Meaningful Use Stage 2. Physicians Offices March 2014

Transcription

1 Meaningful Use Stage 2 Physicians Offices March 2014

2 Presenters J.N. Cook, D.O. MPH, Randi Terry, MBA,

3 Credit where credit is due

4 Long Road Traveled

5 How to Qualify Use a certified EHR Certified HIT Product List (CHPL) Register with CMS EHR Incentive Programs Meet Meaningful Use Criteria Staged criteria based on year of participation Report to CMS

6 The REAL BENEFIT Presentation will not be summary of Meaningful Use (you probably better have that). Will be about the questions you ve asked us or the things we ve stumbled across. ASK LOTS OF QUESTIONS

7 Checking Status Need NPPES ID and Password

8 CHPL Number 2011 (Stage 1) list of CHPL s Ambulatory (EP): 3737 Hospital (EP): (Stage 2) list of CHPL s (both ambulatory and hospital)

9 CHPL Edition (2011, 2014) Project Name/Vendor Name Complete/modular Version Number Required Software (IMPORTANT) Certified for what (especially needed for CQM)

10 2014 Certified Code Must have certified code the ENTIRE reporting period

11 2014 Certified Code

12 CHPL Number

13 CHPL Number

14 CHPL Number In 2014, you MUST have 2014 certified code in place even if you are still in Stage 1 for the ENTIRE quarter

15 CHPL Number Must have proof that you have each software listed

16 Multiple Versions Complete verses modular Check what is different (in this case new QM s were added) Make sure you select 2014

17 Multiple Locations Copy this number, do not try to type it in, 1 and l and L are not easily separated

18 Penalties

19 Penalties

20 Confusion in it s Finest

21 Timing AIU Medicaid Example Multiple stages in one practice

22 Timing Medicare Example Depending on year, you may have 3 years in Stage 1 and 3 years in Stage 2

23 Exception (if your vendor is not ready) 2014 CEHRT Hardship Exception Guidance announced today The Centers for Medicare & Medicaid Services today issued guidance for eligible professionals, eligible hospitals and critical access hospitals that are unable to implement the 2014 Edition of Certified Electronic Health Record technology in time to successfully demonstrate meaningful use for the 2014 reporting year. Visit the EHR Incentive Program webpage for the: 2014 CHERT Hardship Exception Guidance for Eligible Professionals, Guidance/Legislation/EHRIncentivePrograms/Downloads/CEHRT2014_HEG uidance_eps.pdf

24 Exception (if your vendor is not ready) There are no appeals, so make your case

25 Multiple Locations (What counts) Inpatient and ED does NOT count Counts: Urgent Care Free Clinics Surgery Center ½ of the year at practice A and ½ of the year at practice B Nursing Home Visits 50% encounters at location equipped with CEHR (Certified EHR) Core and Menu Items (add everything together from all locations)

26 Multiple Locations (Core and Menu) Combine numbers of CEHR to attest Have to get the numbers from previous locations Residents may count Obtain physician signature

27 Practice at Multiple Places (CEHR) Ask yourself: does the provider have more than 50% of their encounters at a location equipped with a CEHR

28 Practice at Multiple Places

29 Medicaid Expands Eligibility (2013+)

30 How does the state know how many Medicaid encounters you have Medicaid - Avoid an audit

31 Stage of Meaningful Use

32 Stage 2 Key Facts Increased % for nearly all measures New Requirements Focus on electronic data exchange Patient portal required 2014 EHR certification =Upgrade needed =2014 Code =Check YOUR EHR 2014 version ~=ICD-10 ready

33 Increased Requirements Requirement Stage 1 Stage 2 Comment erx 40% 50% Formulary search Demographics 50% 80% Multiple race option Vitals 50% 80% BP > 3 y.o. Smoking Status 50% 80% SNOMED coding Security Risk Analysis 1 1 Include encryption/security of data at rest

34 Menu Stage 1 = Core Stage 2 Requirement Stage 1 Structured Lab Results Patient Education Medication Reconciliation Stage 2 Patient List % 55% Interface Comment 10% 10% Measurement change 50% 50% Transitions to the practice

35 Core

36 Core

37 Core

38 CPOE Exclusions: < 100 Different denominator New definition of licensed healthcare professional

39 CPOE

40 CPOE Licensed Professional Any licensed healthcare professionals and credentialed medical assistants, can enter orders into the medical record for purposes of including the order in the numerator for the objective of CPOE if they can originate the order per state, local and professional guidelines. Credentialing for a medical assistant must come from an organization other than the organization employing the medical assistant.

41 Interventions - Clinical Decision Support Can be ANY 4 CQM s, not the ones you are reporting on

42 Interventions - Clinical Decision Support CMS/ONC didn t like some CDS s that were selected in Stage 1 so they became more specific Make sure you document each CDS and which one of these it relates to Makes sure one relates to a combination of two Most EHR s have this nailed but you have to document.

43 Interventions - Clinical Decision Support Make sure you document each CDS and what reference you use Embed the reference right into you EHR (debate able whether needed).

44 Clinical Decision Support

45 CDS - Document

46 Preventive Care/Patient Reminders Patient portal, robo dialer, etc.

47 View, Download and Transmit AKA: Patient Portal

48 View, Download and Transmit Patient Portal

49 View, Download and Transmit

50 View, Download and Transmit Start early, it takes time Kiosk machines in waiting room or at checkout The excuse of old people doesn t fly Make patient portal useful otherwise patients will use at first and then not later

51 Secure Messaging

52 Secure Messaging - WHY Providers have seen reduction in time responding to inquires and less time spend on the phone Secure messaging has also been shown to increase patient satisfaction with their care. Research demonstrates that secure messaging has been shown to improve patient adherence to treatment plans. While we recognize that EPs cannot directly control whether patients use electronic messaging, we continue to believe that EPs are in a unique position to strongly influence the technologies patients use to improve their own care, including secure electronic messaging. We believe that EPs ability to influence patients coupled with the low threshold make this measure achievable for all EPs

53 Transition of Care What is it? Transitions into a practice Medication reconciliation (50%) Transitions to another site or provider Summary of care record (3 measures)

54 Transition of Care Transition in Transition Out Medication Reconciliation Requirement Summary of Care Document Requirement

55 Summary of Care

56 Summary of Care

57 Summary of Care Direct s Only

58 Summary of Care CCD / CCDa if the provider does not have the information available to populate one or more of the fields listed, either because they can be excluded from recording such information (for example, vital signs) or because there is no information to record (for example, laboratory tests), the provider may leave the field(s) blank. The only exception to this is the problem list, medication list, and medication allergy list.

59 Summary of Care CCD / CCDa

60 Summary of Care CCD / CCDa Many are 26+ pages long

61 Summary of Care CCD / CCDa

62 Summary of Care CCD / CCDa Munson Contact: Colleen DeBie, , bdebie@mhc.net Website: listing of all KNOWN Direct Trust s

63 Transition of Care Transition in Transition Out Medication Reconciliation Requirement Summary of Care Document Requirement

64 Medication Reconciliation New patients Existing patients transitioning back if: 50%

65 Security Risk Analysis

66 Summary - Menu

67 Menu what is your vendor certified for Next Gen ecw, V10

68 Family History

69 Family History Must be entered in Snomed Does not need to be collected every visit (just once) Should not be a problem

70 Syndromic Surveillance

71 Syndromic Surveillance

72 Syndromic Surveillance content/uploads/2013/12/msss-testing-and- Submission-Guide.pdf

73 Syndromic Surveillance Per the state of Michigan, any specialty can participate in this. The submission must go through Sub State HIE (MiHealth Connect). Must have statement of work George Bosnjak (616) You must receive an OID (organizational ID), see link to the left

74 Syndromic Surveillance If you are on the hosted ecw system or hosted Next Gen, Munson IS will assist you with the submission.

75 Electronic Progress Notes The text of the electronic note must be text-searchable and may contain drawings and other content.

76 Electronic Progress Notes - OLD

77 Specialized Registry Munson Healthcare cannot find a specialized registry to work with other than Pinnacle for Next Gen PHO registry will not count, MICR will not count PQRS will not count

78 Quality Measures

79 Find your vendor certification From CHPL list Fro

80 Clinical Quality Measures CMS Recommended

81 2014 CQM issues ONC does not require vendors to configure their EHRs to measure all 64 CQMs 2014 CQMs will be utilized for Stage 1 or Stage 2 reporting PFR not PFP Multiple reporting options CMS website PQRS Group option Medicaid-state reporting

82 CDS CQM Strategy Primary Care 1. Don t panic 2. EHR 2014 certification for specific CQMs 3. Select 9 CQMs appropriate to practice >=3 Domains 4. Select 5 CDS associated with 4 CQMs 5. Select reporting option. Subspecialties 1. Fret but don t panic 2. EHR 2014 certification for specific CQMs 3. Search for 9 CQMs Zero option 4. Search for 5 CDS 5. Read attestation and reporting requirements 6. FAQ watch 7. Select reporting option.

83 Meaningful Use Audits

84 Meaningful Use Audits

85 Meaningful Use Audits

86 Meaningful Use Audits Meaningful Use audits are a when not an if Retain documentation for 6 years post-attestation If found to not be eligible for an EHR incentive payment, payment will be recovered Medicare: (letter) from CMS (make sure you address is accurate) Guidance/Legislation/EHRIncentivePrograms/Do wnloads/ehr_supportingdocumentation_audits. pdf Figliozzi & Company is contractor conduct the audit Pre-audits have kicked in.

87 Meaningful Use Audits Relevant IT systems, system configurations, roles, and processes for each MU criteria System certification documentation (versions, certification #s, etc.) Reports/data for each reporting period Confirmations or other communication for CMS or State A copy of (ONC) certification as well as licensing agreements with the vendor or invoices from the system purchase Specific and concise documentation for all Core and Menu Criteria (Numerator/Denominator & Yes/No) Reports from your CEHRT to document the numbers you attested to for Numerator/Denominator criteria and Quality Measures Documentation that demonstrates how each criteria was met e.g., screen shots, training materials, reports, audit logs, policies/procedures Be sure there are time/date stamps to prove screen shots, etc. were taken during the reporting period Especially for Yes/No criteria

88 Questions

89 Pre-Payment Audits Always ask for Security Risk Analysis

90 GT Surgery Audits Where else do the providers work: Surgery Center Hospital outpatient Free Clinic Urgent Care Do these locations have CEHR

91 Audit Checklist

92 Audit Checklist

93 Reducing the Risk

94 Long Road to.

95 Questions

96 glosuite 8.1 (Menu)

97 glosuite 8.1 (QM)