSA) can claim an additional 10% incentive payment bonus<br />Medicaid<br />30% of all patient encounters must be attributable to Medicaid over any continuous 90-day period within a calendar year<br />Short-term outreach programs not applicable<br />Must re-attest annually<br />20% requirement for Pediatricians<br />33% lower available incentive<br />How are the Incentives Calculated?<br />
  30. 30. What is the Timing?<br />Medicare<br />Medicaid<br />First year (2011) requires continuous 90-day period within the payment year which can attest to Meaningful Use<br />Cannot cross calendar years<br />Can begin as early as 2010 if the state has filed an indication of readiness to capture electronic information<br />90-day attestation period would apply to both 1st and 2nd years in states approved for 2010 incentive<br />Cannot cross calendar years<br />Physician must demonstrate actual full installation to qualify in 2010<br />If you have already implemented and are ready to prove Meaningful Use, the program will begin in 2011<br />
  31. 31. Other Unique Medicaid Differences<br />Outside funds, other than State or local funds, such as through a Stark program, that are directly tied to payment for an EHR will be subtracted<br />Average Allowable Costs in Medicaid program allow ability to accept up to $29,000 in first year and $10,610 in following years without impacting<br />Physicians must choose only one state to apply for Medicaid payments<br />State choice may be changed annually at re-attestation<br />
  32. 32. Switching Incentive Programs<br />Physicians may switch between programs only once during the shared program periods (last year to switch is 2014)<br />After switching, the EP continues at the next ‘program year’<br />Example: After 2 years in Medicare program, an EP would start in year 3 in Medicaid program<br />
  33. 33. What Do Physicians Need to Do?<br /> 2010 2011 <br />2<br />3<br />4<br />5<br />1<br />Choose a Certified Complete EHR<br />Utilize all meaningful use measures for at least 90 consecutive days<br />Choose Medicare or Medicaid incentive program<br />Attest to meaningful use and name of Certified Complete EHR<br />Implement and train usage to all meaningful use measures<br />Receive first payment<br />
  34. 34. Getting Paid<br />Tracking will be done by NPI (National Provider Identifier)<br />A single annual payment<br />Medicare will pay via CMS<br />Medicaid will pay from State Medicaid or designated organization<br />Payments will be made on a rolling basis as Meaningful Use is reported<br />End of reporting period and/or threshold for maximum payment is reached<br />Payments can be reassigned to any entity with a valid employment agreement with the EP<br />Cannot split re-assignment across multiple entities<br />A single database will track participation for both programs<br />Application for each program will include:<br />Identify Medicare or Medicaid program participation<br />Name, NPI, business address and business phone<br />Taxpayer ID Number of payment destination<br />
  35. 35. The time to get started is now!<br />
  36. 36. Prepare An Organized Plan to Implement Now<br /> 2010 2011 <br />2<br />3<br />4<br />5<br />1<br />Choose a Certified Complete EHR<br />Utilize all meaningful use measures for at least 90 consecutive days<br />Choose Medicare or Medicaid incentive program<br />Attest to meaningful use and name of Certified Complete EHR<br />Implement and train usage to all meaningful use measures<br />Receive first payment<br />
  37. 37. Get Started Now<br />If you are not using EHR currently, consider only CCHIT 2011 Comprehensive Certified solutions<br />Pulse EHR is fully CCHIT 2011 Comprehensive Certified<br />Currently installed version meets and exceeds all proposed HHS Complete EHR Certification requirements<br />If you are using an EHR today, perform practice usage gap analysis against proposed measures<br />Expand CPOE usage<br />Discreet data capture<br />Coded systems are key to interoperability use<br />Evaluate which incentive program is best for you<br />Develop a plan for re-assignment of incentive payments<br />
  38. 38. Consider Pulse EHR<br />Easier to buy.<br />Easier to implement.<br />Easier to learn.<br />Easier to use.<br />Easier to adopt.<br />An easier way to meaningful use.<br />
  39. 39. Let’s get started.Contact me directly: browley@pulseinc.comwww.pulseinc.com1.800.444.0882<br />

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