Agenda 2. EHR Incentive Programs 3/5/2015. Overview EHR incentive programs Meaningful Use Differences between Stage 1 and Stage 2

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1 Meaningful Use and the Electronic Health Record Presented by: Susan Reehill CPC, CEMC, CHONC, CPMA Certified Professional Medical Auditor AHIMA Approved ICD-10 CM/PCS Trainer Overview EHR incentive programs Meaningful Use Differences between Stage 1 and Stage 2 Agenda 2 The Medicare and Medicaid EHR Incentive programs provide incentive payments to eligible professionals (EP) who demonstrate meaningful use of electronic health records (EHR). (cms.gov) EPs must demonstrate meaningful use and submit measures for Stages 1, 2 and 3. EHR Incentive Programs 3 1

2 MU is using certified electronic health record (EHR) technology to improve quality, safety, efficiency and reduce health disparities. MU seeks to improve care coordination, population and public health while maintaining privacy and security for patients. Providers must demonstrate MU to receive incentives What is Meaningful Use (MU)? 4 MU seeks to engage patients and families in their health care Per CMS, it s not enough for a provider to have an electronic medical record (EMR). We have to show CMS that we are using the EHR in ways to positively affect the care of the patient. Guidance/Legislation/EHRIncentivePrograms/downloads/beginners_guide.pdf What is Meaningful Use (MU)? 5 EHR Incentive Programs consist of three stages of meaningful use. Each stage has its own set of requirements Stage 1: Data capturing and sharing Stage 2: Advanced clinical processes Stage 3: Improved outcomes How the MU Program works 6 2

3 HITEC Provisions of the American Recovery and Reinvestment Act of 2009: Established CMS EHR Incentive Programs Introduced concept of meaningful use of certified EMR/ EHR technology Identified eligible professionals and eligible hospitals Incentives es are based on the individual, id not the practice Meaningful Use 7 MU is aimed at using EMR/EHR s in a meaningful manner, such as e-prescribing and electronic exchange of health information Reporting clinical quality measures (CQM s) Meaningful Use 8 Who can participate? 9 3

4 Medicare eligible professionals (EP s) Medicaid eligible professionals Medicare eligible hospitals (EH s) Medicaid eligible hospitals Critical Access Hospitals (CAH s) gov/regulations-and-and Guidance/Legislation/EHRIncentivePrograms/eligibil ity.html Qualified participants 10 Medicare EPs include: Doctors of medicine or osteopathy Doctors of dental surgery or dental medicine Doctors of podiatry Doctors of optometry Chiropractors Qualified participants 11 Medicaid EPs include Physicians Nurse practitioners Certified nurse-midwives Dentists Physicians assistants working in a Federally Qualified Health Center (FQHC) or rural health clinic (RHC) that is so led by a physicians assistant **EPs may not be hospital-based Qualified participants 12 4

5 To qualify for an incentive payment under the Medicaid EHR Incentive Program, an eligible professional must meet one of the following criteria: Have a minimum 30% Medicaid patient volume* Have a minimum 20% Medicaid patient volume, and is a pediatrician* Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals * Children's Health Insurance Program (CHIP) patients do not count toward the Medicaid patient volume criteria. Medicaid EHR Incentive Program 13 Professionals eligible for both the Medicare and Medicaid EHR Incentive Programs must choose which program they wish to participate in when they register. An eligible professional may switch programs only once after the first incentive payment is initiated. Most eligible professionals will maximize their incentive payments by participating in the Medicaid EHR Incentive Program. (cms.gov) Eligible for both? 14 MU Stage

6 Focused on EPs capturing patient data and sharing that data with either the patient or other health care providers Can participate for three years in Stage 1 for Medicaid program if they ve adopted, implemented or upgraded to a certified EMR/EHR program MU Stage 1 16 No EHR Reporting period in the first year, but in the 2 nd year, Medicaid EPs must report data on a continuous 90-day period during the calendar year Medicare EPs have to meet the requirement for and report data on a continuous 90-day period for that first year of participation The reporting periods for the remaining years are the entire calendar year (Medicare and Medicaid) MU Stage Core : Everyone who participates must meet and report on all 13 core objectives. 9 menu objectives: Report five of the nine menu objectives that fit with your practice. One objective has to be public health related. Report Clinical Quality Measures (CQMs) gov/regulations-and-and Guidance/Legislation/EHRIncentivePrograms/Downloads/EHR_Medicaid_BegGuide_Stag e1.pdf MU Stage

7 1. Computerized provider order entry (CPOE) 2. Drug-drug and drug-allergy checks 3. Maintain an up-to-date problem list of current and active diagnoses 4. E-Prescribing (erx) 5. Maintain active medication list 6. Maintain active medication allergy list 7. Record demographics MU Stage 1: 13 Core Record and chart changes in vital signs 9. Record smoking status for patients 13 years or older 10. Implement clinical decision support 11. Provide patients with the ability to view, download, or transmit their health information online 12. Provide clinical summaries for patients for each office visit 13. Protect electronic health information MU Stage 1: 13 Core 20 Must report 5 of 9 One must be public health objective 1) Submit electronic data to immunization registries OR 2) Submit electronic syndromic surveillance data to public health agencies MU Stage 1: 9 Menu 21 7

8 3) Drug formulary checks 4) Incorporate clinical lab test results 5) Generate lists of patients by specific condition 6) Send reminders to patients for preventive / follow up care 7) Patient specific education resources 8) Medication reconciliation 9) Summary of care record for transitions of care MU Stage 1: 9 Menu 22 MU Stage 2 23 Focus for Stage 2 MU 17 Core : that everyone who participates must meet. 6 menu objectives: report on 3 out of the 6 available menu objectives. Must include one public health related objective. 9 Clinical quality measures (CQMs) that cover at least three of the domains Report data for the entire calendar year (not just 90 days) MU Stage

9 1. Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders 2. Generate and transmit permissible prescriptions electronically (erx) 3. Record demographic information 4. Record and chart changes in vital signs 5. Record smoking status for patients 13 years old or older MU Stage 2: 17 Core Use clinical decision support to improve performance on high-priority health conditions 7. Provide patients the ability to view online, download and transmit their health information 8. Provide clinical summaries for patients for each office visit 9. Protect electronic health information created or maintained by the Certified EHR Technology MU Stage 2: 17 Core Incorporate clinical lab-test results into Certified EHR Technology 11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach 12. Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up enti e/follo p care 13. Use certified EHR technology to identify patientspecific education resources MU Stage 2: 17 Core 27 9

10 14. Perform medication reconciliation 15. Provide summary of care record for each transition of care or referral 16. Submit electronic data to immunization registries 17. Use secure electronic messaging to communicate with patients on relevant health information MU Stage 2: 17 Core Submit electronic syndromic surveillance data to public health agencies 2. Record electronic notes in patient records 3. Imaging results accessible through CEHRT 4. Record patient family health history 5. Identify and report cancer cases to a State cancer registry 6. Identify and report specific cases to a specialized registry (other than a cancer registry) MU Stage 2: 6 Menu 29 MU Stage 1: 13 core objectives and 9 menu objectives (18 total required) MU Stage 2: 17 core objectives and 6 menu objectives (20 total required) New core objectives in stage 2 New stage 2 menu objectives Differences and Similarities 30 10

11 Beginning in 2014, you must select and report nine of the possible 64 CMS approved CQMs : Six of the possible 44 measures CMS has identified two recommended core sets based on adult versus pediatric patient populations. Clinical Quality Measures (CQM) 31 Nine Clinical Quality Measures (CQMs) that cover at least three of the following domains: Patient and family engagement Patient safety Care coordination Population and public health Efficient user of health care resources Clinical process / effectiveness Clinical Quality Measures (CQM): Domains 32 CQMs measure many aspects of patient care including health outcomes, clinical processes, patient safety, efficient use of health care resources, care coordination, patient engagements, population and public health and adherence to clinical guidelines. Clinical Quality Measures (CQM): Basics 33 11

12 CMS website, including but not limited to: Guidance/Legislation/EHRIncentivePrograms/Meani ngful_use.html Guidance/Legislation/EHRIncentivePrograms/Stage _2.html Resources 34 American Academy of Ophthalmology central/upload/ophthalmology-stage-2-attestation- Guide-2014-rev.pdf central/upload/ophthalmology-attestation-guide pdf Resources 35 Questions and Thank you! 36 12