Agenda. Meaningful Use: What You Really Need to Know. Am I Eligible? Which Program? Meaningful Use Progression 6/14/2013. Overview of Meaningful Use

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1 Agenda Meaningful Use: What You Really Need to Know Presented by: Melissa Francisco American College of Rheumatology Overview of Meaningful Use Eligibility Requirements Stage 1: Basics, Key Changes When Do I Start Stage 2? Stage 2: Basics, New Measures, Changes Q & A Meaningful Use Resources Overview of Meaningful Use rs leverage the capabilities of Certified EHR Technology (CEHRT) to achieve benchmarks that can lead to improved patient care. Meaningful Use Components: 1. Use CEHRT in a meaningful way 2. Use CEHRT for electronic exchange of health to improve quality of care 3. Use CEHRT to submit clinical quality measures Start Year Stages of Meaningful Use Year One: 90 Days 1 1 Subsequent Years: 365 Days 2014 ONLY = 90 Days for Everyone Meaningful Use Progression Am I Eligible? Which Program? Medicare Medicaid Stage 1 Stage 2 Advanced Clinical Processes Stage 3 Improved Outcomes MD, DO, DDM/DDS Part B Medicare Allowable Charges Enrolled in PECOS Not hospital-based Physicians (MD or DO) Nurse practitioner Certified nurse-midwife Dentist Physician assistant 30%+ Medicaid Patient Volume OR- 30%+ Needy Patient Volume (FQHC or RHC) Licensed, Credentialed Not hospital-based Data Capture and Sharing 1

2 Summary of Medicare vs. Medicaid Medicare: Maximum Incentive Payments Medicare EHR Incentive Program Implemented by the Federal Government Maximum Incentive = $44,000 (across 5 years of participation) Payment adjustments begin in 2015 Sequestration reduces incentive payments Medicaid EHR Incentive Program Voluntary for States to Implement Maximum Incentive = $63,750 (across 6 years of participation) No Medicaid payment adjustments Sequestration has no effect on incentive payments Must demonstrate MU in Year 1 Adopt,Implement, & Upgrade in Year 1 Start by 2014 to receive incentives Last payment year is 2016 Start by 2016 to receive incentives Incentives available through 2021 Payment Year First Year of Meaningful Use Attestation CY2011 CY2012 CY2013 CY2014 CY2015+ CY2011 $18, CY2012 $12,000 $18, CY2013 $8,000 $12,000 $15, CY2014 $4,000 $8,000 $12,000 $12, CY $2,000 $4,000 $4,000 $0 CY $2,000 $4,000 $4,000 $0 Total $44,000 $44,000 $39,000 $24,000 $0 GA Medicaid Maximum Incentive Payments Eligibility Quick Check Payments by Calendar Year MedicaidEPs Who Adopted In: $21, $8,500 $21, $8,500 $8,500 $21, $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $8, $8,500 $8,500 $8,500 $8, $8,500 $8,500 $8, $8,500 $8, $8,500 Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750 Service Setting: Did you perform 90% of your services in an inpatient hospital or ER setting? Medicaid: Were at least 30% of your services furnished to Medicaid patients? Medicaid EPs: Are you one of the following (select from list of provider types)? If you are eligible for both programs, choose Medicaid to maximize your incentive payments. What if I ve already started? You can switch ONE TIME before 2015 How Do I Avoid Medicare Penalties? Stage 1 Basics Demonstrate Meaningful Use: EPs that are meaningful users in 2013 EPs who first demonstrate MU in 2014: Demonstrate MU at least 3 months prior to the end of 2014 AND Meet registration and attestation requirements by July 1, 2014 Qualify for an Exception: 1. Lack of internet access/barriers to obtaining IT infrastructure 2. Time-limited exception for newly practicing EPs 3. Unforeseen circumstances such as natural disasters 4. Clinical features limiting EP s interaction with patients Core 15 Measures Report on 26 Total Measures 5 out of 10 Measures CQMs 6 Measures 3 Core/Alternate 3 out of 44 2

3 Key Changes to Stage 1 Policy Change: Qualifying for an exclusion no longer reduces the number of menu objectives required to demonstrate Meaningful Use Denominator Changes: CPOE Vital Signs E-Copy & Online Access CPOE Optional Denominator Denominator: Unique patient with at least 1 medication in medication list Denominator: Number of orders during the EHR reporting period Optional CPOE denominator is available in 2013 and beyond for Stage 1 Gone (But Not Forgotten): Testing of HIE Vital Signs E-Copy & Online Access Age Limits: Exclusion: Age 2 for BP and All three elements not relevant to scopeof practice Age Limits: Exclusion: Vital Signs changes are optional in 2013, but they are required in Age 3for BP, no age limit for BP to be separated from Objective: patients with e- copy of health upon request electronic access to health Objective: patients the ability to view online, download and transmit their health 50% of patients are provided access to their No requirement that 5% of patients actually access their for Stage 1 This change takes effect in 2014 to coincide with 2014 certification and standards criteria Testing of HIE When Do I Start Stage 2? Onetest of electronic transmission of key clinical Requirementremoved effective 2013 The removal of this measure is effective starting in st Year of MU 2 Years Stage

4 Stage 2 Basics New Measures for Stage 2 Report on 29 Total Measures Objective Measure Type Secure electronic messaging 5% Core Core 17 Measures 3 out of 6 Measures CQMs 9 Measures 3 out of 6 NQDs 3 out of 44 Family health history 20% Imaging results 10% Registry reporting cancer and specific cases Ongoing Electronic progress notes 30% New Measure Thresholds Measures on the Move: Where are they Now? Measure MU1 Threshold MU2 Threshold CPOE 30% (Med) 60% (Med); 30% (Lab/Rad) erx 40% 50% Demographic Info 50% 80% Vitals 50% 80% Smoking Status 50% 80% Clinical Summaries 50% (3 Days) 50% (1 Day) Patient Education 10% () 10% (Core) Objective Measure New Location Implementdrug-drug and drug-allergy interaction checks Maintainup-to-date problem list of current and active diagnoses Functionality enabled Clinical Decision Support 80% Summary of Care at Transitions Maintain active medicationlist 80% Summary of Care at Transitions Maintain active medication allergy list 80% Summary of Care at Transitions Implementdrug-formulary checks Functionality enabled E-Prescribing Patient Engagement Requirements for Patient Action: Secure Messaging: More than 5% of patients send secure messages to their provider Online Access: More than 5% of patients access their health online Transitions Summary of Care Document: Send for more than 50% of transitions of care and referrals Electronically transmit for more than 10% of transitions of care and referrals At least one summary of care document sent electronically to recipient with a different EHR vendor or to CMS test EHR Exclusions: CMS is introducing exclusions based on broadband availability in the provider s county 4

5 E-Reporting CQMs National Quality Domains New for 2014 Electronically report CQM data to CMS Who: All Medicare-eligible providers When: Year 2 or beyond of demonstrating MU Medicaid: EPs will report CQM data to their state Patient & Family Engagement Patient Safety Care Coordination Population & Public Health Efficiency Select 9 CQMs Clinical Process Selecting Measures & CQMs 1. Select measures most relevant to your practice 2. Select measures with a denominator greater than 0 Denominator Options: 1. Unique patients seen by EP during reporting period Stratify by Age or Previous Office Visit 2. Number of orders Medications, Labs, Radiology 3. Office visits 4. Transitions of care/referrals EP is the recipient EP is the initiator Meaningful Use Checklist Check eligibility Medicare vs. Medicaid Make sure you can meet all MU objectives Choose Measures & CQMs wisely Monitor performance Seek assistance from credible sources Meaningful Use Resources Melissa Francisco, ACR Staff mfrancisco@rheumatology.org x102 Questions? ACR HIT Webpage: Eligibility Check: Download the EHR EP Decision Tool Meaningful Use Introduction for Eligible Professionals: Guidance/Legislation/EHRIncentivePrograms/Downloads/EHR_Medicaid_Guide_Remediated_20 12.pdf Stage 2 Resources: 5