Meaningful Use Overview Essentials for CAC’s JoAnne Hawkins Meaningful Use Field Team Lead DNC (Contractor) for U.S. Indian Health Service February 13, 2012

Today’s Objectives Understand CMS EHR Incentive Program Understand and differentiate the Meaningful Use Performance Measures and Meaningful Use Clinical Quality Measures Review the current Meaningful Use performance Measures as they pertain to Clinical Application Coordinators

MEANINGFUL USE

Meaningful Use: What is Meaningful Use? Meaningful Use is using certified EHR technology to: Improve quality, safety, efficiency, and reduce health disparities Engage patients and families in their health care Improve care coordination Improve population and public health All the while maintaining privacy and security

Meaningful Use: Stages of Meaningful Use 3 stages of Meaningful Use Requirements will increase over time…more work lies ahead Stage Stage Stage

EP Incentive Estimation CY11 AreaApproximate Total EP’s in Area Total EP's participating in CY 11 EP Medicare “11 Medicare YR 1 Up to $18,000 EP Medicaid “11 Medicaid Year 1 $21,250 Total Medicaid & Medicare "11 Aberdeen107730$ - 73$ 1,551, Alaska $ - 377$ 8,011, Albuquerque $ - 113$ 2,401, Bemidji19770$ - 7$ 148, Billings18200$ - 0 California $ - 148$ 3,145, Nashville4872$ 36, $ 106, $ 142, Navajo $ 198, $ 7,586, $ 7,784, Oklahoma $ 414, $ 5,248, $ 5,662, Phoenix $ - 249$ 5,291, Portland $ 450, $ 2,337, $ 2,787, Tucson38340$ - 34$ 722, Sum All Areas $ 1,098, $ 36,550, $ 37,648,000.00

Hospital Incentives FY11 $5,277,871 $3,419,656 $1,894,466 $2,730,769 $1,727,019 $750,504 $2,584,199 $608,000 $400,000

EH Incentive Estimation FY11 FY 11 Medicaid Hospital Participation Estimated Incentive Payments Aberdeen Area – $5,277,871 Belcourt PHS Indian Hospital, Belcourt, ND Fort Yates PHS Indian Hospital, Fort Yates, ND Pine Ridge PHS Indian Hospital, Pine Ridge, SD Rapid City PHS Indian Hospital, Rapid City, SD Eagle Butte PHS Indian Hospital, Eagle Butte, SD Rosebud PHS Indian Hospital, Rosebud, SD Oklahoma – $2,584,199 Lawton Indian Health Hospital, Lawton, OK W.W. Hastings Indian Hospital, Tahlequah, OK Choctaw Nation Indian Hospital, Talihina, OK Claremore Indian Hospital, Claremore, OK Carl Albert Indian Hospital, Ada. OK Alaska –$3,419,656 Samuel Simmonds Hospital, Barrow, AK (CAH) Maniilaq Health Center, Kotzebue, AK (CAH) Kanakanak Hospital, Dillingham, AK (CAH) Alaska Native Medical Center, Anchorage, AK Mount Edgecumbe Hospital, Sitka, AK Phoenix – $1,727,019 HuHuKam Memorial Hospital, Sacaton, AZ Phoenix Indain Medical Center, Phoenix, AZ Albuquerque – $1,894,466 Santa Fe PHS Indian Hospital, Santa, Fe, NM Mescalero PHS Indian Hospital, Mescalero, NM Zuni PHS Indian Hospital, Zuni, NM Tucson –$ $750,504 Sells PHS Indian Hospital, Sells AZ Navajo- $2,730,769 Chinle Comprehensive Health Care Facility, Chinle, AZ Northern Navajo Medical Center, Shiprock, NM Gallup Indian Medical Center, Gallup, NM FY 11 Medicare Hospital Participation Estimated Incentive Payments Bemidji – $608,000 PHS Indian Hospital, Red Lake, MN Nashville – $400,000 PHS Indian Hospital, Cherokee, NC

EHR CERTIFICATION

Name Space Package or ApplicationVersionPatchRelease Date AGPatient Registration7.1912/3/10 APCLExport /10/10 APSPPharmacy MOD-ePrescribing (eRx) /29/11 BGPClinical Reporting System (CRS)11.036/22/11 BJMDC /24/11 BJPCPCC Mgmt Reporting2.066/2/11 BMCReferred Care Information System (RCIS) 4.075/12/11 BQIiCare2.13/11/11 BRNRelease of Information (ROI)2.034/13/11 BYIMImmunization Exchange Message2.0012/24/11 BGOElectronic Health Record (EHR)1.1806/10/11 LRLab or 372 or 33412/07/10 PXRMEHR Reminders /13/10 BPHRPersonal Health Record (PHR)1.06/22/11 Central Ensemble GuardianEdge/ Symantec8.03/31/11 IPSEC (Windows)2010 VanDyke (AIX)2010 WinHasher Universal Client or HIE Viewer The URL to access the application is /27/11

EHR Certification: EHR Certification Number* Inpatient Certification #: ELL6EAI Ambulatory Certification #: EJKDEAI *The number will be entered during CMS registration and attestation

EHR Certification: Vendor Letter Request Vendor Letter on the IHS MU website at Enter information in each of the fields on the webpage Click the “Submit” button IHS will process the request for each facility IHS will issue a letter to the requesting practice within 10 business days of the initial request The facility will receive the signed IHS EHR Vendor Letter via The letter will be ed to the individual that made the request

ELIGIBLE PROFESSIONALS & HOSPITALS

MEDICARE EHR Incentive Program MEDICAID EHR Incentive Program Implemented by the Federal Government and started January 3, 2011 Voluntary for States to implement - Most are expected to start by late summer 2011 Must initiate participation by 2014 Must participate by 2012 to receive the maximum incentive payment Program ends in 2016 Must initiate participation by 2016 Must participate by 2016 to receive the maximum incentive payment Program ends in 2021 Must demonstrate MU in Year 1 over a consecutive 90-day report period A/I/U option for Year 1 No patient volume requirementMust meet patient volume thresholds Medicare payment reductions begin in 2015 for EH/EPs who do not demonstrate MU of certified EHR technology No Medicaid payment reductions

Eligible Professionals: Medicare & Medicaid Comparison Medicare-only Eligible Professionals Could be eligible for both Medicare & Medicaid incentives Medicaid-only Eligible Professionals Professionals may be eligible for both Medicare & Medicaid, but can only participate in one program at a time

Hospitals only eligible for Medicare incentive Could be eligible for both Medicare & Medicaid (most hospitals) Hospitals only eligible for Medicaid incentive Eligible Hospitals: Medicare & Medicaid Comparison

Eligible Professional: Incentive Program Timeline CY 2011CY /01/11First day of calendar & EHR reporting year01/01/12 09/30/11 LAST day to establish clean-date for the Medicare Incentive Program 09/30/12 10/03/11 LAST day to begin 90-day reporting period for the Medicare Incentive Program 10/01/12 12/31/11Last day of calendar & EHR reporting year12/31/12 02/29/12 LAST day to register & LAST day to attest 02/28/13

Eligible Hospital: Incentive Program Timeline FY 2011FY 2012 First day of calendar & EHR reporting year 10/01/11 06/30/11 LAST day to establish clean-date for the Medicare Incentive Program 06/30/12 07/03/11 LAST day to begin 90-day reporting period for the Medicare Incentive Program 07/01/12 09/30/11 Last day of calendar & EHR reporting year 09/30/12 11/30/11 LAST day to register & LAST day to attest 11/30/12

MEDICAID FOR ELIGIBLE PROFESSIONALS & HOSPITALS

Eligible Professionals & Medicaid: Patient Volume Threshold Eligible Professional (EP) If EP does not practice predominantly at FQHC/RHC: Minimum Medicaid patient volume thresholds If EP does practice predominantly at FQHC/RHC*: Minimum needy individual patient volume thresholds Physicians30% - Pediatricians20%30% Dentists30% Certified Nurse- Midwives 30% NPs30% PAs practicing at an FQHC/RHC that is led by a PA N/A30% * All Tribal clinics are deemed FQHC/RHC for the CMS incentive program

Eligible Hospital: Medicaid Patient Volume Requirement Eligible HospitalsMinimum Medicaid patient volume threshold Acute care hospitals, including Critical Access Hospitals 10% Medicare does not have a patient volume threshold

INCENTIVES

Eligible Professionals: Summary of Medicare & Medicaid Incentives ELIGIBLE PROFESSIONAL MEDICAREMEDICAID Incentives Start CY 2011 Incentives End CY 2016 (max. 5 years, must start by 2014) 2021 (max. 6 years, must start by 2016) Incentive Amount Up to $44,000 total per provider Based on % Medicare claims Additional 10% bonus for EP’s in HPSAs Up to $63,750 total per provider Reimbursement Reduced CY 2015No penalties

Eligible Professionals: Medicare Incentive Payment Example Amount of Payment Each Year of Participation Calendar Year EP Receives a Payment CY 2011CY 2012CY 2013CY2014 CY 2015 and later CY 2011$18,000 CY 2012$12,000$18,000 CY 2013$8,000$12,000$15,000 CY 2014$4,000$8,000$12,000 CY 2015$2,000$4,000$8,000 $0 CY 2016$2,000$4,000 $0 TOTAL$44,000 $39,000$24,000$0

Eligible Professionals: Medicaid Incentive Payment Example Amount of Payment Each Year if Continues Meeting Requirements 1 st Calendar Year EP Receives a Payment CY 2011CY 2012CY 2013CY 2014CY 2015CY 2016 CY 2011$21,250 CY 2012$8,500$21,250 CY 2013$8,500 $21,250 CY 2014$8,500 $21,250 CY 2015$8,500 $21,250 CY 2016$8,500 $21,250 CY 2017$8,500 CY 2018$8,500 CY 2019$8,500 CY 2020$8,500 CY 2021$8,500 TOTAL$63,750

Eligible Hospital: Medicare & Medicaid Incentive Summary HOSPITALMEDICAREMEDICAID Incentives Start FY 2011 Incentives End FY 2016 (max. 4 years, must start by 2015) 2021 (max. 6 years, must start by 2016) Incentive Amount Varies, depending on % Medicare inpatient bed days CAHs based on EHR costs & % Medicare inpatient bed days Varies, depending on % Medicaid inpatient bed days Reimbursement Reduced FY 2015No penalties

PERFORMANCE MEASURES

Eligible Professionals: Meaningful Use Requirements STAGE 1: Meaningful Use Requirements 20 total Performance Measures 15 core performance measures* 5 performance measures out of 10 from menu set* 6 total Clinical Quality Measures 3 core or alternate core 3 out of 38 from menu set * Most measures require achievement of a performance target

Eligible Hospital: Meaningful Use Requirements STAGE 1: Meaningful Use Requirements 19 total Performance Measures 14 core performance measures* 5 performance measures out of 10 from menu set* 15 total Clinical Quality Measures * Most measures require achievement of a performance target

Performance Measures EPEHTargetCore Measure X X >30%CPOE for Medication Orders XX Yes/NoDrug Interaction Checks XX >80%Maintain Problem List X >40%E-Prescribing XX >80%Active Medication List XX>80%Medication Allergy List XX>50%:Record demographics XX >50%Record Vital Signs XX >50%Record Smoking Status XX Yes/NoClinical Quality Measures XX Yes/NoClinical Decision Support Rule XX >50%Electronic Copy of Health Information X >50%Clinical Summaries X>50%Electronic Copy of Discharge Instructions XX Yes/NoElectronic Exchange of Clinical Information XX Yes/NoProtect Electronic Health Information

Performance Measures EPEHTargetMenu Set Measure XX Yes/NoDrug-Formulary Checks X>50%Advance Directives XX >40%Clinical Lab Test Results XX Yes/NoPatient Lists X >20%Patient Reminders X 10%Patient Electronic Access XX>10%Patient Specific Education Resources XX >50%Medication Reconciliation XX >50%Transition of Care Summary XX Yes/No*Immunization Registries Data Submission XX Yes/No*Syndromic Surveillance Data Submission XYes/No*Reportable Lab Results to Public Health Agencies

Eligible Professionals: Clinical Quality Measures Core Set: If denominator = 0, must report on the Alternate Core measures NQF Measure Number & PQRI Implementation Number Clinical Quality Measure Title NQF 0013Hypertension: Blood Pressure Measurement NQF 0028Preventive Care and Screening Measure Pair: a) Tobacco Use Assessment, b) Tobacco Cessation Intervention NQF 0421 PQRI 128 Adult Weight Screening and Follow-up NQF Measure Number & PQRI Implementation Number Clinical Quality Measure Title NQF 0024Weight Assessment and Counseling for Children and Adolescents NQF 0041 PQRI 110 Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or Older NQF 0038Childhood Immunization Status Alternate Core Set

Eligible Professionals: 38 Additional Clinical Quality Measures (Choose 3) Diabetes: (9) Heart Failure (HF): (3) Coronary Artery Disease (CAD): (3) Pneumonia Vaccination Status for Older Adults Anti-depressant medication management: (2) Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation Asthma: (3) Appropriate Testing for Children with Pharyngitis Cancer Prevention and/ or Oncology: (6) Smoking and Tobacco Use Cessation,(3) Ischemic Vascular Disease (IVD): (3) Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: (2) Prenatal Care: (2) Controlling High Blood Pressure Chlamydia Screening for Women Low Back Pain: Use of Imaging Studies

Eligible Hospitals: 15 Clinical Quality Measures 1.Emergency Department Throughput – admitted patients Median time from ED arrival to ED departure for admitted patients 2.Emergency Department Throughput – admitted patients Admission decision time to ED departure time for admitted patients 3.Ischemic stroke – Discharge on anti-thrombotics 4.Ischemic stroke – Anticoagulation for A-fib/flutter 5.Ischemic stroke – Thrombolytic therapy for patients arriving within 2 hours of symptom onset 6.Ischemic or hemorrhagic stroke – Antithrombotic therapy by day 2 7.Ischemic stroke – Discharge on statins 8.Ischemic or hemorrhagic stroke – Rehabilitation assessment 9.VTE prophylaxis within 24 hours of arrival 10.Anticoagulation overlap therapy 11.Ischemic or Hemorrhagic stroke – Stroke Education 12.Intensive Care Unit VTE prophylaxis 13.Platelet monitoring on unfractionated heparin 14.VTE discharge instructions 15.Incidence of potentially preventable VTE

LESSONS LEARNED

Patient Wellness Handout (PWH) Clinical Summaries: Clinical summaries provided to patients for >50% of all office visits within three business days. Configuration: Configure Patient Wellness Handout (PWH) within the EHR. Provide patients their PWH at each patient encounter. Monitor PWH count report. The RPMS system automatically maintains a count of each PWH that is printed. Note: Minimum required data elements include (1) medication list; (2) allergy list; (3) problem list; and (4) lab results

Patient Wellness Handout (PWH) Patient Reminders: >20% of all unique patients who are 0-5 or 65+ years for whom a PWH was printed during the EHR reporting period. Generate and provide a Patient Wellness Handout (PWH) to patients <=5 or 65+ years who are due for a screening/care. Configuration: Create a PWH Add reminders such as: future visit, immunization due, women’s health Attach it to a VA Health Summary type BJPC, patch 7 delivers the future visit appointments and other useful components What would lower your rate for this measure? Not inactivating records for inactive patients according to site policy. Not inactivating records for deceased patients in a timely manner. Note: Printing of the PWH is counted for this measure.

Medication Reconciliation Medication Reconciliation: Perform medication reconciliation for >50% of transitions of care in which the patient is transitioned into the care of the EP. Configuration: EP must document Medication Reconciliation patient education code (M-MR). Provide patient with medication reconciliation PWH. Perform the medication reconciliation for transitions of care. Notes: Printing the Patient Wellness Handout (PWH) and presenting a copy to the patient is recommended as this will allow the EP to meet additional Performance Measures. This MU Performance Measure addresses medication reconciliation when an EP receives a patient into care, but other accreditation bodies (e.g., the Joint Commission, AAAHC) require MR to be done at every transition of care.

C32 There are two C32 Buttons The standalone button in EHR meets Electronic Copy of Health Information and Electronic Exchange of Clinical Information The C32 button in RCIS meets Transition of Care Summary

C32 Electronic Copy of Health Information: >50% of all patients of the EP who request an electronic copy of their health information during the EHR reporting period are provided it within three business days. Configuration: Configure PCC Health Summary, Patient Wellness Handout (PWH), Discharge Summary, and Discharge Instructions within the EHR. Provide the information electronically to the patient, such as by CD provided by the facility or encrypted e- mail (HIM). Document in Release of Information (ROI) requests for electronic copy of health information (enter as Patient/Agent Request Type=Electronic). Document in ROI information was provided electronically (enter as Record Dissemination =Electronic) AND record the Disclosure Date

C32 Electronic Exchange of Clinical Information: Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information. Configuration: This will be accomplished using the C32 button to enable delivery of C32 documents to outside destinations. All federal sites will perform the test by submitting their C32s to the IHS national repository. Results from this test should be entered as a “Yes” or “No” in the Stage 1 Meaningful Use Performance Report for EPs for the purposes of attestation. Tribal RPMS sites have the option to perform the test as described above or with another entity (e.g. a state Health Information Exchange (HIE). Note: Master Patient Index patch will need to be installed for testing to take place. Each site will need to coordinate with their area office for testing.

C32 Transition of Care Summary: The EH/CAH that transitions or refers their patient to another care setting/provider provides a summary of care record for >50% of transitions of care/referrals. Configuration: Print C32 Summary of Care record for all active referrals and give to patient and/or receiving provider. Access the RCIS tab to view list of referrals, including those that have not had a C32 printed. To print a C32, select the patient, click Referrals tab, click the referral, and click the “Print C32 for Referral” button Or RCIS staff views a list of active referrals for which C32s need to be printed by running the “Active Referrals without a Printed C32” report from the Administrative Reports menu. They can then login to the RPMS EHR to print the C32 for a specific referral and provide to the patient and/or receiving provider.

MUCD Drug Interaction Checks: The EP has enabled this functionality for the entire EHR reporting period. Configuration: Establishing Meaningful Use Clean Date (MUCD) Enable and set to mandatory ten order checks to include: (1) Allergy- Contrast Media Interaction, (2) Allergy- Drug Interaction, (3) Critical Drug Interaction, (4) Dangerous Meds for Patients >64, (5) Estimated Creatinine Clearance, (6) Glucophage-Contrast Media, (7) Glucophage-Lab Results, (8) No Allergy Assessment, (9) Allergy Unassessible and (10) Renal Functions Over Age 65. Run the MUCD (Meaningful Use Clean Date) system check in PCC to verify that order checks are configured correctly. Configure order checks and run the MUCD prior to the first day of the EHR reporting period. What would prevent you from meeting this measure? Not having your order checks configured correctly. Not running the MUCD prior to the first day of the EHR reporting period. Note: When site is configured correctly, the MUCD will be set equal to that day’s date. Running the option again doesn’t reset the date. The initial clean date remains the same.

Taxonomies Identify Taxonomies that should be populated for Meaningful Use and coordinate with GPRA coordinator. Taxonomies affect Clinical Quality Measures. Add to taxonomies but never delete from the list. Taxonomies can be view and edited through iCare or RPMS with appropriate keys.

MEANINGFUL USE REPORTS

Meaningful Use Reports Reference Sheet MU ReportReport Name Relative pathKeys RequiredPackageName space VersionPatchRelease DateLinks to related documents EP Patient Volume PVPCORE>ABM>RPTP >MURP>MUPV ABMDZ MU PV SETUP Third Party Billing ABM2.6811/15/2011http:// S/PackageDocs/abm/ab m_ o.pdf Clean Date Report MUCDCORE > APC > MANR > MUR PCC *BJPC266/2/2011http:// ningfuluse/pdf/MUPerfor manceMeasuresLogic.p df EP MU Performance Measures MU1PCORE > APC > MANR > MUR n/aPCC *BJPC266/2/2011http:// ningfuluse/pdf/MUPerfor manceMeasuresLogic.p df EP MU CQM Report EPCORE>GPRA>CI11 >RPT>MUP BGPZMENU (required), BGPZ PATIENT LISTS (optional), BGPZ SITE PARAMETERS (optional), BGPZ TAXONOMY EDIT (optional), BGPZAREA (optional) Clinical Reporting System BGP /23/2011http:// ningfuluse/pdf/CRSMU CQMReportsSimpleLogi cDocument.pdf EH Patient Volume PVHCORE>ABM>RPTP >MURP>MUPV ABMDZ MU PV SETUP Third Party Billing ABM2.6811/15/2011http:// S/PackageDocs/abm/ab m_ o.pdf Clean Date Report MUCDCORE > APC > MANR > MUR PCC *BJPC266/2/2011http:// ningfuluse/pdf/MUPerfor manceMeasuresLogic.p df InPatient Bed Days FEIRCORE>ABM>RPTP >MURP Third Party Billing ABM2.6811/15/2011http:// S/PackageDocs/abm/ab m_026u.pdf EH MU Performance Measures MU1HCORE > APC > MANR > MUR n/aPCC *BJPC266/2/2011http:// ningfuluse/pdf/MUPerfor manceMeasuresLogic.p df EH MU CQM Report CORE>GPRA>CI11 >RPT>MUP BGPZMENU (required), BGPZ PATIENT LISTS (optional), BGPZ SITE PARAMETERS (optional), BGPZ TAXONOMY EDIT (optional), BGPZAREA (optional) Clinical Reporting System BGP /23/2011http:// ningfuluse/pdf/CRSMU CQMReportsSimpleLogi cDocument.pdf * The Performance Measure report relies on a number of packages to collect the necessary data to run the report. Please refer to the EHR for Meaningful Use: Resource and Training Reference Tool for Eligible Professionals or Eligible Hospitals for which packages are needed for each measure. uluse/pdf/EH RforMeaningf ulUseforEPsS cavengerHunt.pdf ningfuluse/pdf/EHRforM eaningfulUseforEHsCA HsScavengerHunt.pdf

WHAT DOES A CAC REALLY NEED TO KNOW Differences/commonalities between: -CORE SET and MENU SETS -PERFORMANCE MEASURES and CLINICAL QUALITY MEASURES -MEASURES FOR EH/CAH versus EP Reports that demonstrate reaching meaningful use Measures that require attestation only Effects of accurate and timely completion of coding queue on MU Effects of inpatient coding and clinical documentation on reaching CQM Effects of PCC errors on MU Effects of complete and comprehensive patient registration on MU

Area MU Coordinators AreaMU Coordinator Phone Number AberdeenCAPT Scott Anderson (605) Alaska Richard Hall Kimi Gosney Erika Wolter (907) (907) (907) AlbuquerqueJacque Candelaria (Acting) (505) Bemidji Jason Douglas Alan Fogarty (218) (218) BillingsCAPT James Sabatinos (406) CaliforniaMarilyn Freeman (916) , ext. 362 NashvilleRobin Bartlett (615) NavajoLCDR Andrea Scott (928) OklahomaAmy Rubin (405) PhoenixCAPT Lee Stern (602) Portland CAPT Leslie Dye Donnie Lee, MD (503) (503) TucsonScott Hamstra, MD (520)

Area MU Consultants(contractors) AreaMU Consultants Phone Number Team Lead (ABQ)JoAnne Regional ConsultantJames Regional ConsultantMark AberdeenCarol AlaskaKaren AlbuquerqueTroy BemidjiBevin x1558 BillingsJoanne CaliforniaTim NashvilleJoAnne NavajoDonna OklahomaJoAnne PhoenixRick PortlandAngela TucsonRick

IHS Meaningful Use: Contact Information Chris Lamer, Meaningful Use Project Lead, IHS (615) Cathy Whaley, Meaningful Use Project Manager, DNC (520) JoAnne Hawkins, MU Field Team Lead, DNC (505)

Questions? Sign up for the MU Listserv!