Meaningful Use Stage 2 Physicians Offices March 2014
Presenters J.N. Cook, D.O. MPH, jcook1@mhc.net Randi Terry, MBA, rterry@mhc.net
Credit where credit is due
Long Road Traveled
How to Qualify 1 2 3 4 Use a certified EHR Certified HIT Product List (CHPL) Register with CMS EHR Incentive Programs Meet Meaningful Use Criteria Staged criteria based on year of participation Report to CMS
The REAL BENEFIT Presentation will not be summary of Meaningful Use (you probably better have that). Will be about the questions you ve asked us or the things we ve stumbled across. ASK LOTS OF QUESTIONS
Checking Status https://ehrincentives.cms.gov/hitech/login.action Need NPPES ID and Password
CHPL Number 2011 (Stage 1) list of CHPL s Ambulatory (EP): 3737 Hospital (EP): 1200 2014 (Stage 2) list of CHPL s (both ambulatory and hospital)
CHPL http://oncchpl.force.com/ehrcert?q=chpl Edition (2011, 2014) Project Name/Vendor Name Complete/modular Version Number Required Software (IMPORTANT) Certified for what (especially needed for CQM)
2014 Certified Code Must have certified code the ENTIRE reporting period
2014 Certified Code
CHPL Number http://oncchpl.force.com/ehrcert?q=chpl
CHPL Number
CHPL Number In 2014, you MUST have 2014 certified code in place even if you are still in Stage 1 for the ENTIRE quarter
CHPL Number Must have proof that you have each software listed
Multiple Versions Complete verses modular Check what is different (in this case new QM s were added) Make sure you select 2014
Multiple Locations Copy this number, do not try to type it in, 1 and l and L are not easily separated
Penalties
Penalties
Confusion in it s Finest
Timing AIU Medicaid Example Multiple stages in one practice
Timing Medicare Example Depending on year, you may have 3 years in Stage 1 and 3 years in Stage 2
Exception (if your vendor is not ready) 2014 CEHRT Hardship Exception Guidance announced today The Centers for Medicare & Medicaid Services today issued guidance for eligible professionals, eligible hospitals and critical access hospitals that are unable to implement the 2014 Edition of Certified Electronic Health Record technology in time to successfully demonstrate meaningful use for the 2014 reporting year. Visit the EHR Incentive Program webpage for the: 2014 CHERT Hardship Exception Guidance for Eligible Professionals, http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/CEHRT2014_HEG uidance_eps.pdf
Exception (if your vendor is not ready) There are no appeals, so make your case
Multiple Locations (What counts) Inpatient and ED does NOT count Counts: Urgent Care Free Clinics Surgery Center ½ of the year at practice A and ½ of the year at practice B Nursing Home Visits 50% encounters at location equipped with CEHR (Certified EHR) Core and Menu Items (add everything together from all locations)
Multiple Locations (Core and Menu) Combine numbers of CEHR to attest Have to get the numbers from previous locations Residents may count Obtain physician signature
Practice at Multiple Places (CEHR) Ask yourself: does the provider have more than 50% of their encounters at a location equipped with a CEHR
Practice at Multiple Places
Medicaid Expands Eligibility (2013+)
How does the state know how many Medicaid encounters you have Medicaid - Avoid an audit
Stage of Meaningful Use
Stage 2 Key Facts Increased % for nearly all measures New Requirements Focus on electronic data exchange Patient portal required 2014 EHR certification =Upgrade needed =2014 Code =Check YOUR EHR 2014 version ~=ICD-10 ready
Increased Requirements Requirement Stage 1 Stage 2 Comment erx 40% 50% Formulary search Demographics 50% 80% Multiple race option Vitals 50% 80% BP > 3 y.o. Smoking Status 50% 80% SNOMED coding Security Risk Analysis 1 1 Include encryption/security of data at rest
Menu Stage 1 = Core Stage 2 Requirement Stage 1 Structured Lab Results Patient Education Medication Reconciliation Stage 2 Patient List 1 1 40% 55% Interface Comment 10% 10% Measurement change 50% 50% Transitions to the practice
Core
Core
Core
CPOE Exclusions: < 100 Different denominator New definition of licensed healthcare professional
CPOE
CPOE Licensed Professional Any licensed healthcare professionals and credentialed medical assistants, can enter orders into the medical record for purposes of including the order in the numerator for the objective of CPOE if they can originate the order per state, local and professional guidelines. Credentialing for a medical assistant must come from an organization other than the organization employing the medical assistant.
Interventions - Clinical Decision Support Can be ANY 4 CQM s, not the ones you are reporting on
Interventions - Clinical Decision Support CMS/ONC didn t like some CDS s that were selected in Stage 1 so they became more specific Make sure you document each CDS and which one of these it relates to Makes sure one relates to a combination of two Most EHR s have this nailed but you have to document.
Interventions - Clinical Decision Support Make sure you document each CDS and what reference you use Embed the reference right into you EHR (debate able whether needed).
Clinical Decision Support
CDS - Document
Preventive Care/Patient Reminders Patient portal, robo dialer, etc.
View, Download and Transmit AKA: Patient Portal
View, Download and Transmit Patient Portal
View, Download and Transmit
View, Download and Transmit Start early, it takes time Kiosk machines in waiting room or at checkout The excuse of old people doesn t fly Make patient portal useful otherwise patients will use at first and then not later
Secure Messaging
Secure Messaging - WHY Providers have seen reduction in time responding to inquires and less time spend on the phone Secure messaging has also been shown to increase patient satisfaction with their care. Research demonstrates that secure messaging has been shown to improve patient adherence to treatment plans. While we recognize that EPs cannot directly control whether patients use electronic messaging, we continue to believe that EPs are in a unique position to strongly influence the technologies patients use to improve their own care, including secure electronic messaging. We believe that EPs ability to influence patients coupled with the low threshold make this measure achievable for all EPs
Transition of Care What is it? Transitions into a practice Medication reconciliation (50%) Transitions to another site or provider Summary of care record (3 measures)
Transition of Care Transition in Transition Out Medication Reconciliation Requirement Summary of Care Document Requirement
Summary of Care
Summary of Care
Summary of Care Direct Emails Only
Summary of Care CCD / CCDa if the provider does not have the information available to populate one or more of the fields listed, either because they can be excluded from recording such information (for example, vital signs) or because there is no information to record (for example, laboratory tests), the provider may leave the field(s) blank. The only exception to this is the problem list, medication list, and medication allergy list.
Summary of Care CCD / CCDa
Summary of Care CCD / CCDa Many are 26+ pages long
Summary of Care CCD / CCDa
Summary of Care CCD / CCDa Munson Contact: Colleen DeBie, 231-935-7904, bdebie@mhc.net Website: listing of all KNOWN Direct Trust emails http://www.munsonhealthcare.org/meaningfuluse
Transition of Care Transition in Transition Out Medication Reconciliation Requirement Summary of Care Document Requirement
Medication Reconciliation New patients Existing patients transitioning back if: 50%
Security Risk Analysis
Summary - Menu
Menu what is your vendor certified for Next Gen 5.8.0.77 ecw, V10
Family History
Family History Must be entered in Snomed Does not need to be collected every visit (just once) Should not be a problem
Syndromic Surveillance
Syndromic Surveillance
Syndromic Surveillance http://mihin.org/wp- content/uploads/2013/12/msss-testing-and- Submission-Guide.pdf https://www.michiganhealthit.org/publichealth/msss/
Syndromic Surveillance Per the state of Michigan, any specialty can participate in this. The submission must go through Sub State HIE (MiHealth Connect). Must have statement of work George Bosnjak (616) 588-4707 gbosnjak@michiganhealthconnect.org You must receive an OID (organizational ID), see link to the left
Syndromic Surveillance If you are on the hosted ecw system or hosted Next Gen, Munson IS will assist you with the submission.
Electronic Progress Notes The text of the electronic note must be text-searchable and may contain drawings and other content.
Electronic Progress Notes - OLD
Specialized Registry Munson Healthcare cannot find a specialized registry to work with other than Pinnacle for Next Gen PHO registry will not count, MICR will not count PQRS will not count
Quality Measures
Find your vendor certification From CHPL list Fro
Clinical Quality Measures CMS Recommended
2014 CQM issues www.cms.gov/ehricentiveprograms ONC does not require vendors to configure their EHRs to measure all 64 CQMs 2014 CQMs will be utilized for Stage 1 or Stage 2 reporting PFR not PFP Multiple reporting options CMS website PQRS Group option Medicaid-state reporting
CDS CQM Strategy Primary Care 1. Don t panic 2. EHR 2014 certification for specific CQMs 3. Select 9 CQMs appropriate to practice >=3 Domains 4. Select 5 CDS associated with 4 CQMs 5. Select reporting option. Subspecialties 1. Fret but don t panic 2. EHR 2014 certification for specific CQMs 3. Search for 9 CQMs Zero option 4. Search for 5 CDS 5. Read attestation and reporting requirements 6. FAQ watch 7. Select reporting option.
Meaningful Use Audits
Meaningful Use Audits
Meaningful Use Audits
Meaningful Use Audits Meaningful Use audits are a when not an if Retain documentation for 6 years post-attestation If found to not be eligible for an EHR incentive payment, payment will be recovered Medicare: Email (letter) from CMS email (make sure you email address is accurate) http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Do wnloads/ehr_supportingdocumentation_audits. pdf Figliozzi & Company is contractor conduct the audit Pre-audits have kicked in.
Meaningful Use Audits Relevant IT systems, system configurations, roles, and processes for each MU criteria System certification documentation (versions, certification #s, etc.) Reports/data for each reporting period Confirmations or other communication for CMS or State A copy of (ONC) certification as well as licensing agreements with the vendor or invoices from the system purchase Specific and concise documentation for all Core and Menu Criteria (Numerator/Denominator & Yes/No) Reports from your CEHRT to document the numbers you attested to for Numerator/Denominator criteria and Quality Measures Documentation that demonstrates how each criteria was met e.g., screen shots, training materials, reports, audit logs, policies/procedures Be sure there are time/date stamps to prove screen shots, etc. were taken during the reporting period Especially for Yes/No criteria
Questions
Pre-Payment Audits Always ask for Security Risk Analysis
GT Surgery Audits Where else do the providers work: Surgery Center Hospital outpatient Free Clinic Urgent Care Do these locations have CEHR
Audit Checklist
Audit Checklist
Reducing the Risk
Long Road to.
Questions
glosuite 8.1 (Menu)
glosuite 8.1 (QM)