This file, uploaded on Feb 6 2012, is an overview of the relevance of the meaningful use program for dentists and dental clinics. This presentation was made by Rachel Ramoni at the 2012 Exan Summit in Vancouver.

1. What
Meaningful
Use
Means
for
Den3sts
Rachel
B.
Ramoni,
DMD,
ScD
Elsbeth
Kalenderian,
DDS,
MPH
Muhammad
Walji,
PhD
February
7,
2012

2. Through
the
2009
HITECH
(Health
Informa3on
Technology
for
Economic
and
Clinical
Health)
Act,
the
United
States
government
commiPed
$27
billion
through
2016
to
incen3vize
the
adop3on
and
“meaningful
use”
of
cer3fied
electronic
health
records
(EHRs).

3. The
goals
are
to:
1) improve
the
accuracy
and
completeness
of
pa3ent
informa3on
2) allow
bePer
coordina3on
of
care
3) provide
secure
access
for
pa3ents
to
their
own
health
data
and
to
foster
shared
decision
making
4) provide
safer
and
lower
cost
care

4. What
does
meaningful
use
mean
for
you?

5. $63,750
Per
Eligible
Provider
Over
6
Years
Under
The
Medicaid
Incen3ve
Program

7. Who
qualifies
as
an
eligible
provider
(EP)?

8. Den3sts
(or
physicians)
who
have
an
na3onal
provider
iden3fier
and
who
meet
the
pa3ent
threshold
volume.
Residents/advanced
graduate
students
can
qualify

9. What
is
the
pa3ent
threshold
volume
and
how
does
an
EP
meet
it?

10. Medicaid* patient encounters in a 90 day period over the previous calendar year
×100
Total patient encounters in a 90 day period over the previous calender year
*
Or
other
payment
op3ons
for
needy
individuals
in
FQHC
or
RHC
seengs,
CHIP
program
qualifies
in
states
with
a
1115
waiver

11. Pa3ent
threshold
volume
can
be
calculated
on
an
individual
basis
or
by
proxy.

12. An
advantage
of
the
proxy
method
is
that
individuals
who
may
not
qualify
on
their
own
can
qualify
on
the
basis
of
the
clinic’s
pa3ent
threshold
volume.

13. An
EP
must
qualify
every
year
for
which
he/she
wishes
to
receive
incen3ve
payment.

14. What
does
a
qualified
EP
have
to
do
to
receive
the
incen3ve
payment?

15. Year
1
APest
to
having
purchased/adopted/
implemented/demonstrated
meaningful
use
of
a
cer3fied
EHR
Years
2
Report
90
days
of
meaningful
use
Years
3-­‐4
Report
full
year
of
meaningful
use
Remember,
the
year
is
with
respect
to
the
eligible
provider,
not
the
clinic.

16. 1
2
3
4
5
6
2012
$42,500
1
2
3
4
5
6
2015
$21,250
$8,500
$17,000

17. How
do
I
get
a
cer3fied
EHR?

18. There
are
two
approaches:
Complete
Modular
Single
system
which
A
set
of
two
or
more
fulfills
all
of
the
systems,
which
requirements
together
fulfill
the
requirements
hPp://onc-­‐chpl.force.com/ehrcert/EHRProductSearch?seeng=Ambulatory
Don’t
forget
to
pay
aPen3on
to
version
numbers!

19. You
obtain
an
EHR
Cer3fica3on
ID
by
selec3ng
your
complete
system
or
the
components
of
your
modular
system
at
hPp://onc-­‐chpl.force.com/ehrcert

20. What
is
meaningful
use?

21. APainment
of
a
set
of
objec3ves
and
repor3ng
of
clinical
quality
measures
using
cer3fied
EHR
technology
Note:
These
requirements
are
for
Phase
1
of
meaningful
use.
Phases
2
and
3
will
have
different
requirements.
Phase
2
is
expected
to
begin
in
2013.

22. You
must
use
your
cer3fied
EHR
to
meet
20
objec3ves:
15
core
5
out
of
10
menu
set
objec3ves
with
objec3ves
at
least
1
public
health
objec3ve

23. Examples
of
core
objec3ves:
Objec-ve Measure Exclusions
Record
pa3ent
demographics
Over
50%
of
pa3ents’
None
(sex,race,
date
of
birth,
demographic
data
recorded
as
preferredlanguage)
structured
data
Record
vital
signs
and
chart
Over
50%
of
pa3ents
2
years
of
Any
EP
who
either
see
no
change
(height,
weight,
blood
age
or
older
have
weight,
height
pa3ents
2
years
or
older,
or
who
pressure,
BMI,
growth
chart
for
and
blood
pressure
recorded
as
believes
that
all
three
vital
signs
children)
structured
data
of
height,
weight,
and
blood
pressure
have
no
relevance
to
their
scope
of
prac3ce
during
the
repor3ng
period
Maintain
up
to
date
problem
list
Over
80%
of
pa3ents
have
at
None
of
current
and
ac3ve
disease
least
one
entry
recorded
as
structured
data
Maintain
ac3ve
medica3on
list
Over
80%
of
pa3ents
have
at
None
least
one
entry
recorded
as
structured
data

24. Examples
of
menu
set
objec3ves:
Objec-ve Measure Exclusions
Generate
lists
of
pa3ents
by
Generate
at
least
one
lis3ng
of
None
specific
condi3on
to
use
for
pa3ents
with
specific
quality
improvement,
condi3on
research,
reduc3on
of
dispari3es,
or
outreach
Use
EHR
technology
to
Over
10%
of
pa3ents
are
None
iden3fy
pa3ent-­‐specific
provided
pa3ent-­‐specific
educa3on
resources
and
educa3on
resources
provide
those
to
the
pa3ent
as
appropriate
Perform
medica3on
Medica3on
reconcilia3on
is
An
EP
who
was
not
the
reconcilia3on
between
care
performed
for
over
50%
of
recipient
of
any
transi3ons
of
seengs
transi3ons
of
care
care
during
the
EHR
repor3ng
period
qualifies
for
an
exclusion
from
this
objec3ve/
measure
N/A
for
academic
den3stry

25. Example
of
public
health
menu
set
objec3ves:
Objec-ve
Measure
Exclusions
Submit
electronic
Perform
at
least
one
test
of
An
EP
who
administers
no
immuniza3on
data
to
data
submission
and
follow-­‐up
immuniza3ons
during
the
EHR
immuniza3on
registries
or
submission
(where
registries
repor3ng
period
or
where
no
immuniza3on
informa3on
can
accept
electronic
data)
immuniza3on
registry
has
the
systems
capacity
to
receive
the
informa3on
electronically
qualifies
for
an
exclusion
from
this
objec3ve/measure.
N/A
for
academic
den3stry.
May
apply
to
those
den3sts
who
provide
flu
immuniza3ons.

26. Unlike
objec3ves,
there
are
no
thresholds
for
the
clinical
quality
measures.
You
must,
however,
be
able
to
report
the
clinical
quality
measures
from
the
EHR.

27. You
must
use
your
cer3fied
EHR
to
meet
6
clinical
quality
measures:
3
core
3
addi3onal
CQMs
CQMs
selected
out
of
If
you
can’t
meet
one
or
more
of
these,
you
can
subs3tute
an
38
op3ons
alternate
core
CQM.

28. Core
CQMs:
•
Hypertension:
%
of
pa3ent
visits
for
pa3ents
aged
18
+
with
a
diagnosis
of
hypertension
who
have
been
seen
for
at
least
2
office
visits,
with
blood
pressure
(BP)
recorded.
•
Preventa3ve
care
and
screening
measure
pair
(tobacco
use
assessment
and
tobacco
cessa3on):
%
pa3ents
aged
18+
who
have
been
seen
for
at
least
2
office
visits
who
were
(a)
queried
about
tobacco
use
1+
within
24
months
and
(b)
received
cessa3on
interven3on.
•
Adult
weight
screening
and
follow
up:
%
of
pa3ents
aged
18
+
with
BMI
calculated
in
the
past
six
months
AND
if
the
most
recent
BMI
is
outside
parameters,
a
follow-­‐up
plan
is
documented.

29. Examples
of
Addi3onal
CQMs:
•
Asthma
Assessment:
%
of
pa3ents
aged
5
-­‐
40
years
with
a
diagnosis
of
asthma
and
who
have
been
seen
for
2+
visits,
who
were
evaluated
during
at
least
one
office
visit
within
12
months
for
the
frequency
(numeric)
of
day3me
and
nocturnal
asthma
symptoms.
•
Pneumonia
Vaccina3on
Status
for
Older
Adults:
%
of
pa3ents
65
years
of
age
and
older
who
have
ever
received
a
pneumococcal
vaccine.

30. How
does
an
EP
report
informa3on
necessary
to
receive
payment?

31. Year
1
Register
at
the
state
and
federal
levels.
Obtain
EHR
Cer3fica3on
ID.
APest
at
the
state
level
to
having
purchased,
adopted,
upgraded,
or
implemented
a
cer3fied
EHR.
Years
2
Report
90
days
of
meaningful
use
(objec3ves
and
clinical
quality
measures)
via
state’s
aPesta3on
system
Years
3-­‐6
Report
full
year
of
meaningful
use
(objec3ves
and
clinical
quality
measures)
via
state’s
aPesta3on
system

32. What
about
the
clinics?

33. It
is
at
the
states’
discre3on
whether
an
EP
may:
•
designate
a
clinic
to
register
and
aPest
on
his/her
behalf
•
assign
payment
to
a
single
clinic
with
whom
he/she
has
a
contractual
rela3onship
Several
states
do
allow
it:
check
on
the
state
registra3on/provider
enrollment
page
to
be
sure.

34. Year
1:
Pueng
it
all
together

35. Determine
if
clinic’s
pa3ent
profile
allows
EPs
to
qualify
via
proxy
approach
Determine
if
individual
EPs
qualify
Determine
if
3rd
par3es
can
register/aPest
on
behalf
of
EPs
in
your
state
Register
EPs
at
the
state
and
federal
levels
Upgrade/adopt
cer3fied
EHR
system
Obtain
EHR
cer3fica3on
ID
APest
to
having
upgraded/adopted
a
cer3fied
EHR
system

36. A
few
rules
and
regula3ons
• An
EP
may
receive
only
one
payment
per
year,
even
if
they
work
at
more
than
one
clinic
• An
EP
does
not
re-­‐start
the
cycle
if
he
or
she
changes
clinics
• Defini3on
of
a
clinic:
A
legally
dis3nct
en3ty.
Clinics
opera3ng
under
the
same
ins3tu3onal
banner
may
or
may
not
be
considered
as
separate
en33es
for
the
purposes
of
the
incen3ve
program

37. Where
do
I
go
for
help?

38. You
can
get
more
informa3on
about
the
par3culars
of
aPes3ng
at
your
state’s
level
via
your
state’s
site.
You
can
find
your
state’s
site
at:
hPp://www.cms.gov/apps/files/statecontacts.pdf

39. The
Regional
Extension
Centers
ONC
has
funded
62
Regional
Extension
Centers
(RECs,
pronounced
RECs)
to
help
providers
achieve
meaningful
use
of
their
EHRs.
RECS
will
provide
“on
the
ground
assistance”.
“REC
services
include
outreach
and
educa3on,
EHR
support
(working
with
vendors,
helping
to
choose
a
cer3fied
system),
and
technical
assistance
in
implemen3ng
health
IT
has
using
it
in
a
meaningful
way
to
improve
care.”
hPp://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3519