27668kuoca - sppm · 2019-01-14 · 11/8/2012 7 mobility & convenience background • medicine...

11/8/2012

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EHR & Your Practice, Stage 2 Meaningful Use is Here!What you Need to Know

presented by

Bill Rust, CEOSherry Hunt, President

November 7, 2012

AAPC Code

27668KUOCA

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Why EHRs & Why Now?

• Increasingly Competitive Market

• Competitive Nature of Recruitment

• Doing More & Doing It… Faster

• Growing Need for Reportable DataFederal/State, Insurers, You

• Simplified (and Secure) Sharing of Patient Information

• Improved Quality of Care

• The Federal Incentives Train is Leaving the Station…

So, What are the Challenges?

• A lot of vendors mean a lot of confusion

• Costs behind costs behind costs

• Failure rate has reached over 50%

• Surprisingly, the federal incentives program can be complex!

• Hundreds of thousands of primary care EPs have received checks…but, only a handful of specialists were successful.

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OK, ONE More Question…

• What Are the Challenges?

• It’s hard to see beyond the glamour of encounter documentation

• A lot of vendors mean a lot of confusion

• Costs behind costs behind costs

• Failure rate has reached over 50%

• Surprisingly, the federal incentives program is complex!

• Hundreds of thousands of primary care EPs have received checks…but, only a handful of specialists were successful.

What Characteristicsare Needed to

Overcome the Challenges?

Market Longevity & Presence

Background

• EHR market is highly volatile

• Many EHRs still in infancy ordeveloped for General Medicine

• Big players are at the whimsof Wall Street

• Most EHRs’ primary market is… NOT Pain Management

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Market Longevity & Presence

What You Need to Know about AllMeds

• Consistent Leadership over 15+ Years

• Significant Pain Management Experience on Medical Directors Board

• Long-term Presence at Pain Management Meetings

• EHR Implementation Workshops at SPPM

• Meaningful Use Training Program

Specialty-SpecificBackground

• Pain Management are NOT General Surgeons or PC Docs or Pediatricians or…

• A SPECIALIZED Clinical Library is the…

…FOUNDATION of an Fully-Functional EHR

• Templates Do NOT Constitute a Library!

• Got 400 Hours to Spare? Most EHR FAILURES Occur Here.

• Majority of Physicians Feel Their EHRwasn’t Built with Them in Mind… …and Are Planning to Replace Them! (HIMSS & Healthcare IT News 6/14/2012)

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Specialty-Specific


•Pain Management is in our DNA

•Founded and chaired by visionary a Surgeon

•AllMeds provides the most robust Pain Management clinical libraries in the industry

•Built by Pain Management docs, constantly expanded… Even More

•Your implementation team has seen it all

Federal EHR Incentives So Far…

Total EP Registrations: 240,343

Medicare: 161,586

Medicaid: 78,757

Total Incentive PaymentAmounts to EPs: $2 Billion

National Incentives ConversionRate = 44%

- CMS, July 2012

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Incentives & Meaningful Use


• MU Dashboard™ keeps you in-the-know… always

• MU-only, dedicated team to successfullyhelp you thru complex process

• MUcare™ provides setup, training, coaching & monitoring

• And…

• The national Incentives Conversion Rateis 44%...

• AllMeds’ is 97%!

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Mobility & Convenience

Background

• Medicine is not a M-F / 9-to-5 occupation. (Practice Administration isn’t, either…)

• Physicians need access to patient data in the office, satellite locations, surgery centers, at home and on-the-go

• Weak infrastructure and security concerns prevented progress for years.

• Technology finally caught up!

Mobility & Convenience


• Unique 24/7, whenever/whereveraccess to patient data andcritical tools

• Fully compatible with HIPAA-secure Internet and wireless protocols

• Use any web-enabled PC to access patient records, schedules, eRx, etc.

• iPhone™ app for true mobilefunctionality

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Efficiency Tools

Background

• Profitability requires more encounters added to each clinic-day

• Physicians’ time is veryvaluable

• Documentation must be accomplishedfaster, while also increasingaccuracy & breadth

• It’s about leveraging yourphysicians’ time & yourpatients’ efforts

Efficiency Tools


• Effortless collection/integration of PFHS, ROS, HPI & MU data

• Encounter documentation & task distribution… with a single click.

• Interfaces with most widely-used diagnostic tools and labs

• Coding Engine = Fewer Delays, Appropriate Payments

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Evidence of Success

Background

• EHR industry has suffered failure rates over 50%

• Many vendors have little to no track record

• Majority of EHR physicians feeltheirs wasn’t built… for them

• Most EHRs begin to fail… just after they go-live!

Evidence of Success

More Pain Management Practices Than Any Other Vendor

Ability to Provide References

Groups of All Sizes

Confidence in Product (Money-Back Guarantee)

MU Conversion Rate Is 97%

Lifetime Customer Retention RateIs Over 90%

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EHR Incentive Program Eligibility

Eligibility is determine by the HITECH Act

There have been no changes in the HITECH Act

The funding for the HITECH Incentive Program have been appropriated

As of October 2012 less than half of the funds have been paid

The National Health Care Program (Obama Care) is a separate program

Am I Too to Late to Participate?

• Medicare

–All EPs begin with 2 Years at Stage 1

–Year 1 Reporting Period = 90 Consecutive Days of MU

–Must Be within the Calendar Year

–EPs Starting in 2013 Will Recognize $39K

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Am I Too Late to Participate?

• Medicaid

–6 Total Nonconsecutive Years Between 2011 & 2021

–Years May Be “Skipped” without Reducing Incentives

–Year 1 Accomplished Simply/Instantly with AIU

–Subsequent Payment Years

• Year 2: 90 Consecutive Days of MU

• Years 3-6: 365 Days of MU

• The 90% Rule

Hospital-based EPs are not eligible for incentive payments.

• Medicare

• Doctor of Medicine or Osteopathy (MD, DO)

• Medicaid

• Physicians (MD, DO, DPM)

• Nurse Practitioners (NP)

• Physician Assistants (PA)Must practice in Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs) that are led by a PA.

Who can participate in the program?

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What are the EHR certification requirements?

• ONC-ATCB certified technology required to participate.

• Complete listing at www.CMS.gov/EHRIncentivesPrograms

• Complete EHR vs EHR ModulesIMPORTANT! EP is responsible for ensuring EHR modules meet full MU criteria.

• Maximum incentive: $44,000/EP over 5 years

• If you skip a year, you miss it and the incentive amount

• Incentives = 75% of allowed Medicare charges/EP

• Payments

– Single lump sum

– Arrives 6-8 weeks after attestation/qualification

• Reporting periods: Calendar year (not fiscal year)

– Participation Year 1: 90 consecutive days

– Participation Years 2-5: full calendar year

2014 Only: 90 consecutive days (all EPs, all Stages)Provided to allow for Stage 2 Implementation Needs. Must be met by October 1, 2014.

Medicare Program Key Points

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Medicare Program

First Year to Achieve

MU

Annual Incentive Payments by Stage of MU

2011 2012 2013 2014 2015 2016 TOTAL

2011$18,000 /Stage 1

$12,000 /Stage 1

$8,000 /Stage 1

$4,000 /Stage 2

$2,000 /Stage 2

$0 /Stage 3 $44,000

2012$18,000 /Stage 1

$12,000 /Stage1

$8,000 /Stage 2

$4,000 /Stage 2

$2,000 /Stage 3 $44,000

2013$15,000 /Stage 1

$12,000 /Stage 1

$8,000 /Stage 2

$4,000 /Stage 2 $39,000

2014$12,000 /Stage 1

$8,000 /Stage 1

$4,000 /Stage 2 $24,000

2015 +$0 /

Penalties

MUST BEGIN BY 2014!

Fin

al Ye

ar for

Pa

yme

nt

• Maximum incentive: $63,750/EP over 6 payment years

– Participation Year 1: $21,250

– Participation Years 2-6: $8500

• “Needy Individuals” Volume Thresholds

– Non-Pediatrician EPs, FQHC & RHC: 30% or more

– Pediatricians: 20% or more

• Administered by states, not CMS.

• EPs should ensure their state has an incentive programin place before beginning process.

Medicaid Key Points

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• Medicaid option for Year 1 to encourage greater participation.

• AIU Definitions (Check with your state agency!)

– Adopting: Acquired & Installed Prior to Incentive

– Implementing: Commenced Using (training, data entry, etc.)

– Upgrading: Upgraded to Certified Technology

• Reporting periods

– If AIU in Year 1: None

– First year meeting MU (Year 2): 90 consecutive days

– Subsequent years (Years 3-6): 12 months

Adopting, Implementing, Upgrading

• 10 Years within which Participate Possible Payment Scenarios

First Year

Annual Incentive Payments w / Possible Payment Scenarios

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 TOTAL

2011 $21,250 $8500 $8500 $8500 $8500 $8500 $63,750

2012 $21,250 $8500 $8500 $8500 $8500 $8500 $63,750

2013 $21,250 - $8500 $8500 $8500 $8500 $8500 $63,750

2014 $21,250 - $8500 $8500 - - - - $38,250

2015 $21,250 - $8500 $8500 $8500 $8500 $8500 $63,750

2016 Last Year to Begin! $21,250 - - - $8500 $8500 $8500 $46,750

No Penalties Defined

Medicaid Timeline

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Stage 1 Objectives Measures and Clinical Quality Measures

CLINICALQUALITY

MEASURES3 Core or Alternate Core

+ 3 Menu Objectives

6 TOTAL CQMs

OBJECTIVES15 Core

+ 5 of 10 Menu

20 TOTAL OBJECTIVES

CORE OBJECTIVES (All) MENU OBJECTIVES (5 of 10)

CPOE 30% Drug/Formulary Checks Enabled

Drug/Drug & Drug/Allergy Enabled Lab Results into EHR 40%

ePrescribing 40% Patient List 1 List

Demographics 50% Patient Reminders 20%

Problem List 80% Timely eAccess to Health Info 10%

Medication List 80% Patient-Specific Education 10%

Med. Allergy List 80% Med. Reconciliation 50%

Vital Signs 50% Summary of Care 50%

Smoking Status 50% Immunization Registries 1 Test

Clinical Decision Support 1 Syndromic Surveillance 1 Test

Report Quality Meas. to CMS 2011: Attest.

eCopy of Health Info 50%

Clinical Summaries 50%

Exchange Key Clinical Info 1 Test

Privacy/Security Analysis

Meaningful Use Objectives: Stage 1

Must choose 1

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Stage 1 Clinical Quality Measures

CORE MEASURES (All, if possible)

NQF 0421/PQRI 128 Adult Weight Screening & Follow Up

NQF 0013 Hypertension: Blood Pressure Measurement

NQF 0028 Preventive Care & Screening Measurea. Tobacco Use Assessmentb. Tobacco Cessation Intervention

ALTERNATE CORE MEASURES (Replacements for Cores)

NQF 0041/PQRI 110 Preventive Care & Screening: Influenza Immunization

NQF 0024 Weight Assessment & Counseling for Children & Adolescents

NQF 0038 Childhood Immunization Status

MENU MEASURES (Choose 3 of 38)

Full List www.cms.gov/EHRIncentivePrograms

3 Total

Changes to Stage 1 that will start in 2013

This Optional CPOE denominator is available in 2013

• CPOE: Current Measure Denominator = Unique patient with at least one medication in their Medication list

• CPOE: 2013 Measure Denominator = Number of orders during the EHR Reporting Period

This Optional Vital Signs in 2013 but is required in 2014

• Vital Signs: Current Measure = Age 2 for BP & Height / Weight with Exclusion of all three elements not relevant to scope of practice

• Vital Signs: 2013 Measure = Age 3 for BP, No age limit for Height/Weight with BP to be separated from Height/Weight

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One test of Electronic Transmission of Key Clinical Information

• Requirement removed in 2013

E-copy and Online Access changes take effect in 2014

• Current Objective = Provide patients with e-copy of health information upon request and Provide patients the ability to view online, download and transmit their health information

• 2014 Objective = Provide patients the ability to view online, download and transmit their health information. The measure of the new objective is 50% of patients have assess to their information; there is no requirement that 5% of patients do access their information for Stage 1.


Public Health Objectives

• Immunizations, Reportable Labs, Syndromic. Addition of “except where prohibited” to all three objectives. This addition is for clarity purposes and does not change the Stage 1 measure for these objectives.

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Stage 1 - Register and Attest

Visit the CMS EHR Incentive Programs website to,

– Register for the EHR Incentive Programs

– Attest for the Medicare EHR Incentive Programs

https://www.cms.gov/EHRIncentivePrograms/ or

https://ehrincentives.cms.gov/hitech/login.action

Example sites

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Login Instructions EPs

• If you are an EP, you must have an active National Provider Identifier (NPI) and have a National Plan and Provider Enumeration System (NPPES) web user account. Use your NPPES user ID and password to log into this system.

• If you are an EP who does not have an NPI and/or an NPPES web user account, navigate to NPPES to apply for an NPI and/or create an NPPES web user account.

• Users working on behalf of an Eligible Professional(s) must have an Identity and Access Management system (I&A) web user account (User ID/Password) and be associated to the Eligible Professional's NPI. If you are working on behalf of an Eligible Professional(s) and do not have an I&A web user account, Create a Login in the I&A System.

Attest

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Attest Objective Example

Attest CQM Example

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Attest Confirmation Example

ONC Summary of Stage 2

New Criteria – Starting in 2014, providers participating in the EHR Incentive Programs who have met Stage 1 for two or three years will need to meaningful use Stage 2 criteria.

Improving Patient Care – Stage 2 includes new objective to improve patient care through better clinical decision support, care coordination and patient engagement.

Saving Money, Time, Lives – With this next stage, EHRs will further save our health care system money, saves time for doctors and hospitals, and saves lives.

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The Stage 2 New Rules’ Bottom Line

• Reduced 2014 reporting period to 1 Quarter (giving vendors and providers time to upgrade systems)

• Some new objectives/measures, some replaced, some combined.

• Greater electronic access to patient health information

• Secure messaging and Online access to healthcare information

• Group reporting for multi-EP practices.

• 2015 Medicare penalties avoided by EPs who…

• Demonstrate MU in 2013, or

• First demonstrate MU by October 1, 2014

How are the requirements in Stage 1 and Stage 2 different?

CLINICALQUALITY

MEASURES3 Core or Alternate Core

+ 3 Menu Objectives

6 TOTAL CQMs

OBJECTIVES15 Core

+ 5 of 10 Menu

20 TOTAL OBJECTIVES

OBJECTIVES17 Core

+ 3 of 6 Menu

20 TOTAL OBJECTIVES

CLINICALQUALITY

MEASURES

1)

9 CQMs 1 in each of 3

domains

or

2) PQRS/Group Reporting

9 TOTAL CQMs

STAGE 1 STAGE 2

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CORE OBJECTIVES (All) CORE OBJECTIVES (cont.)

CPOE 60% meds,30% labs,30% radiology

Secure Messages 5% patients send to EP

ePrescribing 50%(formulary, no EPCS req) Rx Reconciliation 50%

Demographics 80% Summary of Care 50% w/ 10% elect,1 test to diff EHR or CMS

Vital Signs 80% Immunizations on-going transmission

Smoking Status 80% Security Analysis Conduct

Interventions 5 clinical decision spt,Drug/drug, Drug/allergy

MENU OBJECTIVES (3 out of 6)

Labs 55% (incorporated) Imaging Results 20% accessible in EHR

Patient List by specific condition Family History 20%

PreventiveReminders

10% w/ => 2 visits in last 2 years

SyndromicSurveillance

on-going transmission

Patient Access On-line access 50%, 5% accessing

Cancer Case Information

on-going transmission

Visit Summaries 50% Specialized Registry on-going transmission

Education Resources

10% Progress Notes 30% electronic

Meaningful Use Objectives: Stage 2

Stage 2 Clinical Quality Measures

Complete Measure Set

Table 8 www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html

Option 1: 9 out of 64 CQMs

Submit 9 CQMs(including Adult & Pediatrics recommended core) covering at least 3 domains.

Adult = 9 CQMs

Pediatrics = 9 CQMs

Option 2: PRQS (Physician Quality Reporting System)

Satisfy requirements of PQRS EHR Reporting Option using CEHRT

PQRS = 47 CQMs

CQM DOMAINS MEASURES

Patient and Family Engagement

Patient Safety

Care Coordination

Population and Public Health

Efficient Use of Healthcare Resources

Clinical Processes/Effectiveness

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Stage 2 - Attest

Stage 2: Batch Reporting

Starting in 2014, groups will be allowed to submit attestation information for all of their individual EPs in one file for upload to the Attestation System, rather than having each EP individually enter data.

Payment Adjustments

• The HITECH Act stipulates that for Medicare EPs a payment adjustment applies if they are not a meaningful EHR user.

• To avoid Payment Adjustments EPs must continue to demonstrate MU every year to avoid payment adjustments in subsequent years.

Payment Adjustment Year 2015 2016 2017 2018 2019 2020

Based on 90 day EHR Reporting Period

2014* 2014

Based on Full Year EHR Reporting Period

2015 2016 2017 2018

*In order to avoid the 2015 payment adjustment the EP must attest no later than Oct 1, 2014, which means they must begin their 90 day EHR reporting period no later than July 1, 2014.

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Payment Adjustments

Payment adjustments will be applied to the Medicare physician fee schedule (PFS) amount for covered professional services furnished by the EP during the year (including the fee schedule amount for purposes of determining a payment based on the fee schedule amount).

The payment adjustment is 1% per year and is cumulative for every year that an EP is not a meaningful user.

Depending on the total number of Medicare EPs who are meaningful users under the EHR Incentive Programs after 2018, the maximum cumulative payment adjustment can reach as high as 5%.

Payment Adjustment Tip sheethttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/PaymentAdj_HardshipExcepTipSheetforEP.pdf

Payment Adjustments

% ADJUSTMENT ASSUMING LESS THAN 75 PERCENT OF EPs ARE MEANINGFUL USERS

2015 2016 2017 2018 2019 2020+

EP is not subject to the payment adjustment for the e-Rx in 2012

99% 98% 97% 96% 95% 95%


98% 98% 97% 96% 95% 95%

% ADJUSTMENT ASSUMING MORE THAN 75 PERCENT OF EPs ARE MEANINGFUL USERS

2015 2016 2017 2018 2019 2020+


99% 98% 97% 97% 97% 97%


98% 98% 97% 97% 97% 97%

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References & Helpful Resources (cont)

• EHR Incentive Programwww.cms.gov/EHRIncentivePrograms

• EHR Registration and Attestation Site https://ehrincentives.cms.gov/hitech/login.action

• Stage 1 Specification Sheets www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/EducationalMaterials.html

• State-Level HIE Contact Informationhttp://statehieresources.org

• Complete List of Certified EHRhttp://oncchpl.force.com/ehrcert

References & Helpful Resources

• Stage 2 Home Pagewww.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html

• Stage 2 Slideshttp://www.nationalehealth.org/FinalRules

• Payment Adjustment Tip sheet

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/PaymentAdj_HardshipExcepTipSheetforEP.pdf

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Thank [email protected]

[email protected]

Finally, a Disclaimer…The incentive programs described in this presentation are evolving and will change in the future. Therefore, materials presented in this course are subject to change or correction. As of October 2012, everything presented is believed to be accurate.

27668kuoca - sppm · 2019-01-14 · 11/8/2012 7 mobility & convenience background • medicine...

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