Meaningful Use Indiana Association for Health Care Quality, May 2013

W hat’s all this Meaningful Use stuff?

What is America doing to modernize its Healthcare System through Health IT? Why does America need to modernize using Health IT? Enable providers to securely and efficiently exchange patient health information. Give providers the right information, at the right time to offer their patients the right care. Give consumers tools to know their health information so that they can improve their health. Foundational to building a truly 21 st century health system where we pay for the right care, not just more care. Accelerating Meaningful Use Showing Outcomes Protecting Privacy and Security Keeping Patients Safe Promoting Exchange Engaging Consumers Source: Doug Fridsma, MD, Chief Science Officer, Director, Office of Science & Technology, ONC The Compelling Why…..of HITECH

2009 Hitech Act-ARRA The Hitech Act of the American Recovery & Reinvestment Act (ARRA) was signed into law by President Obama in Feb “ It's an investment that will take the long overdue step of computerizing America's medical records, to reduce the duplication and waste that costs billions of healthcare dollars and medical errors that cost thousands of lives each year.... We have done more in 30 days to advance the cause of health- care reform than this country has done in an entire decade.“ February 17, 2009 Appointed the Center for Medicare & Medicaid (CMS) to govern the clinical side of the program The Office of the National Coordinator (ONC) governs the technical side: certification of the EHR at the code level. Both sets of guidelines must be met to qualify for MU Stage One Guidelines: Released July Stage Two Guidelines: Preliminary Release Feb. 2012, Final Release: Aug, 2012

2009 Hitech Act-ARRA Three progressive stages of “meaningful use” over next 5+ years –Stage 1: Capture and track basic data, communication and coordination, sets stage for electronic quality reporting –Stage 2: Quality improvement at the point of care, clinical data exchange –Stage 3: Advanced clinical decision support to promote safety, quality and efficiency (e.g. national high priority conditions, patient access to self ‐ management tools, comprehensive patient data and improving population health) Medicare $$ Incentives: payment for “Meaningful Use”(MU) of an electronic health record (EHR)-by Hospital or Physician Medicaid $$ Incentives: Demonstrate “AIU” -Adoption, Implementation, Upgrade (first year only), or “Meaningful Use”

Eligibility Medicare Fee for Service, Medicare Advantage and Medicaid providers Eligible Professionals (EP) include: Doctors of Medicine or Osteopathy, Dentists, Podiatrists, Optometrists and Chiropractors. Medicaid also includes NPs, Certified Nurse Midwives & PAs. Hospital based EPs are not included (90% or > services are provided on an Inpatient or ED setting). Eligible Hospitals include: Acute Care Hospitals and Critical Access Hospitals, including Emergency Departments(pts being admitted or in an extended Observation status).

The Carrot…. Eligible Providers: Medicare Incentives: ~$44K/eligible provider/5 years Medicaid Incentives: ~$64K/eligible provider/6 years

…….and the Stick Hospitals: Incentive calculated based on cost reporting to CMS After 2015, Medicare penalties for Hospitals and EPs

Health Outcomes Priorities Improve quality, safety, efficiency and reduce health disparities Engage patients and families in their health care Improve care coordination Improve population & public health Ensure adequate privacy and security protection of personal health information

Final Rulings-Stage 1 Stage 1:  1st Submission-90 days of data  2nd submission-12 consecutive months Mandatory Core Measures-15 for Eligible Providers, 14 for Hospitals Menu Set-10 to choose from; 5 deferred until Stage II. Total reporting requirements:  Eligible Providers: report on 20 of 25 MU Measures.  Hospitals: report on 19 of 24 MU Measures.

Stage 1 Core Measures-Mandatory CPOE-1 med order >30%Hospital & Provider ePrescribing-I med order >40%Provider Drug/Drug, Drug/Allergy Checks ONHospital & Provider Problem List >80%Hospital & Provider Medication List >80%Hospital & Provider Medication Allergy >80%Hospital & Provider Vital Signs: Ht, Wt, BP, >2yo >50%Hospital & Provider Smoking Status, 13yo >50%Hospital & Provider Demographic Data >50%Hospital & Provider

Stage 1 Core Measures-Mandatory eCopy of Record, w/in 3 days >50%Hospital & Provider Clinical Decision Support Rule 1Hospital & Provider E-Copy of Discharge Instruction >50%Hospital Provide Clinic Summary >50%Provider Information Exchange 1 testHospital & Provider Protect Pt Info, Security Analysis ConductHospital & Provider Quality Measures: VTE, Stroke, ED 15Hospital Quality Measures: 3 core/3 menu + 38 options 6Provider

Stage 1 Menu Measures-5 Optional Incorporate Clinical Lab Results >40%Hospital & Provider Patient List 1Hospital & Provider Patient Reminders >20%Provider Pt Access to Information: 4days >10%Provider ID Patient Education Needs >10%Hospital & Provider Medication Reconciliation >50%Hospital & Provider Drug Formulary Checks OnHospital & Provider Transfer Summaries >50%Hospital & Provider Record Advanced Directives >50%Hospital Submit Syndromic Data to SDOH TestHospital & Provider Submit Lab Data to SDOH TestHospital Submit Immunizations to SDOH TestHospital & Provider

What’s Coming with Stage 2? Goes into effect October 1, Thresholds and complexity increases Second year added to stage 2 with a 90 day quarterly measurement period; no change in payment model 2015 Payment adjustments confirmed (complete attestation by Oct 2014 to avoid penalties) Hospitals-Report on 19 out of 22 measures EPs-Report on 20 out of 23 measures

What’s Coming with Stage 2? Focus on Patient Engagement-Portal access; view, download or transmit Exclusions will not count toward Menu Items Batch reporting for EPs CPOE changes in denominator, addition of radiology and labs Addition of electronic notes, capturing care team, functional and cognitive status in the summary or care. Better Alignment of Quality measures against other CMS requirements: ACO, PQRS, CHIPRA etc

The Details Core ObjectiveMeasureHospital/Provider CPOE Use of CPOE for >60% of medications, 30% of Laboratory and 30% of radiology Hospital/Provider e-PrescribingE-Prescribing for >50%Provider DemographicsRecord demographics for >80%Hospital/Provider Vital SignsRecord Vital Signs for >80%Hospital/Provider Smoking StatusRecord Smoking Status for >80%Hospital/Provider Interventions Implement 5 clinical decision support interventions + drug/drug and drug/allergy Hospital/Provider LabsIncorporate lab results for >55%Hospital/Provider Patient ListsGenerate patient lists by specific conditionHospital/Provider Preventive Reminders Use the EHR to identify and provide reminders for preventive/follow-up care for >10% of pts with 2 or more office visits in last 2 years. Provider

The Details Core ObjectiveMeasureHospital/Provider eMar Implement eMar and use for > 10% of medication orders (bar code med admin) Hospital Patient Access Provide online access to health information for > 50% with >5% actually accessing Hospital/Provider Visit Summaries Provide office visit summars for >50% of office visits Provider Education Resources Use the EHR to identify and provide education resources for >10% of the patients Hospital/Provider Secure Messages >5% of patients send secure messages to the EP Provider Meds Reconciliation Medication Reconciliation is completed at > 50% of the transitions of care Hospital/Provider Summary of Care Provide Summary of Care Document for >50% of the transitions of care and referrals with 10% sent electronically and at least 1 sent to recipient with a different EHR vendor Hospital/Provider

The Details Core ObjectiveMeasureHospital/Provider Immunizations Successful ongoing transmission of immunization data Hospital/Provider Labs Ongoing submission of reportable lab results Hospital Syndromic Surveillance Ongoing submission of electronic syndromic surveillance data Hospital Security Analysis Conduct or review security analysis and incorporate risk management process Hospital/Provider

The Details MENU ObjectiveMeasureHospital/Provider Progress Notes Enter an electronic progress note for >30% of unique patients Hospital/Provider E-Prescribing >10% of discharge medication orders are e-prescribed Hospital Imaging Results >20% of imaging results are accessible through the certified EHR Hospital/Provider Family HistoryRecord family health history for >20%Hospital/Provider Advanced DirectivesRecord AD for >50% of patients 65yo or olderHospital LabsProvide structured lab results to EPs for >20%Hospital Syndromic Surveillance Ongoing submission of electronic syndromic surveillance data Provider Cancer Registry Successful ongoing transmission of cancer case information Provider Specialized Registry Successful ongoing transmission of data to a specialized registry Provider

Other Related Initiatives; Similar…..but not quite! ICD-9 vs ICD-10 -DEADLINE OCTOBER Dx Codes: from 14,315 to 69,099 (483%) -Px Codes: from 3,838 to 71,957 (1875%) Angioplasty-Moving from 1 code to 854 codes based on site, device & approach! Value Based Purchasing Medical Home Impact of Hospital Acquired Conditions Payment cuts for readmissions PQRI ePrescribing Bundled payments Quality Bonus Payments for Medicare Advantage Accountable Care Organization Mandates ……..

Take Home Concepts Meaningful Use and EHR adoption is a clinical care initiative supported by IT, not an IT program. It will forever change how we provide service to our patients. Our success or failure will depend in great part on our ability to define and standardize our best practice clinical workflows throughout our system. Physician and clinical operation’s leadership will be crucial in each clinic’s, service line’s and facility’s success or failure.

Resources CMS Attestation resources (including Calculator) available at: Page Page Beginners guide for MU at: uide.pdf uide.pdf Payment Webpage: age age

So, in a nutshell………

Thank You Kathy Mathena, MSN, RN Executive Director, Clinical Information Systems Office: