expanded meaningful use

Expanded Meaningful Use Mandates, Excep4ons & A8esta4on Strategies

Wednesday, August 6, 2014 Disclaimer: Nothing that we are sharing is intended as legally binding or prescrip7ve advice. This presenta7on is a

synthesis of publically available informa7on and best prac7ces.

•  Congress mandated payment adjustments to Medicare eligible professionals who are not meaningful users under the EHR Incen=ve Program

•  Payment adjustments will be applied beginning January 1, 2015

•  May be exempt when able to show that demonstra=ng MU would result in significant hardship

Expanded MU Mandates

Expanded MU Payment Adjustments

•  Cumula=ve 1% annual and (depending on total meaningful users under program aLer 2018) max cumula=ve adjustment can reach 5%

Expanded MU Payment Adjustments-‐Medicare Advantage Organiza=ons

•  Audits to be conducted 2years aLer payment year

•  Adjustments “about six months” aLer MAO no=fied of results •  Correc=ve plans must be complete within that six month period

•  CMS surveyed all MAOs that received incen=ve payments to determine if able to meet 2014 EHR soLware requirements & concluded they should allow same flexibility offered to Fee-‐for-‐Service providers for 2014

•  MAO able to use 2011 edi=on CEHRT or combina=on 2011 & 2014 during 2014 repor=ng period if unable to fully implement 2014 edi=on due availability delay issues

•  Beginning 2015, all eligible professionals and hospitals will be required to report using the 2014 edi=on CEHRT

PRIOR TO 5/23/2014 PROPOSED RULE CHANGES •  All providers mandated to upgrade/adopt cert EHR 2014

•  All providers regardless of MU stage use only three-‐month (or 90-‐day) repor=ng period 2014

•  EPs who first demonstrate MU in 2014 must demonstrate 90-‐day repor=ng period to avoid 2015 adjustments

•  Repor=ng period must occur in first 9mos of calendar year 2014, must a_est by October 1, 2014 to avoid adjustments

•  EPs must con=nue to demonstrate MU every year to avoid payment adjustments in subsequent years

Expanded MU Mandates

•  If finalized, 5/23/14 proposed rule change would allow providers to meet Stage 1 or Stage 2 MU with EHRs cer=fied to the 2011 or 2014 criteria -‐ or a combina=on of both

•  Not a blanket policy for all providers, proposals only apply to those who can demonstrate that they are unable to fully implement 2014 edi=on EHRs

•  Note that Stage 1 objec=ves and measures are referenced two ways: 2013 and 2014

–  2013 designa=on references the original Stage 1 objec=ves and measures, and the 2014 reflects those changes CMS finalized in the Stage 2 Final Rule, effec=ve this year

Expanded MU Proposed Changes

Expanded MU Strategy

Expanded MU Strategy

CMS Decision Tool h8ps://www.cms.gov/Regula4ons-‐and-‐Guidance/Legisla4on/

EHRIncen4vePrograms/Downloads/CEHRT_NPRM_DecisionTool-‐.pdf

Note: Beginning in 2015, all eligible providers would be required to report using 2014 Edi7on CEHRT.

If.. and..

then..

•  Proposed rule would formalize =meline to extend Stage 2 through 2016 -‐ earliest a provider would par=cipate in Stage 3 of MU would be 2017

•  CMS proposed to revert CQM repor=ng requirements for providers a_es=ng with 2011 edi=on EHR – EPs would report on 6 selected CQMs as they did in previous years regardless of MU stage

•  Providers with 2014 edi=on would s=ll report on the requirements finalized in the Stage 2 Final Rule

•  Providers using a combina=on of 2011 and 2014 Edi=on CEHRTs would need to meet the CQM requirements depending upon their Stage of MU

Expanded MU Proposed Changes

Expanded MU A_esta=on

•  2014 Defini=on of Stage 1 EPs must meet: –  13 required core objec=ves –  5 menu objec=ves from a list of 9 –  Total of 18 objec=ves

•  Those using 2011 cert EHR or a combina=on of 2011 and 2014 edi=ons choosing to report 2013 Defini=on Stage 1 core & menu objec=ves reference CMS 2013 Defini=on Stage 1 of Meaningful Use webpage

Expanded MU A_esta=on •  What changed for Stage 1 in 2014:

–  Pa4ent Electronic Access-‐addi=on of new core objec=ve to provide pa=ents with ability to view online, download, and transmit health informa=on

–  Record & Chart Changes in Vital Signs-‐increase in age limit for recording blood pressure in pa=ents to age 3; removal of age limit requirement for height and weight (exclusion for eligible professionals: if no pa=ents 3 years or older are seen; if all three vital signs are not relevant to scope; if height and weight not relevant to scope; or if blood pressure not relevant to scope)

–  Electronic Copy of Health Informa4on-‐removal of electronic copy of health informa=on core objec=ve for Stage 1 for all providers

–  Clinical Quality Measures-‐removal of clinical quality measure (CQM) as a separate core objec=ve for Stage 1 for all providers

•  If approved, exemp=on valid for 1 payment year only

•  New applica=on required for following payment year

•  Cannot be exempted in a any case more than 5 years

•  2015 EP hardship app deadline was July 1, 2014

•  2016 applica=on to be published “soon”

Expanded MU Excep=ons

!Infrastructure: must demonstrate that they are in an area without sufficient internet access or face insurmountable barriers to obtaining infrastructure (e.g., lack of broadband) !New Eligible Professionals: insufficient =me to become meaningful users, can apply for a 2-‐year limited excep=on to payment adjustments (if beginng prac=ce in calendar year 2015 would receive an excep=on to the penal=es in 2015 and 2016, but would have to begin demonstra=ng meaningful use in calendar year 2016 to avoid payment adjustments in 2017)

!Unforeseen Circumstances: Examples may include a natural disaster or other unforeseeable barrier


!Pa4ent Interac4on:

•  Lack of face-‐to-‐face or telemedicine interac=on with pa=ent •  Lack of follow-‐up need with pa=ents

!Prac4ce at Mul4ple Loca4ons: Lack of control over availability of cert EHR for more than 50% of pa=ent encounters "

!2014 EHR Vendor Issues: The eligible professional’s EHR vendor was unable to obtain 2014 cer=fica=on or the eligible professional was unable to implement meaningful use due to 2014 EHR cer=fica=on delays


•  A_esta=ons must be completed by each EP reques=ng Excep=on

•  If classified in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) as having one of the following 5 specialty codes below as primary area of prac=ce no exemp=on form is needed – automa=cally exempt from the 2015 payment adjustment based on the data in PECOS

Diagnos=c Radiology

Nuclear Medicine Interven=onal Radiology

Anesthesiology Pathology


•  Regardless of whether an EP “passes,” “hardships,” “skips,” or “fails” their “Stage 1, Year 2” performance during 2014 they will be required to move up to the next stage –  e.g. PRIOR TO 5/23/14 RULE CHANGE :“Stage 2, Year 1” in 2015 (with a full year repor=ng period) & will not get to repeat Stage 1 for a third year

•  Policy applies even if the Medicare EP is granted a “hardship excep=on” for a given repor=ng year, it skips, or it fails


•  Timeline for proposed rule change –  July 21 public comment closed –  Unlike a direct final rule process, CMS will have to promulgate & announce some =me prior to 10/1/14

•  Will your EPs be compliant Oct-‐Dec 2014?

•  Is your EHR cer=fied, 100% ready? •  Will state level registry website be ready with rule change op=ons to facilitate a_esta=on?

•  Will you have systems & policies for pa=ent portal/informa=on exchange in place?



•  Organiza=ons that have already upgraded to 2014 CEHRT, are conserva=vely encouraged to con=nue progress with building systems as originally planned in 2014, un=l addi=onal clarifica=on from CMS through Final Rule

•  Any progress made can only help accomplish the implementa=on of your 2014 compliant EHR for the 2014 and 2015 repor=ng periods

Q&A

Thank You!

Contact your Quirk Project Specialist for Meaningful Use strategy guidance

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