Michael Stearns, MD, CPC, CPFC President and CEO, e-MDs, Inc.

1. Michael Stearns, MD, CPC, CPFC
President and CEO, e-MDs, Inc.

2.  Before ARRA (American Recovery and Reinvestment Act
of 2009)
 PQRI
 E-Prescribing
 EHR Adoption and Reporting Grant Programs
 Medical Home Pilot Project
 Since ARRA
 “Meaningful use”
 Medicaid, Medicare incentives
 HIT Regional Extension Centers
 HIE grants
 Multiple HIT related workforce development and research
grants

3.  American Reinvestment and Recovery Act
 Economic stimulus
 Job creation
 HITECH (HIT for Economic and Clinical Health)
Act
 Focus on the use of health information technology
 Improve healthcare outcomes
 Improve healthcare system performance
 Huge appropriation of money to healthcare IT industry

4.  Over $36B for Provider Incentives
(Medicare/Medicaid)
 Over $4.5B for National Telecommunications
Program
 $2.5B for USDA Telemedicine efforts
 $2B for HIE development (infrastructure)
 $1.5B for FQHCs/CHCs
 Over $1B for Research
 $500M for Social Security Administration
 $85M for Indian Health Service
 $50M for Veterans Administration
This is the largest HIT specific appropriation in US history!

5.  Government to lead standards development for nationwide
exchange and use of health information
 Goal is to improve quality and coordination of care
 Over $40B for HIT infrastructure, HIE, and especially
Medicare/Medicaid incentives to doctors and hospitals for
“meaningful” use of certified HIT
 Saves federal funds and generates additional savings
throughout the health sector through improved quality and
care coordination, reductions in medical errors and
duplicative care
 Strengthens HIPAA to protect identifiable health
information from misuse as use of HIT increases

6.  Physicians must elect to receive incentives
EITHER through the Medicaid or Medicare
program (but can switch once)
 Incentives do not penalize physicians who
already have adopted EHR (just need to
demonstrate meaningful use).
 Hospital-based physicians, e.g., ED,
pathologists, anesthesiologists, are not eligible
for these incentives

7.  EPs that provide substantially all of their
professional services (90% or greater) in an
inpatient or outpatient hospital setting are
considered hospital-based EPs and not eligible
for incentive payments.
 POS (place of service codes will be used to
determine eligibility)
 Rule subsequently relaxed to allow for hospital
employed physicians who practice in clinical
settings to receive incentive payments

8. The “Carrots”
 Incentives begin in Calendar Year 2011 (1/1/2011)
 For maximum bonus ($44,000), must be a “meaningful” user of
certified EHR in CY11 or CY12
 Only need to be a meaningful user for a 90-day-period in first
year!
 Incentive amount is calculated as 75% of allowable Part B
charges for the payment year with an annual caps (defined
below)
 Maximum incentive payments are as follows
 Year 1 - $18,000 (If year 1 is 2011 or 2012, otherwise $15,000)
 Year 2 - $12,000
 Year 3 - $8,000
 Year 4 - $4,000
 Year 5 - $2,000
 Year 6 - $0
 Physicians in health professional shortage areas receive a 10%
increase (e.g., $19,800 in year one)

9. Performance CY11 CY12 CY13 CY14 CY15 CY16 Total
Year ->
Starting
Year
CY11 $18K $12K $8K $4K $2K 0 $44K
CY12 $18K $12K $8K $4K $2K $44K
CY13 $15K $12K $8K $4K $39K
CY14 $12K $8K $4K $24K
CY15 $0 $0 $0K
CY16 $0 $0

10. The “Sticks”
 Bonus amounts decrease starting in CY13
 If not a “meaningful” user by CY15,
 No bonus payments
 Penalties will be applied
 Physicians receive a reduction in fee schedule
 2015 - 1% reduction
 2016 - 2% reduction
 2017 - 3% reduction
 2018 - HHS Secretary has authority to increase penalties
if percentage of physicians who are “meaningful” users is
less than 75%
 Maximum reduction is 5%

11.  Eligibility Requirements for Providers
 Non-hospital-based professionals with ≥ 30% patient
volume attributable to individuals receiving medical
assistance
 Non-hospital-based pediatricians with ≥ 20% of patient
volume attributable to individuals receiving medical
assistance
 Eligible professionals (physicians, dentists, nurse
midwives, rural practice setting PAs, nurse practitioners)
who practice predominately in a Federally-qualified
health center or rural health clinic with ≥ 30% patient
volume attributable to needy individuals

12.  States
authorized to make payments of
$21,250.00 per provider for either
purchasing or implementing an EHR
 Just purchasing alone released funds (Adopt,
Implement or Upgrade to certified EHR – AIU)
 Maximum is $63,750 for physicians
 Canskip years and still be eligible for
payments

13.  For professional who see over 30% Medicaid
 $21,250 in year one
 $8,500 in years 2-6
 Total of $63,750 over 6 years
 For pediatricians with more than 20% but less than
30% Medicaid
 $14,167 in year one
 $5,667 in years 2-6
 Total of $42,500 over 6 years
 Medicaid incentives will have the same total amount
over 6 years regardless of start year (through 2016)
 Provider starting MU in 2016 will still receive up to
$63,750

14. Meaningful Use Dollars Paid to
Ambulatory Providers
:
EPs getting Medicare EPs getting Medicaid pay
Month
incentive pay (amount paid) (amount paid)
May 2011 282 ($5 million) 570 ($12 million)
June 2011 298 ($5 million) 807 ($17 million)
July 2011 669 ($12 million) 1,039 ($22 million)
August 2011 1,232 ($22 million) 1,563 ($33 million)
September 2011 1,427 ($26 million) 1,887 ($40 million)
October 2011 2,050 ($37 million) 2,171 ($46 million)
November 2011 4,351 ($78 million) 2,659 ($56 million)
December 2011 5,001 ($90 million) 3,782 ($79 million)
January 2012 7,666 ($138 million) 3,977 ($83 million)
February 2012 12,365 ($223 million) 4,920 ($103 million)So

16.  CMS and the Office of the National
Coordinator Based MU Criteria on the
recommendation of the HIT Policy
Committee
 Five policy goals
 Based on NQF National Priorities Partnership

17.  Improve quality, safety, efficiency, and reduce
health disparities
 Engage patients and families
 Improve care coordination
 Improve population and public health
 Ensure adequate privacy and security
protections for personal health information

18.  Using certified EHR technology
 Certified – Certification Process Final Rule
recently released
 E-prescribing
 Interoperability
 Reports on clinical quality measures
 Final meaningful use criteria published July 13th,
2010
 Three stages of meaningful use to be rolled
out

19. By the HIT Policy Committee
2011 2013 2015
*From HIT Policy Comm. update
Achieving Meaningful Use of Health Data

20.  The Stage 1 meaningful use criteria focus on:
 Electronically capturing health information in a
coded format
 Using that information to track key clinical
conditions and communicating that information
for care coordination purposes
 Structured or unstructured, but structured preferred
 Implementing clinical decision support tools to
facilitate disease and medication management
 Testing the ability to report clinical quality
measures and public health information.

21.  Criteria will be proposed by the end of 2011
 Goals for the Stage 2 meaningful use:
 Expand on Stage 1 criteria
 Encourage the use of health IT for continuous
quality improvement at the point of care
 Exchange information in the most structured format
possible:
 E.g., electronic transmission of orders entered using
computerized provider order entry (CPOE)
 E.g., electronic transmission of diagnostic test results (such
as blood tests, microbiology, urinalysis, pathology tests,
radiology, cardiac imaging, nuclear medicine tests,
pulmonary function tests, etc.

22.  Criteria to be proposed by the end of 2013
 Goals:
 Promote improvements in quality, safety and
efficiency
 Focus on decision support for national high
priority conditions
 Increase patient access to self management tools
 Provide increased access to comprehensive
patient data
 Improve population health

23.  Measurement Concepts (proposed by HIT
Policy Committee to guide later stages of MU)
 Increased codification of health care data
 Expanded interoperability
 Patient engagement
 Outcomes based analysis
 Medical genomics
 Order tracking
 100% HIT Adoption

24. 1. “Measures of patient activation, including skills, knowledge
and self-efficacy
2. “Measures of patient self management”
3. “Measures of shared decision making or decision quality that
address a combination of patient knowledge and
incorporation of patient”
4. “Measures of patient preferences/experiences of care”
5. “Measures of patient health outcomes, including health risk
status, functional health status, and global measures of
patient health”
6. “Measures of patient access to community resources for
improved/sustainable care coordination”

25.  “Measures assessing ambulatory care-sensitive
preventable admissions”
 Defined as “This measure concept relates to
admissions caused by unaddressed ambulatory
conditions at the onset of symptoms due to
multiple reasons such as inappropriate clinical
management or inefficient systems issues.”
 Physicians need to be engaged to make sure
this type of measure concept is used
appropriately

26.  Requirements:
 Core Set (15)
 Menu Set (pick 5 of 10, include one population/public
health measure)
 Thresholds for use reduced
 Administrative requirements removed
 Decision Support requirements reduced
 Reduced Quality Metrics
 Additional Quality options

27. 1. Record patient demographics
¥ Sex
¥ Race
¥ Ethnicity
¥ Date of Birth
¥ Preferred language
¥ For hospitals date and preliminary cause of death in the
event of mortality).
 More than 50% of patients’ demographic data must
be recorded as structured data

28. 1. Record vital signs and chart changes
 Height
 Weight
 Blood pressure
 Body mass index (BMI)
 Growth charts for children
 More than 50% of patients 2 years of age or older must have height,
weight and blood pressure recorded as structured data.
 (Pulse and respirations not required)
2. Maintain up-to-date problem list of current and
active diagnoses.
 More than 80% of patients must have at least one entry
recorded as structured data.

29. 1. Maintain an active medication list.
 More than 80% of patients have at least one entry
recorded as structured data.
2. Maintain an active medication allergy list.
 More than 80% of patients have at least one entry
recorded as structured data.
3. Record smoking status for patients 13 and older
 More than 50% if patients age 13 or older have smoking
status recorded as structured data.

30. 1. For professionals, provide patients with clinical
summaries for each office visit; for hospitals provide an
electronic copy of hospital discharge instructions upon
request.
 Clinical summaries provided to patients for more
than 50% of all visits within 3 business days.
 More than 50% of all patients who are discharged
from an inpatient or ED of a hospital who request
an electronic copy of their discharge instructions
must be provided with it.

31. 1. Upon request, provide patients with an electronic
copy of their health information (including
diagnostic test results, problem list, medication list,
medication allergies, and for hospitals discharge
summary and procedures).
 More than 50% of requesting patients must
receive an electronic copy within 3 business
days.
 Patient portal and personal health records are
seen as vehicles for this transfer

32. 1. Generate and transmit permissible prescriptions
electronically (does not apply to hospitals).
 More than 40% must be transmitted
electronically using certified EHR technology.
2. Computerized Provider Order Entry for Medication
Orders.
 More than 30% of patients with at least one
medication in their medication list must have at
least one medication ordered through CPOE

33. 1. Implement drug-drug and drug-allergy interaction
checks.
 Functionality must be enabled for these checks for the
entire reporting period.
2. Implement capability to electronically exchange key
clinical information among providers and patient-
authorized entities.
 Must perform at least one test of the EHR’s capacity to
electronically exchange information.

34. 1. Implement one clinical decision support rule and
track compliance with that rule.
 One rule must be implemented.
2. Implement systems to protect privacy and security
of patient data in the EHR
 Must conduct or review a security risk analysis,
implement security updates as necessary and correct
identified security deficiencies

35. 1. Report clinical quality measures to CMS or states.
 For 2011, provide aggregate numerator and
denominator through attestation
 For 2012, electronically submit measures

36.  Implement drug formulary checks.
 Drug formulary check system must be implemented and
it must provide access at least one internal or external
drug formulary during the reporting period.
 Incorporate clinical laboratory test results into
EHRs as structured data
 More than 40% of clinical laboratory test results are in
positive/negative or numerical format and are
incorporated into EHRs as structured data

37.  Generate lists of patients by specific conditions for
use for quality improvement, reduction of
disparities, research or outreach.
 Must generate one listing of patients with a specific
condition
 Use EHR technology to identify patient-specific
education resources and provide those to the
patient as appropriate.
 More than 10% of patients are provided patient specific
education resources

38.  Perform Medication reconciliation between care
settings.
 Medication reconciliation must be performed for more
than 50% of transitions of care.
 Provide summary of care record for patients
referred or transitioned to another provider or
setting.
 Summary of care record must be provided for more than
50% of patient transitions or referrals

39.  Submission of electronic immunization data to
immunization registries or immunization
information systems.
 Must perform at least one test of data
submission and follow-up submission (where
registries can accept electronic submissions)
 Submission of electronic syndromic surveillance
data to public health agencies.
 Must perform at least one test of data
submission and follow-up submission (where
public health agencies can accept electronic
data)

40.  For hospitals - record advanced directives for
patients 65 years or older
 More than 50% of patients aged 65 or older must have an
indication of an advanced directive status recorded.
 For hospitals - submission of electronic data on
reportable laboratory results to public health
agencies.
 Perform at least one test of data submission and follow-up
submission (where public health agencies can accept
electronic data)

41.  For professionals - Send reminders to patients (per
patient preference) for preventative and follow-up
care.
 More than 20% of patients aged 65 or older or age 5 or
younger must be sent appropriate reminders.
 For professionals - Provide patients with timely
electronic access to their health information
(including laboratory results, problem list, medication
list, medication allergies).
 More than 10% of patients must be provided with
electronic access to information within 4 days of its being
updated in the EHR.

42.  Criteria to be proposed by the end of 2013
 Reach the full extent of HIT in clinical care
 Advanced interoperability including extensive sharing of
structured data via HIEs
 Lifecycle of structured data
 Captured at the point of care as codified data
 Concept and modifiers
 E.g., Doubt seizure, myocardial infarction ruled out, etc.
 Stored locally and in data warehouses
 Relationships to modifiers must be preserved
 Retrieved and used for clinical care, reporting, research
 Must be “recomposed” accurately with appropriate context
 Must be in a standard format to allow for cross-platform usage
 Data integrity issues will need to be a focal point to ensure
patient safety and reap the benefits of HIT

43. Speaker Contact Information
Michael Stearns, MD, CPC
President and CEO, e-MDs, Inc.
mstearns@e-mds.com