Medicare & Medicaid EHR Incentive Programs Robert Anthony Deputy Director, Health IT Initiatives Group Office of E-Health Standards and Services Centers for Medicare and Medicaid Services

Eligibility

Who is Eligible to Participate? Eligibility was defined in statute Hospital-based EPs are NOT eligible for incentives DEFINITION: 90% or more of their covered professional services in either an inpatient (POS 21) or emergency room (POS 23) of a hospital Incentives are based on the individual, not the practice

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

Meaningful Use

Conceptual Approach to Meaningful Use Data capturing and sharing Advanced clinical processes Improved outcomes Stage 3 This is the structure to get us where we want to be. It is divided into three stages. The first stage involves collecting health information in a structured way and takes the first steps towards using that data. Structured data is crucial to meaningful use of EHRs. What we mean by structured data is that the system recognizes the data for what it is and knows how that data interacts with other data available in the system. For instance, Microsoft Word knows that aspirin is a seven letter word and even how it should be spelled, but it does not know that it is a drug and one that should be given to patients showing signs of a heart attack or not given to one that is also taking an anticoagulant. This is what we mean by structured data. The second stage involves designing and implementing processes that will use the data collected in a way that we believe will generate improved outcomes. The third stage involves finding out if we were right and determining the effects of meaningful use on outcomes. Stage 2 Stage 1

What are the Requirements of Stage 1 Meaningful Use? 2 Years 2 Years And so on . . . Stage 3 – 1 Year Stage 3 – 1 Year Stage 2 – 1 Year Stage 2 – 1 Year Stage 1 – 1 Year Stage 1 – 90 Days

What are the Requirements of Stage 1? Eligible Professionals 15 core objectives 5 of 10 menu objectives 20 total objectives

Stage 1 EP Core Objectives Computerized physician order entry (CPOE) E-Prescribing (eRx) Report ambulatory clinical quality measures to CMS/States Implement one clinical decision support rule Provide patients with an electronic copy of their health information, upon request Provide clinical summaries for patients for each office visit Drug-drug and drug-allergy interaction checks Record demographics Maintain an up-to-date problem list of current and active diagnoses Maintain active medication list Maintain active medication allergy list Record and chart changes in vital signs Record smoking status for patients 13 years or older Capability to exchange key clinical information among providers of care and patient-authorized entities electronically Protect electronic health information

Stage 1 EP Menu Objectives 5 of 10 Menu Objectives Drug-formulary checks Incorporate clinical lab test results as structured data Generate lists of patients by specific conditions Send reminders to patients per patient preference for preventive/follow up care Provide patients with timely electronic access to their health information Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate Medication reconciliation Summary of care record for each transition of care/referrals Capability to submit electronic data to immunization registries/systems* Capability to provide electronic syndromic surveillance data to public health agencies* * At least 1 public health menu objective + 4 others

Stages of Meaningful Use Data capturing and sharing Advanced clinical processes Improved outcomes Stage 3 This is the structure to get us where we want to be. It is divided into three stages. The first stage involves collecting health information in a structured way and takes the first steps towards using that data. Structured data is crucial to meaningful use of EHRs. What we mean by structured data is that the system recognizes the data for what it is and knows how that data interacts with other data available in the system. For instance, Microsoft Word knows that aspirin is a seven letter word and even how it should be spelled, but it does not know that it is a drug and one that should be given to patients showing signs of a heart attack or not given to one that is also taking an anticoagulant. This is what we mean by structured data. The second stage involves designing and implementing processes that will use the data collected in a way that we believe will generate improved outcomes. The third stage involves finding out if we were right and determining the effects of meaningful use on outcomes. Stage 2 Stage 1

Eligible Professionals Eligible Hospitals & CAHs What are the Requirements of Stage 2 Meaningful Use? Stage 1 Stage 2 Eligible Professionals 15 core objectives 5 of 10 menu objectives 20 total objectives 17 core objectives 3 of 6 menu objectives Eligible Hospitals & CAHs 14 core objectives 5 of 10 menu objectives 19 total objectives 16 core objectives 3 of 6 menu objectives

Stage 1 Menu  Stage 2 Core EP Lab Results Patient Lists Patient Education Summary of Care Records Medication Reconciliation Immunizations Patient Reminders Online Patient Information

New for Stage 2 EP Secure Messaging Family Health History Imaging Results Registry Reporting Progress Notes

Closer Look at Stage 2: Patient Engagement Patient engagement – engagement is an important focus of Stage 2.   EXCLUSIONS – CMS is introducing exclusions based on broadband availability in the provider’s county. Requirements for Patient Action: More than 5% of patients must send secure messages to their EP More than 5% of patients must access their health information online More than 5% of patients must access their health information online (of the more than 50% of patients who received access). Requirements for Patient Action: More than 5% of patients must send secure messages to their EP More than 5% of patients must access their health information online

Closer Look at Stage 2: Electronic Exchange Stage 2 focuses on actual use cases of electronic information exchange: Stage 2 requires that a provider send a summary of care record for more than 50% of transitions of care and referrals. The rule also requires that a provider electronically transmit a summary of care for more than 10% of transitions of care and referrals. At least one summary of care document sent electronically to recipient with different EHR vendor or to CMS test EHR. Credit given when the receiving providers successfully “pulls” info down from HIE. This is in addition to the “push” methods of electronic HIE that were proposed. Stage 2 requires that a provider send a summary of care record for more than 50% of transitions of care and referrals. The rule also requires that a provider electronically transmit a summary of care for more than 10% of transitions of care and referrals.

Clinical Quality Measures

Eligible Hospitals and CAHs Eligible Hospitals and CAHs CQM Reporting in 2013 and 2014 Reporting in 2013 Reporting in 2014 and Beyond EPs Report 6 out of 44 CQMs 3 core or alt. core 3 menu EPs Report 9 out of 64 CQMs Selected CQMs must cover at least 3 of the 6 NQS domains Recommended core CQMs: 9 for adult populations 9 for pediatric populations Eligible Hospitals and CAHs Report 15 out of 15 CQMs Eligible Hospitals and CAHs Report 16 out of 29 CQMs Selected CQMs must cover at least 3 of the 6 NQS domains

CQM Selection and HHS Priorities All providers must select CQMs from at least 3 of the 6 HHS National Quality Strategy domains: Patient and Family Engagement Patient Safety Care Coordination Population and Public Health Efficient Use of Healthcare Resources Clinical Processes/Effectiveness Such as measures in which performance rates are currently low or for which there is wide variability in performance, or that address known drivers of high morbidity and/or cost for Medicare and Medicaid. For example, Medicare- and Medicaid-eligible physicians, and Medicaid-eligible nurse-practitioners, certified nurse-midwives, dentists, physician assistants) Based on the March 2011 report to Congress, "National Strategy for Quality Improvement in Health Care" (National Quality Strategy) (http://www.healthcare.gov/law/resources/reports/nationalqualitystrategy032011.pdf) and the Health Information Technology Policy Committee's (HITPC's) recommendations (http://healthit.hhs.gov/portal/server.pt?open=512&objID=1815&parentname=CommunityPage&parentid=7&mode=2&in_hi_userid=11113&cached=true).

Stage 1 and Stage 2 Resources http://www.cms.gov/ EHRIncentivePrograms/ For questions, please contact: Robert Anthony Office of E-Health Standards and Services Centers for Medicare & Medicaid Services robert.anthony@cms.hhs.gov