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Path To Meaningful Use


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I created and presented this as an overview for the Southern Illinois chapter of the HFMA.

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Path To Meaningful Use

  1. 1. Navigating the Path toward Meaningful Use Southern Illinois HFMA February 18, 2010
  2. 2. Navigating the Path Toward Meaningful Use <ul><li>January 13, 2010 : Official publication in the Federal Register of: </li></ul><ul><ul><li>NPRM: Medicare and Medicaid Programs; Electronic Health Record Incentive Program </li></ul></ul><ul><ul><li>IFR: Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology – effective 30 days post publication regardless of comments! </li></ul></ul><ul><li>March 15, 2010 : Comment submission periods for the NPRM & IFR close </li></ul><ul><li>March – April 2010 : anticipate the final rules on the CMS Electronic Health Record Incentive Program will be published </li></ul><ul><ul><li>By April 15, 2010 : Specifications related to the quality measures </li></ul></ul><ul><ul><li>By July 1, 2010 : Specifications for how to submit quality measures </li></ul></ul><ul><ul><li>Early 2010 – ONC has stated they will issue a separate Notice of Proposed Rulemaking (NPRM) to describe the process for authorizing certification bodies to conduct the testing and certification of Complete EHRs and EHR Modules. </li></ul></ul>
  3. 3. Goals of Meaningful Use <ul><li>Improve quality, safety, efficiency, and reduce health disparities </li></ul><ul><li>Engage patients and families </li></ul><ul><li>Improve care coordination </li></ul><ul><li>Ensure adequate privacy and security of personal health information </li></ul><ul><li>Improve population and public health </li></ul>
  4. 4. The Path to Defining Meaningful Use <ul><li>Balance competing interests – vendors, hospitals, physicians </li></ul><ul><li>Encourage EHR/EMR adoption </li></ul><ul><li>Avoid unnecessary burdens on providers </li></ul><ul><li>Promote innovation </li></ul>
  5. 5. The definition <ul><li>Eligible physicians/eligible hospitals must meet all three requirements for an EHR reporting period within a payment period </li></ul><ul><ul><li>Use a certified EHR in a meaningful manner </li></ul></ul><ul><ul><li>Utilize certified EHR technology to exchange health information to improve quality of care (i.e. care coordination) </li></ul></ul><ul><ul><li>Submit clinical quality measure information and other measures in specified manner </li></ul></ul>
  6. 6. The Incentive Programs <ul><li>Medicare FFS EHR Incentive Program </li></ul><ul><ul><li>Incentive payments made under the original Medicare Program </li></ul></ul><ul><li>Medicaid EHR Incentive </li></ul><ul><ul><li>Incentive payments made under Medicaid </li></ul></ul><ul><li>Medicare Advantage EHR Incentive </li></ul><ul><ul><li>Incentive payments made to qualifying MA organizations </li></ul></ul><ul><li>Medicare EHR Incentive Program </li></ul><ul><ul><li>Includes both the Medicare FFS EHR and the MA EHR incentive programs </li></ul></ul>
  7. 7. The Incentive Programs <ul><li>Incentive Programs are for Meaningful Use of Certified Technology </li></ul><ul><ul><li>Eligible Professionals </li></ul></ul><ul><ul><ul><li>Can not participate in both simultaneously </li></ul></ul></ul><ul><ul><ul><li>May change program participation once </li></ul></ul></ul><ul><ul><li>Hospitals </li></ul></ul><ul><ul><ul><li>Medicare and Medicaid </li></ul></ul></ul>
  8. 8. Medicare-FFS Program <ul><li>Eligible Professionals (EP)s (Medicare) </li></ul><ul><ul><li>Doctor of Medicine or Osteopathy, a doctor of dental surgery or dental medicine, a doctor of podiatric medicine, a doctor of optometry, or a chiropractor </li></ul></ul><ul><ul><li>Meaningful EHR users; not hospital based </li></ul></ul>
  9. 9. Medicare-FFS Program <ul><li>Hospital-based eligible professionals </li></ul><ul><ul><li>Pathologist, anesthesiologist, or emergency physician who furnishes substantially all of (90+%) of services in a hospital setting whether inpatient or outpatient </li></ul></ul><ul><ul><li>Places of services under codes 21, 22, or 23 </li></ul></ul><ul><ul><ul><li>21 = inpatient hospital </li></ul></ul></ul><ul><ul><ul><li>22 = outpatient hospital </li></ul></ul></ul><ul><ul><ul><li>23 = emergency room </li></ul></ul></ul>
  10. 10. Medicare-FFS Program <ul><li>Incentive payment amount, subject to an annual limit, equal to 75% of the Medicare allowed charges for covered professional services </li></ul><ul><li>Incentive payment for up to 5 years </li></ul><ul><li>Increased by 10% for EPs who practice in a HPSA (more than 50% of covered professional services) </li></ul>
  11. 11. Source: CCHIT - Based on Interim Final Rule and NPRM; Maximum Incentive for EP Medicare (not Medicaid or underserved geographies 2010 2011 2012 2013 2014 2015 2016+ Maximum Incentive Stage 1 $18K Stage 1 $12K Stage 2 $8K Stage 2 $4K Stage 3 $2K Stage 3 $0K $44K Stage 1 $18K Stage 1 $12K Stage 2 $8K Stage 3 $4K Stage 3 $4K $44K Stage 1 $15K Stage 2 $12K Stage 3 $8K Stage 3 $4K $39K Stage 1 $12K Stage 3 $8K Stage 3 $4K $24K Less than Stage 3 PENALTY Less than Stage 3 PENALTY PENALTY
  12. 12. Medicare-FFS Program <ul><li>Incentive payment paid to eligible professionals </li></ul><ul><li>EPs may reassign their incentive payment to their employer or an entity which they have a valid employment agreement or contract </li></ul><ul><li>EP may only reassign to one employer </li></ul><ul><li>CMS will use the EPs Medicare enrollment information to determine whether an EP belongs to more than one practice. </li></ul><ul><li>If EP associated with more than one practice, EP must select one tax identification number to receive incentive. </li></ul><ul><li>Payments made on a rolling basis </li></ul>
  13. 13. Medicare-FFS Program <ul><li>What is a Medicare eligible hospital? </li></ul><ul><ul><li>Located in one of fifty states or DC </li></ul></ul><ul><ul><li>CMS will provide incentive payments to hospitals as distinguished by provider number in EH cost reports </li></ul></ul><ul><ul><li>Payment Year = Federal Fiscal Year </li></ul></ul><ul><ul><li>First payment year, EHR reporting period = any 90 continuous days beginning and ending within the year </li></ul></ul><ul><ul><li>Up to 4 years incentive payments; beginning FY 2011 ending after FY 2015. </li></ul></ul>
  14. 14. Medicare-FFS Program <ul><li>Incentive Payment Calculation </li></ul><ul><ul><li>Incentive Payment Amount =[Initial Amount] x [Medicare Share] x [Transition Factor] </li></ul></ul><ul><ul><ul><li>Initial amount = $2,000,000 + [$200 per discharge for the 1,150th - 23,000th discharge] </li></ul></ul></ul><ul><ul><ul><li>Medicare Share = Medicare/(Total x Charges) </li></ul></ul></ul><ul><ul><ul><ul><li>Medicare = # of inpatient bed days for Part A + # of inpatient bed days for MA beneficiaries </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Total = number of Total Inpatient Bed Days </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Charges = Total charges minus charges for charity care divided </li></ul></ul></ul></ul>
  15. 15. Medicare-FFS Program Fiscal Year Fiscal Year Eligible Hospital First Receives the Incentive Payment 2011 2012 2013 2014 2015 2011 1.00 --- --- --- --- 2012 0.75 1.00 --- --- --- 2013 0.50 0.75 1.00 --- --- 2014 .025 0.50 0.75 0.75 --- 2015 --- .025 0.50 0.50 0.50 2016 --- --- .025 .025 .025
  16. 16. Medicare-FFS Program <ul><li>Critical Access Hospitals </li></ul><ul><ul><li>Incentive Payment Calculation </li></ul></ul><ul><ul><ul><li>May receive incentive payments for the reasonable costs incurred for the purchase of depreciable assets like computers and associated hardware/software (excludes any depreciation and interest) </li></ul></ul></ul><ul><ul><ul><li>Incentive payment = product of reasonable costs incurred for the purchase of certified EHR technology x Medicare share percentage </li></ul></ul></ul><ul><ul><ul><li>Medicare share percentage cannot exceed 100 percent </li></ul></ul></ul><ul><ul><ul><ul><li>100 percent </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Sum of Medicare share fraction and 20% points </li></ul></ul></ul></ul>
  17. 17. Medicaid EHR Incentive <ul><li>Eligible Professionals </li></ul><ul><ul><li>Five types of Medicaid professionals; physicians, dentists, certified nurse-midwives, nurse practitioners, and physician assistants practicing in a FHHC or RHC that is so led by a physician assistant </li></ul></ul><ul><ul><li>Not hospital = based with exception of Medicaid EPs practicing predominantly in an FQHC or RHC </li></ul></ul><ul><ul><ul><li>Greater than 50% over a period of 6 months </li></ul></ul></ul>
  18. 18. Medicaid EHR Incentive <ul><li>Eligible Professionals </li></ul><ul><ul><li>30% patient volume attributable to those who are receiving Medicaid </li></ul></ul><ul><ul><ul><li>Minimum of 30% of all patient encounters attributable to Medicaid over any continuous 90 day period within the most recent calendar year prior to reporting </li></ul></ul></ul><ul><ul><li>Two exceptions </li></ul></ul><ul><ul><ul><li>Pediatrician must have 20% </li></ul></ul></ul><ul><ul><ul><li>Medicaid EPs in an FQHC or RHC (50% of their encounters over a 6 month period in the most recent calendar year) must have a minimum of 30% patient volume (over a 90 day period) </li></ul></ul></ul>
  19. 19. Medicaid EHR Incentive Qualifying Patient Volume Threshold Entity Minimum 90-day Medicaid Patient Volume Threshold Or the Medicaid EP practices predominately in an FQHC or RHC – 30% “needy individual” patient volume threshold Physicians 30% Pediatricians 20% Dentists 30% Certified Nurse midwives 30% Physician Assistants when practicing at an FQHC or RHC led by a physician assistant 30% Nurse Practioner 30% Acute care hospital 30% Children’s hospitals
  20. 20. Medicaid EHR Incentive <ul><li>Payments </li></ul><ul><ul><li>Made directly to EP </li></ul></ul><ul><ul><li>States will disperse payments in a calendar year </li></ul></ul><ul><ul><li>Exception-permit payment of incentive payments to “entities promoting the adoption of certified EHR technology” as designated by the State </li></ul></ul><ul><ul><li>States must establish verification procedures that enable Medicaid EPs to voluntarily assign payments to entities promoting EHR technology. </li></ul></ul><ul><ul><li>Must begin receiving payments no later than CY 2016 </li></ul></ul><ul><ul><li>Medicaid EPs can flow in and out of program. Maximum number of incentive years is 6 years ending in 2021 </li></ul></ul>
  21. 21. Medicaid EHR Incentive Maximum Incentive Payment for Medicaid Professionals Cap on Net Average Allowable Costs, per the HITECH Act 85 percent Allowed for Eligible Professionals Maximum Cumulative Incentive over 6-year period $25,000 in Year 1 for most professionals $21,250 $63,750 $10,000 in Years 2 – 6 for most professionals $8,500 $16,667 in Year 1 for pediatricians with a minimum 20% volume, but less than 30% volume, Medicaid patients $14,167 $42,500 $6,667 in Years 2 – 6 for pediatricians with a minimum 20% volume, but less than 30% volume, Medicaid patients $5,667
  22. 22. Medicaid EHR Incentive Payment Scenarios for EPs beginning adoption in the First Year Calendar Year Medicaid EPs who being adoption in 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 $8,500 $8,500 $8,500 $8,500 $8,500 2018 $8,500 $8,500 $8,500 $8,500 2019 $8,500 $8,500 $8,500 2020 $8,500 $8,500 2021 $8,500 TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750
  23. 23. Medicaid EHR Incentive Payment Scenarios for EPs adopted EHR before First Year Calendar Year Medicaid EPs who begin Meaningful Use in 2011 2012 2013 2014 2015 2016 2011 $8,500 2012 $8,500 $8,500 2013 $8,500 $8,500 $8,500 2014 $8,500 $8,500 $8,500 $8,500 2015 $8,500 $8,500 $8,500 $8,500 $8,500 2016 $8,500 $8,500 $8,500 $8,500 $8,500 2017 $8,500 $8,500 $8,500 $8,500 2018 $8,500 $8,500 $8,500 2019 $8,500 $8,500 2020 $8,500 2021 TOTAL $42,500 $42,500 $42,500 $42,500 $42,500 $42,500
  24. 24. Medicaid EHR Incentive <ul><li>Eligible Hospitals </li></ul><ul><ul><li>Acute care and Children’s Hospitals </li></ul></ul><ul><ul><li>Acute care must meet patient volume threshold </li></ul></ul><ul><ul><li>Health care facility where LOS is 25 days or fewer </li></ul></ul><ul><ul><li>Includes some specialty hospitals where the average LOS is 25 days or fewer </li></ul></ul><ul><ul><li>Children’s hospitals do not have patient volume requirements </li></ul></ul><ul><ul><li>CCN that has the last four digits in the series 0001 through 0879 </li></ul></ul>
  25. 25. Medicaid EHR Incentive <ul><li>Children’s Hospitals </li></ul><ul><ul><li>Medicare issued CCNs –numbers whose last four digits are in the 3300 to 3399 series are assigned to Children’s hospitals </li></ul></ul><ul><ul><li>No patient volume threshold requirement </li></ul></ul>
  26. 26. Medicaid EHR Incentive <ul><li>Eligible Hospitals </li></ul><ul><ul><li>Payment is Federal Fiscal Year </li></ul></ul><ul><ul><li>Hospital cost reporting periods can begin with any month of a calendar year and end on the last day of the 12th subsequent month in the next calendar year </li></ul></ul><ul><ul><li>Calculation; (Over 4 years) Overall EHR Amount x Medicaid Share </li></ul></ul><ul><ul><ul><li>Overall amount = Base Amount plus Discharge Related Amount Applicable for each year x transition factor applicable for each year x </li></ul></ul></ul><ul><ul><ul><li>Medicaid Share = Medicaid inpatient days plus Medicaid managed care inpatient days divided by total inpatient bed days x estimated total charges minus charity care charges divided by estimated total charges </li></ul></ul></ul>
  27. 27. Medicaid EHR Incentive <ul><li>Overall EHR amount is equal to the sum over 4 years of </li></ul><ul><ul><li>Base amount of $2,000,000 </li></ul></ul><ul><ul><li>The discharge related amount defined as $200 for the 1,150th through 23,000th discharge for the first payment year multiplied by the transition factor </li></ul></ul><ul><ul><ul><li>For subsequent payment years, States must assume discharges increase by the provider’s average annual rate of growth for the most recent 3 years for which data are available per year. </li></ul></ul></ul>
  28. 28. Medicaid EHR Incentive <ul><li>Medicaid Share = </li></ul><ul><ul><li>Medicaid inpatient bed days + Medicaid managed care inpatient bed day </li></ul></ul><ul><ul><li>_____________________________________ </li></ul></ul><ul><ul><li>Total inpatient days x estimated total charges </li></ul></ul><ul><ul><li>minus charity care </li></ul></ul><ul><ul><li>------------------------------ </li></ul></ul><ul><ul><li>estimated total charges </li></ul></ul>
  29. 29. Medicaid EHR Incentive <ul><li>Payment year is based on Federal fiscal year. </li></ul><ul><li>Determine the discharge related amount on the basis of discharge data from a relevant hospital cost reporting period </li></ul><ul><li>Assume discharges have increased by the average annual growth rate for a hospital over the most recent 3 years of available data from an auditable data source. </li></ul>
  30. 30. Medicaid EHR Incentive <ul><li>Medicaid incentive payments can begin as late as 2016 </li></ul><ul><li>Hospital cost reporting periods can begin with any month of a calendar year and end on the last day of the 12th subsequent month in the next calendar year </li></ul><ul><li>Participants in first year may qualify for an incentive payment by demonstrating any of the following; they have adopted, implemented, or upgraded a certified EHR </li></ul>
  31. 31. Medicaid EHR Incentive <ul><li>Unlike Medicare, Medicaid has no statutory implementation date for making EHR incentive payments. There may be some states that might be prepared to implement their program and make EHR incentive payments to Medicaid providers in 2010 for adopting, implementing, or upgrading certified EHR technology. </li></ul><ul><li>States can initiate implementation of payments to Medicaid EPs and hospitals after the final rule </li></ul>
  32. 32. Medicaid EHR Incentives Hospital Incentives
  33. 33. Medicare Advantage Incentive <ul><li>Provides for incentive payments to qualifying MA organizations for certain of their affiliated EPs who are meaningful users of certified EHR technology during the relevant EHR reporting period for a payment year. </li></ul><ul><li>Qualifying MA organization = an organization that is organized as a health maintenance organization (HMO) </li></ul>
  34. 34. Medicare Advantage Incentive <ul><li>Since there are few federally qualified HMOs, CMS expects MA organizations to primarily qualify for incentive payments as State-licensed HMOs </li></ul><ul><li>Could include an MA organization offering HMO plans </li></ul>
  35. 35. Medicare Advantage Incentive <ul><li>MA Eligible Professional (EP) </li></ul><ul><ul><li>Be employed by the qualifying MA organization </li></ul></ul><ul><ul><li>Be employed by, or be a partner of, an entity that through contract with the qualifying MA organization furnishes at least 80% of the entity’s Medicare patient care services to enrollees of the qualifying MA organization. </li></ul></ul><ul><ul><li>Must furnish at least 20 hours per week of patient care services. </li></ul></ul><ul><ul><li>Not hospital-based </li></ul></ul>
  36. 36. Medicare Advantage Incentive <ul><li>MA-Affiliated Eligible Hospital </li></ul><ul><ul><li>Under common corporate governance with a qualifying MA organization that serves individuals enrolled under MA plans offered by such organization where more than 2/3rds are Medicare individuals enrolled under MA plans </li></ul></ul><ul><ul><li>Common corporate governance = common parent corporation, one is a subsidiary of the other, or organization and the hospital have a common board of directors </li></ul></ul>
  37. 37. Medicare Advantage Incentive <ul><ul><li>Qualifying MA-affiliated hospitals have less than 1/3rd of inpatient bed days of Medicare patients are covered by Medicare FFS-Part A </li></ul></ul><ul><ul><li>MA organizations that intend to ask for reimbursement under MA EHR must indicate as part of submissions of their initial bid </li></ul></ul><ul><ul><li>Require all qualifying MA organizations to self- report and identify themselves, regardless of whether they have MA EPs or MA-affiliated eligible hospitals beginning in 2014. </li></ul></ul>
  38. 38. Medicare Advantage Incentive <ul><ul><li>MA organization would report to CMS the aggregate annual amount of revenue received by each qualifying MA EP for MA plan enrollees of the MA organization </li></ul></ul><ul><ul><li>Incentive payment = 75% of the reported annual MA revenue up to maximum amounts ($18,000) </li></ul></ul><ul><ul><li>If EP salaried, MA organization to propose methodology </li></ul></ul>
  39. 39. Medicare Advantage Incentive <ul><li>MA-affiliated eligible hospital </li></ul><ul><ul><li>Require MA organizations to receive incentive payments for MA-affiliated eligible hospitals under the Medicare FFS EHR incentive program </li></ul></ul>
  40. 40. Are you eligible? <ul><li>Eligible Hospital </li></ul><ul><ul><li>Medicare: Subsection (d) hospitals paid under the inpatient prospective payment system, Critical Access Hospitals; must reside in the 50 states or District of Columbia </li></ul></ul><ul><ul><li>Medicaid: Acute Care Hospitals, Children’s Hospitals </li></ul></ul>
  41. 41. Are you eligible? <ul><li>Medicare </li></ul><ul><ul><li>Doctor of medicine or osteopathy </li></ul></ul><ul><ul><li>Doctor of dental surgery or medicine </li></ul></ul><ul><ul><li>Doctor of podiatric medicine </li></ul></ul><ul><ul><li>Doctor of optometry </li></ul></ul><ul><ul><li>Chiropractor </li></ul></ul><ul><li>Medicaid </li></ul><ul><ul><li>Physicians </li></ul></ul><ul><ul><li>Dentists </li></ul></ul><ul><ul><li>Certified nurse-midwives </li></ul></ul><ul><ul><li>Nurse practitioners </li></ul></ul><ul><ul><li>Physician assistants practicing in an FQHC or RHC that is so led by a physician assistant </li></ul></ul>
  42. 42. What are the dates? <ul><li>Medicare </li></ul><ul><ul><li>Starts January 1, 2011 for EPs </li></ul></ul><ul><ul><li>Starts Oct 1, 2010 for hospitals </li></ul></ul><ul><li>Medicaid </li></ul><ul><ul><li>2010 for those in the process of implementing </li></ul></ul><ul><ul><li>2011 for those already live </li></ul></ul>
  43. 43. When are payments made? <ul><li>Medicare EP </li></ul><ul><ul><li>A payment year is a calendar year starting in 2011 </li></ul></ul><ul><li>Medicaid EP </li></ul><ul><ul><li>2010 for adoption, implementation or upgrade of a certified EHR </li></ul></ul><ul><ul><li>2011 for meaningful use </li></ul></ul><ul><li>Eligible Hospital or CAH </li></ul><ul><ul><li>Federal fiscal year (Oct. 1 – Sept. 31) starting FY 2011 </li></ul></ul>
  44. 44. What are the reporting periods <ul><li>Eligible Professional </li></ul><ul><ul><li>For the first payment year, any continuous 90-day period within a calendar year </li></ul></ul><ul><ul><li>For subsequent years, the calendar year </li></ul></ul><ul><li>Eligible Hospital or CAH </li></ul><ul><ul><li>For the first payment year, any continuous 90-day period within a federal fiscal year </li></ul></ul><ul><ul><li>For subsequent years, the federal fiscal year </li></ul></ul>
  45. 45. The Path to Meaningful Use <ul><li>Three stages of the reporting requirements </li></ul><ul><ul><li>Stage 1: applied in 2011 and 2012 </li></ul></ul><ul><ul><li>Stage 2: applied in 2013 and 2014 </li></ul></ul><ul><ul><li>Stage 3: applied in 2015 </li></ul></ul><ul><li>Stage 1 covered here are for 2011 & 2012 </li></ul><ul><ul><li>Stage 1 applies to first year of use, even if in 2014 </li></ul></ul><ul><ul><li>But stage requirements leap forward to the Stage matching the calendar year after that (Stage 3 in 2015). </li></ul></ul>
  46. 46. The Path to Meaningful Use <ul><li>The Stages of EHR Incentive Program </li></ul><ul><ul><li>Stage 1: Electronic capture of health information in a coded format; tracking key clinical conditions and communicating outcomes for care coordinating; implementing clinical decision support tools to facilitate disease and medication management; and reporting outcomes for public health purposes </li></ul></ul><ul><ul><li>Stage 2: Expands on Stage 1. Encourages use of health IT to enhance computerized provider order entry; transitions in care; electronic transmission of diagnostic test results; and research </li></ul></ul><ul><ul><li>Stage 3: Expands on Stage 2. Promotes improvement to quality and safety; focuses on clinical decision support at a national level by encouraging patient access and involvement; and improved population health data </li></ul></ul>
  47. 47. Stage 1 Requirements <ul><li>Certified EHR technology that includes 25 measures; 17 requiring provider attestation; 8 require submission of information by provider </li></ul><ul><li>Required CPOE usage of 10 percent for all hospital orders and 80 percent of all EP orders </li></ul><ul><li>Defines clinical quality measures for EP and EH </li></ul><ul><li>Requires patients be provided with an electronic copy of test results, problem lists, medication lists, and discharge summary – upon request </li></ul>
  48. 48. Stage 1 Requirements <ul><li>Hospitals and EP able to use an attestation methodology to submit summary information to CMS in 2011. (Process expected by 2012) </li></ul><ul><li>Hospitals must do not need to choose between Medicaid or Medicare incentive program </li></ul><ul><li>Hospitals and EP must implement five clinical decision support rules relevant to clinical quality measures </li></ul>
  49. 49. Meaningful Use <ul><li>Hospital Quality Measures </li></ul><ul><ul><li>35 quality measures (all 35 adopted by NQF; 25 adopted by HQA). Clinical quality measures selected from those endorsed by the NQF or have previously been selected for the RHQDAPU program. </li></ul></ul><ul><ul><li>Existing ‘Core Measures’ requirements and financial incentives (APU) remain in place in parallel to ARRA incentives </li></ul></ul><ul><li>Of the 35 quality measures included in the proposed rule </li></ul><ul><ul><li>All may not be included in the final rule </li></ul></ul><ul><ul><li>~7 are overlapping with existing Core Measures </li></ul></ul><ul><ul><li>Specifications related to these quality measures will be made available “on or before April 1, 2010” </li></ul></ul><ul><ul><li>A “certified” EHR (or module) must be used to capture the measures </li></ul></ul>
  50. 50. Meaningful Use <ul><li>EP Quality Measures </li></ul><ul><ul><li>Two measure sets: A core set for all and an applicable specialty group </li></ul></ul><ul><ul><li>There are over 90 Quality Measures (79 Endorsed by NQF, 5 endorsed only by AQA, 6 not endorsed by any external entity) </li></ul></ul><ul><ul><ul><li>Clinical quality measures primarily selected from those endorsed by the NQF or have previously been selected for the Physician Quality Reporting Initiative (PQRI) program. </li></ul></ul></ul><ul><ul><ul><li>Existing ‘PQRI’ requirements and financial incentives remain in place in parallel to ARRA incentives </li></ul></ul></ul><ul><ul><li>Of the 90 quality measures included in the proposed rule </li></ul></ul><ul><ul><ul><li>All may not be included in the final rule </li></ul></ul></ul><ul><ul><ul><li>~59 are overlapping with existing PQRI Measures </li></ul></ul></ul><ul><ul><ul><li>Specifications related to these quality measures will be made available “on or before April 1, 2010” </li></ul></ul></ul><ul><ul><li>A “certified” EHR (or module) must be used to capture the measures </li></ul></ul>
  51. 51. Reporting Quality Measures <ul><li>The specific quality measures and reporting processes will differ in Stage 1 depending on: </li></ul><ul><ul><li>Medicare or Medicaid incentive reporting </li></ul></ul><ul><ul><li>EP or EH </li></ul></ul><ul><ul><li>Characteristics of the EH or EP </li></ul></ul><ul><ul><li>By year (submit summary for 2011 and details for 2012+) </li></ul></ul><ul><li>Must report EHR incentive clinical quality measures for all applicable cases, without regard to payer. </li></ul><ul><li>Specifications for how to submit quality measures will be released by July 1, 2011. </li></ul>
  52. 52. Reporting Quality Measures <ul><li>EP Specialties covered by this requirement </li></ul><ul><li>Cardiology </li></ul><ul><li>Pulmonology </li></ul><ul><li>Endocrinology </li></ul><ul><li>Oncology </li></ul><ul><li>Proceduralist/Surgery </li></ul><ul><li>Primary Care Physicians </li></ul><ul><li>Pediatrics </li></ul><ul><li>Obstetrics and Gynecology </li></ul><ul><li>Neurology </li></ul><ul><li>Psychiatry </li></ul><ul><li>Ophthalmology </li></ul><ul><li>Podiatry </li></ul><ul><li>Radiology </li></ul><ul><li>Gastroenterology </li></ul><ul><li>Nephrology </li></ul>
  53. 53. Meaningful Use <ul><li>Use CPOE </li></ul><ul><ul><li>Ambulatory - 80% of medications, laboratory, radiology/imaging, and referrals </li></ul></ul><ul><ul><li>Inpatient - 10% of medications, laboratory, radiology/imaging, blood bank, physical therapy, occupational therapy, respiratory therapy, rehabilitation therapy, dialysis, provider consultants, and discharge/transfers. </li></ul></ul>
  54. 54. Meaningful Use <ul><li>Implement drug-drug, drug-allergy, drug-formulary checks </li></ul><ul><li>Maintain an up to date problem list of current and active diagnoses (at least one coded entry or &quot;No Problems exist&quot;) in ICD9-CM or SNOMED-CT for at least 80% of all patients </li></ul>
  55. 55. Meaningful Use <ul><li>Generate and transmit permissible prescriptions electronically (the DEA does not yet allow controlled substances to be e-prescribed) for 75% of all ambulatory prescriptions </li></ul><ul><li>Maintain an active medication list (at least one coded entry or &quot;No Medications taken&quot;) for at least 80% of all patients </li></ul>
  56. 56. Meaningful Use <ul><li>Maintain an active allergy list (at least one entry or &quot;No Allergies reported&quot;) for at least 80% of all patients. </li></ul><ul><li>Record demographics including preferred language, insurance type, gender, race, ethnicity, date of birth, and date of death/cause in the event of inpatient mortality for 80% of patients. </li></ul>
  57. 57. Meaningful Use <ul><li>Record vital signs including height, weight, blood pressure, Body Mass Index (calculated) and growth charts for children 2-20 years for 80% of patients. </li></ul><ul><li>Record smoking status for 80% of patients 13 years or older </li></ul><ul><li>Incorporate 50% of clinical lab test results as structured data using LOINC codes </li></ul>
  58. 58. Meaningful Use <ul><li>Generate a least one report listing patients with a specific condition. The concept is that such reporting can be used for quality improvement, reduction of disparities, and outreach. </li></ul><ul><li>Report aggregate numerator and denominator quality data to CMS in 2011 and exchange it using PQRI XML by 2012 </li></ul>
  59. 59. Meaningful Use <ul><li>Send reminders to at least 50% of all patients who are 50 years and over for preventative care/followup. The intent is to allow the patient to choose between post card, email, phone reminder, or PHR reminder. </li></ul><ul><li>Implement 5 clinical decision support rules relevant to the clinical quality metrics. </li></ul>
  60. 60. Meaningful Use <ul><li>Check insurance eligibility and submit claims electronically for at least 80% of patients. </li></ul><ul><li>Provide 80% of patients who request an electronic copy of their health information in the CCD or CCR format within 48 hours of their request </li></ul>
  61. 61. Meaningful Use <ul><li>Provide 10% of patients with online access to their problem list, medication lists, allergies, lab results within 96 hours of the information being available to the clinician. </li></ul><ul><li>Provide a clinical summary for 80% of all office visits (problem lists, medication lists, allergies, immunizations, and diagnostic test results) in paper or CCD/CCR format </li></ul>
  62. 62. Meaningful Use <ul><li>At least one test of health information exchange among providers of care and patient authorized entities. </li></ul><ul><li>Perform Medication reconciliation for at least 80% of relevant encounters and transitions of care. </li></ul>
  63. 63. Meaningful Use <ul><li>Provide a summary of care record for at least 80% of transitions of care and referrals. This also implies the ability to receive a record and display it in human readable format </li></ul><ul><li>Perform at least one test of the EHR capacity to submit electronic data to immunization registries. </li></ul>
  64. 64. Meaningful Use <ul><li>Perform at least one test of the EHR's capacity to submit electronic lab results to public health agencies. </li></ul><ul><li>Perform at least one test of the EHR's capacity to submit syndromic surveillance data to public health agencies. </li></ul><ul><li>Conduct or review a security risk analysis and implement updates as necessary </li></ul>
  65. 65. Path Toward Meaningful Use <ul><li>Are you eligible? </li></ul><ul><li>Assess existing information systems </li></ul><ul><li>Talk with your vendors about their support of MU </li></ul><ul><ul><li>Need a new one? </li></ul></ul><ul><li>Evaluate workflows as they relate to capturing QM </li></ul><ul><li>Create or revise strategic IT plan </li></ul><ul><li>Assess physician readiness </li></ul><ul><li>Implement! </li></ul><ul><li>Physician adoption </li></ul>
  66. 66. The Road Not Taken Robert Frost <ul><li>Two roads diverged in a yellow wood, </li></ul><ul><li>And sorry I could not travel both </li></ul><ul><li>And be one traveler, long I stood </li></ul><ul><li>And looked down one as far as I could </li></ul><ul><li>To where it bent in the undergrowth </li></ul>
  67. 67. Path Toward Meaningful Use <ul><li>Is EHR in your future? </li></ul><ul><ul><li>If so, how far? </li></ul></ul><ul><ul><li>If not, why not? </li></ul></ul><ul><li>Are you ready to make the investment? </li></ul><ul><ul><li>Are the incentive dollars enough to move EHR implementation up? </li></ul></ul><ul><ul><li>Are the penalties? </li></ul></ul><ul><ul><li>Are the benefits to patient safety, satisfaction and care coordination? </li></ul></ul>
  68. 68. The Road Not Taken Robert Frost <ul><li>I shall be telling this with a sigh </li></ul><ul><li>Somewhere ages and ages hence: </li></ul><ul><li>two roads diverged in a wood, and I -- </li></ul><ul><li>I took the one less traveled by, </li></ul><ul><li>And that has made all the difference. </li></ul>
  69. 69. Deviate from the Path <ul><li>For FY 2015 and each subsequent FY, an eligible hospital that is not a meaningful EHR user will receive a reduction to one-quarter, one-half, and three-quarters of their market basket updates in FY 2015, FY 2016, and FY 2017 and subsequent years respectively. </li></ul>
  70. 70. Deviate from the Path The chart above indicates how market basket payment reduction would work if a hospital is not a meaningful user and/or does not report quality data by FY 2015 and beyond. 2015 2015 2015 2015 2016 2016 2016 2016 2017 2017 2017 2017 Report Data X X X X X X MU EHR X X X X X X Update 2% 1.5% 1.5% 1% 2% 1.5% 1% .5% 2% 1.5% .5% 0