Meaningful Use for 2014 Gerald E. Meltzer MD MSHA Medical Director imedicware Stage 1 Or Stage 2 For 2014? Meaningful Use: Stage 1 For 2014 1
Key Changes for 2014 Patient Electronic Access Clinical Quality Measures Changes in Menu Item Reporting CPOE Vital Signs Stage 1 Changes 2013/4 CPOE 30% of unique patients with medications in medication list must have CPOE Provide patient if requested electronic copy of their health information Stage 1 Changes for 2014 Provide patients ability to view online, download and transmit their health information More than 50% of all unique patients seenby EP during EHR reporting period are provided timely online access to their health information subject to EP's discretion to withhold certain information 2
Stage 1 Changes for 2014 Beginning in 2014, EP no longer permitted to count an exclusion toward the minimum of 5 menu objectives on which they must report if there are other menu objectives which they can select Still must report on one public health measure (e.g. immunizations) Providers must now report on 4 of the 6 following measures: Patient education (10%) Patient reminders (20%) Active formulary (Y/N) Medication reconciliation (50%) Patient list (Y/N) Transition of Care Summary (50%) So what do we have to do to meet Meaningful Use: Stage 2 Core Requirements Unchanged Record demographic information 80% Perform medication reconciliation 50% Incorporate lab tests into EHR 55% Protect electronic health information Record vital signs Provide clinical summaries for each office visit 50% within 1 day 3
Clinical Summary Information Requirements for Clinical Summary Measure Patient name Provider s name and office contact information Date and location of the visit Reason for the office visit Current problem list Current medication list Current medication allergy list Procedures performed dd during the visit iit Immunizations or medications administered during the visit Vital signs taken during the visit (or other recent vital signs) Laboratory test results List of diagnostic tests pending Clinical instructions Future appointments Referrals to other providers Future scheduled tests Demographic information maintained within certified electronic health record technology (CEHRT) (sex, race, ethnicity, date of birth, preferred language) Smoking status Care plan field(s), including goals and instructions Recommended patient decision aids (if applicable to the visit) Enter information into the certified HER technology at the time of the office visit Withhold any information provider determines could cause possible harm Provide modified information in clinical summary to patient (either online or on paper) within one (1) business day Core Requirements Changed 1 Electronic prescribing 50% Record smoking status 80% Provide clinical summaries for each office visit 50% (now can be done with ih patient portal) Core Requirements Changed 2 CPOE Now includes Meds AND Imaging AND Lab Provide patient clinical summaries (VDT) Must provide patients ability to view, download d and transmit their information Clinical decision support Incorporates current medications, medication allergies and problem list 4
CPOE Medications 60% IF ophthalmic medication listed in medication list THEN MUST list ophthalmic medication in PLAN Imaging 30% IF OCT has been recorded dthen order for OCT must be in PLAN Laboratory 30% IF Lab result has been recorded THEN lab order must be in PLAN View, Download Or Transmit CMS believes that physicians are in best position to encourage patients to use health care technology to further their own health care Under Stage 2 requirements more than 5% of patients (or their patient representative)must view online, download or transmit to a third party their health information But this can be done by having the patient use patient portal to print their clinical summary so you actually can fulfill two measures at the same time Clinical Decision Support Use Clinical Decision Support to improve performance on high priority health conditions. Implement 5 clinical decision support interventions Enable drug drug and drug allergy interaction checks. 5
Patient Access Objectives Use secure electronic messaging to communicate with patients on relevant health information Provide patients ability to view online, download and transmit their health information within 4 business days of information being available to the EP Patient Portal Exchanging Health Information Stage 2 criteria places emphasis on health information exchange between providers to improve care coordination for patients 50% of care provider referrals must include a summary of care record 10% of these summary of care records must be provided electronically 6
Information Requirements for Summary Care Patient Name Referring or transitioning provider s name and office contact information (EP Only) Procedures Encounter Diagnosis Immunizations Laboratory test results Vital signs (height, weight, blood pressure, BMI) Smoking status Functional status including activities of daily living, cognitive and disability status Demographic information (Preferred language, sex, race, ethnicity and date of birth) Care plan field including goals and instructions Care team including the primary care provider of record, and any additional known care team member beyond the referring or transitioning provider and the receiving provider Reason for referral Current problem list (EP may also include historical problems at their discretion** Current medication list** Current medication allergy list** Summary Of Care Enter information into certified EHR technology Withhold any information provider determines could cause possible harm Verify presence of elements; Problem List, Medication List, and Medication Allergy List Insert C CDACDA Provide summary of care record when patient is transferred to another setting of care or referred to another provider. New Core Requirement Electronic Messaging Direct Use secure electronic messaging to communicate with patients on relevant health information (Datamotion) A secure message must be sent using electronic messaging function by more than 5% of unique patients seen by an EP during the EHR reporting period Patient Portal Secure Messaging 7
Menu Items Now Included In Core Generate patient list one list Patient reminders/preventive care 20% Patient education 10% Summary of care record for each transition of care or referral 10% Immunization registries (exempt) Report 3 Of 6 Menu Items 1. Submit electronic syndromic surveillance data to public health agencies N/A 2. Record electronic notes in patient records 30% 3. Imaging results accessible in EHR 10% 4. Record patient family health history 20% 5. Identify and report cancer cases to a State cancer registry N/A 6. Identify and report specific cases to specialized registry (e.g. IRIS) 2014 Reporting Period Changes Stage 1 Year 1 any 90 day period Everyone else calendar period New Users MUST ATTEST ON OR BEFORE October 1 st to avoid penalty in 2015 Hardship Exemptions to new docs in practice If you miss a year 8
Two scorecards Stage 1 Stage 2 Check regularly l Audit capabilities Scorecards Stage 2 Scorecard References http://www.cms.gov/regulations and Guidance/Legislation/EHRIncentivePrograms/D ownloads/stage2_meaningfulusespecsheet_ta blecontents_eps.pdf http://www.cms.gov/regulations and Guidance/Legislation/EHRIncentivePrograms/D ownloads/stage2_guide_eps_9_23_13.pdf http://www.aao.org http://www.asoa.org 9
What s new for 2014? PQRS/CQM Clinical Quality Measures 2014+ Although clinical quality measure (CQM) reporting has been removed as core objective, all EP are required to report on CQMs to demonstrate meaningful use Beginning in 2014, all providers, regardless of their stage of meaningful use, will report on CQMs in the same way Clinical Quality Measures For 2014 Criteria: EPs must report on 9 CQMs; or Cataract Measure Group; or ReportCQMs Using Iris Registry All Medicare eligible eligible providers beyond their first year of demonstrating meaningful use must electronically report their CQM data to CMS 10
PQRS 2014 To avoid the 2% penalty on 2016 Medicare payments, physicians must report three PQRS measures on 50% of eligible FFS patients To receive a 0.5% bonus payment 9 CQM measures Cataract Group EHR or Registry Reporting Physicians who cannot meet bonus requirement may report on fewer measures and/or domains CMS will review such submissions to ensure that more measures do not apply Claims Based Reporting Submit measures on the same CMS 1500 form as the associated exam Link diagnosis codes to exam as well as to the measure. If exam is denied, the measure will be denied also; both must be resubmitted While CMS does not require a charge fee, your system may require a fee to release the claim Therefore, put 1 cent in the charge field Watch the remittance advice for N365 or C096 to assure the PQRS measure(s) was accepted 9 PQRS Measures Communication and care coordination Measure 138 Melanoma Coordination of Care Registry Only Measure 141 POAG Reduction IOP by 15% or Care Plan Documented Measure 256 Biopsy Follow up Registry Only Community/Population Health Measure 256 Tobacco Use Screening and Cessation Prevention Patient Safety Measure 130 Documentation of Medications in medical record Measure 132 Cataract Complications within 30 days following cataract surgery requiring additional surgical procedures Registry Only 11
9 PQRS Measures Effective Clinical Care Measure 12 POAG Optic Nerve Evaluation Measure 14 ARMD Dilated Macular Exam Measure 18 Diabetic Retinopathy Documentation of presence or absence of macular edema Measure 19 Diabetic Retinopathy Communication with Physician managing ongoing diabetes care Measure 117 Diabetes Mellitus Dilated Eye Exam Measure 137 Melanoma Continuity of Care Recall System Registry Only Measure 140 ARMD Counseling on Antioxidant Supplement Measure 191 Cataract 20/40 VA or better within 90 days of cataract surgery Registry Only Cataract Measure Group Reporting period: Approximately April or May (as it takes CMS time to qualify the registry ) through September 30, 2014 Report 20 surgical cases, at least 11 of which must be Medicare Part B patients Remaining may have commercial or Medicare Advantage Plan coverage Submit data to either IRIS Registry or a qualified CMS registry Registry Based Reporting Submit data to Academy's IRIS Registry or a CMS qualified registry Unlike claims based reporting, registry reporting doesnot haveto besubmitted in real time Those who've never successfully reported for PQRS in the past are more likely to succeed via registry reporting 12
EHR Reporting Report your nine measures in three quality domains through an EHR enrolled in the Academy s IRIS Registry, you can simultaneously qualify for the Medicare EHR incentive program's Stage 2 clinical quality measures CQM Reporting Period Reporting and submission periods for EPs beyond their first year of Meaningful Use submitting CQMs electronically beginning with CY 2014 For 2014 only, all providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a three month EHR reporting period. Medicare providers can either report their CQMs for the entire year or select an optional three month reporting period for meaningful use. For Medicare providers, this three month reporting period is calendar year in order to align with existing CMS quality measurement programs, such as the Physician Quality Reporting System (PQRS). CMS is permitting this one time three month reporting period in 2014 only so that all providers who must upgrade to 2014 Certified EHR Technology will have adequate time to implement their new Certified EHR systems. 13