How to receive your incentive dollars quickly Zoom to Meaningful Use How to receive your incentive dollars quickly

What is Meaningful Use? Government program to promote adoption of electronic health record systems (EHR) Part of the ARRA (stimulus) legislation $32 billion was set aside for this purpose Physicians receive incentive payments for “meaningful use” of an EHR Administered through the Medicare and Medi-Cal programs

What do I need to start? A certified EHR ZoomMD is ONC-ATCB certified by CCHIT You must be a Medicare or Medi-Cal provider. Must have an NPI number through NPPES Annual Part B charges that will qualify for maximum Medicare incentives: $24000 Part B charges for $18000 $16000 Part B charges for $12000 $10,667 Part B charges for $8000 $5,334 Part B charges for $4000 $2,667 Part B charges for $2000 $20000 Part B charges for $15000

Specific Medicare / Medi-Cal requirements Can participate in either the Medicare or Medi-Cal program (one-time switch allowed) For the Medicare program, you must have $24000 in annual charges to Medicare For the Medi-Cal program, 30% of your patient volume must be Medi-cal patients (20% if you are a pediatrician) Your inpatient volume cannot exceed 90% of your total volume Annual Part B charges that will qualify for maximum Medicare incentives: $24000 Part B charges for $18000 $16000 Part B charges for $12000 $10,667 Part B charges for $8000 $5,334 Part B charges for $4000 $2,667 Part B charges for $2000 $20000 Part B charges for $15000

The ZoomMD method Themes to live by It is a practice effort, not a doctor effort Everyone must fulfill their role With everyone doing their part, MU is achievable MU Champion is designated by the practice Physician has ultimate responsibility Choose options wisely and let the system do the heavy lifting whenever possible. Track, track, track Keep your eyes on the goal

What do I have to do to earn the incentive payments? Meet meaningful use requirements 15 core measures 5 menu measures 3 core or alternate core clinical quality measures 3 additional clinical quality measures These requirements will increase in stages over time. Annual Part B charges that will qualify for maximum Medicare incentives: $24000 Part B charges for $18000 $16000 Part B charges for $12000 $10,667 Part B charges for $8000 $5,334 Part B charges for $4000 $2,667 Part B charges for $2000 $20000 Part B charges for $15000

Moving forward: Staging of “Meaningful use” “These goals can be achieved only through the effective use of information to support better decision-making and more effective care processes that improve health outcomes and reduce cost growth.” Focus of: 2015 Stage 3 Improved outcomes 2013 Stage 2 Advanced clinical processes 2011 Stage 1 Data capture and sharing “Phased-in series of improved clinical data capture supporting more rigorous and robust quality measurement and improvement.” Connecting for Health, Markle Foundation “Achieving the Health IT Objectives of the American Recovery and Reinvestment Act” April 2009

Roles – Color legend Color Role Physician/NP/PA MA or Nurse Front office staff/ administration ZoomMD setup Each position will have a specific role. The above indicates primary responsibility for data entry. Others will still have a responsibility to review data and take any appropriate action. Each member of the staff has a specific role to play towards achieving meaningful use

MU Stage 1 Measures – Core MU Stage 1 Measures – Core. Must meet ALL 15 Green = provider; Yellow = MA; Brown = office; Blue = ZoomMD Measure Metric Problem List 80% Electronic Prescriptions 40% Active Medication Allergy List CPOE (for medication only) 30% Active Medication List Drug-drug and drug-allergy alerts Turn on Smoking Status (>13 y.o.a.) 50% Electronically exchange info Test Vital Signs and Growth Charts Clinical decision support rules 1 Clinical Summaries Report quality measures 6 Electronic copy of health info Privacy and security of patient data in EHR YES Patient Demographics Metric = % of patient charts that should have this information or % of items that need to be completed in order to satisfy that particular measure.

MU Stage 1 Measures – Menu set MU Stage 1 Measures – Menu set. Must meet 5 of 10 Blue = potential choices setup by ZoomMD. Rest not required in Stage 1 Measure Metric Drug formulary checks Yes Electronic Immunization data Test Labs as structured data* 40% Syndromic Surveillance Patients and Conditions list YES Reminders (<5 or >65) 20% Patient-Specific education 10% Electronic patient access to information Medication reconciliation 50% Summary of Care provided for transitions of care Labs as structured data can be chosen if Quest labs are an option. If not, Electronic patient access to information can be chosen.

MU Stage 1 Clinical Quality Measures – Reportable through EHR Report 3 core or alternate core CORE MEASURES 1. Hypertension: Blood Pressure Measurement 2. a. Tobacco Use Assessment b. Tobacco Cessation Intervention 3. Adult Weight Screening and Follow-up ------------------ALTERNATE CORE MEASURES------------------------ 1. Weight Assessment and Counseling for Children and Adolescents 2. Influenza Immunization for Patients ≥ 50Years Old 3. Childhood Immunization Status

MU Stage 1: Clinical Quality Measures Additional set Choose and submit 3 additional quality measures from a list of 38 Chooses measures appropriate to your specialty Do not have to achieve any particular number in the measure reported Primary care physicians can achieve this requirement by reporting on a single disease – Diabetes Mellitus

What do I do? Physicians/Nurse practitioners/PAs A. Electronic prescriptions Computerized physician order entry (medication only) B. Report on core or alternate core measures Tobacco Use Assessment and Tobacco Cessation Intervention Weight a. Adult Weight Screening and Follow-up b. Weight Assessment and Counseling for Children and Adolescents (pediatrics) Order influenza vaccine for patients >50 (substitute for 1 or 2 above) C. Choose and report 3 quality measures for your specialty Diabetes recommended for primary care D. Order labs through Quest

What do I do? Physicians/NPs/PAs Data Review recommended for patient safety Review is not mandated for Meaningful Use Problem List Medication related information Active Medication Allergy List Active Medication List Drug-drug and drug-allergy alerts (automatically fire) Drug formulary information Smoking Status (>13 y.o.a.) Vital Signs and Growth Charts (Growth charts – peds) Labs received into EHR Childhood immunization status (pediatricians)

What do I do? Medical Assistant Enter Problem List Based on provider’s prior note Active Medication Allergy List Enter based on old records and patient report Active Medication List Enter patient’s current medication Smoking Status (>13 y.o.a.) Record patient’s smoking status Vital Signs and Growth Charts Enter vital signs and growth charts at each visit Measure blood pressure

What do I do? Business/Administration/Front office Demographics entry Ensure all patients have all demographics and insurance information and map to Newcrop Clinical Summaries Give each patient a copy of their clinical summary Electronic copy of health info Give or send patients electronic copy of health info upon request Privacy and security of patient data in EHR Plan, monitor, report

What do I do? Practice designee – ZoomMD to assist Build clinical decision support rule – one rule Setup practice to receive electronic lab results from Quest Test Electronically exchange information Electronic Immunization data Syndromic Surveillance Done automatically Drug formulary checks Turn on drug-drug and drug-allergy alerts Patients and conditions list

Zap your prescriptions electronically Physicians: Four steps to Meaningful Use Physician role + other roles = achievement of meaningful use Zap your prescriptions electronically Prescribe electronically Offer assistance with weight reduction. Review patient weight and follow-up as required Offer tobacco cessation help. Review tobacco use and intervene as required Measure clinical quality. Record data as required for selected clinical quality measures

Why is it important for me the physician to achieve Meaningful Use? Enhance quality of care Meaningful use criteria will become standard of care Improved communication with other physicians Collection of data in structured format will enable data analysis and can drive outcomes Incentive payments

Medicare program: Incentive Payments for Eligible Professionals (physicians) for Meaningful Use of EHR In dollars. Green = Assumes providers meet all criteria in 2011 or 2012 Funding year Adoption year 2011 2012 2013 2014 2015 18000 12000 8000 15000 4000 2000 2016 TOTAL 44000 39000 24000 PENALTY

Medicare Penalties for not meeting MU Penalties are applied to each physician’s Medicare payments 2015 2016 2017 and beyond 1% 2% 3%

Eligible professional (physician) – Medi-Cal incentive payments (Dollars) Medi-Cal program has no penalties. Typical schedule. Calendar year Adoption year 2011 2012 2013 2014 2015 2016 21250 8500 2017 2018 2019 2020 2021 TOTAL 63750