American Recovery & Reinvestment Act Meaningful Use Dawn Ross, Clinical Informatics Director Linda Wilson, Meaningful Use Coordinator 10/26/2015
Overview American Recovery and Reinvestment Act of 2009 (ARRA) aka Stimulus Act To save and create jobs 831 billion for infrastructure, education, health and energy, federal tax incentives, expansion of unemployment, and other Health Information Technology for Economic and Clinical Health Act (HITECH) Part of ARRA 155 billion for healthcare Promote Adoption and Meaningful Use of HIT 25.8 billion for EHR Incentive Program EHR Incentive Program Meaningful Use (MU)
Overview Goals of the Program Improve Quality, Safety, and Efficiency of Care, while reducing disparities Engage Patients and their Families in Their Care Promote Public and Population Health Improve Care Coordination Promote Privacy and Safety of Electronic Health Records
Overview Eligible Hospitals (EH) and Eligible Professionals (EP) will be incentivized for demonstrating use of a Certified Electronic Health Record Technology (CEHRT) in a meaningful manner Beginning in 2015 EH and EPs are penalized for not demonstrating MU
Overview Stage 3 is last stage Stage 3 can change, but this is the last stage MU is rolled into MIPS in 2019 Clinical Effectiveness, patient safety, HIE 2015 Align to calendar year 90 day reporting period Some exclusions apply 2016 1 Year reporting period Some exclusions apply
Overview 2017 First year anyone can do Stage 3 Anyone can do Stage 3, or where they were in 16 All reporting periods are a full calendar year Except 1 st year Medicaid Flexibility allows 2014 or 2015 CEHRT Can choose any combination of functional and CQM Need to be careful when upgrading as may not be backward compatible esubmission of CQMs mandated if on 2015
Overview 2018 Everyone is on Stage 3 Must be on 2015 CEHRT Must submit CQMs electronically (QRDA-I) CQMs Rules will come from IPPS (EH) each April and PFS (EP) each July
Overview Medicare Doctors of Medicine Doctors of Osteopathy Doctors of Dental Surgery or Medicine Doctors of Podiatric Medicine Doctors of Optometry Chiropractors Medicaid Physicians Dentists Certified Nurse Midwives Nurse Practitioners Certain Physician Assistants Requires 30% payer mix (20% for pediatricians)
Overview Run by CMS Medicare Medicaid Run by individual State Medicaid Agencies Maximum Incentive $44,000 Maximum Incentive $63,500 Payment Over 5 Consecutive Years Payment Adjustments Begin in 2015 Must Demonstrate MU Each Year Must Begin Program by 2014 to Qualify for Incentives Payments Over 6 six years; Does Not Have to be Consecutive No Payment Adjustment if Only Eligible for Medicaid Program In Year 1, May Receive Incentive for AIU; Must Demonstrate MU in Consecutive Years to Qualify for Incentive Must Begin Program by 2016 to Qualify for Incentives
Meaningful Use
Overview of Stages
Modified Stage 2 (2017)/Stage 3 Protect Patient Information Electronic Prescribing Clinical Decision Support Computerized Provider Order Entry Patient Electronic Access to Health Information Coordination of Care through Patient Engagement Health Information Exchange Public Health and Clinical Data Registry Reporting
Protect Patient Health Information Stage 1 2014 Security Risk Assessment with Risk Mitigation Plan Stage 2 2015-2017 Stage 3 Added encryption Must be completed / reviewed every reporting period Added review of physical and administrative safeguards
erx Stage 1 2014 Stage 2 2015-2017 Stage 3 40% of eligible prescriptions are transmitted electronically (EP) EP-50% EH-10% Formulary Check EP-50% EH-10% Formulary Check *Exclusion for EH in 2015 only EP-80% EH-25% Formulary Check Enabled formulary checking (Y/N) Subsumed into erx
Clinical Decision Support Stage 1 2014 Stage 2 2015 2017 Stage 3 One CDS rule Increased to five CDS interventions (does not have to be a rule) and needs to relate to at least four different quality measures Increased to five CDS interventions (does not have to be a rule) and needs to relate to at least four different quality measures Same as Stage 2 Drug-Drug and Drug-Allergy Checking Same Same Same
CPOE Stage 1 2014 Stage 2 2015-2017 Stage 3 30% of medication orders must be entered by a provider 60% of medication orders must be entered by a provider 60% of medication orders must be entered by a provider 60% 30% of laboratory orders must be entered by a provider 30% of laboratory orders must be entered by a provider 60% 30% of radiology orders must be entered by a provider 30% of radiology orders must be entered by a provider 60% of diagnostic imaging
Patient Access (VDT) Stage 1 2014 Stage 2 2015 2017 Stage 3 10% of patients must have all the tools needed to enroll Core; 50% of patients have the tools needed to enroll; 5% have viewed their portal; information must be posted within 4 business days VDT View: 50% of patients have access to health information within 36 hours after discharge EH; 4 business days - EP VDT View: 80% of patients have access to health information online within 36 hours (48 for EP) OR Application Program Interface (API) Subsumed into measure >/= to 1 patient seen during reporting period have VDT. 2017=5% of patients >10% must view, download, or transmit
Patient Education Stage 1 2014 Stage 2 2015 2017 Stage 3 More than 10% of unique patients have education documented; EHR must be able to suggest education More than 10% of unique patients are given EHR suggested education More than 10% of unique patients are given EHR suggested education 35% of patients are electronically provided EHR suggested education
Secure Messaging (EP Only) Stage 1 2014 Stage 2 2015 2017 Stage 3 NA EP-5% of unique patients seen in the reporting period sent a secure message EP Only 2015: Y/N 2016: 1 patient has sent message 2017: 5% are sent a secure message 25% of patients are sent a secure message
Transition of Care Summary (out) Stage 1 2014 Stage 2 2015-2017 Stage 3 Menu; Send a ToC Summary for at least 50% of patients being transitioned to another provider or level of care Core; Send a ToC Summary for at least 50% of patients being transitioned to another provider or level of care Core; Problem List must have at least one entry on 80% of unique patients Problems must be in SNOMED Core; Send an electronic ToC Summary for at least 10% of patients being transitioned to another provider or level of care Send an electronic Summary of Care record to.>10% of transitions and referrals being transitioned to another provider or referral. Send an electronic ToC Summary for at least 50% of patients being transitioned to another provider or level of care Core; Med Allergy List must have at least one entry on 80% of unique patients Core; Perform at least one successful exchange of a ToC Summary with another provider with a different EMR vendor Core; Medication List must have at least one entry on 80% of unique patients Allergy List and Medication List cannot be blank; Problem List cannot be blank and must be in SNOMED Problems, Allergies and Medications must be included; new CCDS
Transition of Care Summary (in) (Stage 3) Stage 1 2014 Stage 2 2015 2017 Stage 3 NA NA NA 40% of transitions or referrals received (including new patients) have the Summary of Care document incorporated if the SOC is available.
Med Reconciliation (Stage 1/2) Stage 1 Stage 1 2014 Stage 2 Menu; At least 50% have a medication reconciliation performed of incoming transitions Core; At least 80% of patients must have a medication on their medication list Core; At least 80% of patients must have a medication allergy listed on their allergy list Same Same Same Core; At least 50% have a medication reconciliation performed of incoming transitions Subsumed into other measures Subsumed into other measures
Data Reconciliation (Stage 3) Stage 1 2014 Stage 2 2015 2017 Stage 3 Menu; At least 50% have a medication reconciliation performed of incoming transitions Core; At least 50% have a medication reconciliation performed of incoming transitions At least 50% have a medication reconciliation performed on incoming transitions 80% of transitions or referrals received have a clinical reconciliation performed; includes medications, problems, and allergies Core; At least 80% of patients must have a medication on their medication list Subsumed into other measures Core; At least 80% of patients must have a medication allergy listed on their allergy list Subsumed into other measures
Incorporate Information into EHR (Stage 3) Stage 1 2014 Stage 2 2015-2017 Stage 3 NA NA NA 5% of patients have patient generated or nonclinical generated health information incorporated into EHR
Public Health and Data Reporting (3/5; 4/6) Active Engagement vs. ongoing submission Centralized repository Options: Immunization (send and receive) Syndromic Electronic Case Reporting Public Health Registry (can count 3 (4) times) Clinical Data Registry (can count 3 (4) times) Reportable Labs (EH only)
Inactive/Topped Out/Subsumed Demographics Vital Signs Smoking Status 2015-2017 and Stage 3 Incorporate Lab Results Generate patient list by condition emar (PPID) Advance Directives Imaging Results Patient Family History e-notes Ambulatory Lab Results Patient Reminders Clinical Summary 10/26/2015 Transition of Care Summary Measure 1&3 26
Clinical Quality Measures Domains Patient and Family Engagement Patient Safety Care Coordination Population and Public Health Efficient Use of Healthcare Resources Clinical Processes/Effectiveness
Clinical Quality Measures Report 9 of 64 Recommended Set Can Choose Others Based on Patient Population Alignment with Other Quality Programs PQRS ACO PCMH IQR
Questions? 10/26/2015 29