1. Meaningful use and PCMH How to kill two birds with one (or more) stones!

2. To Do: Quickly review meaningful use criteria and PCMH Identify the similarities between the two programs Shamelessly plug the services available from NC AHEC

3. NC AHEC Statewide Map 3 Mountain Greensboro South East Northwest Southern Regional Area L Charlotte Wake Eastern

4. www.ahecqualitysource.com

6. Funds will be distributed through Medicare and Medicaid incentive payments to eligible professionals “EPs”, who are “meaningful EHR users.” The Recovery Act establishes financial incentives beginning in January 2011 for eligible professionals (EPs) who are meaningful EHR users. Beginning in 2015, payment adjustments will be imposed on EPs who are not meaningful EHR users. Health Information Technology for Economic and Clinic Health (HITECH) Act

7. To receive the financial incentives (and avoid reductions), providers must demonstrate “meaningful use” of health information technology This means Eligible Providers must: ▫Use a certified EHR (system certification began October 2010) with clinical decision support ▫Electronic exchange of information. At minimum, eRx (electronic prescribing) and coordination of care ▫Capturing and generating data reports on specific indicators and quality of care Meaningful Use – The Very Basics

8. Payments for Meaningful use of Certified EHR from 2011 – 2015 Medicaid Providers (up to $63,750 per provider) 1.Based on Medicaid Patient Volume 2.MD, DO, DDS, NP, CNM & PAs with exceptions OR Medicare Providers (up to $44,000 per provider) 1.Based on % of allowable charges 2.MD, DO HITECH Act

9. To be eligible for Incentive Payments: The eligible professional must meet the Medicaid or Medicare program requirements The EHR system being adopted and used by the eligible professional MUST meet federal certification standards. And… the provider must demonstrate or attest to using specific functions of the EHR required in the meaningful use final rule.

10. Medicare vs. Medicaid differences MedicareMedicaid Federal Government will implement State by State implementation (including option for additional requirements) Payment reductions begin in 2015 for providers that do not demonstrate MU No Medicaid payment reductions Must demonstrate MU in Year 1 for 90 day reporting period, 12-month reporting in subsequent years Adopt/Implement/Upgrade option for 1 st participation year (by attestation/contract), 90 days in year 2, 12 months thereafter Maximum incentive is $44,000 for EPs - (10% bonus for EPs in HPSAs) Maximum incentive is $63,750 for EPs EP qualifying based on allowable charges – provider specific EP qualifying can be based on practice ratio of encounters to achieve 30% threshold Last year a provider may initiate program is 2014; Payment adjustments begin in 2015 Last year a provider may initiate program is 2016 10

11. Quick Overview: Successful Meaningful Use in Stage One: ▫Qualify for Incentive program under Medicare or Medicaid ▫Use of an ARRA Certified EHR system ▫Adopt, implement or upgrade your system OR ▫Attest to the successful completion and use of 15 Core Elements ▫Attest to the successful completion and use of 5 of the 10 Additional Items ▫Quality measures

12. Meaningful Use: A Phased Approach Between NOW and 2015 Stage 1 Use CPOE to collect discrete health data, implement clinical decision support tools, report quality measures, track conditions and coordinate care. Stage 2 Focus on structured data exchange and continuous quality improvement. Criteria Due: end of 2011. Stage 3 Advanced decision support and population health. Criteria due: end of 2013.

13. Stage 1 Policy Priority: Improving quality, safety, efficiency, and reducing health disparities

14. 6/9/10 Stage 1 Policy Priority: Improving quality, safety, efficiency, and reducing health disparities

15. 6/9/10

16. Menu Set – Choose 5 of 10 Improving quality, safety, efficiency, and reducing health disparities

17. Menu Set ctd.– Choose 5 of 10 Engage patients and families in their health care – Improve care coordination

18. Menu Set ctd.– Choose 5 of 10 Improve population and public health (must choose at least 1 of these 2)

21. What’s in a name? Patient Centered Medical Home (PCMH) ▫What is it?  - It’s a concept - A model for care delivery. ▫Care is coordinated across all elements of the patient’s community, including the health care system, and is facilitated by health information technology, to ensure patients get care when and where they need and want it. – AAFP

22. PCMH, A History…. The AAP introduced the medical home concept in 1967, initially referring to a central location for archiving a child’s medical record. 2002 the AAP expanded the medical home concept to include these operational characteristics: accessible, continuous, comprehensive, family- centered, coordinated, compassionate, and culturally effective care. The AAFP, 2004 The ACP, 2006“advanced medical home”

23. The AAP, AAFP, ACP, and AOA, representing approximately 333,000 physicians, have developed the following joint principles to describe the characteristics of the PC-MH. The Patient Centered Medical Home (PCMH) is an approach to providing comprehensive primary care for children, youth and adults. The PCMH is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. Principles: Personal physician Physician directed medical practice Whole person orientation Care is coordinated and/or integrated Joint Principles of the Patient Centered Medical Home February 2007

24. Consensus? Right now, by most standards… “Achieved PCMH recognition from NCQA” 383 NC providers in November 507 NC providers in January

25. Source: NCQA

26. National Committee on Quality Assurance’s (NCQA) definition: The Patient Centered Medical Home is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.

27. 27 NCQA PCMH Content and Scoring Standard 1: Access and Communication A.Has written standards for patient access and patient communication** B.Uses data to show it meets its standards for patient access and communication** Pts 4 5 9 Standard 2: Patient Tracking and Registry Functions A.Uses data system for basic patient information (mostly non-clinical data) B.Has clinical data system with clinical data in searchable data fields C.Uses the clinical data system D.Uses paper or electronic-based charting tools to organize clinical information** E.Uses data to identify important diagnoses and conditions in practice** F.Generates lists of patients and reminds patients and clinicians of services needed (population management) Pts 2 3 6 4 3 21 Standard 3: Care Management A.Adopts and implements evidence-based guidelines for three conditions ** B.Generates reminders about preventive services for clinicians C.Uses non-physician staff to manage patient care D.Conducts care management, including care plans, assessing progress, addressing barriers E.Coordinates care//follow-up for patients who receive care in inpatient and outpatient facilities Pts 3 4 3 5 20 Standard 4: Patient Self-Management Support A.Assesses language preference and other communication barriers B.Actively supports patient self-management** Pts 2 4 6 Standard 5: Electronic Prescribing A.Uses electronic system to write prescriptions B.Has electronic prescription writer with safety checks C.Has electronic prescription writer with cost checks Pts 3 2 8 Standard 6: Test Tracking A.Tracks tests and identifies abnormal results systematically** B.Uses electronic systems to order and retrieve tests and flag duplicate tests Pts 7 6 13 Standard 7: Referral Tracking A.Tracks referrals using paper-based or electronic system** PT 4 4 Standard 8: Performance Reporting and Improvement A.Measures clinical and/or service performance by physician or across the practice** B.Survey of patients’ care experience C.Reports performance across the practice or by physician ** D.Sets goals and takes action to improve performance E.Produces reports using standardized measures F.Transmits reports with standardized measures electronically to external entities Pts 3 2 1 15 Standard 9: Advanced Electronic Communications A.Availability of Interactive Website B.Electronic Patient Identification C.Electronic Care Management Support Pts 1 2 1 4 ** Must Pass Elements

28. Improving Quality of Care by Organizing Care Around Patients Although the earlier PCMH program addressed many of these issues, PCMH 2011 strengthens and adds to existing elements. Robust patient centeredness is an important program goal: There is a stronger focus on integrating behavioral healthcare and care management Patient survey results help drive quality improvement Patients and their families are involved in quality improvement. NCQA Statement on new standards

29. PCMH 2011 Basics There are six standards, ▫including 6 must pass elements, Score of these elements results in one of three levels of recognition Requires completion of a web-based data collection tool and supporting documentation

30. Source: NCQA

34. Hmm…..

35. 35 NCQA PCMH Content and Scoring & MU! Standard 1: Access and Communication A.Has written standards for patient access and patient communication** B.Uses data to show it meets its standards for patient access and communication** Pts 4 5 9 Standard 2: Patient Tracking and Registry Functions A.Uses data system for basic patient information (mostly non-clinical data) B.Has clinical data system with clinical data in searchable data fields C.Uses the clinical data system D.Uses paper or electronic-based charting tools to organize clinical information** E.Uses data to identify important diagnoses and conditions in practice** F.Generates lists of patients and reminds patients and clinicians of services needed (population management) Pts 2 3 6 4 3 21 Standard 3: Care Management A.Adopts and implements evidence-based guidelines for three conditions ** B.Generates reminders about preventive services for clinicians C.Uses non-physician staff to manage patient care D.Conducts care management, including care plans, assessing progress, addressing barriers E.Coordinates care//follow-up for patients who receive care in inpatient and outpatient facilities Pts 3 4 3 5 20 Standard 4: Patient Self-Management Support A.Assesses language preference and other communication barriers B.Actively supports patient self-management** Pts 2 4 6 Standard 5: Electronic Prescribing A.Uses electronic system to write prescriptions B.Has electronic prescription writer with safety checks C.Has electronic prescription writer with cost checks Pts 3 2 8 Standard 6: Test Tracking A.Tracks tests and identifies abnormal results systematically** B.Uses electronic systems to order and retrieve tests and flag duplicate tests Pts 7 6 13 Standard 7: Referral Tracking A.Tracks referrals using paper-based or electronic system** PT 4 4 Standard 8: Performance Reporting and Improvement A.Measures clinical and/or service performance by physician or across the practice** B.Survey of patients’ care experience C.Reports performance across the practice or by physician ** D.Sets goals and takes action to improve performance E.Produces reports using standardized measures F.Transmits reports with standardized measures electronically to external entities Pts 3 2 1 15 Standard 9: Advanced Electronic Communications A.Availability of Interactive Website B.Electronic Patient Identification C.Electronic Care Management Support Pts 1 2 1 4 ** Must Pass Elements

36. Source: NCQA

48. Dollars and Sense…. Meaningful use Incentive $ from CMS ▫($44,000 or $63,750 per eligible provider) Efficiencies ▫Workflows, UDS data, PDSA data, patient sat… etc Health Information Exchange Accountable Care Organizations ▫Shared savings in reducing readmissions…. etc

49. Chart is placed at vitals station H,W,BP Taken & recorded Patient is called to vitals station Patient is taken to exam room Chart is placed in sleeve on exam door Paper trigger Template needed How many vitals stations? How often do we room without vitals? Are cuffs and scales available in rooms? How many BPs do we miss?

50. Quick little QI project on BPs Could result in: BPs taken/recorded (affects Rx, MU) in BP outcomes if change of location (PCMH, MU) in number of BMIs recorded (MU) All could result in $$ (everybody speaks the language of $$)

52. Baseline (blue) to 12 months (red) 23 practices working on Diabetes

53. Paper Charts Electronic Health Records Meaningful use of HIT Improved Clinical Outcomes Patient Centered Medical Home Learn how to: Select a certified EHR that meets your needs Implement an EHR for optimal use in your practice Learn how to: Assess the needs of your practice in an EHR system. Redesign your paper practice to ready for an EHR. Learn how to: Use your EHR to meet the federal requirement s for the HITECH Act Meaningful Use Incentive Payments from Medicare or Medicaid Learn how to: Produce population – based reporting to test the efficacy of your care Use proven methods and techniques to improve the outcomes of your patients Learn how to: Meet the requirements of the NCQA Recognition program for PCMH Approach the PCMH application process with improvement techniques 53 1. Electronic Disease Registry 2. Templates to Guide Care 3. Disease Protocols and Team Based Care 4. Patient Self Management Support

54. Practice support Coordinato r QI Consultants Practice Support Coordinator Technical Assistance Specialist QI Consultants

55. www.ahecqualitysource.com

56. Websites www.ahecqualitysource.com www.ncqa.org www.cms.gov/EHRIncentivePrograms