Medicare and Medicaid EHR Incentive Payment Basics

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2 Medicare and Medicaid EHR Incentive Payment Basics PPS Hospitals and CAHs, along with physicians providing care in OPDs, hospital clinics, and private practices are eligible for the program. These providers qualify to receive incentives, if they are: A meaningful user of certified (EHR) systems They are eligible to receive temporary EHR incentive payments Hospitals: Medicare AND Medicaid. Physicians: Medicare OR Medicaid. Eligible providers must be meaningful users of certified EHR systems beginning g2015 to avoid Medicare py payment reductions (no Medicaid penalties). 2

3 Major Changes to Final Rule Proposed drule December 2010 Final Rule July 2010 All or nothing approach. Some flexibility for meeting MU requirements. Physicians in hospital OPDs and clinics excluded. Physicians in hospital OPDs and clinics, now included, per legislation fix. CAHs ineligible for Medicaid incentives. CAHs now eligible for both Medicaid AND Medicaid incentives. High number of quality measures, required, not all of which had electronic specifications. Fewer qualitymeasuresto to report; allwith electronic specifications. Inequitable treatment of multi campus li hospital systems. Multi campus hospital system inequity not addressed. 3

4 Qualifying Process Verify eligibility Register for EHR Incentive Program Ensure EHR technology is certified Achieve status as a meaningful user Attest MU status to CMS Receive incentive payments 4

5 1. Verify Eligibility

6 1 Verify Eligibility: Hospitals Eligible Hospitals (EHs) that qualify can receive both Medicare and Medicaid incentive payments Medicare Medicaid Eligible: Subsection (d) hospitals hospitals paid under IPPS Critical Access Hospitals (CAHs) Ineligible: Cancer hospitals Children's hospitals Psychiatric and Rehabilitation hospitals and units Long Term Care hospitals Eligible if Medicaid volume is at least 10%: Acute care hospitals average length of stay of 25 days or fewer CAHs Cancer hospitals Eligiblewithoutvolume criteria: Children s hospitals CMS provider number is from and predominantly treats individuals under 21 years of age 6

7 1 Verify Eligibility: Professionals EligibleProfessionals (EPs) that qualifycan receive onlymedicare or Medicaid incentive payments, not both Medicare Eligible if not hospital based: Doctor of Medicine or Osteopathy Doctor of Dental Surgery or Dental Medicine Doctor of Podiatric Medicine Doctor of Optometry Chiropractor Medicaid Eligible if not hospital based and minimum 30% Medicaid volume (exception, 20% for pediatricians): i i Physicians Nurse Practitioners (NPs) Certified Nurse Midwives (CNMs) Dentists Ineligible Hospital based EPs defined as: Furnishing 90% or more of their services in either the inpatient or emergency department of a hospital Place of service (POS) code: 21 (Inpatient Hospital), or 23(Emergency Room, Hospital) Eligible without hospital based exclusion: Physician Assistants (PAs) working in a Federally Qualified Health Center (FQHC) or Rural Health Centers (RHC) led by a PA with minimum 30% patient volume attributable to needy patients. 7

8 2. Register for the EHR Incentive Program

9 Register for EHR Incentive Program Electronic registration CMS will establish on line provider registration as early as January Eligible hospitals and physicians and other professionals should register even before they are meaningful users. 9

10 3. Ensure EHR Technology is Certified

11 Securing EHR Certification Authorized Testing and Certification Bodies (ONC ATCBs) Final rule governing certification entities (June 2010): Office of the National Coordinator (ONC) expects to determine the certifying bodies by this summer. This is a temporary certification process; permanent to begin ONC anticipates the first products to be MU certified in fall No EHR products are currently certified for MU. Standards and certification criteria for vendors and providers Final rule specifying standards and certification criteria (June 2010) While vendors may seek certification for newer products, they will be less likely to do so for legacy systems. Burden will be on providers to ensure certification for all modules associated with each MU objective/measure. All providers must certify under the permanent certification process in 2013 regardless of whether they certified for MU under the temporary program in 2011 or

12 4. Become a Meaningful User of EHR systems

13 Meaningful Use Requirements Will Increase Over Time The goal of MU is the achievement of certain, specific objectives through the use of EHR functionality and qualify reporting requirements. Each EHR functionality objective has an associated measure that determines a provider s performance on that objective. Stage 1 Qualifying criteria for initial years: Providers first eligible for Stage 1 in Objectives focus on capturing data via EHR and reporting data. Establishes core and menu set of EHR functionalities for EPs (15 core + 5 menu) and EHs (14 core + 5 menu). (e.g. CPOE use is the objective. Measure = EH/EP must place medication orders via CPOE for at least 30% of all patients). One core functionality is reporting on clinical quality measures (CQMs); 15 for EHs and 6 of 44 for EPs. Sta ages 2 and years: To be defined in future regulations. Next regulations expected in early FFY 2012 for FFY 2013 implementation. Each stage builds upon the previous. CMS has indicated Stage 2 and 3 will require EHR use that promotes improvements in quality outcomes, safety, and efficiency. d 3Qualifying criteria for later 13

14 Stages of Meaningful Use For Stage 1, Medicare and Medicaid MU requirements are identical for providers who qualify for both programs. Providers that qualify only for Medicaid may need to meet additional requirements determined by the state. First Qualifying Year Stage criteria EHs and EPs must meet in each payment year: FFY 2011 FFY 2012 FFY 2013 FFY 2014 FFY 2015 and Beyond FFY 2011 Stage 1 Stage 1 Stage 2 Stage 2 TBD FFY 2012 Stage 1 Stage 1 Stage 2 TBD FFY 2013 Stage 1 Stage 1 TBD FFY 2014 Stage 1 TBD FFY 2015 TBD 14

15 Meaningful Use: EHR Functionality Criteria Core Criteria: Allmustbemet met CPOE (Computerized Physician Order Entry) Drug drug and drug allergy interaction checks Maintain current problem list of active diagnoses Maintain active medication list Maintain active medication allergy list Record demographics Record and chart changes in vital signs Record smoking status for patients 13 and older Report hospital/ambulatory clinic measures to CMS/states Implement one clinical decision support rule Provide patients with an e copy of their health information upon request Capability to exchange key clinical information among providers of care and patient authorized entities electronically Protect electronic health information Provide patients with an e copy of their discharge instructions at time of discharge upon request (EHs only) E prescribing (EPs only) Provide clinical summaries for patients for each office visit (EPs only) Providers may claim certain objective(s)/measure(s) is inapplicable to them if they meet CMS criteria of such an exception. 15

16 Meaningful Use: EHR Functionality Criteria Menu Criteria: EHs and EPs must meet 5 of these, including one public health objective (i.e. may opt out of 5) Drug formulary checks Incorporate clinical lab test results as structured data Generate lists of patients by specific conditions Use certified EHR technology to identify patient specific education resources and provide to patient, if appropriate p Medication reconciliation Summary of care record for each transition of care/referrals Send reminders to patients per patient preference for preventative/follow up care (EPs only) Provide patients with timely electronic access to their health information (EPs only) Record advanced directives for patients 65 years or older (EH only) Capability to provide electronic submission of reportable lab results to public health agencies (EHs only) Capability to submit electronic data to immunization registries/systems Capability to provide electronic syndromic surveillance data to public health agencies Public health objectives Providers may claim certain objective(s)/measure(s) is inapplicable to them if they meet CMS criteria of such an exception. 16

17 Meaningful Use: Measuring Functionality Objectives Measurement thresholds for each of the EHR functionality objective differs based on the particular objective (four options): Obtain a defined threshold % for the objective using specific numerators and denominators Generally: Inpatient & ED; unique patients [Objective: CPOE] Enable certain EHR functionality [Objective: Implement Drug Drug and Drug Allergy Checks] Accomplish objective Perform test related to (Yes or No) objective [Objective: Protect Electronic Health [Objective: Capability to Electronically Information ] Exchange Key Clinical Information] 17

18 Meaningful Use: Core (required) Objective # 1 of 14 CPOE Computerized Provider Order Entry Stage 1: >30% of unique patients admitted to Inpatient or Emergency departments, and who have at least one med order in the EHR, have at least one med ordered by CPOE (Stage 2: >60%) medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per State, local, and professional guidelines. 18

19 Meaningful Use: Core (required) Objective # 2 of 14 Implement Drug Drug and Drug Allergy Checks Eligible hospital or EP has enabled this functionality for the entire EHR reporting period. 19

20 Meaningful Use: Core (required) Objective # 3 of 14 Problem List Current and Active Diagnoses >80% of unique patients (IP & ED) have at least one entry, or indication that no problems are known. Entered as structured data 20

21 Meaningful Use: Core (required) Objective # 4 of 14 Maintain Active Medication List >80% of unique patients (IP & ED) have at least one entry, or indication that patient is not currently prescribed any medication. Entered as structured data 21

22 Meaningful Use: Core (required) Objective # 5 of 14 Maintain Active Medication Allergy List >80% of unique patients (IP & ED) have at least one entry, or indication that patient has no known medication allergies. Entered as structured data 22

23 Meaningful Use: Core (required) Objective # 6 of 14 Demographics >50% of unique patients (IP & ED) have the following demographics recorded as structured data: Preferred Language Gender Race Ethnicity Date of birth Date & preliminary cause of death in the event of in hospital mortality 23

24 Meaningful Use: Core (required) Objective # 7of 14 Vital signs >50% of unique patients (IP & ED) ages 2 and over have these recorded as structured data: Height Weight Blood pressure 24

25 Meaningful Use: Core (required) Objective # 8 of 14 Smoking status >50% of unique patients (IP & ED) ages 13 and over have smoking status recorded as structured data 25

26 Meaningful Use: Core (required) Objective # 9 of 14 Report clinical quality measures Successfully report to CMS hospital clinical i l quality measures specified by CMS 26

27 Meaningful Use: Core (required) Objective # 10 of 14 Clinical Decision Support Rule Implement one clinical decision support rule related l dto a high h priority i hospital condition i along with the ability to track compliance with that t rule 27

28 Meaningful Use: Core (required) Objective # 11 of 14 Electronic Health Information for Patients >50% of unique patients (IP & ED) who request an electronic copy of their health information: Are provided with same within 3 business days including diagnostic test results, problem list, medication lists, medication allergies, discharge summary, procedures Exclusion available if there are no such requests 28

29 Meaningful Use: Core (required) Objective # 12 of 14 Electronic Copy of Discharge Instructions >50% of unique patients (IP & ED) who request an electronic copy of their discharge instructions: Are provided with same at discharge Exclusion available if there are no such requests 29

30 Meaningful Use: Core (required) Objective # 13 of 14 Health Information Exchange Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information (for example, problem list, medication list, medication allergies, and diagnostic test results) among providers of care and patient authorized entities electronically 30

31 Meaningful Use: Core (required) Objective # 14 of 14 Protect Electronic Health Information 45 CFR (a)(1) Prevent, Detect, Contain, and Correct security violations. Required: Risk Analysis Risk Management Sanction Policy Information System Activity Review correct identified security deficiencies as part of its risk ikmanagement process 31

32 Meaningful Use: Quality Reporting Quality reporting is specifically required by law to achieve meaningful use Therefore quality reporting is a core EHR functionality objective for both EHs and EPs Overview of EHR Quality Measure Reporting Requirements: Stage one requires submission of aggregate data only no measurement of quality performance. Limited to measures that can be captured electronically. EHs and EPs required to collect measures for all patients, regardless of payer. It is required that Certified EHR technology be able to calculate each measure s numerator, denominator, and exclusions. Measures are applicable for 2011 and 2012 (first two years of the program). EHs and EPs attempting to achieve MU must electronically submit quality data in AllEH and EP measures have been endorsed d by the National lquality Forum (NQF). 32

33 Meaningful Use: Quality Reporting EH and EP quality reporting requirements EHs (IPPS and CAHs) EPs Must report data on 15 quality measures related to: Stroke care. Prevention and treatment of blood clots (venous thromboembolism). ED throughput measures. Must report data on 6 quality measures from a selection, with some restrictions, of 44 total measures. 3 measures must be from a set of 6 identified by CMS as core or alternative core measures. 3 measures must be from the remaining set of 38 measures. 33

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36 Meaningful Use: Menu Objective # 1 of 10 (Pick 5) Drug Formulary Checks Enabled Access to at least one internal or external formulary for the entire EHR reporting period 36

37 Meaningful Use: Menu Objective # 2 of 10 (Pick 5) Advance Directives Inpatient only Age 65+ >50% have aean indication dcato of an advance a directive e status Recorded as structured data 37

38 Meaningful Use: Menu Objective # 3 of 10 (Pick 5) Clinical Lab test results Inpatient and Emergency Department patients Clinical lab results expressed as either Positive/Negative ost egat eaffirmation ato Numerical >40% of these are stored as structured data 38

39 Meaningful Use: Menu Objective # 4 of 10 (Pick 5) Generate Lists of Patients Generate at least one list of patients with a specific condition Objective: for use in quality improvement, reduction of disparities, research, or outreach 39

40 Meaningful Use: Menu Objective # 5 of 10 (Pick 5) Identify Patient Specific Education Resources Inpatient and Emergency Department >10% of all unique patients are provided patientspecific education resources, if appropriate As identified by the EHR 40

41 Meaningful Use: Menu Objective # 6 of 10 (Pick 5) Medication Reconciliation Inpatient and Emergency Department >50% of all unique patients received from another setting of care or Another provider of care or Believes an encounter is relevant 41

42 Meaningful Use: Menu Objective # 7 of 10 (Pick 5) Summary Care Record Summary Care Record provided for >50% of all transitions to another setting or provider of care 42

43 Meaningful Use: Menu Objective # 8 of 10 (Pick 5) Public Health Immunizations Must Select one of 3 Public Health Objectives Perform at least one test submitting electronic data to immunization registry Follow up submission if test is successful Exclusions: No registry has the capability of receiving this data electronically Hospital administers no immunizations during the reporting period 43

44 Meaningful Use: Menu Objective # 9 of 10 (Pick 5) Public Health Lab Results Must Select one of 3 Public Health Objectives Perform at least one test submitting reportable lab results to public health agency Follow up submission if test is successful Exclusion: No registry has the capability of receiving this data electronically 44

45 Meaningful Use: Menu Objective # 10 of 10 (Pick 5) Public Health Syndromic Surveillance Must Select one of 3 Public Health Objectives Perform at least one test submitting electronic syndromic surveillance data to a public health agency Follow up submission if test is successful Exclusion: No public agency has the capability of receiving this data electronically 45

46 5. Attest Meaningful Use Status to CMS

47 5 Attesting to Meaningful Use Electronic Attestation EHs and EPs must attest to CMS that: A certified EHR system is used; and That EHR successfully achieves the EHR functionality requirements and associated measures. EHs and EPs must also attest to CMS on the quality reporting requirements in 2011, that: The measure data dt were generated tdas output tof a certified EHR; Report aggregate results to CMS or states (in the case of Medicaid providers); The data (including numerators, denominators, and exclusions for each of the applicable measures) are accurate; and The data for each measure include all patients to whom the measure applies. CMS willdevelop auditstrategy around MU attestation. 47

48 5 Attesting to Meaningful Use Attestation Timing CMS will establish a web based attestation tool by April Attestation will occur once per payment year, following completion of the EHR reporting period. A provider s first year for attestation is any continuous 90 day period that falls within the payment year. Subsequent reporting years will be the entire payment year. Attesting to Medicare MU versus Medicaid MU In Stage 1, EHs eligible for both Medicare and Medicaid EHR incentive program should certify for Medicare MU and will be automatically deemed MUs for Medicaid. EHs and EPs eligible only for the Medicaid EHR incentive program must attest to Medicaid MU. States may add additional criteria to Medicaid requirements (within limits). 48

49 5 Attesting to Meaningful Use Attestation for EPs who work at multiple locations An EP who works at multiple locations, but does not have certified EHR technology available at all of them would: Have to have 50% of their total patient encounters at locations where certified EHR technology is available. Would base all MU measures only on encounters that occurred at locations where certified EHR technology is available. 49

50 Attestation: Medicaid First Year Requirements States may elect to establish first year Medicaid payments before EHs and EPs achieve MU status If states design their Medicaid EHR incentive program for first year payment before MU status is achieved, EHs and EPs must: Attest to have adopted, implemented, or upgraded to Certified EHR technology. Adopt, implement, or upgrade means: Acquire, purchase, or secure access to Certified EHR technology; Install or commence utilization of Certified EHR technology capable of meeting meaningful use requirements; or Expand the available functionality of Certified EHR technology or upgrade from existing EHR technology to Certified EHR technology. 50

51 6. Receive EHR Incentive Payments

52 Medicare Hospital Incentive Payment Process Year One After the 90 day period is over, hospital attests that it was a meaningful user, and then interim i incentive i will be distributed ib d as a single payment. CMS anticipates making first Medicare incentive payments in May Subsequent years After the year is over, hospital attests that it was a meaningful user, and then interim incentive will be distributed as a single payment. Final calculation through cost report settlement Interim incentive payment calculated using most recently submitted 12 month cost report once the hospital has qualified as a meaningful user. Final incentive payment determined in settlement of first 12 month cost reporting period that begins after the start of the payment year. 52

53 Medicare EHR Incentives for PPS Hospitals 53

54 Medicare EHR Incentives for PPS Hospitals Excludes : Exempt Psych and Rehab Units, Newborn, Swing bed Revised Worksheet S 10 (effective cost report periods beginning 02/01/10. If charity care charges are not available, charity care ratio equals 1. 54

55 Medicare Transition for PPS Hospitals Year hospital first qualifies FFY FFY FFY FFY FFY FFY FFY FFY FFY FFY FFY

56 Medicare EHR Incentives for CAHs CAH Medicare EHR incentive payments Basis for CAHMedicare EHR incentive i payments is the reasonable cost reimbursement structure. Design of Medicare EHR incentives allows CAHs to accelerate and increase the inpatient payment for depreciation of reasonable costs for purchase of depreciable assets such as computers and associated hardware and software, to support meaningful use of certified EHR technology Reasonable costs can be depreciated in a single year, rather than over the life of the assets. The costs of assets incurred in previous years that have not been fully depreciated may also be included. Mdi Medicare s share of CAH EHR incentives is calculated l dthe same as the PPS hospital EHR incentives plus 20 percentage points (not to exceed 100%). Incentive payments available to CAHs for up to four consecutive years. CAHs will be paid through a prompt interim payment (subject to reconciliation). 56

57 Medicaid EHR Incentive for PPS Hospitals and CAHs Medicaid EHR incentive payment formula for PPS hospitals and CAHs Similar to Medicare EHR incentive formula design. Built on a base amount of $2 million per hospital, per year. Adjusted: Upward by hospital s all payer py discharges (same as Medicare formula, but includes the hospital s projected average annual rate of growth for years 2 through 4); then Downward by hospital s Medicaid percent of total patient days (rather than Medicare percent) with an adjustment to account for charity care (same as Medicare formula). Allocation of Medicaid EHR incentives Transition factor for distribution of Medicaid EHR incentives to be developed and applied by States. Payments can be made over the course of a minimum of 3 years but no more than 6 years. Annual Medicaid EHR incentive payment may not exceed 50 percent of the hospital s aggregate incentive payment (over a 2 year period, may not exceed 90 percent of the aggregate payment). 57

58 EP EHR Incentive Payments An EP that qualifies as both a Medicare EP and Medicaid EP Must notify CMS when registering for the program to elect Medicare or Medicaid incentive payments. May switch only one time, and only for a payment year before Reassignment of Payments EP may, but is not required to, reassign incentive payments to their employer or to an entity with which they have a contractual arrangement. Reassignment allows the employer or entity to bill and receive payment for the EP's covered professional services. Even when an EP reassigns the incentive payments py it is the EP that must register for the program, attest to MU status and be subject to Medicare payment penalties if not a MU beginning

59 Medicare EHR Incentives for EPs EP payments are the lesser of 75% of the physician's allowed charges for the year or a specified maximum amount Year EP first qualifies: CY 2011 CY 2012 CY 2013 CY 2014 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 $ 12,000 CY 2015 $ 2,000 $ 4,000 $ 8,000 $ 8,000 CY 2016 $ 2,000 $ 4,000 $ 4,000 Total $ 44,000 $ 44,000 $ 39,000 $ 24,000 $ 0 Incentive for EPs who predominantly furnish services in a health professional shortage area (HPSA) is increased by 10%. 59

60 Medicaid EHR Incentives for EPs CY 2011 $ 21,000 Year EP first qualifies: CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016 CY 2012 $ 8,500 $ 21,000 CY 2013 $ 8,500 $ 8,500 $ 21,000 CY 2014 $ 8,500 $ 8,500 $ 8,500 $ 21,000 CY 2015 $ 8,500 $ 8,500 $ 8,500 $ 8,500 $ 21,000 CY 2016 $ 8,500 $ 8,500 $ 8,500 $ 8,500 $ 8,500 $ 21,000 CY 2017 $ 8,500 $ 8,500 $ 8,500 $ 8,500 $ 8,500 CY 2018 $ 8,500 $ 8,500 $ 8,500 $ 8,500 CY 2019 $ 8,500 $ 8,500 $ 8,500 CY 2020 $ 8,500 $ 8,500 CY 2021 $ 8,500 Total $ 63,750 $ 63,750 $ 63,750 $ 63,750 $ 63,750 $ 63,750 60

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62 Failure to Achieve MU Beginning in 2015 = Medicare Payment Penalties Medicare payment penalties for PPS hospitals Penalties will reduce the hospital update factor (marketbasket) and will apply to ¾ of the applicable marketbasket update (the other ¼ will be at risk under inpatient hospital quality reporting program). FFY 2015 = 33 1/3% of ¾ of applicable marketbasket (results in 25% reduction) FFY 2016 = 66 2/3% of ¾ of applicable marketbasket (results in 50% reduction) FFY 2017 = 100% of ¾ of applicable marketbasket (results in 75% reduction) Medicare payment penalties for CAHs Penalties will reduce CAHs allowable Medicare cost reimbursement percentage. FFY 2015 = %. FFY 2016 = %. FFY 2017 = %. Medicare payment penalties for EPs Penalties will adjust Medicare physician fee schedule reimbursement. CY 2015 = 99% CY 2016 = 98% CY 2017 = 97% No Medicaid payment penalties 62

63 Jonathan Kolarik, RN MBA OFMQHIT Project Manager Oklahoma Foundation for Medical Quality Q y This material is provided by the Oklahoma Foundation for Medical Quality, under the Health Information Technology Regional Extension Center grant number 90RC0005/01, funded by the Office of the National Coordinator, United States Department of Health and Human Services.

64 OFMQ Oklahoma Foundation for Medical Quality QIO (Quality Improvement Organization) CMS (Centers for Medicare & Medicaid Services) Independent, non profit, community based organization (founded in 1972) Our Mission Statement: Leading efforts to improve healthcare and improve lives

65 Organizational Vision Resource for health care quality and improving outcomes: Evidence Based Research Collaboration HIT Implementation Health Quality Empowering Consumers

66 OFMQHIT REC OFMQ Health Information Technology Regional Extension Center American Recovery & Reinvestment Act (ARRA) Stimulus Package HITECH Act Office of the National Coordinator for Health Information Technology (ONC) Incentive payments for providers to adopt Electronic Health Records & HIE Achieve Meaningful Use

67 OFMQHIT Mission Furnish assistance to providers by: Education Outreach Technical Assistance To achieve: Implementation of EHR Meaningful Use of EHR

68 Scope of Services ARRA Incentive & Meaningful Use Assessment Practice & Workflow Analysis EMR Vendor Selection & Optimization Project Planning & Vendor Oversight Go Live Support & Training Post Go Live Practice Assessment & EMR Optimization IT Security Review & Assessment

69 Eligible Providers (EP) Individual and SmallGroup Practices Less than 10 clinicians Focused on: Service Settings: Uninsured, underinsured Medically underserved Public & Critical Access Hospitals Community Health Centers Rural Health Clinics

70 REC Clinicians with prescriptive privileges PRIMARY CARE PROVIDER MD DO NP MW PA Family Practice x x x x x Obstetrics and Gynecology x x x x x General Medicine x x x x x Internal Medicine x x x x x Pediatric Medicine x x x x x

71 REC Provider Services Target 1,000 PPCPs by February 2011 Currently over 150 Priority Primary Care Providers (PPCPs) Enrolled Most 1 3 Providers / Practice 27% of the priority i providers in the state 82% have not yet implemented an EHR Working with OKPCA to enroll 70 PPCPs working at FQHCs.

72 REC CAH / Rural Services Rural and CAH Supplemental Grant Rural Hospitals Critical Access Hospitals Less than 50 Licensed Beds 66 Facilities Targeted Need to achieve Meaningful Use by February 2012 Notification of Award Pending (but soon!)

73 Issues, Barriers & Problems Communication Physicians may be unaware of ARRA, HITEC and availability of REC Services Need to communicate sense of urgency to providers EHR vendors are at capacity (months to get started) EHRs are complex to implement (months to implement)

74 Issues, Barriers & Problems Communication Meaningful Use incomplete ( final rule due in late spring ): Final Rule released (Certification Final Rule also released) Certification implications for Vendors: Coding Testing Certification Process Upgrades Delays in Physician Implementation

75 Meaningful Use Focused on Capture of Structured Data Electronic Exchange of Information Quality & Sf Safety Empowering Patients & Families

76 Meaningful Use Core Set vs. Menu Set Core: 15 Objectives Menu: 5 of 10 Objectives Practice Management Deferred to Stage 2 Electronic Claims Submission Electronic Eligibility Checking Decreased Thresholds POS 22 Outpatient Hospital Removed Employed Physicians Now Eligible

77 Meaningful Use Quality Measures (44 Total) 3 Core: Blood Pressure Tobacco Status Adult Weight Screening & Follow up Alternate Core: Children & Adolescent Weight Influenza Screening for Patients over 50 Childhood Immunization Status 3 Others (from set of 38)

78 How Can We Work Together? Collaboration & Partnership Get the word out Newsletters Websites Publications Availability of OFMQHIT REC Services ARRA & Meaningful Use Sense of Urgency

79 How Can We Work Together? Creative Cooperation Creative Cooperation EHR / MSO Partnerships Hospitals extending services to: Critical Access Hospitals (CAH) Rural Hospitals Rural Providers REC Participation Implementation Training Other Ideas?

80 Thank You! Jonathan Kolarik, RN MBA OFMQHIT Project Manager Oklahoma Foundation for Medical Quality

81 Questions 81

82 Resources AHA 2010 'Meaningful Use' Conference Call Series

83 ARRA CAH CIO / CMIO CMS CPOE CY EH EHR EP FQHC FFY FR HIE HIT MU NPRM PA RHC Acronyms American Recovery and Reinvestment Act Critical Access Hospital Chief Information Officer / Chief Medical Information Officer Center for Medicare and Medicaid Services Computer Provider Order Entry Calendar Year Eligible Hospital Electronic Health Record Eligible Professionals Federally Qualified Health Center Federal Fiscal Year Final Rule Health Information Exchange Health Information Technology Meaningful Use Notice of Proposed Rule Making Physician Assistant Rural Health Clinic 83