Presentation on theme: "Meaningful Use and the EHR Incentive Program"— Presentation transcript:
1Meaningful Use and the EHR Incentive Program NIHB Annual Consumer Conference
2EHR Incentive ProgramThe Medicare and Medicaid EHR Incentive Programs will provide incentive payments to eligible professionals (EPs), eligible hospitals (EHs) and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology.EHR Incentive Program rewards providers/hospitals for achieving MU.
3Meaningful Use Eligibility Certified EHR Meaningful Use Measures Clinical Quality MeasuresComponents of MU:- Eligibility: requirements for providers/hospitals within Medicare/Medicaid.- Certified EHR: RPMS is now certified – all patches and applications are released/available- MU Measures – how you are utilizing the EHR’s functionality.- Clinical Quality Measures: no targets – simply report performance.In general, an EP/EH will demonstrate MU in Stage 1 by utilizing certified EHR technology to:- Meet the applicable MU measures, and- Report on the applicable clinical quality measures.Satisfying each of these requirements will qualify the EP/EH for an incentive payment.
4Provider EligibilityTo be eligible for the Medicaid incentive program, a provider must have a Medicaid patient volume of 30%.
5Meaningful Use Eligibility Certified EHR Meaningful Use Measures Clinical Quality MeasuresCertified EHR:RPMS EHR is certified for both inpatient and outpatient facilities. EPs/EHs will use same system.
6Certified RPMS EHR Requirements Name SpacePackage or ApplicationVersionPatchRelease DateAGPatient Registration7.1912/3/10APCLExport3.02711/10/10APSPPharmacy MOD-ePrescribing (eRx)7.010104/29/11BGPClinical Reporting System (CRS)11.036/22/11BJMDC321.016/24/11BJPCPCC Mgmt Reporting2.066/2/11BMCReferred Care Information System (RCIS)4.075/12/11BQIiCare2.13/11/11BRNRelease of Information (ROI)4/13/11BYIMImmunization Exchange Message012/24/11BGOElectronic Health Record (EHR)1.186/10/11LRLab5.21027 or 372 or 33412/07/10PXRMEHR Reminders1.510074/13/10BPHRPersonal Health Record (PHR)Central Ensemble2011GuardianEdge/ Symantec8.03/31/11IPSEC (Windows)2010VanDyke (AIX)WinHasher1.6Universal Client -Continuity of Care Record (CCR)*4/27/11* Universal Client -Continuity of Care Record (CCR) – now known as HIE Viewer is installed on the central servers so there is no installation needed at each facility. The URL to access the application is http://ditdev4.d1.na.ihs.gov:9090/DocViewerThe logon username & password are D1 credentials so each user needs a D1 account and must be added to the Active Directory group that allows access to the HIE Viewer. The AD Group is “IHS NHINC GUI Users”. Contact the help desk to get this added.Current list of required patches/applications is always available at – look for “Application Checklist” link.
7Meaningful Use Eligibility Certified EHR Meaningful Use Measures Clinical Quality MeasuresMU Measures – how you are utilizing the EHR’s functionality.Most measures are same for EPs/EHs, some differences.
8Meaningful Use Measures Yes/No MeasuresImplement drug-drug and drug-allergy checksGenerate at least one report listing patients with a specific conditionMeasures with TargetsRecord smoking status for more than 50% of patientsProvide patient-specific education resources for more than 10% of patientsMU Measures – how you are utilizing the EHR’s functionality.EPs required to meet 20 measures, EHs required to meet 19 measures.*Note: This slide includes brief descriptions of some sample measures. This is not a full list of all MU measures.
9Meaningful Use Measures EP Core Set Measures (15)EH Core Set Measures (14)Use CPOE for medication ordersImplement drug-drug and drug-allergy checksRecord demographicsePrescribingMaintain up-to-date problem list, medication list, medication allergy listRecord and chart changes in vital signsRecord smoking statusImplement one clinical decision support ruleReport clinical quality measuresEPs/EHs must meet every measure in the core set.*Note: This slide includes brief descriptions of core set measures. This is not a full list of all MU measures; this does not list all requirements for each measure.Provide patients an electronic copy of health info upon requestProvide clinical summaries for office visitsProvide electronic copy of discharge instructions upon requestCapability to electronically exchange key clinical information (perform test)Protect electronic health information (security risk analysis)
10Meaningful Use Measures EP Menu Set Measures (10)EH Menu Set Measures (10)Implement drug formulary checksIncorporate clinical lab test results into certified EHRGenerate lists of patients by specific conditionsRecord advance directivesSend reminders to patientsProvide patients with timely electronic access to their health informationUse certified EHR to identify and provide patient-specific education resourcesEPs/EHs must meet 5 measures in the menu set, including one public health measure.*Note: This slide includes brief descriptions of menu set measures. This is not a full list of all MU measures; this does not list all requirements for each measure.Perform medication reconciliation for patients referred to the EP/EHProvide summary of care records for patients referred to other providers/facilitiesSubmit electronic data to immunization registriesSubmit electronic syndromic surveillance data to public health agenciesSubmit electronic data on reportable lab results to public health agencies
11Meaningful Use Eligibility Certified EHR Meaningful Use Measures Clinical Quality MeasuresClinical Quality Measures – no targets, simply report performance.Different CQM sets for EPs and EHs.
12Clinical Quality Measures: EPs Core/Alternate Core Set (6)HypertensionTobacco Use Assessment/Cessation InterventionAdult Weight Screening/Follow-upWeight Assessment/Counseling for ChildrenAdult Influenza ImmunizationChildhood ImmunizationAdditional Measures (38)Breast Cancer Screening; Cervical Cancer Screening; Colorectal Cancer ScreeningEPs report rates for 6 CQMs. May report zero denominators, but those do not count as rates.EP measures look like GPRA measures (e.g., hypertension, tobacco use assessment and cessation intervention, influenza immunization for adults), BUT- have slightly different logic (e.g., different age range),- and are calculated/reported for each provider, not facility aggregate like GPRA.
13Clinical Quality Measures: EHs Emergency Department (2)Median time from ED arrival to ED departure for admitted patients; median time from admit decision time to ED departure time for admitted patientsStroke (7)Anticoagulation for A-fib/flutter, discharge on statins, stroke education, etc.Venous Thromboembolism (6)Anticoagulation overlap therapy, discharge instructions, etc.EHs will report rates for 15 CQMs in three areas: ED, stroke, and VTE.
14Medicare Incentive Program Requirements and Amounts for EPs who begin in 2011 or 2012YearRequirementIncentive1Demonstrate MU for 90-day period$18,0002Demonstrate MU for full calendar year$12,0003Demonstrate MU for full calendar year$8,000Must begin by 2014 to receive incentive payments.For EPs beginning in:2011 or 2012 – up to $44,000 available over 5 years.2013 – up to $39,000 available over 4 years.2014 – up to $24,000 available over 3 years.Demonstrating MU means meeting targets/goals over the reporting period, for example:Implement drug-drug and drug-allergy checksGenerate at least one report listing patients with a specific conditionRecord smoking status for more than 50% of patientsProvide patient-specific education resources for more than 10% of patients4Demonstrate MU for full calendar year$4,0005Demonstrate MU for full calendar year$2,000
15Medicare Incentive Payments Payment YearFirst Year EP Demonstrates MU20112012201320142015CY 2011$18,000CY 2012$12,000CY 2013$8,000$15,000CY 2014$4,000CY 2015$2,000$0CY 2016Total$44,000$39,000$24,000Must begin by 2014 to receive incentive payments.For EPs beginning in:2011 or 2012 – up to $44,000 available over 5 years.2013 – up to $39,000 available over 4 years.2014 – up to $24,000 available over 3 years.Demonstrating MU means meeting targets/goals over the reporting period, for example:Implement drug-drug and drug-allergy checksGenerate at least one report listing patients with a specific conditionRecord smoking status for more than 50% of patientsProvide patient-specific education resources for more than 10% of patients
16Medicaid Incentive Payments Requirements and Amounts for EPsYearRequirementIncentive1Adopt/Implement/Upgrade to certified EHR technology$21,2502Demonstrate MU for 90-day period$8,5003Demonstrate MU for full calendar year$8,5004Demonstrate MU for full calendar year$8,500Must begin by 2016 to receive incentive payments. Total of $63,750 available over 6 years.Demonstrating MU means meeting targets/goals over the reporting period, for example:Implement drug-drug and drug-allergy checksGenerate at least one report listing patients with a specific conditionRecord smoking status for more than 50% of patientsProvide patient-specific education resources for more than 10% of patients5Demonstrate MU for full calendar year$8,5006Demonstrate MU for full calendar year$8,500
17EHR Incentive Program Registration All EPs/EHs will begin registration on CMS website. If participating in the Medicaid program, will continue registration process on the state Medicaid site.
18EHR Incentive Program Registration Screenshot of Registration page on CMS website:1 – Register for the Medicare and/or Medicaid EHR Incentive Programs2 – Registration User Guides and Webinar3 – General information about registration requirements – NPI, NPPES (CMS National Plan and Provider Enumeration System), TIN, I&A (CMS Identity and Access Management)4 – State Medicaid program launch dates and info5 – Attestation page
19EHR Incentive Program Registration Medicare EPs:Register with CMSMedicaid EPs:Register with state Medicaid programHospitals:Register as dual-eligibleWith CMS for MedicareWith state Medicaid program for MedicaidCertified EHR is not required for registration!
20Regional Extension Center The RECs will support and serve health care providers to help them quickly become adept and meaningful users of EHRs. RECs are designed to make sure that primary care clinicians get the help they need to use EHRs.Provide training and support services to assist providers in adopting EHRsOffer information and guidance to help with EHR implementationProvide technical assistanceRECs are designed to support providers in achieving MU.State RECs vs. NIHB REC.NIHB REC is working in collaboration with IHS to provide support.REC funding supports the work of EHR deployment team, clinical consultants providing ongoing EHR training, development of resources, etc.
21REC vs Incentive Program Regional Extension CenterEHR Incentive ProgramEHR certification ruleMeaningful use ruleSupport providers and hospitals in achieving MUReward providers and hospitals for achieving MU
22Regional Extension Center Eligible ProvidersRegional Extension CenterEHR Incentive ProgramPhysicians (MDs and DOs)Family PracticeGeneral PracticeInternal MedicineObstetrics and GynecologyPediatricsAdolescent MedicineGeriatricsPhysician AssistantsNurse PractitionersCertified Nurse MidwivesAlaska CHA/PsMedicare EPsPhysicians (MDs and DOs)DentistsPodiatristsOptometristsChiropractorsMedicaid EPsCertified Nurse MidwivesNurse PractitionersPhysician Assistants*Definitions of eligible providers come from different pieces of legislation: HITECH Act, Public Health Service Act, Social Security Act, etc.Funding for REC based on the number of providers who sign up and participate in the program. This funding supports REC participants and others who are working to achieve MU.
23Provider Responsibilities Regional Extension CenterEHR Incentive ProgramSign up with RECGo live with certified EHRAchieve MURegister with CMS/StateAchieve MUAttest/submit each yearCompleting Milestone = REC FundingDemonstrating MU = Incentive PaymentHave discussed REC and CMS responsibilities:- support you in achieving MU- reward you for achieving MUEach milestone/step/goal is critical for each provider:- Funding for the REC is dependent upon each provider achieving each milestoneIncentive payments to EPs/EHs are dependent upon the EP/EH demonstrating MUImportant to sign up so the REC receives enough funding to accomplish its mission.
24Regional Extension Center EHR Incentive ProgramONCCMS$$$$$$$$IHSNIHB AI/AN RECEPs/EHsNIHB REC vs. State RECs:- RPMS-EHR expertise- Clinical consultants- Supporting work in Indian Country1. Provider signs up with NIHB AI/AN REC2. Provider “goes live” with certified EHR3. Provider achieves meaningful use
25NIHB REC M1: Sign Up http://nihb.org/rec/rec.php Download and complete form, send completed form to NIHB. We will contact you with questions if needed.
26NIHB REC M2: Go LiveWe will send you a form – just complete it and return it.We will verify data using Site Tracker (Site Checker) tool – please install BNP and BCER on your system if you haven’t already!
27NIHB REC M3: Achieve MU Medicare EPs Medicaid EPs and others Provide CMS Attestation IDMedicaid EPs and othersProvide attestation data from RPMS-EHR reportsTo qualify for M3 grant credit, NIHB must (in general) enter numerators/denominators, responses to yes/no measures, and exclusions. We are still looking at this process.Others would include all nurse practitioners, certified nurse midwives, and physician assistants – even if they do not meet the 30% Medicaid patient volume requirement.
28Things to Do Now Sign up with the NIHB REC Designate a Meaningful Use CoordinatorInstall RPMS EHR patches and other required software applications for certificationReview MU Measures and redesign workflowsRegister for EHR Incentive Program (pending launch of State program for Medicaid EPs/EHs)An EP/EH’s 90-day MU demonstration period cannot begin until all required patches and software applications are installed!An EP/EH can register with CMS (and the State, if applicable) any time – prior to or during the 90-day MU demonstration period.
292011 Timeline Hospitals Providers Medicare: Last 90-day period within FY 2011 to demonstrate MU is July 1 – Sept 30, 2011Medicaid: Check with state about deadlinesProvidersMedicare: Last 90-day period within CY 2011 to demonstrate MU is Oct 1 – Dec 31, 2011An EP/EH’s 90-day MU demonstration period cannot begin until all required patches and software applications are installed!
30Resources www.usetinc.net/ehr www.cms.gov/ehrincentiveprograms/ Frequently Asked QuestionsEHR Incentive Program Eligibility, RegistrationStatus of State Medicaid ProgramsMU ListservRPMS-EHR Certification Info
31ContactVicki French United South and Eastern Tribes