1. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services S2MU Part II: Choosing wisely among Menu Requirements and Clinical Quality Measures Moderator: Mary Zile, BSN, MHSA Speakers: Andrew Bledsoe, MBA Nathan Diller, MBA, MHSA

2. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Agenda Overview of Meaningful Use Deep Dive: S2MU Menu Measures Deep Dive: Clinical Quality Measures Question & Answers 2

3. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Overview of Meaningful Use

4. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Definition of Meaningful Use Use of ONC-HIT Certified Electronic Health Records (EHR) Electronic Exchange of Health Information Quality Reporting 4

5. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services HITECH: Policy Framework Better care for individuals, better health for populations, and lower per-capita costs. IHI-Triple Aim Initiative

6. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Pillars of Meaningful Use Improve quality, safety, efficiency, and reduce health disparities Provide access to comprehensive patient health data for patient’s health care team Use evidence-based order sets and CPOE Apply clinical decision support at the point of care Generate lists of patients who need care and use them to reach out to patients Engage patients and families Provide patients and families with timely access to data, knowledge, and tools to make informed decisions and to manage their health Improve care coordination Exchange meaningful clinical information among professional health care team Improve population and public health Submit immunization, syndromic surveillance and reportable disease data to public health agencies Ensure privacy and security protection for personal health information Protect confidential information through operating policies, procedures, and technologies Provide transparency of data sharing to patient

7. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services 7

8. Why S2MU Matters Stage 2 Meaningful Use serves as a foundation for other health care innovation initiatives S2MU is a glide path to: Accountable care organizations Medical home Payment reform initiatives 8

9. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Stages of Meaningful Use http://www.cms.gov/EHRIncentivePrograms

10. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services 10

11. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services 11 For Medicare Hospitals:

12. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Medicare Payment Adjustments Medicare EPs who are not meaningful users will be subject to a payment adjustment beginning on January 1, 2015. 12

13. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Medicare Payment Adjustments EPs who first demonstrated meaningful use in 2011 or 2012 must demonstrate meaningful use for a full year in 2013 to avoid payment adjustments in 2015. They must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years. 13

14. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Hardship Exceptions for Medicare EPs EPs can apply for hardship exceptions in the following categories: Infrastructure New EPs Unforeseen circumstances By specialist/provider type 14

15. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Meaningful Use – Who is eligible for incentives? Eligible Providers in Medicare Eligible Providers in Medicaid Eligible Professionals (EPs) Doctor of Medicine or Osteopathy Physicians (Pediatricians have special eligibility & payment rules) Doctor of Dental Surgery or Dental Medicine Nurse Practitioners (NPs) Doctor of Podiatric MedicineCertified Nurse-Midwives (CNMs) Doctor of OptometryDentists ChiropractorPhysician Assistants (PAs) who practice in a Federally Qualified Health Center (FQHC) or rural health clinic (RHC) that is led by a PA Eligible Hospitals Acute Care Hospitals Critical Access Hospitals (CAHs)Children’s Hospitals No Changes from Stage 1 Meaningful Use

16. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services S2MU Change in Total Objectives Required 16 Stage 1 MU – Eligible ProfessionalsStage 2 MU – Eligible Providers 15 core objectives17 core objectives 5 of 10 menu objectives3 of 6 menu objectives 20 total objectives Stage 1 MU – Eligible Hospitals & CAHs Stage 2 MU – Eligible Hospitals & CAHs 14 core objectives16 core objectives 5 of 10 menu objectives3 of 6 menu objectives 19 total objectives

17. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services How to Get to S2MU 17 17 Core Objectives 3 of 6 Menu Objectives 9 Clinical Quality Measures Meaningful Use

18. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Deep Dive: S2MU Menu Measures 18

19. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Stage 2 MU EP Menu Objectives Menu ObjectiveMeasure 1. Imaging Results More than 20% of imaging results are accessible through Certified EHR Technology 2. Family History Record family health history for more than 20% of unique patients 3. Syndromic Surveillance Successful ongoing transmission of syndromic surveillance data 4. CancerSuccessful ongoing transmission of cancer case information 5. Specialized Registry Successful ongoing transmission of data to a specialized registry 6. Progress Notes Enter an electronic progress note for more than 30% of unique patients

20. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Menu Set Requirements 20 ObjectiveStage 1 MUStage 2 MUSummary of Change Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT N/A More than 10% of all tests whose result is one or more images ordered by an EP during the EHR reporting period are accessible through CEHRT. New Requirement

21. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Menu Set Requirements 21 ObjectiveStage 1 MUStage 2 MUSummary of Change Record patient family health history as structured data N/A More than 20% of all unique patients seen by the EP during the EHR reporting period have a structured data entry for one or more first-degree relatives. New Requirement

22. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Menu Set Requirements 22 ObjectiveStage 1 MUStage 2 MUSummary of Change Record electronic notes in patient records N/A Enter at least one electronic progress note created, edited and signed by an EP for more than 30% of unique patients with at least one visit during the EHR reporting period. Electronic progress notes must be text- searchable. New Requirement

23. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Menu Set Requirements 23 ObjectiveStage 1 MUStage 2 MUSummary of Change Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice N/A Successful ongoing submission of electronic syndromic surveillance data from CEHRT to a public health agency for the entire EHR reporting period. New Requirement

24. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Menu Set Requirements 24 ObjectiveStage 1 MUStage 2 MUSummary of Change Capability to identify and report cancer cases to a State cancer registry, except where prohibited, and in accordance with applicable law and practice N/A Successful ongoing submission of cancer case information from CEHRT to a public health central cancer registry for the entire EHR reporting period. New Requirement

25. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Menu Set Requirements 25 ObjectiveStage 1 MUStage 2 MUSummary of Change Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice N/A Successful ongoing submission of specific case information from CEHRT to a specialized registry for the entire EHR reporting period. New Requirement

26. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Deep Dive: Clinical Quality Measures 26

27. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Domains Patient and Family Engagement Patient Safety Care Coordination Population/Public Health Efficient Use of Healthcare Resources Clinical Process/Effectiveness 27

28. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services How do CQMs relate to the CMS Incentive Programs? Although reporting CQMs is no longer a core objective of the EHR Incentive Programs, all providers are required to report on CQMs in order to demonstrate Meaningful Use. In 2014 and beyond, reporting programs (i.e., PQRS, eRx reporting) will be streamlined in order to reduce provider burden.

29. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Alignment Among Programs 2014 represents CMS’s commitment to aligning quality measurement and reporting among programs, including Hospital Inpatient Quality Reporting Program, PQRS, CHIPRA, and ACO Programs. Hospital Inpatient Quality Reporting Program PQRSCHIPRAACO

30. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Reporting CQMs in 2014 and Beyond Beginning in 2014, all Medicare-eligible providers in their second year and beyond of demonstrating meaningful use must electronically report their CQM data to CMS. Medicaid providers will electronically report their CQM data to their state.

31. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Clinical Quality Measures ProviderPrior to 20142014 and Beyond* EPs Complete 6 out of 44: 3 core or 3 alt. core + 3 menu Complete 9 out of 64 Must cover at least 3 NQS domains Recommended core CQMs include: 9 CQMs for the adult population 9 CQMs for the pediatric population Prioritize NQS domains Eligible Hospitals and CAHs Complete 15 out of 15 Complete 16 out of 29 Choose at least 1 measure in 3 NQS domains

32. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Please note: In 2014, providers will only demonstrate Meaningful Use for a three-month period EP’s – Calendar Year EH’s – Fiscal Year (Medicare Providers three month period must be tied to quarter) All subsequent reporting period will be entire year 32

33. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Reporting Options for EP’s – 2014 and After CategoryData LevelPayer LevelSubmission Type Reporting Schema EP’s in First Year of MUAggregateAll PayerAttestationSubmit 9 CQM’s covering 3 Domains EP’s Beyond the First Year of Demonstrating Meaningful Use Option 1AggregateAll PayerElectronicSubmit 9 CQM’s covering 3 Domains Option 2PatientMedicare OnlyElectronicSatisfy Requirements of PQRS using CEHRT Group Reporting (Only EP’s Beyond the First Year of Demonstrating Meaningful Use) EP’s in an ACO (Medicare Shared Savings Program or Pioneer ACO’s PatientMedicare OnlyElectronicSatisfy Requirements of ACO EP’s Satisfactorily Reporting via PQRS Group Reporting Options PatientMedicare OnlyElectronicSatisfy Requirements of PQRS Group reporting using CEHRT 33

34. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Recommended Core CQM’s For both adult and pediatric providers, CMS is recommending certain core CQM’s for providers These recommendations were based on the following: Conditions contributing to morbidity and mortality Conditions representing national public health priorities Conditions common to health disparities Conditions driving healthcare costs Measures allowing agencies to more effectively measure quality care Measures that include patient and/or caregiver engagement 34

35. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Recommended Core CQM’s 35 Adult Recommended Core Measures NQF: 018 Controlling High Blood PressureNQF: 022 Use of High-Risk Medications in the Elderly NQF: 028 Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention NQF: 052 Use of Imaging Studies for Low Back PainNQF: 418 Preventative Care and Screening: Screening for Clinical Depression and Follow-UpNQF: 419 Documentation of Current Medications in the Medical RecordNQF: 421 Preventative Care and Screen: Body Mass Index Screening and Follow-UpNQF: TBD Closing the Referral Loop: Receipt of Specialist Report

36. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Recommended Core CQM’s 36 Pediatric Recommended Core Measures NQF: 002 Appropriate Testing for Children and PharyngitisNQF: 024 Weight Assessment and Counseling for Nutrition and Physical ActivityNQF: 033 Chlamydia Screening for WomenNQF: 038 Childhood Immunization StatusNQF: 069 Appropriate Treatment for Children with Upper Respiratory InfectionNQF: 108 ADHD: Follow-Up Care for Children Prescribed ADHD MedicationNQF: 418 Preventative Care and Screening: Screening for Clinical Depression and Follow-UpNQF: TBD Children Who Have Dental Decay or Cavities

37. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services CQM By Specialty The CQM’s can be grouped by the following areas: Asthma - 1 Cancer Screening and Oncology Measures – 7 Cardiovascular Care Measures – 11 Coordination of Care Measures – 1 Family Medicine Measures – 15 Dental Care Measures – 2 Diabetes Measures – 8 Measures for Elderly Patients – 4 37

38. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services CQM By Specialty Functional Status Measures – 3 Imaging Measures 2 Infectious Disease Measures – 7 Mental Health and Substance Abuse Measures – 13 Pediatric Measures – 9 Prenatal Measures – 2 Preventative Care Measures – 16 Vaccination Measures – 3 Vision Care Measures – 6 Women’s Health Measures – 5 38

39. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Reporting Specifications Each eCQM can be described in 3 different ways depending on the intended use: HTML - This is a human readable format so that the user can understand both how the elements are defined and the underlying logic used to calculate the measure. XML – This is a computer readable format which enables the automated creation of queries against an EHR or other operational data store for quality reporting. Value Sets – Value sets are the specific codes used by developers to program the system to accurately capture patient data in the EHR system. 39

40. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Q&A Session 40

41. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Additional MU Information Tri-State Regional Extension Center www.tristaterec.org/S2MU CMS EHR Incentive Program Home Page http://www.cms.gov/EHRIncentivePrograms/ Office of National Coordinator for Health IT http://healthit.gov/ 41

42. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services References / Resources http://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/2014_Cl inicalQualityMeasures.html http://www.healthit.gov/providers-professionals/how- attain-meaningful-use http://www.cms.gov/apps/ama/license.asp?file=/QualityM easures/Downloads/EP_MeasureSpecifications.zip http://motorcycleguy.blogspot.com/2012/11/hashtag- soup-relating-qdm-hqmf.html

43. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services References / Resources http://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/Electroni c_Reporting_Spec.html 43