1. Meaningful Use and the EHR Incentive Program
NIHB Annual Consumer Conference

2. EHR Incentive Program
The Medicare and Medicaid EHR Incentive Programs will provide incentive payments to eligible professionals (EPs), eligible hospitals (EHs) and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology.
EHR Incentive Program rewards providers/hospitals for achieving MU.

3. Meaningful Use Eligibility Certified EHR Meaningful Use Measures
Clinical Quality Measures
Components of MU:
- Eligibility: requirements for providers/hospitals within Medicare/Medicaid.
- Certified EHR: RPMS is now certified – all patches and applications are released/available
- MU Measures – how you are utilizing the EHR’s functionality.
- Clinical Quality Measures: no targets – simply report performance.
In general, an EP/EH will demonstrate MU in Stage 1 by utilizing certified EHR technology to:
- Meet the applicable MU measures, and
- Report on the applicable clinical quality measures.
Satisfying each of these requirements will qualify the EP/EH for an incentive payment.

4. Provider Eligibility
To be eligible for the Medicaid incentive program, a provider must have a Medicaid patient volume of 30%.

5. Meaningful Use Eligibility Certified EHR Meaningful Use Measures
Clinical Quality Measures
Certified EHR:
RPMS EHR is certified for both inpatient and outpatient facilities. EPs/EHs will use same system.

6. Certified RPMS EHR Requirements
Name Space
Package or Application
Version
Patch
Release Date AG
Patient Registration
7.1 9
12/3/10
APCL
Export
3.0 27
11/10/10
APSP
Pharmacy MOD-ePrescribing (eRx)
7.0
1010
4/29/11
BGP
Clinical Reporting System (CRS)
11.0 3
6/22/11
BJMD
C32
1.0 1
6/24/11
BJPC
PCC Mgmt Reporting
2.0 6
6/2/11
BMC
Referred Care Information System (RCIS)
4.0 7
5/12/11
BQI
iCare
2.1
3/11/11
BRN
Release of Information (ROI)
4/13/11
BYIM
Immunization Exchange Message 01
2/24/11
BGO
Electronic Health Record (EHR)
1.1 8
6/10/11 LR
Lab
5.2
1027 or 372 or 334
12/07/10
PXRM
EHR Reminders
1.5
1007
4/13/10
BPHR
Personal Health Record (PHR)
Central Ensemble
2011
GuardianEdge/ Symantec
8.0
3/31/11
IPSEC (Windows)
2010
VanDyke (AIX)
WinHasher
1.6
Universal Client -Continuity of Care Record (CCR)*
4/27/11
* Universal Client -Continuity of Care Record (CCR) – now known as HIE Viewer is installed on the central servers so there is no installation needed at each facility. The URL to access the application is 
The logon username & password are D1 credentials so each user needs a D1 account and must be added to the Active Directory group that allows access to the HIE Viewer. The AD Group is “IHS NHINC GUI Users”. Contact the help desk to get this added.
Current list of required patches/applications is always available at – look for “Application Checklist” link.

7. Meaningful Use Eligibility Certified EHR Meaningful Use Measures
Clinical Quality Measures
MU Measures – how you are utilizing the EHR’s functionality.
Most measures are same for EPs/EHs, some differences.

8. Meaningful Use Measures
Yes/No Measures
Implement drug-drug and drug-allergy checks
Generate at least one report listing patients with a specific condition
Measures with Targets
Record smoking status for more than 50% of patients
Provide patient-specific education resources for more than 10% of patients
MU Measures – how you are utilizing the EHR’s functionality.
EPs required to meet 20 measures, EHs required to meet 19 measures.
*Note: This slide includes brief descriptions of some sample measures. This is not a full list of all MU measures.

9. Meaningful Use Measures
EP Core Set Measures (15)
EH Core Set Measures (14)
Use CPOE for medication orders
Implement drug-drug and drug-allergy checks
Record demographics
ePrescribing
Maintain up-to-date problem list, medication list, medication allergy list
Record and chart changes in vital signs
Record smoking status
Implement one clinical decision support rule
Report clinical quality measures
EPs/EHs must meet every measure in the core set.
*Note: This slide includes brief descriptions of core set measures. This is not a full list of all MU measures; this does not list all requirements for each measure.
Provide patients an electronic copy of health info upon request
Provide clinical summaries for office visits
Provide electronic copy of discharge instructions upon request
Capability to electronically exchange key clinical information (perform test)
Protect electronic health information (security risk analysis)

10. Meaningful Use Measures
EP Menu Set Measures (10)
EH Menu Set Measures (10)
Implement drug formulary checks
Incorporate clinical lab test results into certified EHR
Generate lists of patients by specific conditions
Record advance directives
Send reminders to patients
Provide patients with timely electronic access to their health information
Use certified EHR to identify and provide patient-specific education resources
EPs/EHs must meet 5 measures in the menu set, including one public health measure.
*Note: This slide includes brief descriptions of menu set measures. This is not a full list of all MU measures; this does not list all requirements for each measure.
Perform medication reconciliation for patients referred to the EP/EH
Provide summary of care records for patients referred to other providers/facilities
Submit electronic data to immunization registries
Submit electronic syndromic surveillance data to public health agencies
Submit electronic data on reportable lab results to public health agencies

11. Meaningful Use Eligibility Certified EHR Meaningful Use Measures
Clinical Quality Measures
Clinical Quality Measures – no targets, simply report performance.
Different CQM sets for EPs and EHs.

12. Clinical Quality Measures: EPs
Core/Alternate Core Set (6)
Hypertension
Tobacco Use Assessment/Cessation Intervention
Adult Weight Screening/Follow-up
Weight Assessment/Counseling for Children
Adult Influenza Immunization
Childhood Immunization
Additional Measures (38)
Breast Cancer Screening; Cervical Cancer Screening; Colorectal Cancer Screening
EPs report rates for 6 CQMs. May report zero denominators, but those do not count as rates.
EP measures look like GPRA measures (e.g., hypertension, tobacco use assessment and cessation intervention, influenza immunization for adults), BUT
- have slightly different logic (e.g., different age range),
- and are calculated/reported for each provider, not facility aggregate like GPRA.

13. Clinical Quality Measures: EHs
Emergency Department (2)
Median time from ED arrival to ED departure for admitted patients; median time from admit decision time to ED departure time for admitted patients
Stroke (7)
Anticoagulation for A-fib/flutter, discharge on statins, stroke education, etc.
Venous Thromboembolism (6)
Anticoagulation overlap therapy, discharge instructions, etc.
EHs will report rates for 15 CQMs in three areas: ED, stroke, and VTE.

14. Medicare Incentive Program
Requirements and Amounts for EPs who begin in 2011 or 2012
Year
Requirement
Incentive 1
Demonstrate MU for 90-day period
$18,000 2
Demonstrate MU for full calendar year
$12,000 3
Demonstrate MU for full calendar year
$8,000
Must begin by 2014 to receive incentive payments.
For EPs beginning in:
2011 or 2012 – up to $44,000 available over 5 years.
2013 – up to $39,000 available over 4 years.
2014 – up to $24,000 available over 3 years.
Demonstrating MU means meeting targets/goals over the reporting period, for example:
Implement drug-drug and drug-allergy checks
Generate at least one report listing patients with a specific condition
Record smoking status for more than 50% of patients
Provide patient-specific education resources for more than 10% of patients 4
Demonstrate MU for full calendar year
$4,000 5
Demonstrate MU for full calendar year
$2,000

15. Medicare Incentive Payments
Payment Year
First Year EP Demonstrates MU
2011
2012
2013
2014
2015
CY 2011
$18,000
CY 2012
$12,000
CY 2013
$8,000
$15,000
CY 2014
$4,000
CY 2015
$2,000 $0
CY 2016
Total
$44,000
$39,000
$24,000
Must begin by 2014 to receive incentive payments.
For EPs beginning in:
2011 or 2012 – up to $44,000 available over 5 years.
2013 – up to $39,000 available over 4 years.
2014 – up to $24,000 available over 3 years.
Demonstrating MU means meeting targets/goals over the reporting period, for example:
Implement drug-drug and drug-allergy checks
Generate at least one report listing patients with a specific condition
Record smoking status for more than 50% of patients
Provide patient-specific education resources for more than 10% of patients

16. Medicaid Incentive Payments
Requirements and Amounts for EPs
Year
Requirement
Incentive 1
Adopt/Implement/Upgrade to certified EHR technology
$21,250 2
Demonstrate MU for 90-day period
$8,500 3
Demonstrate MU for full calendar year
$8,500 4
Demonstrate MU for full calendar year
$8,500
Must begin by 2016 to receive incentive payments. Total of $63,750 available over 6 years.
Demonstrating MU means meeting targets/goals over the reporting period, for example:
Implement drug-drug and drug-allergy checks
Generate at least one report listing patients with a specific condition
Record smoking status for more than 50% of patients
Provide patient-specific education resources for more than 10% of patients 5
Demonstrate MU for full calendar year
$8,500 6
Demonstrate MU for full calendar year
$8,500

17. EHR Incentive Program Registration
All EPs/EHs will begin registration on CMS website. If participating in the Medicaid program, will continue registration process on the state Medicaid site.

18. EHR Incentive Program Registration
Screenshot of Registration page on CMS website:
1 – Register for the Medicare and/or Medicaid EHR Incentive Programs
2 – Registration User Guides and Webinar
3 – General information about registration requirements – NPI, NPPES (CMS National Plan and Provider Enumeration System), TIN, I&A (CMS Identity and Access Management)
4 – State Medicaid program launch dates and info
5 – Attestation page

19. EHR Incentive Program Registration
Medicare EPs:
Register with CMS
Medicaid EPs:
Register with state Medicaid program
Hospitals:
Register as dual-eligible
With CMS for Medicare
With state Medicaid program for Medicaid
Certified EHR is not required for registration!

20. Regional Extension Center
The RECs will support and serve health care providers to help them quickly become adept and meaningful users of EHRs. RECs are designed to make sure that primary care clinicians get the help they need to use EHRs.
Provide training and support services to assist providers in adopting EHRs
Offer information and guidance to help with EHR implementation
Provide technical assistance
RECs are designed to support providers in achieving MU.
State RECs vs. NIHB REC.
NIHB REC is working in collaboration with IHS to provide support.
REC funding supports the work of EHR deployment team, clinical consultants providing ongoing EHR training, development of resources, etc.

21. REC vs Incentive Program
Regional Extension Center
EHR Incentive Program
EHR certification rule
Meaningful use rule
Support providers and hospitals in achieving MU
Reward providers and hospitals for achieving MU

22. Regional Extension Center
Eligible Providers
Regional Extension Center
EHR Incentive Program
Physicians (MDs and DOs)
Family Practice
General Practice
Internal Medicine
Obstetrics and Gynecology
Pediatrics
Adolescent Medicine
Geriatrics
Physician Assistants
Nurse Practitioners
Certified Nurse Midwives
Alaska CHA/Ps
Medicare EPs
Physicians (MDs and DOs)
Dentists
Podiatrists
Optometrists
Chiropractors
Medicaid EPs
Certified Nurse Midwives
Nurse Practitioners
Physician Assistants*
Definitions of eligible providers come from different pieces of legislation: HITECH Act, Public Health Service Act, Social Security Act, etc.
Funding for REC based on the number of providers who sign up and participate in the program. This funding supports REC participants and others who are working to achieve MU.

23. Provider Responsibilities
Regional Extension Center
EHR Incentive Program
Sign up with REC
Go live with certified EHR
Achieve MU
Register with CMS/State
Achieve MU
Attest/submit each year
Completing Milestone = REC Funding
Demonstrating MU = Incentive Payment
Have discussed REC and CMS responsibilities:
- support you in achieving MU
- reward you for achieving MU
Each milestone/step/goal is critical for each provider:
- Funding for the REC is dependent upon each provider achieving each milestone
Incentive payments to EPs/EHs are dependent upon the EP/EH demonstrating MU
Important to sign up so the REC receives enough funding to accomplish its mission.

24. Regional Extension Center
EHR Incentive Program
ONC
CMS $ $ $ $ $ $ $ $
IHS
NIHB AI/AN REC
EPs/EHs
NIHB REC vs. State RECs:
- RPMS-EHR expertise
- Clinical consultants
- Supporting work in Indian Country
1. Provider signs up with NIHB AI/AN REC
2. Provider “goes live” with certified EHR
3. Provider achieves meaningful use   

25. NIHB REC M1: Sign Up http://nihb.org/rec/rec.php
Download and complete form, send completed form to NIHB. We will contact you with questions if needed.

26. NIHB REC M2: Go Live
We will send you a form – just complete it and return it.
We will verify data using Site Tracker (Site Checker) tool – please install BNP and BCER on your system if you haven’t already!

27. NIHB REC M3: Achieve MU Medicare EPs Medicaid EPs and others
Provide CMS Attestation ID
Medicaid EPs and others
Provide attestation data from RPMS-EHR reports
To qualify for M3 grant credit, NIHB must (in general) enter numerators/denominators, responses to yes/no measures, and exclusions. We are still looking at this process.
Others would include all nurse practitioners, certified nurse midwives, and physician assistants – even if they do not meet the 30% Medicaid patient volume requirement.

28. Things to Do Now Sign up with the NIHB REC
Designate a Meaningful Use Coordinator
Install RPMS EHR patches and other required software applications for certification
Review MU Measures and redesign workflows
Register for EHR Incentive Program (pending launch of State program for Medicaid EPs/EHs)
An EP/EH’s 90-day MU demonstration period cannot begin until all required patches and software applications are installed!
An EP/EH can register with CMS (and the State, if applicable) any time – prior to or during the 90-day MU demonstration period.

29. 2011 Timeline Hospitals Providers
Medicare: Last 90-day period within FY 2011 to demonstrate MU is July 1 – Sept 30, 2011
Medicaid: Check with state about deadlines
Providers
Medicare: Last 90-day period within CY 2011 to demonstrate MU is Oct 1 – Dec 31, 2011
An EP/EH’s 90-day MU demonstration period cannot begin until all required patches and software applications are installed!

30. Resources www.usetinc.net/ehr www.cms.gov/ehrincentiveprograms/
Frequently Asked Questions
EHR Incentive Program Eligibility, Registration
Status of State Medicaid Programs
MU Listserv
RPMS-EHR Certification Info

31. Contact
Vicki French United South and Eastern Tribes