Meaningful Use: a Primer

Transcription

1 Health Information Technology Extension Center of Los Angeles Meaningful Use: a Primer Mary Mitchell Director of Meaningful Use

2 Defined as: What is Meaningful Use? A. Use of a certified EHR in a meaningful manner (e.g.: clinical documentation, e-prescribing, etc.) B. Use of certified EHR technology for electronic exchange of health information C. Use of certified EHR technology to submit clinical quality and other measures 2

3 Practical Approach: Meaningful Use IS Health Care Transformation Meaningful Use Quality Reporting Clinical Decision Support Improving Care Coordination Engaging Patients Managing Population Health 3

4 2011 *2012 * Stages of Meaningful Use Stage I Data Capture and Sharing Stage II Advanced Clinical Processes Stage III Improved Outcomes * to be defined in future rulemaking 4

5 What It Means for Providers $ Investment of Time and Money Improved Outcomes Challenges Change Adaptation Practice Records Conversion Access Responsiveness Patient Involvement Increased Efficiency 5

6 How Do I Achieve Meaningful Use? Good News: You are already achieving many of these measures! Medicare: Demonstrate in 1 year Initiate by 2014 Payments begin in 2011 Fee schedules reduced beginning 2015 if not achieving meaningful EHR use Medicaid: Adopt/implement/upgrade option 1 st year Initiate by 2016 No payment reductions Last year of payments is

7 Implementation Phases & Criteria Phase 1: Objectives & Measures Meet 15 Core Objectives Meet 5 of 10 Menu Set Core Objectives Satisfy 3 Core Clinical Quality Measures (CQMs) Satisfy 3 of 38 Additional Set CQMs Submit by attestation Phase 2 : Advanced Clinical Process Phase 3 : Improved Outcomes 7

8 15 Core Objectives for Eligible Providers (meet all) Computerized Provider Order Entry E-Prescribing Report ambulatory clinical quality measures to CMS/States Implement one clinical decision support rule Provide patients with an electronic copy of their health information, upon request Provide clinical summaries for patients for each office visit Check for drug-drug and drug-allergy interactions Record demographics Maintain an up-to-date problem list of current and active diagnoses Maintain active medication list Maintain active medication allergy list Record and chart changes in vital signs Record smoking status for patients 13 years or older Capability to exchange key clinical information among providers of care Protect electronic health information 8

9 Menu Set Core Objectives for Eligible Providers (meet 5 of the 10) Drug-formulary checks Incorporate clinical lab test results as structured data Generate lists of patients by specific conditions Send reminders to patients per patient preference for preventive/follow up care Provide patients with timely electronic access to their health information Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate Reconcile medications Summary of care record for each transition of care/referral Capability to submit electronic data to immunization registries/systems* Capability to provide electronic surveillance data to public health agencies* * At least 1 public health objective must be selected 9

10 Core Clinical Quality Measures (CQMs) (satisfy 3) 1. Hypertension blood pressure measurement 2. Preventive care and screening measure pair Tobacco use assessment Tobacco cessation intervention 3. Adult weight screening and follow up 4. Weight assessment and counseling for children and adolescents 5. Preventive care and screening Influenza immunization for patients > 50 years old 6. Childhood immunization status 10

11 Additional Set of CQMs EPs must complete 3 of Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b) Effective Continuation Phase Treatment 2. Appropriate Testing for Children with Pharyngitis 3. Asthma Assessment 4. Asthma Pharmacologic Therapy 5. Breast Cancer Screening 6. Cervical Cancer Screening 7. Chlamydia Screening for Women 8. Colorectal Cancer Screening 9. Controlling High Blood Pressure 10. Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) 11. Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol 12. Coronary Artery Disease (CAD): Oral Anti-platelet Therapy Prescribed for Patients with CAD 13. Diabetes: Blood Pressure Management 14. Diabetes: Eye Exam 15. Diabetes: Foot Exam 16. Diabetes: Hemoglobin A1c Control (<8.0%) 17. Diabetes: Hemoglobin A1c Poor Control 18. Diabetes: Low Density Lipoprotein (LDL) Management and Control 19. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care 20. Diabetic Retinopathy: Documentation of Presence/Absence of Macular Edema and Level of Severity of Retinopathy 11

12 Additional Set of CQMs EPs must complete 3 of 38 (continued) 21. Diabetes: Urine Screening 22. Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) 23. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) 24. Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation 25. Ischemic Vascular Disease (IVD): Blood Pressure Management 26. Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control 27. Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 28. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement 29. Low Back Pain: Use of Imaging Studies 30. Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer 31. Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients 32. Pneumonia Vaccination Status for Older Adults 33. Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) 34. Prenatal Care: Anti-D Immune Globulin 35. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation 36. Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients 37. Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies 38. Use of Appropriate Medications for Asthma 12

13 Regional Extension Centers are Formed Neutral, Not-For-Profit organizations established to provide training, support and technical assistance to help primary care providers select, implement and use EHRs Selection, purchase & implementation of EHR Workflow redesign Connection to health information exchange Attainment of Meaningful Use Compliance with privacy and security Goal is for 100,000 priority primary care providers across the country to become meaningful users of EHRs within four years 13

14 HITEC-LA Goals Establish L.A. Care s REC program as a trusted brand providing objective, high quality information and assistance to providers Deliver technical assistance to priority primary care providers and other members by April 2012 Create 3,000 meaningful EHR users by April

15 Are You Eligible for REC Services and CMS Meaningful Use Payments? Provider Type/License Eligible for subsidized REC Services Eligible for Medi-Cal Incentives 1 Eligible for Medicare Incentives Medical Doctor (MD) YES 2 YES 3 YES 3 Doctor of Osteopathy (DO) YES 2 YES 3 YES 3 Psychiatrists (MD) NO 4 YES 3 YES 3 Dentist NO 4 YES YES Nurse Practitioner (NP) YES 2 YES 3 NO Certified Nurse Midwife (CNM) YES 2 YES 3 NO Chiropractor NO 4 NO YES Physician Assistant (PA) YES 2 YES 5 NO Psychologists NO 4 NO NO Optometrists NO 4 YES YES Podiatrists (DPM) NO 4 NO YES Residents NO YES 3 YES 3 1 Must meet Medi-Cal Patient volume criteria: 3 Non-Hospital based: if more than 90% or the provider s services are performed in a hospital in-patient or emergency room Minimum 30% Medicaid patient volume setting, that provider is Hospital-Based and not eligible for the EHR incentive program Minimum 20% Medicaid patient volume and is a pediatrician 4 May be eligible for REC services on a Fee for Service basis Practice predominantly in a Federally Qualified Health Center or Rural Health Clinic and have a minimum 30% 5 Physician Assistants are only eligible if practicing in FQHC or RCH that is Physician Assistant-led patient volume of needy individuals 2 Non-Hospital based, certified in Internal Medicine, Family Practice, Pediatrics, Adolescent Medicine, OB/GYN, or Family Practice practicing in one of the following settings: Physician Practices of 10 providers or less Community health centers, primary care clinics and rural health clinics Ambulatory care clinics associated with public hospitals, critical access hospitals, or rural hospitals Other medically underserved settings 15 15

16 Medicaid Incentives Eligible Providers are those that see 30% Medicaid, Medicaid HMO or uninsured patients over any 90 day period during the year. Pediatricians must see 20% Medicaid, Medicaid HMO or uninsured patients. To qualify for the first payment, an EP must implement, upgrade or acquire an EHR. Payout occurs over 6 years with the last payment year being EPs can receive entire incentive payment even if they don t implement a system until First Calendar Year in Which Eligible Provider Receives a Medicaid Incentive Payment Calendar Year $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 16

17 Medicare Incentives Eligible Providers are those that receive a minimum of $25,000 in Medicare reimbursement for the entire year. During 2011, EPs only have to demonstrate Meaningful Use for 90 days. During 2012+, EPs must demonstrate Meaningful Use for entire year. First Calendar Year in Which Eligible Provider Receives a Medicare Incentive Payment Calendar Year $18, $12,000 $18, $8,000 $12,000 $15, $4,000 $8,000 $12,000 $12, $2,000 $4,000 $8,000 $8,000 $ $2,000 $4,000 $4,000 $0 Total $44,000 $44,000 $39,000 $24,000 $0 17

18 Incentives: Time Is Money for Providers $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 2011/ Medicare* $44,000 $39,000 $24,000 $0 OR Medicaid** $63,750 $63,750 $63,750 $63,750 * Eligible for payments up to 75% of Medicare billings (min. $25K to qualify for full amount) ** 30% of patients visits must be Medicaid to qualify for full amount (20% for pediatricians) 18

19 Differences Between Medicare and Medicaid Incentives Medicare Federal Government will implement Claims payment reductions begin in 2015 for providers that do not demonstrate Meaningful Use Must demonstrate MU in Year 1 Maximum incentive is $44,000 for EPs MU definition is common for Medicare Last year a provider may initiate program is 2014 Last year to register is 2016 Payment adjustments begin in 2015 Only physicians, subsection(d) hospitals and CAHs Medicaid Voluntary for States to implement (may not be an option in every State) No Medicaid payment reductions Adopt/Implement/Upgrade option for 1 st participation year Maximum incentive is $63,750 for EPs States can adopt certain additional requirements for MU Last year a provider may initiate program is 2016 Last year to register is 2016 Five types of EPs, acute care hospitals (including CAHs) and children s hospitals 19

20 Who Does HITEC-LA Serve? Our members only Membership is free to all Some free services to all members; subsidized services for PPCPs. Providers do not have to be L.A. Care Health Plan Providers 7,800 Priority Primary Care Providers in L.A. County including anyone with prescribing privileges. Practices of less than 10 Community health centers Public hospitals Specialists are welcome 3,000 meaningful users 20

21 HITEC-LA and other RECs in the Big Picture $19.2B HITECH Program: How the Pieces Fit Together Regional Extension Centers Workforce Training Medicare and Medicaid Incentives & Penalties State Grants for HIE Standards & Certification Framework Privacy & Security Framework ADOPTION MEANINGFUL USE EXCHANGE Improved Individual & Population Health Outcomes Increased Transparency & Efficiency Improved Ability to Study & Improve Care Delivery Health IT Practice Research 21

22 Providing Skilled, Subsidized Assistance to Eligible Providers from Start to Finish 1. Plan 2. Transition 3. Implement 4. Operate & Maintain Readiness Assessment Practice Workflow Redesign EHR Implementation Achieving Meaningful Use EHR System Selection HIT Education & Training Partnering with state and local HIEs Prepare for Future Pay for Performance 22

23 Added Benefits of Working with a REC Experienced Knowledge & technical expertise Allow you to make fully educated choices Learn about all your options Access group volume discounts Free or discounted services Peer-to-Peer Network Impartial advocate No cost to join Not us or them it s we Assistance in meeting critical deadlines 23

24 HITEC-LA Can Help You Reap the Benefits Focus on Stage 1 Clinical Measures You have an EHR? Stage 1 MU MU Assessment MU Gap Analysis Workflow Redesign Optimize System Training Support It all starts with Meaningful Use! No EHR? Stage 1 MU MU Assessment System Selection Workflow Design Implementation Training Support MU Gap Analysis 24

25 A Big Change Brings A Lot of Questions Productivity loss? Workflow? Right EHR? Staff training? Meaningful Use? Use Hospital EHR? Cash flow? Timelines? Penalties? Will I miss out? Use IPA/MSO? Necessary? How? Configuration? Pay for Performance? Scanning? Patient impact? Buy? Test runs? Incentives? Urgent? Out of pocket costs? 25

26 Benefits of our Peer-to-Peer Network TOP 10 EHR LESSONS LEARNED 1. The transition takes longer than you ll expect; it s too hard to scan charts as patients come in 2. Scanning/organizing/sorting take time to do it right, especially for cross-referencing systems 3. Data conversion from my old system (e.g. medical billing company) can come with a substantial cost (as much as $10k) if buying from a new or different vendor 4. I didn t have an IT person with my old system; now I need one 5. I need support for both my internal network and software 6. I need to clarify and access the ongoing support I ll need (e.g. response time) 7. Staff learning curve varies by person; some take much longer to adapt 8. Your EHR vendor will pursue your loyalty for their products & services, and solid implementation will make or break your investment 9. I need to check the financial stability of my EHR vendor before signing 10. It will take longer to break even on the cost than expected We can help you with proper planning & implementation to avoid learning the hard way! 26

27 Where to Start Contact HITEC-LA Register to begin your free enrollment with our unbiased experts who will help you learn about: defining your needs, options and alternatives vendor selection, group purchasing discounts practice assessment process achieving meaningful use, qualifying for incentives 27

28 Important Dates Important Dates January 1, 2011 Reporting year begins for eligible professionals January 3, 2011 Registration for the Medicare EHR Incentive Program begins March 1, 2011 Registration begins for Medi-Cal eligible professionals April 2011 Attestation for the Medicare EHR Incentive Program begins May 2011 EHR Incentive Payments expected to begin October 1, 2011 Last day for eligible professionals to begin their 90-day reporting period for calendar year 2011 for the Medicare EHR Incentive Program December 31, 2011 Reporting year ends for eligible professionals February 29, 2012 Last day for eligible professionals to register and attest to receive an Incentive Payment for calendar year (CY)

29 Important Links CMS Official EHR Incentive Program website: Medi-Cal EHR Provider Incentive Portal website: 29

30 Meaningful Use Made Easier 1 (888)