Successehs webinar-stage-2-and-3-mu-130424105245-phpapp02 (1)

Meaningful Use Stages 2 and 3 –
Eligible Professionals

Adele Allison
National Director of Government Affairs

April 10, 2013
888.879.7302 • www.SuccessEHS.com

MU2 and 3 – Eligible Professionals
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Meaningful Use – State of the Union
• $11.8 Billion in Total Incentives Program to Date
o ↑ $2.4 Billion in Medicare Incentives Paid – Hospitals/Providers
o ↑ $1.8 Billion in Medicaid Incentives Paid – Hospitals/Providers
o ↑ $7.3 Billion in Medicare/Medicaid to Hospitals

• ↑ 372,000 Hospitals / Professionals registered
• 49 States, D.C. and PR have launched Medicaid Programs
o Hawaii, Guam, Am. Samoa – Unknown
o Virgin Islands – Unknown


Meaningful Use – State of the Union
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Active Registrations
o
o

•

Medicare Eligible Providers → 253,477 (834,769 U.S. Physicians – 30%)

o

•

Hospitals → 4,257 (5,724 in U.S. – 74%)
Medicaid Eligible Providers → 114,866 (U.S. Physicians – 14%)

Hospital Attestation → $7,861,299,090
Medicare EP Stage 1 Attestation → $2,134,906,925
Program to Date Top 10 Physician Specialties – Payments
21,685 Internal Med.

22,565 Family Med.

8,416 Cardiology

3,643 OB/Gyn

4,886 Gastro

3,356 Urology

3,354 Ophthal.

4,222 Gen’l Surgery

5,716 Ortho

3,301 Neurology

29,778 Other

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Medicaid EP Year 1 & Year 2 Attestation → $1,595,896,115
Program to Date Eligible Professionals – Payments

AIU
MU

53,337 Physicians

12,443 Nurse Prac.

1,527 Mid-Wives

5,247 Dentists

833 Physician Asst.

4,964 Physicians

1,126 Nurse Prac.

181 Mid-Wives

70 Dentists

68 Physician Asst.


Meaningful Use – Highest / Lowest
•

Top 5 States – Hospitals/Providers (34%)
State
Medicare Medicaid Paid Count

Texas
California
Florida
New York
Pennsylvania
•

$501,037,496

$481,333,892

14,288

$479,811,536

$461,003,962

15,717

$530,306,093

$299,686,531

12,443

$370,073,044

$276,918,295

11,207

$374,894,112

$169,392,763

11,617

Total
$982,371,388
$940,815,499
$829,992,624
$646,991,338
$544,286,875

Lowest 5 States – Hospitals/Providers (7%)
State

Medicare Medicaid Paid Count

Total

Hawaii

$29,956,453

$0

482

$29,956,453

Vermont

$10,157,423

$19,555,139

793

$29,712,562

North Dakota

$16,408,274

$3,254,834

341

$19,663,108

Wyoming

$5,766,153

$9,718,002

214

$15,484,155

District of Columbia

$8,585,360

$0

392

$8,585,360


Polling the Audience


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Stage 2

Stage 1

4 Marks of Meaningful Use

Adopt and
Use CEHRT

Move
DATA


Capture
DATA

Report
DATA

Stage 1 Changes – CY2013-14
• Core CPOE Denominator – CY2013 and beyond → “New” Option:

# of

orders for Rx during EHR Reporting Period

• Core Vitals Exclusion Clause – CY2014

→ “New”: EP can split to exclude

1 only of BP and/or Height-Weight

• Core Vitals Age Requirements – CY2014 → “New”: BP patients age 3+
• Core Test of Exchanging Key Clinical Information → Removed
• Core ePrescribing Exclusion → Added where EP not within 10 mile
radius of ePharmacy effective CY2013

• 3 Menu Measures → Public Health for Immunizations, Reportable Labs and
Syndromic Surveillance → Removed “except where prohibited”

• Core Electronic Copy and Menu Timely Electronic Access →
Replaced with CY2014 Stage 2 measure of Patient View, Download and Transfer

• Core Submission of CQMs part of MU definition
• Stage 1 EPs must choose 5 Menu Measures if available

• Cultural Shift
o Change is hard → “We’ve
always done it this way.”
o Leadership and Professionalism

Adopt and
Use CEHRT

• Redesign will create
temporary Chaos
• Address techno-challenged
users
o Scribes
o Focused training
o Super-users

• Celebrate your success!


• Workflows must be
consistent
• 3 Data-entry Types
1. Narrative Text
2. Structured Data
3. Object-oriented, Codified Data

• Apply the 5-Rights
1.
2.
3.
4.
5.

Right Information
Right Person Capturing
Right Data Format
Right Technology Channel
Right Time in Workflow


Capture
DATA

• Define your Use Cases
o
o
o
o

Referral Management
ED/Hospitalization Notification
Emergency – “Break-the-Glass”
New/Unknown Patient

• Use Cases → 2 Clear Goals
o ↑ Quality
o ↓ Costs

Move
DATA


• Interface vs. HIE
• Health Information Exchange
o Sustainability Model
o Emerging Technology

• Clinical Data Reporting is
Crucial!
o Drive Reimbursement Reform
under ACA (E.g. VBM)
o Physician Compare Website

• CQMs to be electronically
submitted by CY2014
• Medicare Data → PQRS
o Claims-based
o Registry-based
o EHR Direct

• Medicaid Data → Ind. State
o Process and Timelines
o Interface or HIE


Report
DATA

MU2 Health IT Implementation List
CEHRT
Extensions

CEHRT
Standard Offerings
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CPOE

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eRx, Rx History and Formulary
(E.g., Surescripts / RxHub)

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Rx Database

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Master Patient Index

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Evidence-based Guidelines

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Patient Administration

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Advanced Patient Portal

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Detailed Vitals

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Patient Education

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Smoking Status

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HIE → Direct / Exchange

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Population Health Mgmt.

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Bidirectional Lab Interface / HIE

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Thin-Client Operations

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Immunization Interface / HIE

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Data Encryption Technology

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PACS Interface / HIE

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Internet Enabled Technology

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Structured Knowledge Base

Public Health, Cancer and/or
Specialty Registry Interface / HIE

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Documentation Tools

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Hosting / Emergency Backup


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Medicare Penalties
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Applies to EPs treating Medicare Part B PFS Patients
HITECH requires Payment Adjustment if no MU by 2015
Adopt, Implement or Upgrade (AIU) is NOT MU
Payment Adjustment based on prior year’s reporting period – 2
year lag
MU in 2011/2012 = Full Year of MU in 2013 to avoid penalty
Any MU in 2013 = No Adjustment in 2015
Medicare MU registration & attestation by 10.1.2014 = No
Adjustment in 2015
This means 90-day reporting period no later than 7.1.2014
EP must continue to meet MU annually to avoid adjustments in
subsequent years
Hospital-based EPs (90% of Services) not eligible so not subject to
penalties


Medicare Penalties
• Penalties are cumulative with other CMS Programs
2015
EP subject to MU adjustment only
EP also subject to eRx adjustment
EP also subject to PQRS adjustment
EP also subject to Value-Based
Modifiers (VBM)

2016

2017

2018

2019

2020+

99%

98%

97%

96%

95%

95%

98%

98%

97%

96%

95%

95%

96.5%

96%

95%

94%

93%

93%

+/TBD

+/TBD

+/TBD

+/TBD

+/TBD

+/TBD

• EP Hardship Exceptions
1.
2.
3.
4.
5.

Infrastructure → E.g. Lack of Broadband
New EP → 2-year limited exception
Unforeseen Circumstances → E.g. Natural Disaster
Lack of Face-to-Face or F/up Need with Patients → E.g. Pathology,
Radiology, Anesthesiology
Multiple Locations and Lack of control over availability of CEHRT
for more than 50% of patient encounters


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Clinical Quality Measures (CQMs)
• Removed as MU Measure → Now Part of Definition of
“Meaningful EHR User”
• Electronic reporting by CY2014 for ‘Care regardless of Stage
• PQRS will be the vehicle for Clinical Reporting for ‘Care
• Clinical Reporting will drive VBM under ACA
• Reporting will be reported publicly on “Physician Compare”
• ACA requires CMS to align MU with other Federal programs (E.g.
PQRS and eRx)

• No change in ‘Care CQMs through CY2013 → 2 Reporting
Methods
o Manual calculation / Attestation on CMS website
o eReporting under PQRS EHR Incentive Program Pilot

• ‘Caid EPs → Look to State on process and timelines

Clinical Quality Measures (CQMs)
• Prior to CY2014 → Manual attestation of 6:44 CQMs
• CY2014 and Beyond → Electronic submission of 9:64 CQMs
o First year EP → Aggregated data for All Payers through attestation
o Subsequent Years, 2 Options
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Electronic reporting of Aggregate data for All Payers, or
Individual Continuity-of-Care Document (CCD) on Medicare only through
PQRS EHR Direct using CEHRT

• 9 CQMs must include 1 measure in 3 Nat’l Quality Strategy
Domains, minimal (Core Sets of 9 Recommended)
1.
2.
3.
4.
5.
6.

Patient and Family Engagement
Patient Safety
Care Coordination
Population and Public Health
Efficient Use of Healthcare Resources
Clinical Processes / Effectiveness


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Plugging into the Matrix
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Americans are plug into the Matrix more than ever
88% Age 18+ have a cell phone (77% of Rural Residents)
• 67% Texting → Dominates, especially with Teens
75% of all Teens text
o Teens average 60 texts per day
o Girls text more than boys at 100 / day compared to 50 / day
o Black teens text average of 80 / day
o

57% have a Laptop
• 19% have a Tablet Computer
• 19% Own and e-book Reader
52% Adult Americans use phones while watching TV
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Plugging into the Matrix
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Area of
Family, Friends, Both Equally
Is Patient Decision-making Affected? Yes!
Professional
Advice Sought
Fellow stress mgmt.
49% Influences view of diet, exercise, Patients

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Accurate Diagnosis
91%
5%
• 38% Affected decision about seeing a doctor
Rx Information
85%
9%
• 38% Altered
Alternative Treatment way of coping with Chronic Condition
63%
24%
Specialist Recommendation
62%
27%

/

2%
3%
Pain
5%
6%

Hospital Recommendation

62%

27%

6%

Illness Emotional Support

30%

59%

5%

Quick Remedy for Health
Issues

41%

51%

4%


Gov’t and PPC – By the Numbers
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23 percent of federal budget goes to health care
36 times ACA mentions Patient Centeredness
15 times ACA references the Medical Home
93 times ACA references Quality Measures
29 times ACA links Quality to reporting Clinical Data
100 times ACA discusses Value-Based and Payment
Modifiers as relates to Hospital/MD Reimbursement
and Measures*
* Commercial payers are now launching VBP payment models.


Patient Centered Care and the Gov’t
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Behavioral Economics is about an Engaged Patient
o
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Effects of social, cognitive, emotion factors on patient decision-making
E.g., Airport McDonalds Story, MyFitnessPal

Federal Gov’t → Leadership role in Health Care Reform
Transition → Episodic Care to Long-Term Healing and Wellness
Patient Centered Care → Measured Quality Performance
Federal Policymaking grounded in Patient Centered Care
Regs CMS Meaningful Use Stage 2 - 7 Measures
o Regs CMS Accountable Care Organizations (ACOs) – 7 Measures
o Regs CMS Value-based Purchasing – Differential Payment Based on Quality
o Regs CMS Public Measure Transparency – Physician Compare Website
o Other Agency Initiatives – CMS PCORI, HRSA PCMH and VA PACT
o


Proposed Stage 2 Core Measures

Fed. Objective
Programs & Measure
Patient Engagement
Threshold
Exclusions

No.

Implement CDS to improve on high-priority
condition:
None
5 Rules and Rx alerting
1.
5 CDS interventions for 4 or more CQMs
during entire reporting period; and
by attestation
2.
Enable drug-drug and drug-allergy checks
for entire reporting period.
For each office visit to patients within 24 hours,
EP has no office visit
which includes up-to-date lists of problems,
during EHR reporting
50% (Unchanged)
medications and Rx allergies (paper and electronic
period
must be avail. to pt.)

1

Implement Clinical Decision
Support and Track Compliance

2

Provide Patients with Clinical
Summaries

3

Use EHR for Patient-Specific
Education Resources

Provide patient-specific education resources to all
patients

10% (Unchanged but EP has no office visit
made Core and “if
appropriate removed) period

4

Generate Lists of Patients by
Condition

1 List with a Specific Condition for use in quality
improvement, reduction of disparities, research
or outreach

By attestation (Made
Core)

5

Use of secured messaging with
Patients

Send secured messages to patients seen during
reporting period

6

Patients can view online, download and transfer 1.
Timely Electronic Access to Health
info within 4 days of being available to EP, subject
Information
to EPs discretion to withhold certain info
2.

Send Reminders to Patients
7

Preventative and follow-up care for all patients
based on clinically relevant info for anyone with 2
or more office visits in past 24 months

None

EP has no office visit
10%
period

EP has no orders /
creates info required
50% of all pts.,

>50% visit in county
and
with >50% with
5% of pts. access
4Mbps broadband
avail.

10% (↓ from 20%, all
patients and Made
Core)

EP has no office visit in
previous 24 months

ACOs and Patient Engagement
• 33 Quality Performance Measures
• 7 Patient / Caregiver Experience
Measure
Getting Timely Care, Appointments and Information
How Well Your Doctors Communicate
Patients’ Rating of Doctor
Access to Specialists
Health Promotion and Education
Shared Decision-Making
Health Promotion and Education

Method of Data Submission
Survey
Survey
Survey
Survey
Survey
Survey
Survey

• Final Rule requires CMS qualified Survey Vendor by 2014
• HITPC Preliminary Stage 3 Draft (Aug → Final Recommendations expected
in Nov)

o Patients Option to submit data online → 10% submit Medical Histories
o Patient education in non-English languages
o 10% of Patients ability to update and correct information online

NCQA PCMH 2011
Standard and Element

PCMH and Patient Engagement
Points

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20
4
4
2
2
2
2
4
17
3
4
4
5
17
4
3
4
3
3
9
6
3
18
6
6
6
20
4
4
4
3
3
2

PCMH Standard 1: Enhance Access and Continuity
Element A: Access during office hours
Element B: Access after hours
Element C: Electronic Access
Element D: Continuity
Element E: Medical Home Responsibilities
Element F: Culturally & Linguistically Appropriate Services (CLAS)
Element G: Practice Organization
PCMH Standard 2: Identify and Manage Patient Populations
Element A: Patient Information
Element B: Clinical Data
Element C: Comprehensive Health Assessment
Element D: Using Data for Population Management
PCMH Standard 3: Plan and Manage Care
Element A: Implement evidence-based guidelines

Element B: Identify High-Risk Patients
Element C: Manage Care
Element D: Management Medications

Element E: Electronic Prescribing
PCMH Standard 4: Provide Self-Care and Community Support

Element A: Self-Care Process
Element B: Referrals to Community Resources

PCMH Standard 5: Track and Coordinate Care
Element A: Test Tracking and Follow-up

Element B: Referral Tracking and Follow-up
Element C: Coordinate with Facilities / Care Transitions

PCMH Standard 6: Measure and Improve Performance
Element A: Measures of performance
Element B: Patient / Family feedback
Element C: Implements Continuous Quality Improvement
Element D: Demonstrates Continuous Quality Improvement
Element E: Performance Reporting
Element F: Report Data Externally

Number
of Factors
34
4
5
6
3
4
4
8
35
12
9
10
4
23
3
2
7
5
6
10
6
4
25
10
7
8
22
4
4
4
4
3
3

NCQA now offers a new Distinction in Patient Experience
o
o
o

Optional with PCMH Recognition
“Consumer Experience is Critical Component of Quality of Care”
Uses CAHPS PCMH Survey to access:
Access

Information

Communication

Coordination of Care
Comprehensiveness

Self-Management Support and Shared Decision-Making

100

149

Must
Pass?
Yes
No
No
No
No
No
No
No
No
No
Yes
No
No
Yes
No
No
Yes
No
No
Yes
No
No
No
Yes
No
No
No

6

VBP & Patient Engagement
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Hospitals → CMS payment adjustments based on
patient experience – Oct. 1, 2012
Evaluated / Scored on performance improvements
over baseline
Patient Experience → HCAHPS scores
Hospital staff → patient satisfaction, customer service
and communication training

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Results published on Hospital Compare website
ACA has Physician VBM program starting in 2015
based on 2013 performance
Physician Compare website now in place to show
performance metrics - first publishing (limited) in
CY2013
CMS launching CAPHS survey for MDs – FR 3.22.2013


Communication Shift
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Patient Portals have existed since 1990
o
o

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Patient Engagement was transactional – Financial Focus
56M accessed records through Patient Portal (Oct 2011)

Paradigm shift in the way health information disseminated

Pull Information Model
Push Information Model


Stage 3 Policymaking – CY2015
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ONC Draft Recommendations → Comments
from Nov. 2012 through Jan. 2013

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CPOE
o
o

Recording of Date/Time Reviewed

o

Bidirectional Lab Interface

o

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Delinquency Results Tracking

o

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“Never” Drug-Drug Interactions (DDI)

Orders for Referrals/TOC

ePrescribing → 50% Formulary Checking
Demographics EHR Certification Criteria
o

Occupation/Industry Codes

o

Sexual orientation, gender identity

o

Disability status (patient reported v. medically determined)


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Problems, Meds, Allergies EHR Certification Criteria
o
o

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CDS to support additions, edits, deletions (E.g., Hypoglycemic Rx → DM Dx?)
Coding of Rx allergies and linkage to drug family

Advanced Directives recorded → Patients 65+
CDS Greatly Expanded
o

15 CDS Interventions linked to CQMs

o

EHR Certification Criteria – “Ingesting” interventions from repositories

o

Patient-oriented dashboards for QI

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Accessibility of ALL imaged results (E.g. ECGs)

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High-priority Family Histories

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Patient-Preference Automated “Transmit” Care Record Summary

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Patient generated health information into EHR (E.g. Questionnaires)


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Patient requested “amendment” to health record
Patient-Ed available in top 5 non-English languages
10% of Patients using electronic messaging with EP
Received TOC
o
o

Data Sets defined in Continuity of Care Record for TOCs

o

•

Reconcile Rx, Rx Allergies, Problems
Acknowledged “Receipt” of Electronic Results

Inbound Immunization Data and baseline
recommendations by age

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Query/Retrieve Production HIE

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Population Management
o

ID undiagnosed patients with HTN, BP control

o

Referral of Smoker to quit-line services


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5 Tips for Success – Patient Engagement
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Tip 1: Measure Patient Satisfaction Pre- and Post-Project
Tip 2: Involve the Provider(s)
o
o

•

They must drive the medical responses
They are going to get mad with some survey results

Tip 3: Address Cultural-Change Challenges
o
o

“Our patients will never go online”

o

•

“One more thing I have to do!”
Creates a mutual interdependence between Providers and Patients

Tip 4: Add a “filter” and Map the Workflow
o

Make the workflow someone’s job (Think “Care Team”)

o

Get Providers into a routine (E.g. See patients, answer emails / flags,
cycle again)

o

Perhaps schedule time on the Provider’s calendar


5 Tips for Success – Patient Engagement
•

Tip 5: Promote, Promote, Promote!
o

o

o

o

o

o
o

o

Refine the Message → Faster way to get lab results, refills, etc.;
No more Phone-Tag!
Strategically place Brochures (E.g., Ck-in / Ck-out, Waiting
Room)

Add information on appt. reminder cards → “Use our online
scheduling!”
Remind patients of ability to request refills online when they
call for refills
Computer in waiting room to assist patients in registering,
completing paperwork, etc.
Replace “on-hold” music with introduction to patient portal
Add-on announcements with all statements, newsletters and
ePublications
Improve organizational branding


5 Tips for Success – HIE and TOC
•

Tip 1: Define your Use Cases
o
o

•

Does it improve quality?
Does it decrease costs?

Tip 2: Involve the Stakeholders
o

o

•

Tip 3: Understand your HIE Market
o

o
o

•

Hospital
Specialty Providers
Statewide / Local Market Progress and Barriers
HISP Providers for Direct
Exchange for more advance Query / Retrieve HIE

Tip 4: Allow ample bandwidth to plan and implement
o
o

Data-Sharing Agreements, SOW
Understand related Costs


6 Health IT Tips – Your IT Vendor
• Tip 1: Meaningful Use, PQRS and Other Dashboards?
o Metrics / Analytics by Provider
o Facilitates quick numerators/denominators for MU attestation
o Clinic analytics with drill-through details

• Tip 2: Patient Portal Inherent with System?
o Should be part of Core Offering
o Avoids Additional vendor and integration considerations

• Tip 3: Single database solution for PM and EHR
• Tip 4: EHR Direct PQRS
• Tip 5: More than just first call support
o Initiative Toolkits (E.g. MU, PCMH, PQRS)
o Consulting Support with domain experts

• Tip 6: Ongoing Client Educational Offerings


CEUs available at:
webinars@successehs.com
Copies available on SlideShare or
www.SuccessEHS.com/webinars

Added to The BRIEF or Questions:
adelea@successehs.com

Follow me on Twitter:
www.twitter.com/Adele_Allison


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