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“No matter how dramatic the end result, the good to greattransformations never happened in one fell swoop.
There was no single defining action, no grand program, no onekiller innovation, no solitary lucky break, no wrenchingrevolution.
Good to great transformation comes about by acumulative process – step by step, action by action, decisionby decision, turn by turn, that adds up to sustained spectacularresults. “
Jim CollinsGood to Great
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“No matter how dramatic the end result, the good to greattransformations never happened in one fell swoop.
There was no single defining action, no grand program, no onekiller innovation, no solitary lucky break, no wrenchingrevolution.
Good to great transformation comes about by acumulative process – step by step, action by action, decisionby decision, turn by turn, that adds up to sustained spectacularresults. “
Jim CollinsGood to Great
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Meaningful Use Readiness
Getting Started: A Meaningful Use Checklist
Peter Cucchiara, BSMIS MBA
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See the pathbefore we walk it
To Readiness
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What is MUto you?
Placement&
Considerations
What is this
work?
Ways to Plan theProcess
Assessment ToolDemonstration
Do we have the right people in the right seatson the bus? Jim Collins
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What is Meaningful Use
Using certified EHR technology in a meaningful
manner (which includes e-prescribing for
eligible providers and meeting the MU criteria)
Use
Connecting a certified EHR in a manner that provides for the electronic exchange of health information to improve the quality of care.
Connect
SubmitUsing the technology to submit information to CMS on clinical quality measures and other measures selected by CMS.
ARRA specifies three requirements for “meaningful use”
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MU Grocery List
25 Requirements of which we need to fulfill 2015 Core, 5 Discretionary6 Clinical Measures16 Numerator/Denominator Calculations8 Attestation itemsDetermine our EPAdopt implement upgrade incentive opportunityVolume criteria
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What is Meaningful Use – The First Cut
Goal A
Goal B
Goal C
Goal D
Goal E
Improve quality, safety, efficiency, & reduce health disparities
Engage Patients and Families
Improve Care Coordination
Improve Population and Public Health
Ensure adequate privacy and securityProtection for PHI
(15)
(4)
(3)
(2)
(1)
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What is Meaningful Use – The Second Cut
Core
- Of the 25 objectives 15 are required
- Goal A (11) Goal B (2) Goal C (1)
- Goal D (?) Goal E (1)
DiscretionaryMenu
- 10 discretionary/menu requirements from which 5 must be chosen- Must choose 1 Goal D measure Improving Population & Public Health- Electronic access for patients (PHR, portal) is discretionary.
ClinicalMeasures
- 44 Measures for EP’s - Pick 6
- 3 Core required (BP, Tobacco status, adult weight) or…
- 3 Alternates plus additional 3 from remaining pool of 38
NumeratorsDenominators
- Of the 25 objectives 16 require N/D Calculations
- 10 Calculations require certified EMR technology
- 6 Calculations do not require certified EMR technology
Attests - Of the 25 objectives 8 require attestations
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3
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What is Meaningful Use – The Third Cut
4P’s
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Adopt, Implement, Upgrade (AIU)
• In their first year of participation in the Medicaid incentive payment program, EPs may qualify for an incentive payment by demonstrating any of the following:
– that they have adopted (acquired & installed),
• implemented (commenced utilization), or• upgraded (upgrade to a certified version or expanded
functionality, e.g. CDSS, e-prescribing)
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Eligible Providers (EPs)
Medicare
Doctor of MedicineDoctor of OsteopathyDoctor of DentistryDoctor of Dental SurgeryDoctor of Podiatric MedicineDoctor of OptometryChiropractor
Medicaid
PhysiciansDentistsNurse MidwivesNurse PractitionersPAs in PA led FQHC*PAs in Rural Health Clinic
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Volume Criteria
– General Rule: 30% patient encounters attributable to those receiving Medicaid. To be measured over any continuous 90-day period in the previous calendar year.
– 2 Exceptions:
1. If EP practices predominantly in an FQHC or RHC, must have 30% of patient encounters attributable to “needy individuals”
Definition of predominantly = over 50% of patient encounters over a period of 6 months occurs at an FQHC or RHC
Definition of needy individuals = receiving medical assistance from Medicaid or CHIP; receiving uncompensated care; or receiving care at no-cost or reduced cost based on a sliding-scale
2. Pediatricians may have at least 20% patient encounters attributable to those receiving Medicaid
Source: CMS, US DHHS
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Summing Up So Far
25 Requirements of which we need to fulfill 2015 Core, 5 Discretionary6 Clinical Measures16 Numerator/Denominator Calculations8 Attestation itemsDetermine our EPAdopt implement upgrade incentive opportunityVolume criteria
?How much workHow much timeImpactCostReady
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“Meaningful Use” Criteria a Focal Point Across Previously Disparate Initiatives
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For example
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PCMH MU
Is it just a matter of Oranges and Apples
Recognition/Documentation
Paid Per Patient (in NYS)
M‘caid, M‘care & Payers
State and Federal
9 standards 7 elements166 factors
Certification/Attestation
Paid Per Provider
Medicaid, Medicare
Federal
5 care goals 20 objectives (options and choices)
?
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Medical HomeMeaningful Use
PPC1: Access and Communication
PPC2: Patient Tracking & Registry
PPC3: Care Management
PPC4: Pt Self Management Support
PPC5: Electronic Prescribing
PPC6: Test Tracking
PPC7: Referral Tracking
PPC8: Performance Rpt/Imprvmnt
PPC9: Advanced Electronic Comm
Goal A: Improve quality, safety, _______ efficiency, & reduce health _______ disparities
Goal B: Engage Patients and Families
Goal C: Improve Care Coordination
Goal D: Improve Population and Public Health
Goal E: Ensure Adequate Privacy & Security Protection for PHI
A Simple Comparison
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How Much Overlap? PCMH Elements that relate to HIT (69%)
Ginsburg, Maxfield, O’Malley, Piekes, Pham, Making Medical Homes Work Moving from Concept to Practice Center for Studying Health System Change #1 December 2008
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Home Sweet MeaningfulMedical Home
Patient Centered Care
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The MU Assessment Tool
Some Assessment Tool Results
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Milestone Map of the Journey
EMR Certification(Fall 2010)
Transformational Change
Assess NumeratorsAnd denominators
Adopt Implement Upgrade(Fall 2010 – 2011)
Stage I April 2011?
2012
Count EP’sAnd volume
criteria(now)
Choose MedicareOr medicaid andCalculate 5 yearReturn (now)
EMR Attestation$25K
(Late 2010/2011)
Stage II 2013 - 2014
Stage III 2014 - 2016
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Achieving a balance between
RecognitionAttestation
Applied PrinciplesProcess Gains
Guiding Principle 1
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MU Three Main Process Work Strands
Process HIT/MU/MHOrganizational
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Questions
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Thank You