Meaningful Use of EHRs for the Eligible Professional
Meaningful Use of EHRs for the Eligible ProfessionalSolutions for Independent Practices
To Qualify for the Incentive Funds, Eligible ProfessionalsMust Prove Meaningful Use of a Certified EHR SystemEligible Professional setting. CMS will use the place-of-service bodies according to the meaningfulUnder the Medicare provision, an EP codes on physician claims – 21 (inpatient use guidelines of the HHS Certificationis a physician as defined in the Social hospital) and 23 (emergency room; program. McKesson’s Practice Partner®Security Act section 1861 to include: hospital) – to make this determination. v9.5, Medisoft® Clinical v17 sp1 and Lytec® MD 2011 are 2011/2012 compliant– a doctor of medicine or osteopathy Meaningful Use and were ONC-ATCB certified* as a EPs will be eligible for the incentive Complete EHR by CCHIT.– a doctor of dental surgery or of dental payments if: medicine Registration and Reporting – they use a certified EHR technology Registration by providers for the EHR– a doctor of podiatric medicine in a meaningful manner incentive program opened in January– a doctor of optometry 2011. Registration for both Medicare and – the certified EHR is connected in a manner that provides for the electronic Medicaid programs are managed by CMS– a chiropractor exchange of health information to and accessible online atThe Medicaid HIT Incentive program improve the quality of care www.cms.gov/EHRIncentivePrograms/20_expands the definition of “eligible RegistrationandAttestation.asp.professional” to also include: – and in using the EHR, the provider submits information on clinical quality measures In the first reporting year, providers– a certified nurse mid-wife will need to prove meaningful use of The Stage 1 Meaningful Use criteria required measures over any continuous– a nurse practitioner focused on the electronic capture of 90-day period. In the subsequent years,– a physician assistant practicing in patient data were published in the the reporting period will be based on the an FQHC or RHC that is led by a Final Rule issued on July 28, 2010. full calendar year. For 2011, providers physician assistant Physicians must meet 15 Core and five will report all measures through an of 10 Menu objectives (see Tables 3 attestation method through a web-basedProviders participating in Medicare and 4, respectively). Over time, EPs will portal and will begin electronic reportingAdvantage (MA) programs will qualify be required to meet Stage 2 and Stage to CMS in 2012.as an EP if they match one of two 3 criteria that will be released in futuredescriptions below: rule making and will focus on improved States can determine when their clinical processes and the decision Medicaid programs will begin and are1. Furnish, on average, at least 20 allowed to propose additional core support and quality measurement hours/week of patient-care services meaningful use criteria that would be reporting and outcomes respectively. and are employed by the qualifying required of physicians to successfully MA organization Certified EHR system participate in their Medicaid incentive Certification standards are aligned with program. Under the Medicaid program,2. Are employed by, or a partner of, an the meaningful use criteria. Authorized providers are not required to prove entity that through contract with the Testing and Certification Bodies (ATCBs) meaningful use in the first year; instead qualifying MA organization furnishes have been named by the Office of the they need to prove that they are in the at least 80% of the entity’s Medicare National Coordinator of Health IT. The process of adopting, implementing or patient care services to enrollees of the first to be named were the Certification upgrading certified EHR technology. qualifying MA organization Commission of Health Information Technology (CCHIT®), The Drummond Incentives will be paid to providers inHospital-based physicians who furnish Group and InfoGard Laboratories, Inc. single, consolidated annual payments.“substantially all” of their services ina hospital are not eligible for the EP *Certification ID: CC-1112-589589-1. Thisincentive, defined as providing at least Providers must use an EHR solution that certification does not represent an endorsement by has been certified by one of these bodies the U.S. Department of Health and Human Services or90% of their services in a hospital guarantee the receipt of incentive payments.
Government Incentives for Providers to DriveEHR AdoptionThe passage of the American Recovery Incentives are based on the lesser ofand Reinvestment Act (ARRA) provides either 75% of the provider’s Medicareincentives for office-based physicians Part B allowed charges (the lesser ofand other providers to tap into the the actual charge or the Medicarepower of electronic health records (EHRs). physician fee schedule amount) basedProviders may be eligible to benefit from on claims submitted to Medicarethe incentives, whether through first-time during the incentive payment year.deployment of EHRs or completion of And, physicians practicing in CMS-existing healthcare IT projects. designated Physician Shortage Areas will earn an additional 10% bonus.Incentive OverviewEligible Professionals (EPs) can qualify This program will be administered by Practice Partner v9.5,under either the Medicare or Medicaid CMS under the direction of the Secretary Medisoft Clinical v17 sp1provision. EPs must be office-based to be of the Department of Health and Human and Lytec MD 2011eligible, and they cannot collect incentive Services (HHS). CC-1112-589589-1payments from both provisions. Learn more at: mckesson.com Medicaid ProvisionMedicare Provision Beginning in 2011, office-based physicians encounters will be determined by theBeginning in 2011, EPs who are who qualify under the Medicaid provision encounters attributable to Medicaid (or“meaningful users” of certified EHRs could collect a sum total of $63,750 — “needy individuals” in an FQHC or RHC)are entitled to receive up to $44,000 calculated as 85% of EHR net average over any continuous 90-day period withinof total Medicare incentive payments allowable cost not exceeding $25,000 in the most recent calendar year prior toover five years — from 2011 to 2015. the first year, followed by 85% of annual the reporting year. Providers must beginThe structure of the maximum costs not exceeding $10,000 over the adopting, implementing or upgrading aincentives is shown in Table 1. next five years as shown in Table 2. certified EHR system in the first year and demonstrate “meaningful use” beginning Table 1 Table 2 in the second year to receive the incentive Maximum Incentive Payments – Medicare Maximum Incentive Payments – Medicaid payments. The States will administer the Payment Adoption Year Adoption Year Medicaid program in their respective states. Year Now - 2011 2012 2013 2014 Payment 30% Provider 20% Pediatrician Year 2011 - 2016 2011 - 2016 2011 $18K – – – 2012 $12K $18K – – Year 1 $21,250 $14,167 Payment Reduction 2013 $8K $12K $15K – Year 2 $8,500 $5,667 For office-based physicians who do not 2014 $4K $8K $12K $12K Year 3 $8,500 $5,667 adopt EHR technology by 2015, Medicare 2015 $2K $4K $8K $8K Year 4 $8,500 $5,667 payments will be reduced by: Year 5 $8,500 $5,666 2016 – $2K $4K $4K Year 6 $8,500 – 1% in 2015 Total $44K $44K $39K $24K $5,666 – 2% in 2016 (up to 2021) Shortage Area $48.4K $48.4K $42.9K $26.4K Total $63,750 $42,500 – 3% in 2017 and beyondOffice-based physicians can qualify To be eligible under this provision, more In 2018 and beyond, the HHS Secretaryfor a one-time, “early adopter” than 30% of their patient encounters may increase one additional percent perincentive of $3,000 if they qualify must be attributable to Medicaid, year (maximum of 5%) contingent upon thefor the program in 2011 or 2012. or 20% for pediatricians. Patient levels of overall EHR adoption in the market.
Providers Must Meet all 15 Core Objectives Table 3: Core Objectives Meaningful Use Stage 1 Core Objectives Eligible Professional (EP) Objective Measures Use CPOE for medication orders directly entered by any licensed healthcare More than 30% of unique patients with at least one medication in their medication professional who can enter orders into the medical record per state, local and list seen by the EP have at least one medication order entered using CPOE professional guidelines Implement drug-drug and drug-allergy interaction checks The EP has enabled this functionality for the entire EHR reporting period More than 40% of all permissible prescriptions written by the EP are transmitted Generate and transmit permissible prescriptions electronically (eRx) electronically using certified EHR technology More than 50% of all unique patients seen by the EP have demographics recorded as Record demographics: preferred language, gender, race, ethnicity, date of birth structured data More than 80% of all unique patients seen by the EP have at least one entry or an Maintain an up-to-date problem list of current and active diagnoses indication that no problems are known for the patient recorded as structured data More than 80% of all unique patients seen by the EP have at least one entry (or an Maintain active medication list indication that the patient is not currently prescribed any medication) recorded as structured data More than 80% of all unique patients seen by the EP have at least one entry (or Maintain active medication allergy list an indication that the patient has no known medication allergies) recorded as structured data Record and chart changes in vital signs: Height, Weight, Blood pressure, Calculate For more than 50% of all unique patients age 2 and over seen by the EP — height, and display BMI, Plot and display growth charts for children 2-20 years, including BMI weight and blood pressure are recorded as structured data More than 50% of all unique patients 13 years old or older seen by the EP have Record smoking status for patients 13 years old or older smoking status recorded as structured data Implement one clinical decision support rule relevant to specialty or high clinical Implement one clinical decision support rule priority along with the ability to track compliance with that rule For 2011, provide aggregate numerator, denominator, and exclusions through attestation as discussed in the final rule Report ambulatory quality measures to CMS or the States* For 2012, electronically submit the clinical quality measures as discussed in the final rule Provide patients with an electronic copy of their health information (including diagnostic More than 50% of all patients of the EP requesting an electronic copy of their health test results, problem list, medication lists, medication allergies), upon request information are provided it within 3 business days Clinical summaries provided to patients for more than 50% of all office visits within Provide clinical summaries for patients for each office visit 3 business days Capability to exchange key clinical information (for example, problem list, medication Performed at least one test of certified EHR technology’s capacity to electronically list, medication allergies, diagnostic test results), among providers of care and patient exchange key clinical information authorized entities electronically Protect electronic health information created or maintained by the certified EHR Conduct or review a security risk analysis and implement security updates as necessary technology through the implementation of appropriate technical capabilities and correct identified security deficiencies as part of its risk management process*EPs will be required to report on a total of six quality measures, three core measures plus three from a list of 38 Clinical Quality Measures (not designated by specialty)
Providers Must Choose 5 of the 10 Menu Objectives Table 4: Core Objectives Meaningful Use Stage 1 Menu Objectives Eligible Professional (EP) Objective Measures The EP has enabled this functionality and has access to at least one internal orImplement drug-formulary checks external drug formulary for the entire EHR reporting period More than 40% of all clinical lab tests results ordered by the EP or by an authorized provider of the eligible hospital or CAH for patients admitted to its inpatient or emergencyIncorporate clinical lab-test results into certified EHR technology as structured data department (POS 21 or 23) during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured dataGenerate lists of patients by specific conditions to use for quality improvement, Generate at least one report listing patients of the EP with a specific conditionreduction of disparities, research or outreach More than 20% of all unique patients 65 years or older or 5 years old or younger wereSend reminders to patients per patient preference for preventive/follow up care sent an appropriate reminder during the EHR reporting period More than 10% of all unique patients seen by the EP are provided timely (availableProvide patients with timely electronic access to their health information (including to the patient within four business days of being updated in the certified EHRlab results, problem list, medication lists, medication allergies) within four business technology) electronic access to their health information subject to the EP’sdays of the information being available to the EP discretion to withhold certain informationUse certified EHR technology to identify patient-specific education resources and More than 10% of all unique patients seen by the EP are provided patient-specificprovide those resources to the patient if appropriate education resources More than 80% of all unique patients seen by the EP have at least one entry (orMaintain active medication allergy list an indication that the patient has no known medication allergies) recorded as structured dataThe EP who receives a patient from another setting of care or provider of care or The EP performs medication reconciliation for more than 50% of transitions of care inbelieves an encounter is relevant should perform medication reconciliation which the patient is transitioned into the care of the EPThe EP who transitions their patient to another setting of care or provider of care The EP who transitions or refers their patient to another setting of care or provider ofor refers their patient to another provider of care should provide summary of care care provides a summary of care record for more than 50% of transitions of care andrecord for each transition of care or referral referrals Performed at least one test of certified EHR technologys capacity to submitCapability to submit electronic data to immunization registries or immunization electronic data to immunization registries and follow up submission if the test isinformation systems and actual submission in accordance with applicable law successful (unless none of the immunization registries to which the EP submits suchand practice information have the capacity to receive the information electronically) Performed at least one test of certified EHR technology’s capacity to provide electronicCapability to submit electronic syndromic surveillance data to public health agencies syndromic surveillance data to public health agencies and follow-up submission if theand actual submission in accordance with applicable law and practice test is successful (unless none of the public health agencies to which an EP submits such information have the capacity to receive the information electronically)