Meaningful Use Mini-Camp Presentation

Meaningful Use Mini-Camp
October 21, 2015
LISA ISRAEL, MBA, CPHIMS, CPHQ
EMR/MEANINGFUL USE SPECIALIST
REDWOOD COMMUNITY HEALTH COALITION

Agenda
• Introductions
• California Technical Assistance Program
• 2015-2017 Modification Final Rule
• Challenging Measures
• Strategic Planning for Meaningful Use
• Q&A

CTAP:
California Technical
Assistance Program

CTAP:
California Technical Assistance Program
• New funding program funded by ONC
• CalHIPSO is Regional Extension Center
• RCHC is Local Extension Center
• RCHC Members/Affiliates are part of RCHC CTAP group

CTAP:
• Program is milestone-driven
• DHCS pays CalHIPSO for each milestone
• CalHIPSO pays RCHC 80%
of what DHCS pays them

• The GOOD news:
• RCHC will funnel 80% of what CalHIPSO pays them back to the
health centers
• Payments are per provider.
• Milestones include:
• Enrollment
• Successful attestation for AIU or MU
• Specialist “bonus”
• Legally binding contract with HIE
CTAP:

Milestone CalHIPSO Pays RCHC RCHC Pays Health Center
Signed CTAP Contract $400 $320
EP is Specialist $600 $480
DHCS-Approved AIU Application $1,200 $960
First year attestation (S1, S2, S3) $1,800 $1,440
Subsequent year attestation (S1, S2, S3) $400 $320
HIE Contract $400 $320
• First year/second year attestations based on “scheduled” year for MU program.
• 80% pass-through applies to 2015 and may be adjusted in 2016 and 2017
• Program is for 3 years – payments payable each year based on milestones met that year
CTAP:

Milestone 2015
TA Agreement 320
Specialist Bonus 480
AIU 960
MU Stage 1, Year 1 0
MU Stage 1, Year 2 0
Total Payment for EP for 2015 1760
Example: Dentist, never participated in MU
(AIU for 2015)
CTAP:

Example: Family Practitioner
Scheduled for Stage 2/Year 1 – No HIE Contract Signed
Milestone 2015
TA Agreement 320
MU Stage 2, Year 1 1,440
Total Payment for EP for 2015 1,760
CTAP:

• Enrollment
• Enrollment package in binder pocket.
• Must have complete enrollment agreement to participate
• RCHC has 200 enrollment slots available
• Last year MU attestations ~230 EPs for all health centers
• Enroll strategically
• Available slots for each health center based on number of EPs as
percentage of total EPs.
CTAP:

• Enrollment, cont’d
• Complete Practice Enrollment Agreement first, submit to RCHC
with list of participating EPs
• Within 4 months, must have Technical Assistance Agreement
signed by EACH PROVIDER who is participating
• TA will be provided to each health center, not each provider
• If you don’t have all of your EPs enrolled, that doesn’t mean all the rest are out of
luck!
CTAP:

CTAP:
Example of Assignment of Providers
Health Center # of EPs Percentage of total
# of Participating Slots
assigned
#1 60 20% 40
#2 100 33% 66
#3 20 7% 14
Assumptions: Total EP population assigned to RCHC 300
Total slots available: 200

• Prepare for enrollment
• Practice enrollment agreement
• Attach list of EPs who will participate
• Good time to think about Dental MU because of specialist bonus!!
• Announcement of number of EPs per health center will be made
via email next week.
CTAP: What to do now

Modification Final Rule
2015-2017

DISCLAIMER
• All information given in this seminar relates to Medicaid
Meaningful Use rules for EPs only.
• Information included in this presentation and seminar is
for informational purposes only.
• References to Stage 1 and Stage 2 in this presentation
refer to the stages for which EPs are scheduled in 2015.
• The CMS Final Rule reviewed in this presentation may
be found at https://s3.amazonaws.com/public-
inspection.federalregister.gov/2015-25595.pdf

REVIEW OF PROGRAM BASICS
• The EHR Incentive Program (“Meaningful Use”) will
pay incentives through 2021.
• Eligible professionals can participate for 6 years.
• Participation years do not have to be consecutive.
• The last year that an eligible professional
can begin participation is 2016.

BIG CHANGES!
• Reporting periods changed
• Stages 1 and 2 have merged together
• Some measures removed as redundant, duplicative
or topped out
• Now 10 Measures for both S1 and S2 – No more
Core/Menu Measures
• Nothing was added!

Reporting Periods
• 90-day reporting period for 2015 for everyone
• Full calendar year reporting period for 2016-2017 for
everyone
• Option to report Stage 3 in 2017.
• If report Stage 3 in 2017, can report for 90-day reporting
period.
• EVERYONE will report Stage 3 in 2018

Redundant, Duplicative, or
Topped Out
Drug Formularies* Summary of Care (M1 & M3)
Demographics* Lab Results*
Up-to-Date Problem List* Patient Lists
Active Medication List* Reminders
Active Medication Allergy List* Electronic Notes
Record Vital Signs* Imaging Results*
Record Smoking Status* Family Health History
Clinical Visit Summary
* Incorporated into another “active” measure
Most items are still required for PCMH certification/recertification

Stages 1 and 2 Have MERGED
Stage 1 Stage 2

One Set of Measures
 CPOE  Patient Education
 E-Prescribing  Medication Reconciliation
 Clinical Decision Support  Summary of Care (HIE)
 Patient Electronic Access  Public Health
 Privacy & Security  Secure Messaging

CPOE (%)
• The Measure: >60% of medication, 30% of lab, and 30%
of radiology orders are entered using CEHRT.
• Stage 1 EPs may use alternate measure for medication
orders: 30%
• Exclusion: EPs who write fewer than 100 orders each for
medications, labs, and radiology

E-Prescribing (%)
• The Measure: >50% of permissible Rx’s are compared to
one formulary and transmitted electronically using CEHRT
• Stage 1 – threshold is 40%
• Exclusions:
• EP writes < 100 prescriptions during reporting period
• OR – there is no pharmacy within 10 miles that
accepts e-scripts.

Clinical Decision Support (Y/N)
• Measure 1: 5 CDS interventions tied to >= 4 CQMs.
• Measure 2: Drug-Drug and Drug-Allergy interaction
checks enabled for entire EHR reporting period.
• Exclusion for S2: M2 Only – EP writes < 100 medication
orders
• Stage 1 EPs may use Alternate Measure in 2015:
• 1 CDS rule
• No drug interaction check

Patient Electronic Access (%)
• Measure 1: 50% of unique patients seen are provided
online access within 4 business days
• Measure 2: At least 1 patient PER EP actually views/
downloads/transmits (reduced from 5%).
• Stage 1 EPs may use alternate exclusion for M2
in 2015, as Stage 1 did not have equivalent
Core Measure.

Privacy & Security (Y/N)
• Conduct or review a security risk analysis in accordance
with the requirements (see Tip Sheet page 3 for
requirements)
• No exclusions

• > 10% of unique patients seen by EP are provided
educational resources identified by CEHRT
• Exclusion: No office visits in the EHR reporting period.
• Stage 1 EPs may use Alternate Exclusion in 2015 if they did
not intend to select this measure for a Stage 1 Menu choice.
Per CMS: “…we acknowledge that it may be difficult for a provider to
document intent and will not require such documentation.”
Patient Education (%)

Medication Reconciliation (%)
• >50% of patients transitioned into care of EP has
medication reconciliation performed
• Stage 2 exclusion: Any EP who was not the recipient of any
transitions of care during the EHR reporting period
• Stage 1 EPs may use Alternate Exclusion
in 2015 if they did not intend to select this
measure for a Stage 1 Menu choice.

Summary of Care (HIE) (%)
• Stage 2: 10% of Summary of Care records are created in
CEHRT and sent electronically
• Will go more into this statement in Challenging Measures
section
• Stage 1: Alternate Exclusion;
this did not have equivalent Core Measure

Public Health (Y/N)
• Active engagement with a Public Health Agency or Clinical
Data Registry to submit electronic public health data using
CEHRT.
• Registry options:
• Immunization registry
• Syndromic Surveillance
• Specialized Registry
• Stage 2 must meet 2 of the 3 options
More on this in the Challenging Measures section!

Secure Messaging (Y/N)
• 5% of unique patients send electronic message that
contains health information
• Modified Objective: Capability = Yes
• Stage 1 EPs may use “Alternate Exclusion”
as Stage 1 does not have an equivalent
core measure

Technology Updates
• 2014 CEHRT will be used for 2015 and 2016 reporting
• Until you are ready to attest to Stage 3, you can continue
to use 2014 CEHRT
• Must upgrade to 2015 CEHRT to report Stage 3 (2017 or
2018)

Patient Electronic Access
(Patient Portal)
• Measure 1: 50% of unique patients seen are provided
online access within 4 business days
• Measure 2: At least 1 patient PER EP actually views/
downloads/transmits (reduced from 5%).
• Stage 1 EPs may use alternate exclusion for M2 in 2015, as
Stage 1 did not have equivalent Core Measure

• Challenges
• No Exclusions
• Portals not available in Spanish
• Possible Solutions
• PEDS/Teens – activate PEDS/deactivate at age 12
• Activate dental patients
• Staff incentive
Patient Electronic Access
(Patient Portal)

Summary of Care (HIE)
• Challenges
• What does “sent electronically” mean?
• Verbiage different from prior rule that stipulated NwHIN Exchange
Participant to send.
• Final rule states that CMS is “widening the pathways acceptable for
transmitting Summary of Care records.”
• Probably does NOT mean faxing, as CMS states that is analog.
• May allow for sending via secure/encrypted email.
• Referral partners not set up to receive electronic
transmission

Summary of Care (HIE)
• For now:
• Awaiting CMS to publish a FAQ answer to definition of electronic
transmission.
• Keep using methods you have for sending electronic referrals and records.
• Provider relationships and referral partner office staff – do they have
capacity to receive electronic transmission?
• What are other health centers doing?
• Discuss at bi-weekly focus calls

Public Health (Y/N)
• Active engagement with a Public Health Agency or Clinical
Data Registry to submit electronic public health data
using CEHRT.
• Registry options:
• Immunization registry – Final rule struck bidirectional requirement
• Syndromic Surveillance
• Specialized Registry

Challenges and Options
• CalREDIE provider portal:
• Online manual entry – does not meet MU requirements that data be
submitted electronically using CEHRT
• California Cancer Registry
• EP is excluded if does not diagnose or treat cancer
• Most EPs in our CHCs would meet this exclusion
• No other statewide Public Health options

Challenges and Options
• Exclusions
• An exclusion will not count as 1 of the 2 needed to successfully attest
for this measure
• If exclude for 1, then need to attest for the other 2
• If exclude for 2, then need to attest for the remaining 1.
• Likelihood
• For Stage 2, attest to immunization registry option, exclude for the
other two options.
• Stage 1 only needs to attest to 1 of the 3 options, so IZ registry will
meet this measure

Strategic Planning for
Meaningful Use:
What to do when you get back to
your health centers

• Get a baseline, if you do not have one
• Run the reports that you do have and compare them to the final rule
measures
• The measures did not change enough to prevent you from using the reports you have!
• Are you too low on any of the measures? Let’s find out why!
• CTAP enrollment – get started!
• Strategic enrollment – providers who are at highest likelihood of
successful attestation
Strategic Planning for MU

• Update groups in SLR
• SLR will go down on/about December 15 for
reprogramming
• Anticipated that AIU and group updates will remain open
• SLR may take about 5-6 months to reprogram – so
attestation would be extended
• Any providers AIU?
• Can do it now!

• Biweekly Focus Calls
• Restarting Thursday, October 29, 2-3 p.m.
• Every other Thursday from 2-3 p.m.
• Calls will not be recorded – great to team up to have a representative
• Call for topics/questions will go out on Monday prior to the call
• Calendar invitations sent out October 14
• If you did not receive one, let me know and I will add you to the invite list

• Questions?
• Freaking out?
• Is the sky falling?
Contact Me!
This is my job!
May not have the answer, but I know where to find it!

Meaningful Use Mini-Camp Presentation

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