Meaningful Use Mapping the Course

Transcription

1 Meaningful Use Mapping the Course The Louisiana Health Care Quality Forum is a private, not for profit organization whose mission is to lead evidence based, collaborative initiatives to improve the health of Louisiana citizens. In partnership with the Office of the National Coordinator for Health Information Technology (ONC) U.S. Department of Health and Human Services Grant #90RC0049

2 Diete Dobroski, Project Coordinator Louisiana Health Care Quality Forum (LHCQF) A private, non-profit organization whose mission is to lead evidence-based collaborative initiatives to improve the health of Louisiana citizens. LHCQF has a volunteer board and over 200 stake-holders. Initiatives include: o Health Information Technology o Quality Measurement o Clinical Quality Improvement o Patient-Centered Medical Home o Quality First Louisiana Health Information Technology (LHIT) Resource Center The only Regional Extension Center selected by the Office of the National Coordinator to provide Meaningful Use assistance in Louisiana. 2

3 The American Recovery and Reinvestment Act (ARRA) of 2009 Grants designed to modernize healthcare and its infrastructure o State Regional Extension Centers o State Health Information Exchanges Financial incentives made available to eligible providers/hospitals to adopt and meaningfully use certified electronic health record (EHR) technology.

4 M E D I C A R E M E D I C A I D

5 THE INCENTIVE PROGRAMS MEDICARE Up to $44, over 5 years Eligible Professionals: Doctor of Medicine or Osteopathy Doctor of Dental Surgery or Dental Medicine Doctor of Podiatric Medicine Doctor of Optometry Chiropractor MEDICAID $63, over 6 years Eligible Professionals: Physicians Nurse Practitioners Certified Nurse Mid-Wives Dentists Physicians Assistants who lead a FQHC or RHC

6 Medicare EP Incentive Payment Schedule Year & later 2011 $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 * No incentives after Penalties start in 2015

7 Medicaid EP Incentive Payment Schedule 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

8 Mapping your course First key steps Determine eligibility Register online with CMS Guidance/Legislation/EHRIncentivePrograms/R egistrationandattestation.html Commitment!

9 Mapping your course Program Eligibility Medicare Non Hospital Based Medicaid Non Hospital Based Use Certified EHR Adopt Certified EHR Bill Medicare for provider services Have 30% Medicaid patient volume Pays 75% of allowable charges up to the annual maximum. In year one, $24,000 in allowable charges is required to receive maximum incentive. *AIU Pediatricians with a 20 29% Medicaid patient volume receive a reduced incentive.

10 Medicaid Year One (Y1) Adopt/Implement/Upgrade (AIU) Adopt Acquired and/or installed ex: evidence of executed contract installation of certified EHR technology Implement Commenced utilization of the certified system ex: staff training, documenting in the system Upgrade Upgrade to certified version of EHR or add new functionality to meet the requirements No MU reporting period to receive the $21,

11 Certified EHR Technology An EHR system that has the technological capability, functionality and security to help providers meet the meaningful use objectives. The EHR system must be tested and issued certification Providers must use this certified technology in a meaningful manner to receive the financial incentives and avoid future penalties

12 Getting your Medicaid AIU Incentive Run a report showing at least 30% of all encounters/patient days within a consecutive 90 day period from the previous calendar year are Medicaid (As any payer) Starting in 2013 providers may use a consecutive 90 day period from the preceding 12 months to qualify for AIU Check your information with: PECOS Medicaid Provider Relations NPPES (NPI Website Check the Certified Health IT Product List chpl.force.com/ehrcert click on the Add to Cart button next to your EHR, click on Get CMS EHR certification ID and record this number. Register with CMS 12

13 Getting your Medicaid AIU Incentive What to expect An from CMS acknowledging your registration for the state program An from the state containing your incentive registration/attestation documents. You may also find these documents online at Submit documents along with a vendor contract, an invoice or other proof of adopted certified EHR and return via or fax as indicated on the forms. This will satisfy your first year obligation for the Medicaid incentive. Payment may be expected within 2-4 weeks 13

14 What is Meaningful Use?

15 GRASS

16 Meaningful Use of GRASS

17 LEAVES

18 Meaningful Use of LEAVES

19 Meaningful Use is using certified EHR technology to: Improve care coordination Improve population and public health Maintaining privacy and security Engage patients and families in their health care Improve quality, safety, efficiency and reduce health disparities

20 Stage 1 Meaningful Use Must Report 15 Core Objectives Computerized physician order entry (CPOE) Drug drug and drug allergy interaction checks E Prescribing (erx) 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 Implement one clinical decision support rule Report ambulatory clinical quality measures to CMS/States Provide patients with an electronic copy of their health information, with in 3 days Provide clinical summaries for patients for each office visit Capability to exchange key clinical information among providers of care and patientauthorized entities electronically Protect electronic health information

21 Stage 1 Meaningful Use Must report 5 of 10 Menu Set Objectives 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 Medication reconciliation Summary of care record for each transition of care/referrals Capability to submit electronic data to immunization registries/systems* Capability to provide electronic syndromic surveillance data to public health agencies* * At least 1 public health objective must be selected.

22 Exclusions Some MU objectives are not applicable to every provider s clinical practice Ex: Dentists do not perform immunizations; chiropractors do not e prescribe; specialists who may not take vitals.

23 Clinical Quality Measures Eligible Professionals Core Set CQMs NQF Measure Number & PQRI Implementation Number NQF 0013 NQF 0028 NQF 0421 PQRI 128 Clinical Quality Measure Title Hypertension: Blood Pressure Measurement Preventative Care and Screening Measure Pair: 1) Tobacco Use Assessment, b) Tobacco Cessation Intervention Adult Weight Screening and Follow Up

24 Clinical Quality Measures Eligible Professionals Alternate Core Set CQMs NQF Measure Number & PQRI Implementation Number NQF 0024 NQF 0041 PQRI 110 NQF 0038 Clinical Quality Measure Title Weight Assessment and Counseling for Children and Adolescents Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or Older Childhood Immunization Status

25 Additional Set CQM EPs must complete 3 of Diabetes: Hemoglobin A1c Poor Control 2. Diabetes: Low Density Lipoprotein (LDL) Management and Control 3. Diabetes: Blood Pressure Management 4. Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) 5. Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) 6. Pneumonia Vaccination Status for Older Adults 7. Breast Cancer Screening 8. Colorectal Cancer Screening 9. Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD 10. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) 11. Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)effective Continuation Phase Treatment 12. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation 13. Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy 14. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care 15. Asthma Pharmacologic Therapy 16. Asthma Assessment 17. Appropriate Testing for Children with Pharyngitis 18. Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR)

26 19. Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients 20. Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients 21. Diabetes: Eye Exam 22. Diabetes: Urine Screening 23. Diabetes: Foot Exam 24. Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL- Cholesterol 25. Heart Failure (HF): Warfarin Therapy Patients with Atria l Fibrillation 26. Ischemic Vascular Disease (IVD): Blood Pressure Management 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. Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) 30. Prenatal Care: Anti-D Immune Globulin 31. Controlling High Blood Pressure 32. Cervical Cancer Screening 33. Chlamydia Screening for Women 34. Use of Appropriate Medications for Asthma 35. Low Back Pain: Use of Imaging Studies 36. Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control 37. Diabetes: Hemoglobin A1c Control (<8.0%) 38. 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

27 Disclaimer On August 23, 2012, CMS announced the final rule for Stage 2 of Meaningful Use in the EHR Incentive Payments Program. The following slides have been updated to reflect the changes. The LHIT Resource Center will continue examining the new rule to help providers understand the measures and to define the processes necessary to achieve Meaningful Use

28 Stages of Meaningful Use * * * * *3-month quarter EHR reporting period for Medicare and continuous 90-day EHR reporting period (or 3 months at state option) for Medicaid EPs. All providers in their first year in 2014 use any continuous 90-day EHR reporting period.

29 Stage 1 and Stage 2 Comparisons 15 Core Objectives 5 of 10 Menu Set Objectives A total of 20 Objectives Stage 1 3 core or 3 alt. core CQMs 3 menu set CQMs A total of 6 CQMs 17 Core Objectives 3 of 5 Menu Set Objectives A total of 20 Objectives Stage 2 9 CQMs (in at least 3 of the 6 domains) Or PQRS submitted electronically (not manually) NOTE: in stage two you will no longer to be able to choose menu set objectives or CQMs that don t apply to the practice if there are others available that do apply.

30 Stage 1 Changes and Stage 2 Core Objectives EP/EH/ all All All Objective Stage 1 Proposed Stage 2 Stage 1 changes Use CPOE for medication orders directly entered by any licensed health care professional who can enter orders into the medical record per state, local and professional guidelines Implement drug drug and drug allergy interaction checks More than 30% of unique patients with at least one medication in their medication list seen by the EP have at least one medication entered using CPOE The EP has enabled this functionality for the entire EHR reporting period Use CPOE for more than 60% of medication, 30% of laboratory and 30% of radiology orders. Combined with Clinical Decision Support Core Objective Denominator changed to number of orders in the reporting period. Optional in 2013, Required in 2014 EP All All Generate and transmit permissible prescriptions electronically (erx) Record demographics: preferred language, gender, race, ethnicity, date of birth, and date and preliminary cause of death in the event of mortality in the eligible hospital or CAH Maintain up to date problem list of current and active diagnoses EP only More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology More than 50% of all unique patients seen by the EP have demographics as recorded structured data More than 80% of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data E Rx for more than 50%. Drug formulary requirement added to this objective. Record demographics for more than 80% For EH added Date and preliminary cause of death in the event of mortality in the Hosp. Removed in Stage 2 **is now a required field in the summary of care record used in the transition of care measure

31 EP/EH/ ALL? Objective Stage 1 Proposed Stage 2 All Maintain active medication list More than 80% of all unique Removed in patients seen by the EP or admitted Stage 2 to the eligible hospital or CAH have **is now a at least one entry (or an indication required field in that the patient is not currently the summary of prescribed any medication) recorded care record as structured data used in the transition of care measure All Maintain active medication allergy list More than 80% of all unique Removed in patients seen by the EP or admitted Stage 2 to the eligible hospital or CAH have **is now a at least one entry (or an indication required field in that the patient has no known the summary of medication allergies) recorded as care record structured data used in the transition of All Stage 1 Changes and Stage 2 Core Objectives Record and chart vital signs: height, weight, blood pressure, calculate and display BMI, plot and display growth charts for children 2 20 years, including BMI All Record smoking status for patients 13 years or older For more than 50% of all unique patients age 2 and over seen by the EP or admitted to the eligible hospital or CAH, height, weight, and blood pressure recorded as structured data More than 50% or all unique patients 13 years or older seen by the EP or admitted to the eligible hospital or CAH have smoking status recorded as structured data care measure Record vital signs for more than 80% Record smoking status for more than 80% Stage 1 changes Age Limits: Age 3 for Blood Pressure, No age limit for Height/Weight. Exclusion: Allows BP to be separated from height/weight Optional in 2013, required in 2014

32 Stage 1 Changes and Stage 2 Core Objectives EP/EH/ ALL? All Objective Stage 1 Proposed Stage 2 Stage 1 changes Implement one clinical decision support rule and the ability to track compliance with the rule Implement one clinical decision support rule Implement five clinical decision support interventions & implement drug/drug and drug/allergy checks. Decision support must be directly related to 4 CQMs. All Report clinical quality measures to CMS or the States For 2011, provide aggregate numerator, denominator, and exclusions through attestation; For 2012, electronically submit clinical quality measures No longer a measure but reporting is still required for MU ALL **New core Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available to the EP Provide online access to health information for more than 50% with more than 5% actually accessing EPs = 4 bus days EH 36 hrs

33 EP/EH/ ALL? Stage 1 Changes and Stage 2 Core Objectives Objective Stage 1 Proposed Stage 2 Stage 1 changes Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies, discharge summary, procedures), upon request More than 50% of all unique patients of the EP who request an electronic copy of their health information are provided it within 3 business days ** this measure combined with new core measure Provide patients the ability to view online, download and transmit their health information. Required in 2014 EPs = 4 bus days EH 36 hrs EP Only Provide clinical summaries for each office visit Clinical summaries are provided to patients for more than 50% of all visits within 3 business days Provide office visit summaries in 24 hours All Capability to exchange key clinical information (ex: problem list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically Performed at least one test of the certified EHR technology s capacity to electronically exchange key clinical information Removed in 2013 Removed in 2013

34 Stage 1 Changes and Proposed Stage 2 Core Objectives EP/EH/ All? All Objective Stage 1 Proposed Stage 2 Stage 1 changes Protect electronic health information created or maintained by certified EHR technology through the implementation of appropriate technical capabilities Conduct or review a security risk analysis per 45 CFR (a)(1) and implement updates as necessary and correct identified security deficiencies as part of the EP s risk management process EP New core measure for Stage 2 Use secure electronic message to communicate with patients on relevant health information All Implement drug formulary checks The EP/eligible hospital/cah has enabled this functionality and has access to at least one internal or external drug formulary for the entire EHR reporting period All Moved from S1 menu to S2 core Incorporate clinical lab test results into certified EHR technology as structured data More than 40% of all clinical lab test results ordered by the EP whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data No Change More than 5% of patients send secure messages to their EP Removed in Stage 2 has been combined with erx Objective Incorporate lab results for more than 55%

35 Stage 1 Changes and Stage 2 Core Objectives EP/EH / All? EP Objective Stage 1 Proposed Stage 2 Stage 1 changes Moved from S1 menu to S2 core Send reminders to patients per patient preference for preventative/follow up care More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period More than 10% of all unique patients who have had 2 or more office visit with the EP within the 24 months prior to the beginning of the EHR reporting period were sent a reminder, per patient preferences All Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within 4 business days of the information being available to the EP More than 10% of all unique patients seen by the EP are provided timely (available to the patient within 4 business days of being updated in the certified EHR technology) (36 hours for hospital discharges) electronic access to their health information subject to the EP s discretion to withhold certain information ** this measure combined with new core measure Provide patients the ability to view online, download and transmit their health information. Required in 2014 All Moved from S1 menu to S2 core Use certified EHR technology to identify patientspecific education resources and provide those resources to the patient, if appropriate More than 10% of all unique patients seen by the EP or admitted to the eligible hospital or CAH are provided patientspecific education resources No change

36 Stage 1 Changes and Stage 2 Core Objectives EP/EH/ All? Objective Stage 1 Proposed Stage 2 Stage 1 changes All Moved from S1 menu to S2 core The EP, who receives a patient from another setting of care or believes an encounter is relevant should perform medication reconciliation The EP, performs medication reconciliation for more than 50% of transitions of care in which the patient is transition into the care of the EP or admitted to the eligible hospital or CAH No change All Moved from S1 menu to S2 core The EP, who refers their patient to another provider of care should provide a summary of care record for each transition of care or referral The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals 1. The EP that transitions their patient to another care setting must provide a summary of care record for more than 50% of transitions of care. 2. The EP must electronically submit that transition of care using Certified EHR Technology so the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the nationwide health information network more than 10% of the time.

37 EP/EH/ ALL? All Stage 1 Changes and Stage 2 Core Objectives Core Objective Stage 1 Proposed Stage 2 Stage 1 changes Moved from S1 menu to S2 core Capability Performed at least one test of the certified Successful ongoing to submit electronic data to immunization EHR technology s capacity to submit transmission of registries or Immunization Information electronic data to immunization registries immunization data Systems and actual submission in and follow up submission if the test is for the entire accordance with applicable law and successful (unless none of the immunization reporting period practice registries to which the EP submits such information have the capacity to receive such information electronically) All Stays Menu for EPs, Moved to core for EH in stage 2 Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice Performed at least one test of certified EHR technology s capacity to provide electronic syndromic surveillance data to public health agencies and follow up submission if the test is successful (unless none of the public health agencies to which the EP submits such information have the capacity to receive such information electronically Successful ongoing transmission of syndromic surveillance data All Moved from S1 menu to S2 core Generate lists of patients by specific conditions Generate at least one report listing patients of the EP, eligible hospital, or CAH with a specific condition. No change

38 EP/EH/ ALL? EH Stage 1 Changes and Stage 2 Core Objectives Core Objective Stage 1 Proposed Stage 2 Stage 1 changes Moved from S1 menu to S2 core Capability to submit electronic reportable laboratory results to public health agencies, except where prohibited, and in accordance with applicable law and practice. Performed at least one test of certified EHR technology's capacity to submit electronic data on reportable lab results to public health agencies and follow up submission if the test is successful (unless none of the public health agencies to which an eligible hospital submits such information have the capacity to receive the information electronically). Successful ongoing submission of electronic reportable laboratory results from Certified EHR Technology to a public health agency for the entire EHR reporting period as authorized, and in accordance with applicable State law and practice. core EH New core for EH/CAH only. Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (emar). More than 10 percent of medication orders created by authorized providers of the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period are tracked using emar.

39 EP/EH/ All? Stage 2 Menu Set Objectives Core Objective Stage 1 Proposed Stage 2 Stage 1 changes All Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through Certified EHR Technology. More than 10% of imaging results (Image and report) are accessible through Certified EHR Technology All Record patient family health history as structured data Record family health history for more than 20% of all unique patients EP Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice. Successful ongoing transmission of cancer case information to public health central cancer registry EP Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice. Successful ongoing transmission of data to a specialized registry

40 EP/EH/ All? Stage 2 Menu Set Objectives Core Objective Stage 1 Proposed Stage 2 Stage 1 changes EH EH Record whether a patient 65 years old or older has an advance directive Generate and transmit permissible discharge prescriptions electronically (erx) More than 50 percent of all unique patients 65 years old or older admitted to the eligible hospital's or CAH's inpatient department (POS 21) during the EHR reporting period have an indication of an advance directive status recorded as structured data. More than 10 percent of hospital discharge medication orders for permissible prescriptions (for new, changed, and refilled prescriptions) are queried for a drug formulary and transmitted electronically using Certified EHR Technology. All Record electronic notes in patient records Enter at least one electronic progress note created, edited and signed by an eligible professional for more than 30 percent of unique patients

41 Help with steering the way The only Regional Extension Center selected by ONC to provide Meaningful Use assistance in Louisiana. 6.2 million awarded over two years to serve the state of Louisiana to assist 1,042 primary care providers in LA (currently serving over 1400) Assistance with: o Choosing the best EHR for your practice o Minimizing workflow disruptions. o Ensuring eligibility for incentives. o Navigating federal regulations

42 Questions? Diete Dobroski Project Coordinator Louisiana Health Care Quality Forum (225)

43 Colby LeMaire Manager of Client Services

44 History Established as a private, not-for-profit 501(c)3 in Carry forward recommendations of the Louisiana Health Care Redesign Collaborative - Rebuilding/redesigning the health care delivery system after Hurricanes Katrina and Rita Provides for a statewide public-private partnership dedicated to improving the quality of health and health care Mission: To lead evidence-based, collaborative initiatives to improve the health of Louisiana residents

45 Philosophy and Structure Role is to be one of a learning system for stakeholders - Not a regulatory body with punitive functions - All program efforts are voluntary Support pilot programs and demonstration projects to test ideas Objective and transparent

46 Governance Volunteer board representing major regions of the state and balanced across key stakeholders in health care - Providers, i.e., physicians, medical practices, hospitals, health systems - Payers, i.e., health insurance plans and public programs such as Medicaid - Purchasers, i.e., employers who purchase health insurance for employees - Consumers and organizations representing consumer interests

47 Without LaHIE

48 Transforming Health IT

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56 User can choose results from the various sources for graphing and trending.

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58 Break the Glass Accessing patient sensitive locked information

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63 Continuity of Care Document (CCD) Consolidation of current patient information

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66 THE TIMELINE VIEW Specialized View

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68 time Define a specific period within the timeline to view results only during that date range

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71 What do you do to participate? Simple Web based access NO hardware or software requirements Use Personal PC, Network PC, Smartphone, ipad Hospitals : Sign the participation form Submit test data and complete interface All employed or affiliated providers gain membership with hospital Other providers: Home Health, Surgery Centers, Individual Providers, Medical Homes Communicate with LaHIE the current platform used for operations Sign participation form Submit test data and complete interface Begin use at appropriate time

72 Wrap Up Know the patient Know the provider Understand patient problems Understand patient history Preventatively care for patient Move toward wellness paradigm Improve quality of care Improve the ongoing health and wellness of all in Louisiana!

73 Questions? COLBY LEMAIRE (985)