understanding meaningful use - 26feb2010
DESCRIPTION
Wondering about the meaning of Meaningful use? Pulse offers a brief overview of the forthcoming Meaningful Use requirements and what you need to do as a physician to be eligible to receive ARRA Stimulus money when it becomes available.TRANSCRIPT
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ARRA HITECH Meaningful Use Update
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What Does it All Mean to You?
Two programs with substantial incentive payment programs Medicare offers up to $44,000 per physician Medicaid offers up to $63,750 per physician
Non-participation leads to reimbursement penalties 1% penalty in 2015 2% penalty in 2016 3% penalty in 2017 5% penalty in 2019
Qualification requires: Certified Complete EHR Meaningful Use
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What Do Physicians Need to Do?
Choose a Certified Complete EHR
2010 2011
Utilize all meaningful use measures for at least 90 consecutive days
Choose Medicare or Medicaid incentive program
Attest to meaningful use and name of Certified Complete EHR
Implement and train usage to all meaningful use measures
Receive first payment
2 3 4 51
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Lots of Questions
How will I prove I’m meeting Meaningful Use measures?
How long do I have to prove Meaningful Use measures?
How will I prove I’m using a Certified Complete EHR?
Will the incentive payments be made to physicians or practices?
How often will payments be made?
Which incentive program is best for me…Medicare or Medicaid?
What if my local HIE isn’t live yet?
Many questions are ready to be answered today, this presentation will address many of the most common questions encountered.
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When will it all be finalized?
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Where Is It All Leading?
2015
2013
2011
Enable significant and measurable improvements in population health through a transformed delivery system.
Adapted from Health Information Technology Meaningful EHR Use Workgroup, June 16, 2009
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Building An Electronic Healthcare Network
Personal Health Records Health Vault/Google Health
Electronic Health Records Certified Complete EHR $20 billion Incentive payments available
Health Information Exchanges/Regional Health Information Organizations – Connecting Patient Data within Medical Trade Areas $564 million grants issued Feb. 12th, in all 50 states
National Health Information Network – A network of networks HIE grants earmarked with NHIN funding
SureScripts™ - National clearing-house for prescriptions
Regional Centers – Consulting with Primary Care Practices $250 million in grants issued Feb. 12th in 39 regions
Community College Consortia to Educate Information Technology Professionals in Health Care $70 million to be awarded March ‘10
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What Do Physicians Need to Do?
Choose a Certified Complete EHR
2010 2011
Utilize all meaningful use measures for at least 90 consecutive days
Choose Medicare or Medicaid incentive program
Attest to meaningful use and name of Certified Complete EHR
Implement and train usage to all meaningful use measures
Receive first payment
2 3 4 51
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Utilize Certified EHR Technology
Certified EHR Technology
Certified Complete EHRMeets all 25 measures
Certified EHR ModuleMeets 1 of 24 measures
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HHS Certification Process
Rules expected in February to define process for how certifying bodies will be named, certified and issue certifications
CCHIT will almost certainly be a certifying body Already aligned certification criteria with proposed MU measures Dr. Mark Leavitt, CCHIT Chair: “Unless they pass a law saying that certifying
bodies cannot start with the letter C, we will be a certifying body.”
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What is a Certified Complete EHR?
CCHIT mapped latest proposed requirements to 2011 Comprehensive Certification
Pulse EHR first to fully certify for CCHIT 2011 Ambulatory Comprehensive Certification without any restrictions
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What Do Physicians Need to Do?
Choose a Certified Complete EHR
2010 2011
Utilize all meaningful use measures for at least 90 consecutive days
Choose Medicare or Medicaid incentive program
Attest to meaningful use and name of Certified Complete EHR
Implement and train usage to all meaningful use measures
Receive first payment
2 3 4 51
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New: Staged Approach to Meaningful Use
2011 2012 2013 2014 2015
2011 Stage 1 Stage 1 Stage 2 Stage 2 Stage 3
2012 Stage 1 Stage 1 Stage 2 Stage 3
2013 Stage 1 Stage 2 Stage 3
2014 Stage 1 Stage 3
2015 Stage 3Firs
t Pay
men
t Yea
r
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Proposed Meaningful Use Measures: Stage 1Stage 1 Meaningful Use Proposed Requirements Pulse EHR FunctionUse Computerized Physician Order Entry (CPOE)
MedicationsLaboratoryRadiology/imagingProvider referrals
Orders Module
Incorporate clinical lab-test results into EHR as structured data Orders Module
Implement drug-drug, drug-allergy, drug formulary checks ePrescribing
Generate and transmit permissible prescriptions electronically ePrescribing
Maintain active medication and medication allergy list ePrescribing
Electronically complete medication reconciliation of two or more medication lists (compare and merge) into a single medication list that can be electronically displayed in real-time
ePrescribing
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Proposed Meaningful Use Measures: Stage 1Stage 1 Meaningful Use Proposed Requirements Pulse EHR FunctionMaintain an up-to-date problem list of current and active diagnoses Charge capture/Orders
Implement 5 clinical decision support rules Encounter capture
Provide clinical summaries for patients for each office visit Encounter capture
Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, and outreach
Clinical reporter
Report quality measures to CMS or the States Clinical reporter
Send preventive/ follow up care reminders to patients per patient preference
Health maintenance and alerts
Record and chart changes in vital signs for at least 80% of all unique patients age 2 and over
Vitals capture
Record “smoking status” for at least 80% of all unique patients 13 years or older
Social History capture
At least 80% of all unique patients seen have demographics recorded as structured data
Patient chart
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Proposed Meaningful Use Measures: Stage 1Stage 1 Meaningful Use Proposed Requirements Pulse EHR FunctionCheck insurance eligibility electronically from public and private payers
Practice Management
Claims filed electronically to public and private payers Practice Management
Provide an electronic copy of health information to patients upon request
Pulse Patient Portal
Enable a user to provide patients with online access to their clinical information, including, at a minimum, lab test results, problem list, medication list, medication allergy list, immunizations, and procedures.
Pulse Patient Portal
Enable a user to electronically transmit a patient summary record to other providers and organizations
Interoperability standards
Capability to exchange key clinical information among providers of care and patient authorized entities electronically
Interoperability standards
Enable a user to submit electronic data to immunization registries Interoperability standards
Enable a user to provide electronic syndromic surveillance data to public health agencies
Interoperability standards
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Comments? You Have Until March 15th
Federal eRulemaking Portal: http:// www.regulations.gov Identified by RIN 0991-AB58
Regular, Express, Overnight Mail, Hand Delivery or CourierDepartment of Health and Human Services
Office of the National Coordinator for Health Information Technology
Attention: HITECH Initial Set Interim Final Rule
Hubert H. Humphrey Building, Suite 729D
200 Independence Ave., SW.
Washington, DC 20201
All comments received before the close of the comment period will be available for public inspection at http://www.regulations.gov
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Comment Sample…Health IT Policy Committee
Allow providers to defer up to five proposed measures from 2011-13 Providers could not defer all measures from a single priority area No deferrals in the privacy and security priority area
Certain meaningful use measures should remain mandatory, such as: Using computerized physician order entry systems Providing patients with electronic copies of discharge instructions Recording patient demographics as structured data Transmitting certain prescriptions electronically
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Stage 2 Preview HHS anticipates redefining objectives to include not only the capturing of
data in electronic format but also the exchange of that data in increasingly structured formats
Stage 2 meaningful use criteria preview: “CPOE use” will include not only the percentage of orders entered
directly by providers through CPOEs but also the electronic transmission of those orders
“Incorporate clinical lab-test results into EHR as structured data” will be expanded, where feasible
Measures that currently require the performance of a capability test will be revised to require the actual submission of that data
Measures that currently allow the provision and exchange of unstructured data will require the provision and exchange of electronic and structured data, where feasible
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How will Meaningful Use be proven?
Attestation to CMS1. Complete EHR Certification information (supplied by Pulse)
2. Describe performance on all functional measures required for Meaningful Use
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Clinical Reporting Measures
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Core Clinical Reporting Measures
Reports on patient care from administration and medical record data Allows identification of patterns in diagnosis and treatment All reporting must use a Certified Complete EHR to capture and calculate results
All Physicians are required to report information on Core measures
Proposed Required Core Clinical Reporting Measures1. Inquiry Regarding Tobacco Use
2. Blood pressure measurement
3. Drugs to be avoided in the elderly
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Specialty Specific Proposal Measures
Cardiology Pulmonology Endocrinology Oncology Surgery Primary Care Pediatrics
OB GYN Neurology Psychiatry Ophthalmology Podiatry Radiology Gastroenterology Nephrology
Specialty measures will be limited to a required subset of 3 to 5 measures based on the availability of electronic measure specifications and comments received
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How will Clinical Quality Measures be Submitted?
For 2011, an attestation methodology will be used to submit summary information to CMS on clinical quality measures as a condition of demonstrating meaningful use of Certified EHR Technology
HHS and State CMS Technology is expected to be ready to receive data electronically starting in 2012 Many Health Information Exchanges are considering offering physicians the
service of packaging and submitting meaningful use data.
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What Do Physicians Need to Do?
Choose a Certified Complete EHR
2010 2011
Utilize all meaningful use measures for at least 90 consecutive days
Choose Medicare or Medicaid incentive program
Attest to meaningful use and name of Certified Complete EHR
Implement and train usage to all meaningful use measures
Receive first payment
2 3 4 51
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Who Qualifies?
Medicare Eligible Providers (EP)
Doctor of medicine or osteopathy Doctor of dental surgery of
medicine Doctor of podiatric medicine Doctor of optometry Chiropractor
Medicaid Eligible Providers (EP)
Physicians Dentists Certified nurse – midwives Nurse practitioners Physicians assistants in FQHC or
RHC led by a Physician assistant
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Medicare Up to $44,000 over 5 years 75% of submitted allowable
charges to Medicare, up to the capped amount for that year Part B claims for the Fee for
Service program Items in the Medicare Physician’s
Fee Schedule “Professional” components only,
no “Technical” components
Medicaid Up to $63,750 over 6 years Flat fees to cover 85% cost of
purchasing, implementing and maintaining an EHR Average allowable cost for EHR
purchase, including implementation and hardware is $54,000
Average allowable annual cost for maintenance is $20,610
How are the Incentives Calculated?
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Payment Calendars
Medicaid incentive qualification must start by 2015, no payments beyond 2021
2011 2012 2013 2014 2015 2016 Total
2011 $18,000 $12,000 $8,000 $4,000 $2,000 $0 $44,000
2012 $18,000 $12,000 $8,000 $4,000 $2,000 $44,000
2013 $15,000 $12,000 $8,000 $4,000 $39,000
2014 $12,000 $8,000 $4,000 $24,000
2015+ $0Firs
t Att
esta
tion
Year
Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Total
$21,250 $8,500 $8,500 $8,500 $8,500 $8,500 $63,750
Medicaid Calendar
Medicare Calendar
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Medicare Full incentive payment in 2011
requires allowable charges of $24,000 Lower allowable charges result in
lower incentive payments
Eligible Providers in a Health provider shortage area (HPSA) can claim an additional 10% incentive payment bonus
Medicaid 30% of all patient encounters must
be attributable to Medicaid over any continuous 90-day period within a calendar year Short-term outreach programs not
applicable Must re-attest annually
20% requirement for Pediatricians 33% lower available incentive
How are the Incentives Calculated?
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Medicare First year (2011) requires
continuous 90-day period within the payment year which can attest to Meaningful Use
Cannot cross calendar years
Medicaid Can begin as early as 2010 if the
state has filed an indication of readiness to capture electronic information
90-day attestation period would apply to both 1st and 2nd years in states approved for 2010 incentive
Cannot cross calendar years
Physician must demonstrate actual full installation to qualify in 2010
If you have already implemented and are ready to prove Meaningful Use, the program will begin in 2011
What is the Timing?
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Other Unique Medicaid Differences
Outside funds, other than State or local funds, such as through a Stark program, that are directly tied to payment for an EHR will be subtracted
Average Allowable Costs in Medicaid program allow ability to accept up to $29,000 in first year and $10,610 in following years without impacting
Physicians must choose only one state to apply for Medicaid payments
State choice may be changed annually at re-attestation
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Switching Incentive Programs
Physicians may switch between programs only once during the shared program periods (last year to switch is 2014)
After switching, the EP continues at the next ‘program year’
Example: After 2 years in Medicare program, an EP would start in year 3 in Medicaid program
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What Do Physicians Need to Do?
Choose a Certified Complete EHR
2010 2011
Utilize all meaningful use measures for at least 90 consecutive days
Choose Medicare or Medicaid incentive program
Attest to meaningful use and name of Certified Complete EHR
Implement and train usage to all meaningful use measures
Receive first payment
2 3 4 51
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Getting Paid Tracking will be done by NPI (National Provider Identifier) A single annual payment
Medicare will pay via CMS Medicaid will pay from State Medicaid or designated organization
Payments will be made on a rolling basis as Meaningful Use is reported End of reporting period and/or threshold for maximum payment is reached
Payments can be reassigned to any entity with a valid employment agreement with the EP Cannot split re-assignment across multiple entities
A single database will track participation for both programs Application for each program will include:
Identify Medicare or Medicaid program participation Name, NPI, business address and business phone Taxpayer ID Number of payment destination
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The time to get started is now!
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Prepare An Organized Plan to Implement Now
Choose a Certified Complete EHR
2010 2011
Utilize all meaningful use measures for at least 90 consecutive days
Choose Medicare or Medicaid incentive program
Attest to meaningful use and name of Certified Complete EHR
Implement and train usage to all meaningful use measures
Receive first payment
2 3 4 51
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Get Started Now
If you are not using EHR currently, consider only CCHIT 2011 Comprehensive Certified solutions Pulse EHR is fully CCHIT 2011 Comprehensive Certified
Currently installed version meets and exceeds all proposed HHS Complete EHR Certification requirements
If you are using an EHR today, perform practice usage gap analysis against proposed measures Expand CPOE usage Discreet data capture Coded systems are key to interoperability use
Evaluate which incentive program is best for you
Develop a plan for re-assignment of incentive payments
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Consider Pulse EHR
Easier to buy.Easier to implement.Easier to learn.Easier to use.Easier to adopt.
An easier way to meaningful use.
