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Meaningful Use: What You Really Need to Know to Earn the Incentives

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Presentation on theme: "Meaningful Use: What You Really Need to Know to Earn the Incentives"— Presentation transcript:

1 Meaningful Use: What You Really Need to Know to Earn the Incentives
Stacey Novogoratz – WHITEC Field Operations Manager

2 The Wisconsin Health Information Technology Extension Center (WHITEC)

3 Objectives Provide a high-level background of Meaningful Use (MU ) and the HITECH Act Outline the Medicare & Medicaid EHR Incentive Programs Provide tips for navigating the MU measures Discuss Registration & Attestation processes

4 Background

5 American Recovery and Reinvestment Act of 2009 (ARRA)
Signed February 17, 2009 by President Obama Established the Health Information Technology for Economic and Clinical Health (HITECH) Act

6 HITECH Act Research to enhance HIT Regional extension centers
Adoption of EHRs Workforce training Improved individual and population health outcomes Increased transparency and efficiency Improved ability to study and improve care delivery Meaningful Use of EHRs Medicare & Medicaid Incentives and penalties State grants for health Information exchange Exchange of health information Standards & certification framework The HITECH Act’s Framework for Meaningful Use of Electronic Health Records (EHRs). Establishes the role and function of the Office of the National Coordinator for Health Information Technology (ONC) Various funding initiatives within the Act support the framework that you see here. The HITECH Act program focuses on attaining meaningful use of EHRs as a pathway toward improved health system performance. The attainment of meaningful use depends, in turn, on adoption of EHRs and the development of security and private pathways for exchanging health information. Adoption and exchange will be supported by a variety of HITECH Act initiatives “Ultimately, we believe “meaningful use” should embody the goals of a transformed health system.” Meaningful use, in the long-term, is when EHRs are used by health care providers to improve patient care, safety, and quality.” – David Blumenthal Privacy & Security framework Research to enhance HIT Blumenthal D. Launching HITECH. N Engl J Med Jan 4.

7 A Seasonal View of MU... Snow Meaningful Use of Snow Andrew McFarlane
Melinda Shelton Snow Meaningful Use of Snow

8 Meaningful use is… Using certified EHR technology1 to:
Improve quality, safety, efficiency, and reduce health disparities Engage patients and families Improve care coordination, and population and public health Maintain privacy and security Meaningful use is defined by the Centers for Medicare and Medicaid (CMS). Meaningful use mandated in law to receive incentives. 1 Certification as defined by ONC-Authorized Testing and Certification Body (ONC-ATCB). For more information on certified EHRs and the process of certification, visit Source: 8 8 8

9 Meaningful Use: Path to better outcomes and quality
Stage 1 Data capture and sharing Stage 2 Advanced clinical processes Stage 3 Improved outcomes Graduated approach to introducing more objectives over 5 year period. Stage 2 = Will expand on Stage 1 to focus on continuous quality improvement at the point of care, greater use of CPOE likely, more robust exchange of health information. The five deferred objectives will need to be met here. Stage 3 = Will focus on "promoting improvements in quality, safety and efficiency" with an emphasis on decision support, patient access to self-management tools, access to comprehensive patient data and improving population health. WHITEC should be sustainable in the long term so we would be available for consultation in later stages of MU. Improved quality of patient care Better clinical outcomes Improved population health outcomes Increased transparency and efficiency Empowered individuals More robust research data on health system

10 Dr. David Blumenthal, former National Coordinator of HIT, emphasizes:
“HIT is the means, but not the end. Getting an EHR up and running in health care is not the main objective behind the incentives provided by the federal government under ARRA. Improving health is. Promoting health care reform is.” - At the National HIPAA Summit in Washington, D.C. on September 16, 2009

11 Stage 1 MU criteria focuses on…
Electronically capturing health information in a standardized format Using that information to track key clinical conditions Communicating that information for care coordination processes Initiating the reporting of clinical quality measures and public health information Using information to engage patients and their families in their care The criteria for meaningful use are based on a series of specific objectives, each of which is tied to a measure that allows Eligible Professionals and hospitals to demonstrate that they are meaningful users of certified EHR technology. EPs must report on all CORE objectives and five objectives from the menu set*. For the menu set, one of the two public health criteria (immunization or syndromic surveillance data) must be selected. EPs must report on six total quality measures, three from the core list and three from the additional list. CMS. (2010, August). EHR Incentive Program. Retrieved 2010, from Basic Overview of Stage 1 Meaningful Use: Reporting period is 90 days for first year and 1 year subsequently Reporting through attestation Objectives and Clinical Quality Measures Reporting may be yes/no or numerator/denominator attestation To meet certain objectives/measures, 80% of patients must have records in the certified EHR technology Source: 11 11 11

12 Stage 2 MU criteria will focus on…
More rigorous health information exchange (HIE) Increased requirements for e-prescribing and incorporating lab results Electronic transmission of patient care summaries across multiple settings More patient-controlled data 12

13 Stage 3 MU criteria will focus on…
Improving quality, safety and efficiency, leading to improved health outcomes Decision support for national high priority conditions Patient access to self-management tools Access to comprehensive patient data through patient-centered HIE Improving population health 13 13

14 Medicare and Medicaid EHR Incentive Programs
14 14

15 The Centers for Medicare & Medicaid Services (CMS) is making available up to $27 billion in EHR incentive payments, or as much as $44,000 (through Medicare) or $63,750 (through Medicaid) per eligible professional. 15

16 Payment Timeline for EPs
The sooner professionals start successfully demonstrating meaningful use, the sooner they will maximize their EHR incentive payments. Fall 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 $18,000 $12,000 $8,000 $4,000 $2,000 $15,000 $21,250 $8,500 Stage 1 Stage 2 Stage 3 Medicare Incentive Payments $44,000 $39,000 $24,000 $63,750 Maximum Payments The figure above gives a snapshot of the two incentive programs. The rows refer to the calendar payments made to providers each year when they continue to meet requirements for meaningful use, up to the maximum given for the incentive period. For the Medicare program, the incentive payments vary depending on what year the provider successfully demonstrates meaningful use. For example, an EP who first demonstrates meaningful use in 2013 and in each subsequent year is eligible for up to $39,000 in Medicare incentives, while an EP who first demonstrates in 2011 is eligible for the maximum amount of $44,000. The last year to begin participation in the program is 2014. Medicaid payments do not vary depending on the year the EP first participates in the Medicaid EHR Incentive Program. The last year to begin the program is 2016. Pediatricians who participate in the Medicaid EHR Incentive Program at the 20-29% patient volume receive two-thirds of the full EHR incentive amount. Medicaid Incentive Payments Sources: 16

17 Overview of Medicare and Medicaid EHR Incentive Programs
Medicare EHR Incentive Program Medicaid EHR Incentive Program Year 1 options Must be a meaningful user in Year 1 Adopt/Implement/Upgrade option in Year 1 Who is eligible? 5 types of EPs, subsection (d) hospitals and CAHs 5 types of EPs, acute care hospitals (including CAHs) and children’s hospitals Important dates Last year to start is 2014 Last payment is in 2016 Last year to start is 2016 Last payment is in 2021 Fee schedule reductions Begin in 2015 for EPs that are not meaningful users None Meaningful use definition MU definition will be common for Medicare States can adopt a more rigorous definition (based on common one) Who will implement? Federal government (will be an option nationally) Voluntary for states to implement In Medicare EHR Incentive Program, there is an extra amount available for EPs practicing in predominantly Health Professional Shortage Area (HPSA) 17 Sources: 17

18 Eligibility Medicare-only Eligible Professionals
Could be eligible for both Medicare & Medicaid incentives Medicaid-only Eligible Professionals

19 Comparing Medicare and Medicaid EHR Incentive Programs for EPs
Medicare EHR Incentive Payments Medicaid EHR Incentive Payments Maximum incentives are $44,000 over 5 consecutive years Incentive payments decrease if starting after 2012 Incentive payments based on Fee-for-Service allowable charges Must begin by 2014 to receive incentive payments; last payment year is 2016 Extra amount available for EPs practicing in predominantly Health Professional Shortage Areas Maximum incentives are $63,750 over 6 years (do not need to be consecutive) The first year payment is $21,250; $8,500 for next 5 years Must begin by 2016 to receive incentive payments; last payment year is 2021 Source: 19 19 19

20 EP Eligibility: Medicaid
Must be one of 5 types of EPs Must either: Have ≥ 30% Medicaid patient volume (≥ 20% for pediatricians only); or Practice predominantly in an FQHC or RHC with ≥30% needy individual patient volume Licensed, credentialed No OIG exclusions, living Must not be hospital-based

21 Other Eligibility Considerations
An EP who works at multiple locations, but does not have certified EHR technology available at all of them: Must have 50% of total patient encounters at location(s) where certified EHR technology is available Must base all MU measures only on encounters that occurred at those locations An EP cannot be hospital-based 90% of services performed in Place of Service (POS) 21 (Inpatient) or 23 (Emergency Dept)

22 Other Eligibility Considerations – cont’d
An EP may switch programs once after receipt of an incentive payment, but must do so before 2014 An EP who practices in multiple states and qualifies for Medicaid incentives must choose one state from which to receive payment

23 Medicare Penalties An EP who does not demonstrate MU by 2015 will be subject to payment reductions in their Medicare reimbursement schedule Medicaid-only EPs are not subject to payment reductions Payment reductions may apply for any EP who accepts Medicare, even if you only participate in the Medicaid EHR incentive program Payment reductions start at 1%, increasing a percentage each year, to a maximum of 5%

24 Meaningful Use 24 24

25 MU criteria for Eligible Professionals
STAGE 1 STAGE 2 STAGE 3 MU criteria for Eligible Professionals 15 core objectives 5 objectives out of 10 from menu set Including one public health measure 6 total Clinical Quality Measures 3 core or alternate core 3 out of 38 from additional set Source: 25 25

26 Stage 1 Objectives for EPs
Core Set: Must Do All 15 Use CPOE e-Prescribing Drug-drug & drug allergy checks Medication list Allergy list Problem list Decision support Record demographics Smoking status Vital signs Clinical summaries to patient Electronic exchange Health info to patients Clinical quality measures Protect health information Providers are required to report (to CMS or the State) on all 15 objectives plus 5 from the menu list. Menu objectives –may defer 5 of 10 *Not all MU objectives are applicable to every EP. These EPs would be excluded from having to meet that measure (i.e. dentists reporting on immunization measures). Each objective has an associated ‘measure’, which is the criteria the provider will have to demonstrate (i.e. objective (maintain active medication list), measure (more than 80% of patients have at least one entry recorded ) Source: 26 26 26

27 Stage 1 Objectives for EPs
Menu Set: Must do 5 of 10 Incorporate clinical labs Medication reconciliation Implement drug-formulary checks Generate patient list Patient electronic access Send reminder Patient-specific education Clinical summaries to provider Submit electronic data to immunization registry* Submit electronic syndromic surveillance data* *At least 1 public health objective must be selected. Source:

28 Clinical Quality Measures
Core Set: Must Do 3 NQF Measure Number & PQRI Implementation Number 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 Clinical Quality Measures
Alternate Core Set: Can choose from if Core Set measures do not apply NQF Measure Number & PQRI Implementation Number 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 Reporting Clinical Quality Measures to Medicare
2011 Submit aggregate CQM numerator, denominator, and exclusion data to CMS or the States by ATTESTATION. 2012 Required to electronically submit aggregate CQM numerator, denominator, and exclusion data to CMS or the States. Electronic submission of CQM reports for Medicaid not required until 2013

31 Applicability of MU objectives & measures
Not all MU objectives are applicable to every practice For example, Chiropractors don’t e-prescribe; Dentists don’t immunize EPs who qualify for the Medicare and Medicaid EHR Incentive Programs would be excluded from having to meet non-applicable measures Must attest a zero denominator for that objective Exclusions do not count against the 5 deferred measures Source: 31 31

32 Tips for navigating the MU measures
Understand your vendor’s certification Reports are dependent on data in certain fields Could require some workflow changes You must have the ability to acquire all components of the Complete EHR Even if you are not selecting a certain menu set measure (e.g. patient portal), you need to at least have the ability to acquire the functionality Remember that measures for EPs are based on individual providers Consider how to handle different gaps for different providers Develop communication strategy and process for tracking

33 Tips for navigating the MU measures
Objectives that are attestation only (Yes / No): Implement drug-drug & drug-allergy interaction checks Report ambulatory clinical quality measures Implement one clinical decision support rule Capability to exchange key clinical information Protect electronic health information Implement drug formulary checks Generate lists of patients by specific conditions Capability to submit electronic data to immunization registries Capability to submit electronic syndromic surveillance data to public health agencies

34 Tips for navigating the MU measures
Objectives that have NO exclusions: Implement drug-drug & drug-allergy interaction checks Maintain an up-to-date problem list Maintain active medication list Record demographics Report ambulatory clinical quality measures Implement one clinical decision support rule Capability to exchange key clinical information Protect electronic health information Generate lists of patients by specific conditions Use certified EHR technology to identify patient-specific education resources

35 Tips for navigating the MU measures
Core Measure 3 – Maintain Problem List Must be stored as structured data ICD-9 and SNOMED-CT® are the standard Based on unique patients One patient seen multiple times only counts once in the denominator Problem list doesn’t necessarily need to be updated every time An indication that there are no problems is acceptable

36 Tips for navigating the MU measures
Core Measure 4 – e-Prescribing (eRx) Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the EHR reporting period. Does not include authorizations for other items or services (e.g. durable medical equipment If a patient requests a paper prescription, this cannot be excluded from the denominator EPs cannot receive incentive payments from the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) and the Medicare EHR Incentive Program for the same year EPs can receive MIPPA and Medicaid EHR Incentive payments in the same year

37 Tips for navigating the MU measures
Core Measure 10 – Clinical Quality Measures (CQMs) EPs may submit results for CQMs that were not certified by the vendor CQM reports must be generated by certified technology If pulling from a data warehouse, the data warehouse may need to be certified Denominators of zero are acceptable, however... If zero for a core measure denominator, the EP must report on an alternate core measure, up to three Even if all 6 core measures have zero denominators, the EP must still report on 3 of the 38 additional measures The three additional measures can’t be from the alternate core set

38 Tips for navigating the MU measures
Core Measure 14 - Electronic Exchange of Clinical Information The use of physical media (e.g. USB, CD) does not meet the measure Exchange must be with a different legal entity not sharing a common database Options to test exchange may include: Vendor-specific functionality Direct through the Wisconsin Statewide Health Information Network (WISHIN) Other Health Information Service Providers (HISPs)

39 Registration and Attestation

40 https://ehrincentives.cms.gov/hitech/login.action
Medicare & Medicaid EHR Incentive Program Registration and Attestation System https://ehrincentives.cms.gov/hitech/login.action Start here for both programs Medicare: Complete both registration & attestation through this site Medicaid: Register through this site, then complete application through ForwardHealth Portal

41 Registration – What you need for EPs
Logging in: National Provider Identifier (NPI) National Plan and Provider Enumeration System (NPPES) User ID and Password Choosing a program: You must know whether you are applying for the Medicare or Medicaid EHR Incentive Program Reassigning payments: Payee Tax Identification Number (if you are reassigning your benefits). Payee National Provider Identifier (NPI) (if you are reassigning your benefits).

42 Registering or attesting on behalf of an EP
You must have an active Identity and Access Management System (I&A) web user account Must be associated with the EP’s NPI (requires EP’s approval)

43 Attestation – What you need for Medicare EPs
EHR certification number Dates of 90-day reporting period Numerators & denominators for applicable measures Ex: Clinical summaries provided to patients for more than 50% of all office visits within 3 business days Good idea to print the summary page at the end of successful attestation You will not receive an confirmation

44 Applying for the WI Medicaid EHR Incentive Program
Begin at CMS site – select Medicaid Must wait 2 full business days before proceeding to application for WI program ForwardHealth Portal account is required Portal Administrators will automatically have access to the Wisconsin Medicaid EHR Incentive Program application Will need patient volume data for 90-day reporting period For EPs using the eligible member patient volume, a standard deduction of 8.08% is applied to account for CHIP encounters

45 Adopt/Implement/Upgrade (AIU) for Medicaid EPs
Adopt = demonstrate acquisition, installation, or contractual proof of a future acquisition of certified EHR technology Implement = meet the criteria for adopting certified EHR technology and demonstrate actual implementation, installation, or utilization of certified EHR technology Upgrade = meet the criteria for adopting and implementing and demonstrate expansion of the certified EHR technology’s functionality such as the addition of an e-prescribing functionality or Computerized Physician Order Entry.

46 Documentation of AIU Adoption Implementation Upgrade
Receipt(s) for certified EHR technology Contract for certified EHR technology Implementation One from each List List One: Receipt(s), Contract List Two: Maintenance agreement, Installation contract or receipt(s), system logs, Evidence of cost, contract, or third party certification of certified EHR technology training Upgrade Receipt(s) Executed contract *Additional documentation may be considered but must, at a minimum, identify the certified EHR technology adopted, implemented or upgraded and indicate the certified EHR technology acquired or purchased.

47 Certified Health IT Product List (CHPL)
For EPs, select Ambulatory Practice Type Search to find the product you use Add product(s) to your cart until your product(s) meet 100% of the CMS required criteria Request a CMS EHR Certification ID for CMS attestation ID contains 15 alphanumeric characters Is NOT the same as the CHPL Product Number Only need to get this once if attesting for multiple EPs who use the same system You must have a complete EHR, even if not attesting to menu set measures that may require additional modules Go to CHPL website for demo

48 Incentive Payments Medicare Medicaid
EPs will receive full $18K (2011 & 2012) once they have $24K in allowed Part B charges for a calendar year This is tracked by Medicare Medicaid Payments reassigned to an organization will be sent through an electronic funds transfer (EFT) EPs receiving payments themselves are encouraged to set up an ETF, however, can receive paper checks

49 Other Resources CMS EHR Incentive Programs – Office of the National Coordinator for Health IT – WI DHS – Medicaid EHR Incentive Program – WHITEC – WISHIN –

50 Contact Information Stacey Novogoratz, WHITEC Field Operations Manager (608)

51 Questions? WHITEC, operated as a division of MetaStar, is funded through a cooperative agreement award from the Office of the National Coordinator, Department of Health and Human Services Award No. 90RC0011/01


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