Meaningful Use of an EHR System Slide content by: David Ford of CMA CalHIPSO Meaningful Use Consultant & Reena Samantaray Director of Outreach & Education, CalHIPSO July 2010 Presented by Dr. Sherellen Gerhart
The American Recovery and Reinvestment Act (ARRA) Feb 2009
Health Information Technology for Economic and Clinical Health Act or HITECH Act Goals of Bill as put forth by Congress: Requiring the government to take a leadership role to develop standards by 2010 that allow for the nationwide electronic exchange and use of health information to improve quality and coordination of care. Investing $20 billion in health information technology infrastructure and Medicare and Medicaid incentives to encourage doctors and hospitals to use HIT to electronically exchange patients health information. Saving the government $10 billion, and generating additional savings throughout the health sector, through improvements in quality of care and care coordination, and reductions in medical errors and duplicative care. Strengthening Federal privacy and security law to protect identifiable health information from misuse as the health care sector increases use of health IT.
The American Recovery and Reinvestment Act (ARRA) $36 billion investment by the Federal Government in Health IT. $2 billion in grant funds for HIE and for technical assistance to providers. $34 billion paid out directly to providers who prove meaningful use of a certified EHR system. Intent:.
Medicare Provider Incentives Medicare Providers, who are not hospital-based, can receive up to $44,000 for demonstrating meaningful use of certified EHR systems. Incentives are paid out over five years, beginning in 2011. Providers who adopt EHR after 2014 will not receive payments. Providers with an existing EHR system are also eligible. Providers practicing in a Health Professions Shortage Area are eligible for 10% bonus payments. Eligible providers: Physician (MD or DO), Dentist, Podiatrist, Optometrist or chiropractor.
Medicare Provider Incentives First Year of Adoption 2011 2012 2013 2014 2011 $18,000 -- -- -- 2012 $12,000 $18,000 -- -- 2013 $8,000 $12,000 $15,000 -- 2014 $4,000 $8,000 $12,000 $12,000 2015 $2,000 $4,000 $8,000 $8,000 2016 $0 $2,000 $4,000 $4,000 Total $44,000 $44,000 $39,000 $24,000
Medi-Cal Provider Incentives Medi-Cal Providers are eligible to receive up to $63,750 in incentive payments, paid out over 6 years, for demonstrating meaningful use. Eligibility for Medi-Cal providers is limited in scope, and is targeted toward safety net providers. Incentives will be paid by the State of California (Federal funding pass through). Incentives are available in the first year for adoption, implementation, or upgrade. Eligible Providers: MD or DO, NP, CNMW
Three Ways to Qualify for the Medi-Cal Incentives Non-hospital-based providers: 1. 30% of patient volume is Medi-Cal. 2. Pediatricians for whom at least 20% of patient volume is Medi-Cal. ** 3. Practice primarily in an FQHC, and 30% of patient volume is needy individuals (Medi- Cal, Healthy Families, Sliding Scale, or uncompensated care). ** Peds patient volumes in 20-29% range will receive 2/3 of max incentive
Medi-Cal Provider Incentives 2011 2012 2013 2014 2015 2016 2011 $21,250 - - - - - 2012 $8,500 $21,250 - - - - 2013 $8,500 $8,500 $21,250 - - - 2014 $8,500 $8,500 $8,500 $21,250 - - 2015 $8,500 $8,500 $8,500 $8,500 $21,250-2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250 2017 - $8,500 $8,500 $8,500 $8,500 $8,500 2018 - - $8,500 $8,500 $8,500 $8,500 2019 - - - $8,500 $8,500 $8,500 2020 - - - - $8,500 $8,500 2021 - - - - - $8,500 Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750
What is Meaningful Use? Three criteria listed in ARRA: 1.Demonstrate to HHS that EHR was used in a meaningful manner, including e-prescribing. 2.The EHR is connected in a way to facilitate information exchange. 3.The physician reports on clinical quality measures.
Meaningful Use Two Tracks Medicare Medi Cal CMS Regs DHCS
Final Rule on Meaningful Use Released on July 13 th, will be officially noticed in the Federal Register on July 28 th. Per Federal Rules, it takes effect 60 days after it is noticed (September 26 th ). Only finalizes meaningful use for the Medicare Incentive Program. (Stages 1 and 2)
Three Stages of Meaningful Use First Payment Year 2011 Stage 1 2011 2012 2013 2014 2015+ 2012 Stage 1 Stage 1 2013 Stage 2 Stage 1 Stage 1 2014 Stage 2 Stage 2 Stage 1 Stage 1 2015+ TBD TBD TBD TBD TBD
Putting it All Together First Payment Year 2011 $18,000 Stage 1 2012 $12,000 Stage 1 2013 $8,000 Stage 2 2014 $4,000 Stage 2 2015 $2,000 TBD 2016 - TBD 2011 2012 2013 2014 2015+ $18,000 Stage 1 $12,000 Stage 1 $8,000 Stage 2 $4,000 TBD $2,000 TBD $15,000 Stage 1 $12,000 Stage 1 $8,000 TBD $4,000 TBD $12,000 Stage 1 $8,000 TBD $4,000 TBD - TBD - TBD
Objectives and Measures
Objectives and Measures Eligible Providers Report (to CMS or the State) on 15 required objectives, plus 5 menu items (from a list of 10). and 6 quality measures (3 core and 3 chosen from menu of 41.) Each objective has an associated measure, which is the criteria the provider will have to demonstrate.
Required Objectives and Measures Objective Record patient demographics Record vital signs and chart changes Maintain up-to-date problem list Maintain active medication list. Maintain active medication allergy list. Measure More than 50% of patients demographic data recorded More than 50% of patients 2 years of age or older have height, weight, and blood pressure recorded More than 80% of patients have at least one entry recorded More than 80% of patients have at least one entry recorded More than 80% of patients have at least one entry recorded
Required Objectives and Measures Objective Record smoking status for patients 13 years of age or older. Provide patients with clinical summaries for each office visit. On request, provide patients with an electronic copy of their health information Generate and transmit permissible prescriptions electronically Computer provider order entry (CPOE) for medication orders Measure More than 50% of patients 13 years of age or older have smoking status recorded Clinical summaries provided to patients for more than 50% of all office visits within 3 business days. More than 50% of requesting patients receive electronic copy within 3 business days. More than 40% are transmitted electronically using certified EHR technology. More than 30% of patients with at least one medication in their medication list have at least one medication ordered through CPOE.
Required Objectives and Measures Objective Implement drug-drug and drugallergy interaction checks. Implement capability to electronically exchange key clinical information among providers. Implement one clinical decision support rule Implement systems to protect privacy and security of patient data. Report clinical quality measures to CMS or states. Measure Functionality is enabled for these checks for the entire reporting period. Perform at least one test of EHR s capacity to electronically exchange information. One clinical decision support rule implemented. Conduct or review a security risk analysis, implement security updates as necessary, and correct identified security deficiencies. For 2011, provide aggregate numerator and denominator through attestation.
Clinical Quality Measures
Clinical Quality Measure Reporting Eligible providers will report on six quality measures three required core measures, and three selected from a list of 41. Hospitals will report on 15 required clinical quality measures (there are no optional measures for hospitals). The measures are selected from NQF or PQRI (providers) or the Joint Commission (hospitals).
Core Measures Core Measures Preventive Care and Screening Measure Pair: a. Tobacco Use Assessment, b. Tobacco Cessation Intervention. Hypertension: Blood Pressure Measurement. Adult Weight Screening and Follow-Up.
Alternate Core Measures Alternate Core Measures Preventive Care and Screening: Influenza Immunization for Patients -> 50 Years Old.- Weight Assessment and Counseling for Children and Adolescents. Childhood Immunization Status.
Other Important Provisions of the Rule Limits on States ability to deviate from this rule for the purposes of Medicaid Incentives. Provider protections: 1.Ability to not report on up to five core objectives. 2.Protection for measures that the provider cannot control. Method of Reporting- For 2011 only, it s attestation. After that, it will be through an online system.
Other Important Provisions of the Rule Recorded data does not need to be collected by the provider receiving the incentive. Many of the measures (height and weight, for example) can be collected by office staff, NPs, PAs, etc. Data received from other providers forwarded in referral forms, for example is allowed. Many data points, such as smoking, only need to be recorded once during the reporting period. They do not need to be recorded at every office visit.
What Does Hospital-Based Mean? Restricted to inpatient or emergency room settings (Point of Service Code 21 or 23). 90% of patient encounters are provided in the hospital inpatient or emergency room setting. Definition applies to Medicare and Medi- Cal
Clinics and Medical Groups Assignment of incentive payments At the Provider s discretion. Practice-level calculation of patient volume. Physicians who practice at multiple locations can select one location for purposes of patient volume.
Coffee Beans Meaningful Use of Coffee Beans
About CalHIPSO Formed by three key partners representing target priority primary care providers : California Medical Association (CMA) California Association of Public Hospitals & Health Systems (CAPH) California Primary Care Association (CPCA) CalHIPSO is tasked with supporting targeted providers throughout CA successfully adopt electronic health records One of three Regional Extension Centers serving California
CalHIPSO s Target Providers Priority Primary Care Providers (MD, DO, PA, NP, CNMW) working in the following care settings: Private physician practices of 10 providers or less Community health centers & non profit primary care clinics Ambulatory care clinics operated by public hospitals Critical Access and Rural Hospital Clinics Other medically underserved settings Goal is to assist 6,100 PPCPs achieve meaningful use over the next two years
Education & Training Curriculum Optimizing Quality Reporting Group Purchasing Contracts Provider Registry & Enrollment Standard Deployment of EHRs Outreach, Enrollment and Education Readiness Assessments and Capacity Building Vendor Selection Workflow Assessment & Redesign Project Mgmt. Meaningful Use Reporting Service Partners EHR Products (SaaS Offerings) Product Specific Templates and Configuration Interfaces Implementation Project Management Ongoing Maintenance Meaningful Use Reporting Financial Operations ARRA/ONC Reporting Quality Assurance
Why Would Providers Join CalHIPSO? You are ready to adopt an EHR, and want some help doing it You already have an EHR, but want assistance with Meaningful Use You want additional support and training from a neutral, trusted source during your EHR implementation & post go-live You want to save money and access the federal incentives payments as soon as possible You want to use EHR to expand the impact of quality improvement in your daily clinical practice
How do providers enroll? 1. Visit www.calhipso.org 2. Complete a Provider Registration Form 3. Submit a Provider Enrollment Agreement 4. Make payment via PayPal (note: Membership Fees are waived for PPCPs and non-ppcps working in predominantly primary care practices who join in 2010) 5. Start working with CalHIPSO or your Local Extension Center CalHIPSO is now enrolling providers!
www.calhipso.org 1-888-589-4897 info@calhipso.org
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