1. Meaningful Use 2013 Changes Overview JoAnne Hawkins Meaningful Use Sr
Meaningful Use Changes Overview JoAnne Hawkins Meaningful Use Sr. Healthcare Policy Analyst DNC (Contractor) for  U.S. Indian Health Service January 29, 2013

2. Today’s Objectives
Review and understand CMS EHR Incentive Program Stage 1, 2013 changes
Review Patient Volume Calculation changes
Review Performance Measure changes 2

3. 2013 Changes
All changes made for 2013 are not retroactive to CY/FY 2011 or 2012

4. Meaningful Use

5. What is Meaningful Use?
Meaningful Use is using certified EHR technology to:
Improve quality, safety, efficiency, and reduce health disparities
Engage patients and families in their health care
Improve care coordination
Improve population and public health
All the while maintaining privacy and security
The ultimate objective of Meaningful Use is to improve patient care. The CMS Final Rule released on July 28th identified five broad priorities – listed on this slide -- for making these improvements. Each priority concentrates on an aspect of patient care. Every aspect of Meaningful Use is focused on fulfilling 1 or more of these 5 priorities. 5

6. 3 Stages of Meaningful Use
This image shows a conceptual graphic of the advancements of meaningful use.
After the rule making period which led to the Final Rule that is now published in the Federal Register, 3 stages of meaningful use were established. Stage 1 which takes place in 2011 through 2013 is aimed at data capture and sharing. Stage 2 which begins in is aimed at advanced clinical processes and Stage 3 which is slated for 2016 targets improved outcomes. 6

7. Timeline

8. Eligible Professionals: Incentive Program Timeline
CY 2013
01/01/13
First day of calendar and EHR reporting year
10/03/13
Last day to begin 90-day reporting period for the Medicare Incentive Program
12/31/13
Last day of calendar and EHR reporting year
02/28/14
Last day to register and attest

9. Eligible Hospitals: Incentive Program Timeline
FY 2013
10/03/12
First day of calendar and EHR reporting year
07/01/13
LAST day to begin 90-day reporting period for the Medicare Incentive Program
09/30/13
Last day of fiscal year and EHR reporting year
11/30/13
Last day to register and attest

10. Medicaid EP/EH MU Timeline
2011
2012
2013
2014*
2015
2016
2017
A/I/U
Stage1
MU 90 Days
Stage 1
MU 365 Days
Stage 2
Stage 3 10

11. Medicare EP/EH MU Timeline
2011
2012
2013
2014*
2015
2016
Stage1
MU 90 Days
Stage 1
MU 365 Days
Stage 2
MU 90
Days
Stage 3 11

12. Eligible Professionals: Medicare Incentive Payment Example
Amount of Payment Each Year of Participation
Calendar Year EP Receives a Payment
CY 2011
CY 2012
CY 2013
CY2014
CY 2015 and later
$18,000
$12,000
$8,000
$15,000
CY 2014
$4,000
CY 2015
$2,000 $0
CY 2016
TOTAL
$44,000
$39,000
$24,000
Chart showing annual payments based on the first year an EP qualifies for an incentive payment. If the EP qualifies for their first incentive payment in either calendar year 2011 or calendar year 2012, their incentive payments would be: year 1: $18,000, year 2: $12,000, year 3: $8,000, year 4: $4,000, year 5: $2,000. This would total $44,000 over the course of 5 years participating in the program. If the EP qualifies for their first incentive payment in calendar year 2013, their incentive payments would be: year 1: $15,000, year 2: $12,000, year 3: $8,000, year 4: $4,000. This would total $39,000 over the course of 4 years participating in the program. If the EP qualifies for their first incentive payment in calendar year 2014, their incentive payments would be: year 1: $12,000, year 2: $8,000, year 3: $4,000. this would total $24,000 over the course of 3 years participating in the program. There are no incentive payments for an EP who begins demonstrating meaningful use starting in calendar year 2015 or later. The last payment year for the incentives is 2016. 12

13. Eligible Professionals: Medicaid Incentive Payment Example
Amount of Payment Each Year if Continues Meeting Requirements
1st Calendar Year EP Receives a Payment
CY 2011
CY 2012
CY 2013
CY 2014
CY 2015
CY 2016
$21,250
$8,500
CY 2017
CY 2018
CY 2019
CY 2020
CY 2021
TOTAL
$63,750
Chart showing annual payments based on first year EP qualifies for an incentive payment in the Medicaid EHR incentive program. If you start participating anytime between 2011 and 2016, your first year payment would be $21,250. Subsequent payments for the remaining 5 years that an EP can participate would be $8,500 each year they qualify. At the end of the 6 years, if you continue to meet the program requirements to qualify for payment, your total incentive payments would be $63,750.
The total for pediatricians who meet the 20 percent patient volume but fall short of the 30 percent patient volume is $14,167 in the first year and $5,667 in subsequent years. This adds up to a maximum Medicaid EHR incentive payment of $42,500 over a six-year period.
NOTE: A provider will receive payment for A/I/U during their first participation year. However, their A/I/U participation year does not count towards the Meaningful Use participation years. Providers will start Stage 1 of their during their second payment year as outlined below:
Payment year 1- A/I/U
Payment year 2- MU Stage 1, year one (demonstrate MU for 90 days)
Payment year 3- MU Stage 2, year two (demonstrate MU for 365 days) 13

14. EP Patient Volume and Medicaid Hospital Incentive calculation

15. Eligible Professionals and Medicaid: Patient Volume Threshold
Eligible Professional (EP)
If EP does not practice predominantly at FQHC/RHC:
Minimum Medicaid patient volume thresholds
If EP does practice predominantly at FQHC/RHC*:
Minimum needy individual patient volume thresholds
Physicians
30%
- Pediatricians
20%
Dentists
Certified Nurse-Midwives
NPs
PAs practicing at an FQHC/RHC that is led by a PA
N/A
* All Tribal/Urban clinics are deemed FQHC/RHC for the CMS incentive program

16. EP Patient Volume
Current Patient Volume Calculation is based on Medicaid Paid Claims
Beginning in 2013, the patient volume calculation will include:
Medicaid paid claims
Zero paid claims
Individuals enrolled in Medicaid at the time of service
CHIP encounters for patients in Title 19 and Title 21 Medicaid expansion programs (still cannot include CHIP stand-alone Title XXI encounters)
Release date for New Patient Volume Report will be April 30, 2013.
Practicing Predominantly- States will have the flexibility to allow EPs to use a six-month period within the prior calendar year or preceding 12 month period from the date of attestation for the definition of practicing predominantly (more than 50% of the encounters).
Option to determine volume based on a 90 day period in the previous calendar year OR a 90 day period in the previous 12 months preceding the date of attestation.
Medicaid encounters defined where any services were rendered on any one day to an individual enrolled in an eligible Medicaid program. Encounters no longer have to be paid to be counted.
Provider patient volume can include CHIP encounters in the numerator if part of Title XIX expansion of part of Title XXI expansion (still cannot include CHIP stand-alone Title XXI encounters). 16

17. EP Patient Volume Calculation
EP Patient Volume Calculation 2013 (Non-Medicaid Expansion State) –
Federal Sites
Numerator =
Medicaid Paid + Zero Paid Claims +
Medicaid Enrolled
Denominator =
All encounters for that EP
EP Patient Volume Calculation 2013 Medicaid Expansion State –
Federal Sites
Numerator =
Medicaid Paid + Zero Paid Claims+ CHIP+ Medicaid Enrolled
Denominator =
All encounters for that EP

18. EP Needy Patient Volume
EP Patient Volume Calculation – Needy Individual (Tribal and Urban sites)
Numerator =
Medicaid Paid + Zero Paid Claims +
Medicaid Enrolled + CHIP (Title 19 & Title 21) + Uncompensated Care
Denominator =
All encounters for that EP

19. Patient Volume Look-Back Period
Prior to 2013, patient volume was calculated on a 90-day period on the previous calendar year (qualification year)
Beginning in 2013, states have the option to allow EPs to generate a patient volume report based on a different look-back period, either:
across a 90-day period in the last 12 months preceding the provider’s attestation; or
a 90-day period in the previous calendar year

20. Medicaid Hospital incentive calculation

21. Medicaid Incentive Hospital Calculation Change
Prior to 2013, Medicaid Hospital Incentive Calculation was based on the most recent cost report data (previous year)
Participation beginning in 2013 can utilize data from the most recent continuous 12-month period prior to attestation
FEIR report will be updated to reflect the data elements needed for Medicaid Hospital Incentive Calculation

22. Stage 1 2013 Mu Performance AND Clinical quality Measures

23. 2013 MU Requirements Stage 1: 2013 Objectives and Measures
Eligible Professionals must complete:
13 core objectives
5 out of 10 objectives from menu set
6 total Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from additional set)
Eligible Hospitals must complete:
12 core objectives
15 Clinical Quality Measures
Note: A new performance measure report will be released in March 2013

24. Stage 1: 2013 Performance MeasuresEH
Target
Core Measure X
>30%
CPOE for Medication Orders *Measure change*
Yes/No
Drug Interaction Checks
>80%
Maintain Problem List
>40%
E-Prescribing *New Exclusion added*
Active Medication List
Medication Allergy List
>50%:
Record Demographics
>50%
Record Vital Signs
Record Smoking Status
Clinical Quality Measures *Removed in 2013*
Clinical Decision Support Rule
Electronic Copy of Health Information
Clinical Summaries
Electronic Copy of Discharge Instructions
Electronic Exchange of Clinical Information *Removed in 2013*
Protect Electronic Health Information

25. 2013: Stage 1 Performance MeasuresEH
Target
Menu Set Measure X
Yes/No
Drug Formulary Checks
>50%
Advance Directives
>40%
Clinical Lab Test Results
Patient Lists
>20%
Patient Reminders
10%
Patient Electronic Access
>10%
Patient Specific Education Resources
Medication Reconciliation
Transition of Care Summary
*Immunization Registries Data Submission
*Syndromic Surveillance Data Submission
*Reportable Lab Results to Public Health Agencies

26. CPOE
Objective: Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed health care professional who can enter orders into the medical record per state, local, and professional guidelines.
DENOMINATOR: Number of medication orders created by the EP during the EHR reporting period
NUMERATOR: The number of medication orders in the denominator recorded using CPOE
THRESHOLD: The resulting percentage must be more than 30 percent in order for an EP to meet this measure
EXCLUSION: Any EP who writes fewer than 100 medication orders during the EHR reporting period

27. e-Prescribing
Objective: Generate and transmit permissible prescriptions electronically (eRx) .
DENOMINATOR: Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the EHR reporting period; or Number of prescriptions written for drugs requiring a prescription in order to be dispensed during the EHR reporting period
NUMERATOR: The number of prescriptions in the denominator generated, queried for a drug formulary and transmitted electronically using CEHRT
THRESHOLD: The resulting percentage must be more than 50 percent in order for an EP to meet this measure
EXCLUSIONS: Any EP who:
(1) Writes fewer than 100 permissible prescriptions during the EHR reporting period; or
(2) Does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP’s practice location at the start of his/her EHR reporting period.

28. Eligible Professionals: Clinical Quality Measures
Core Set: If denominator = 0, must report on the Alternate Core measures
NQF Measure Number and
PQRI Implementation #
Clinical Quality Measure Title
NQF 0013
Hypertension: Blood Pressure Measurement
NQF 0028
Preventive Care and Screening Measure Pair:
a) Tobacco Use Assessment,
b) Tobacco Cessation Intervention
NQF 0421
PQRI 128
Adult Weight Screening and Follow-up

29. Eligible Professionals: Clinical Quality Measures
Alternate Core Set
NQF Measure Number and
PQRI Implementation #
Clinical Quality Measure Title
NQF 0024
Weight Assessment and Counseling for Children and Adolescents
NQF 0041
PQRI 110
Preventive Care and Screening: Influenza Immunization for Patients
50 Years Old or Older
NQF 0038
Childhood Immunization Status

30. Eligible Professionals: 38 Additional Clinical Quality Measures (Choose 3)
Diabetes: 9
Heart Failure (HF): 3
Coronary Artery Disease (CAD): 3
Pneumonia Vaccination Status for Older Adults
Anti-depressant medication management: 2
Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation
Asthma: 3
Appropriate Testing for Children with Pharyngitis
Cancer Prevention and/ or Oncology: 6
Smoking and Tobacco Use Cessation: 3
Ischemic Vascular Disease (IVD): 3
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: 2
Prenatal Care: 2
Controlling High Blood Pressure
Chlamydia Screening for Women
Low Back Pain: Use of Imaging Studies

31. Eligible Hospitals: 15 Clinical Quality Measures
Emergency Department Throughput – admitted patients
Median time from ED arrival to ED departure for admitted patients
Admission decision time to ED departure time for admitted patients
Ischemic stroke – Discharge on anti-thrombotics
Ischemic stroke – Anticoagulation for A-fib/flutter
Ischemic stroke – Thrombolytic therapy for patients arriving within 2 hours of symptom onset
Ischemic or hemorrhagic stroke – Antithrombotic therapy by day 2
Ischemic stroke – Discharge on statins
Ischemic or hemorrhagic stroke – Rehabilitation assessment
VTE prophylaxis within 24 hours of arrival
Anticoagulation overlap therapy
Ischemic or Hemorrhagic stroke – Stroke Education
Intensive Care Unit VTE prophylaxis
Platelet monitoring on unfractionated heparin
VTE discharge instructions
Incidence of potentially preventable VTE 31

32. Resources

33. Resources
Stage 1 Changes Tip Sheet :
Stage 2 Final Rule:

34. Area MU Contacts Area Area MU Contact Email Phone Number Aberdeen
CAPT Scott Anderson
(605)
Alaska
Richard Hall Kimi Gosney
Karen Sidell
(907)
(907)
(907)
Albuquerque
Jacque Candelaria
(505)
Bemidji
Jason Douglas
(218)
Billings
CAPT James Sabatinos
(406)
California
Marilyn Freeman
Steve Viramontes
(916) x.362
(916) x.359
Nashville
Robin Bartlett
(615)
Navajo
CDR Michael Belgarde
Donna Nicholls
(928)
(505)
Oklahoma
Amy Rubin
(405)
Phoenix
CAPT Lee Stern
Keith Longie, CIO
(602)
(602)
Portland
Woody Crow
(503)
Tucson
Scott Hamstra, MD
(520)

35. Regional Extension Center
REC
REC Contact
Areas
NIHB
Tom Kauley
(505)
All
ANTHC
Richard Hall
Kimi Gosney
Karen Sidell
(907)
(907)
(907)
Alaska
CRIHB
Tim Campbell
Rosario Arreola Pro
Amerita Hamlet
(707)
(916) x.1300
(916) x.1323
California
NPAIHB
Katie Johnson
(503)
Portland
USET
Vicki French
(615)
Aberdeen
Albuquerque
Bemidji
Billings
Nashville
Navajo
Oklahoma
Phoenix
Tucson 35

36. IHS Meaningful Use: Contact Information
Contact
Title
Phone
Chris Lamer
Meaningful Use Project Lead, IHS
(615)
Luther Alexander
MU Project Manager, DNC
(301)
JoAnne Hawkins
MU Healthcare Policy Analyst, DNC
(505) , x1525
Cecelia Rosales
MU Requirements Manager, DNC
(505) , x1230

37. Questions?
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