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

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Presentation on theme: "Meaningful Use: What You Really Need to Know to Earn the Incentives Stacey Novogoratz – WHITEC Field Operations Manager."— 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 Regional extension centers Workforce training Medicare & Medicaid Incentives and penalties State grants for health Information exchange Standards & certification framework Privacy & Security framework Adoption of EHRs Meaningful Use of EHRs Exchange of health information Improved individual and population health outcomes Increased transparency and efficiency Improved ability to study and improve care delivery Research to enhance HIT HITECH Act Blumenthal D. Launching HITECH. N Engl J Med. 2010 Jan 4.

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

8 Meaningful use is… 8 Using certified EHR technology 1 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 Source : 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

9 Meaningful Use: Path to better outcomes and quality Stage 1 Data capture and sharing Stage 2 Advanced clinical processes Stage 3 Improved outcomes  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 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 11 Stage 1 MU criteria focuses on… Source: STAGE 1 STAGE 2STAGE 3

12 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 Stage 2 MU criteria will focus on… STAGE 1 STAGE 2 STAGE 3

13 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 Stage 3 MU criteria will focus on… STAGE 1 STAGE 2 STAGE 3

14 Medicare and Medicaid EHR Incentive Programs

15 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.

16 Payment Timeline for EPs Fall 201020112012201320142015201620172018201920202021 $18,000$12,000$8,000$4,000$2,000 $18,000$12,000$8,000$4,000$2,000 $15,000$12,000$8,000$4,000 $12,000$8,000$4,000 $21,250$8,500 $21,250$8,500 $21,250$8,500 $21,250$8,500 $21,250$8,500 $21,250$8,500 Stage 1 Stage 2Stage 3 Medicare Incentive Payments Medicaid Incentive Payments $44,000 $39,000 $24,000 $63,750 Maximum Payments Sources: The sooner professionals start successfully demonstrating meaningful use, the sooner they will maximize their EHR incentive payments.

17 17 Medicare EHR Incentive ProgramMedicaid EHR Incentive Program Year 1 optionsMust 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 datesLast year to start is 2014 Last payment is in 2016 Last year to start is 2016 Last payment is in 2021 Fee schedule reductionsBegin in 2015 for EPs that are not meaningful users None Meaningful use definitionMU 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 Sources: Overview of Medicare and Medicaid EHR Incentive Programs

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

19 19 Comparing Medicare and Medicaid EHR Incentive Programs for EPs Source: 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

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

25 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 25 Source: STAGE 1 STAGE 2STAGE 3

26 26  Use CPOE  e-Prescribing  Drug-drug & drug allergy checks  Medication list  Allergy list  Problem list  Decision support  Record demographics Source: Core Set: Must Do All 15  Smoking status  Vital signs  Clinical summaries to patient  Electronic exchange  Health info to patients  Clinical quality measures  Protect health information Stage 1 Objectives for EPs

27  Incorporate clinical labs  Medication reconciliation  Implement drug- formulary checks  Generate patient list  Patient electronic access  Send reminder  Patient-specific education Stage 1 Objectives for EPs Menu Set: Must do 5 of 10  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 0013Hypertension: Blood Pressure Measurement NQF 0028Preventive 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 0024Weight 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 0038Childhood 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 31 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:

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): 1.Implement drug-drug & drug-allergy interaction checks 2.Report ambulatory clinical quality measures 3.Implement one clinical decision support rule 4.Capability to exchange key clinical information 5.Protect electronic health information 6.Implement drug formulary checks 7.Generate lists of patients by specific conditions 8.Capability to submit electronic data to immunization registries 9.Capability to submit electronic syndromic surveillance data to public health agencies

34 Tips for navigating the MU measures Objectives that have NO exclusions: 1.Implement drug-drug & drug-allergy interaction checks 2.Maintain an up-to-date problem list 3.Maintain active medication list 4.Record demographics 5.Report ambulatory clinical quality measures 6.Implement one clinical decision support rule 7.Capability to exchange key clinical information 8.Protect electronic health information 9.Generate lists of patients by specific conditions 10.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 Medicare & Medicaid EHR Incentive Program Registration and Attestation System 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 e-mail 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 –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

48 Incentive Payments Medicare –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) 729-2703

51 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 Questions?

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