Meaningful Use: Moving Toward Stage 2
 

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Learn more about the next stage in Meaningful Use and how that affects today's health care providers.Will there be changes in the measures required to receive Medicare or Medicaid Incentive funds? ...

Learn more about the next stage in Meaningful Use and how that affects today's health care providers.Will there be changes in the measures required to receive Medicare or Medicaid Incentive funds? Will there be any changes to data capturing? Find out in this informative presentation.

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Meaningful Use: Moving Toward Stage 2 Presentation Transcript

  • 1. Meaningful Use – Moving Toward Stage 2 Adele Allison National Director of Government Affairs, SuccessEHS
  • 2. Background – ARRA/HITECH
  • 3.
    • Signed 2/17/09 in Denver, CO
    • Purpose : Stimulate the economy through investments in infrastructure, unemployment benefits, transportation, education, and healthcare .
  • 4.
    • Health Care is in the Spotlight
      • Affordable Care Act - Health Care Reform ($828B)
      • Fueling push for HIT ($54B per year savings)
      • Rapid market movement and positioning
    • Up to $45B for direct EHR adoption: 
      • $20B in Medicare Incentives
      • $14B in Medicaid Incentives
  • 5. HITECH Goals
  • 6.
    • Push Provider Adoption of approved (certified) EHR Technology
    • Capture DATA
    • Move DATA – Interoperability
    • Report DATA
    • $27B in “Carrots” - incentives :
      • Up to $48,400 through Medicare
      • Up to $63,750 through Medicaid
  • 7. Meaningful Use: 3-part equation
  • 8.
    • 3-Part Equation for MU:
      • Part 1: Certified EHR Technology – The Tool
      • Part 2: Implementation – Practice Reengineering / Redesign
      • Part 3: Support – Available, Responsive and Ongoing
  • 9. Meaningful Example
  • 10.
    • Stage 1 – Objectives & Measures
    • Objectives are broad spanning goals/activities
    • Measures are specific task(s) requirements
    • Meeting the measures = meeting the Objectives for that Stage
    • Stage 1 MU
      • 15 Core Measures required by all EP’s
      • 10 Menu Measures from which EP’s choose 5
    • 13 Exclusion Clauses – Exclusions will reduce the number of Objectives required by EP
  • 11.
    • Stage 1 – Medicare Incentive
    • Types of Providers - §495.100 :
      • Medicare: MD, DO, DDS, DMD, DPM, OD, DC
    • Must have PECOS Number with CMS
    • Must register with CMS
      • Registration Website: cms.gov/EHRIncentivePrograms/
    • Year 1: 15 Core + 5 Menu Objectives/Measures for continuous 90-days
  • 12.
    • Stage 1 – Medicare Incentive
    • Year 2 and Beyond: Full Year of MU
    • CY2011-12 - Must gather data, run calculations, attest and send to CMS
    • CY2013 and Beyond – Electronic Submission of CQMs
    • Qualification is reviewed annually
  • 13. Potential Medicare Incentives Calendar Year First Calendar Year in which the EP Receives an Incentive Payment   2011 2012 2013 2014 2015 and subsequent years 2011 $18,000         2012 $12,000 $18,000       2013 $8,000 $12,000 $15,000     2014 $4,000 $8,000 $12,000 $12,000   2015 $2,000 $4,000 $8,000 $8,000 $0 2016   $2,000 $4,000 $4,000 $0 TOTAL $44,000 $44,000 $39,000 $24,000 $0 Shortage Area Totals* $48,400 $48,400 $42,900 $26,400 $0 * Providers practicing in a federally identified shortage area are eligible for a 10% increase .
  • 14.
    • Stage 1 – Medicaid Incentive
    • Types of Providers - §495.100:
      • Medicaid: Physicians, Dentists, Certified Nurse Midwives, Nurse Practitioners, Physician Assistants (in FQHC/RHC led by a PA)
    • Year 1: Adopt, Implement, Upgrade - §495.302 :
      • Acquire, purchase, or secure access to certified EHR technology;
      • Install/use certified EHR technology capable of MU; or
      • Expand functionality of certified EHR solution at the practice with:
        • Staffing, Maintenance, Training, or Upgrading from existing EHR to certified EHR technology.
  • 15.
    • Stage 1 – Medicaid Incentive
    • Year 2: MU for 90 continuous days
    • Years 3 through 6: MU for full year
  • 16. Potential Medicaid Incentives Calendar Year First Calendar Year in which the EP Receives an Incentive Payment 2011 2012 2013 2014 2015 2016 2011 $21,250           2012 $8,500 $21,250         2013 $8,500 $8,500 $21,250       2014 $8,500 $8,500 $8,500 $21,250     2015 $8,500 $8,500 $8,500 $8,500 $21,250   2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250 2017 $0 $8,500 $8,500 $8,500 $8,500 $8,500 2018 $0 $0 $8,500 $8,500 $8,500 $8,500 2019 $0 $0 $0 $8,500 $8,500 $8,500 2020 $0 $0 $0 $0 $8,500 $8,500 2021 $0 $0 $0 $0 $0 $8,500 TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750
  • 17. Forecasting Stage 2
  • 18.
    • Since Stage 1 Final Rule
    • ONC - Exit Dr. Blumenthal , Enter Dr. Farzad Mostashari
    • Stage 2 – Tactical Deployment
    • Rapid Market Positioning in HC Orgs
    • New Payment Models Developing
      • CMMI
      • ACOs
      • Bundled Payments -> Revenue Cycle Mgmt (RCM) and Enterprise Resource Planning (ERP)
  • 19.
    • Since Stage 1 Final Rule
    • State Initiatives Challenged (RECs, HIEs)
    • Enter the iPad clinicians’ companion device
    • NHIN Direct Project launched Jan. 2011
    • Industry Hungry for Data
  • 20.
    • Since Stage 1 Final Rule
    • HITPC -> Recommendations to CMS June 16 th
    • Push Stage 2 Launch to CY2014
    • ONC NPRM for Vendors (Certification) -> Q4 2011
    • CMS NPRM for Providers -> Q1 2012 – Final Rule June, 2012
  • 21.
    • Since Stage 1 Final Rule
    • 5 Categories for Stage 2 Recommendations:
      • Static Measures
      • Menu Measures Converted to Core
      • Expansion of Stage 1 Thresholds and Scope
      • New Stage 2 Measures
      • Removed Measures
  • 22. Data Capture
  • 23.
    • Non-Structured Information
    • Example: Narrative Typing or Speech-to-Text
    • Pros: Personalized Note, Ultimate Flexibility, “The Patient is still a Human”
    • Cons: Not Reportable, Not Researchable, Not Machine Process-able, Non-Standard, ↑ Risk
  • 24.
    • Structured Data
    • Example: Combo or Drop-Down Boxes; User-defined Fields
    • Pros: Typically Customizable, Information Uniformity, Supports Reporting
    • Cons: Not conducive to Interoperability and Industry-wide Standards
  • 25.
    • Codified/Object-Oriented Data
    • Example: Vocabularies such as ICD9, SnoMed, LOINC
    • Pros: Very Reportable, Researchable, Machine Process-able, Standardize, Interoperable
    • Cons: Limits Flexibility in Documentation, “Cookie-Cutter” Notes
  • 26. Meaningful Use – Stage 1 vs. Stage 2
  • 27.
    • Stage 1 – About Starting Adoption
    • No Encounter Note
    • Flexibility – Menu Measures
    • Flexibility – Clinical Quality Measures (CQMs)
    • “ Tests” in Moving Data
  • 28.
    • Stage 2 – Tactical Use
    • Patient Engagement – “Behavioral Economics”
    • Production Mode for Moving Data – Focus on Transitions of Care
    • Increased Threshold and Measure Scope
    • Expansion through New Measures
    • Electronic Reporting of CQMs
    • CQMs broader in scope
  • 29. Static Measures – Stage 2
  • 30.
    • 80% of Patients have Active Problem List
      • 1 entry as structured data; or
      • “ No Known Problems” as structured data
    • 80% of Patients have Active Medications List
      • 1 entry as structured data; or
      • “ No Medications” as structured data
    • 80% of Patients have Active Medications Allergy List
      • 1 entry as structured data; or
      • “ No Known Allergies” as structured data
    • Enable Alerting of Drug-Drug and Drug-Allergy Checks
  • 31. Menu into Core Measures – Stage 2
  • 32.
    • Implement Drug Formulary Checks
    • 40% of Lab Results Ordered in EHR as Structured Data
      • Recorded as Positive / Negative, or
      • Numerical Format
    • 50% of Transition in Care with Medications Reconciled
      • When receiving patient in transition
      • Example: Hospital Discharge
    • 50% of Transitions Show Provision of Care Record Summary Provided
      • Provided in Paper or Electronic
  • 33. Expanded Stage 1 Measures – Stage 2
  • 34.
    • 60% Patients with Rx – 1+ Rx Ordered through CPOE ( ↑ from 30%)
    • 80% Patients with Demographics with ability to Stratify ( ↑ from 50%)
    • 80% Patients with Vitals recorded ( ↑ from 50%)
    • CDS for improvement on high-priority conditions ( ↑ from 1 CDS Rule)
    • Patient Lists for multiple parameters ( ↑ from 1 list with specific condition)
  • 35.
    • 10% Patient given Patient-Specific Education (“If Appropriate” Removed)
    • Actual Immunization Data Submitted (No longer “Test” Data)
    • CQMs Reported to CMS or State (Expanding)
    • Attest to encryption/security “at rest” ( ↑ from simple assessment)
    • 50% Patient Rx ePrescribed ( ↑ from 30%)
  • 36.
    • 10% All Patients sent clinical reminder ( ↓ from 20%, but now “All” Patients)
    • 50% Patients provided Clinical Summary in 24 hours ( ↑ 3 Business Days)
    • 10% Patients/Family can view and download longitudinal health information within 24 hours of encounter ( ↑4 Business Days)
    • Actual submission of Syndromic Surveillance Data
    • Actual submission of Reportable Cancer Conditions
  • 37. New Measures – Stage 2
  • 38.
    • 60% Patients with Lab Results – 1+ Lab Ordered through CPOE
    • 1 Radiology Test Ordered through CPOE
    • 10% Patients recorded Care Plans ( Including Goals and Instructions)
    • 10% Patients recorded Care Team Members (Including PCP)
    • 25 Patients have Advance Directive and ability to access
  • 39.
    • 30% of Visits have an Electronic Note (no scanning/non-searchable)
    • 25 Patients have been sent Secured Online Messages
    • 20% Patients have Communication Preferences recorded
    • 25 Transactions of Electronic Summary of Care Record sent
  • 40. Removed Measures – Stage 2
  • 41.
    • 50% Patients requesting Electronic Copy of Record – provided in 3 Business Days
    • Perform 1 Test of Exchanging Electronic Information
  • 42. For more information about MU 2 & industry trends, visit www.successehs.com for white papers, articles, blog posts and more! Click here for our industry blog