04/19/23

American Academy of PediatricsOhio Section

Cathy Costello, JDOHIP

Manager, REC Services

May 13, 2011

1

Who is the Ohio Health Information Partnership?

04/19/23 2

The Ohio Health Information Partnership

Nonprofit partnershipState-designated Regional Extension Center and Health Information ExchangeFederal funding through Office of National Coordinator of HIT, Department of Health & Human Services Board members have vested interest in its success

04/19/23 3

04/19/23 4

OHIP’s Founders

How can we help achieve the State’s health transformation

objectives?

04/19/23 5

Addressing the Hot Spots

• Regional Extension Center Services– Helps providers adopt EHRs

and achieve meaningful use– Available at no cost to

pediatricians regardless of physician’s eligibility for Medicaid incentives

• Health Information Exchange– Connects providers so they

can electronically exchange data to better coordinate care

04/19/23 6

Regional Extension Center Services

04/19/23 7

Care Summaries e-Prescribing

Regional Extension Center Physician Sign-ups

8

Over 60,000 physicians have signed up nationally to receive REC services

04/19/23

04/19/23 9

Preferred EHR Vendors

04/19/23 10

ProOhio Vendor Program

IT SupportDocument ImagingHuman ResourcesBilling & Coding Security Controls Change Management Data Management

04/19/23 11

Loan Program

HEALTH INFORMATION EXCHANGE

04/19/23 12

An HIE moves patient information electronically among physician offices, hospitals and other health professionals directly involved in a patient’s care, such as pharmacies and labs.

04/19/23

What is aHealth Information Exchange?

13

Create a secure, sustainable Health Information Exchange

To protect ALL patient records;

Enable providers to access necessary, patient-authorized health information; and

Improve the overall level of health care provided throughout the state of Ohio. 04/19/23

What is OHIP’s Vision?

14

Phasing of HIE Services

15

• 10 Hospitals• 100 Offices

• 20 Hospitals• 200 Offices

• 20 Hospitals• 200 Offices

Confidential, For Internal Discussion Only04/19/23

Prioritize coordination of care;

Everyone pays a little;

No one pays a lot; and

Everyone helps enroll/implement physicians.

04/19/23

Community Model

16

More Information on REC Servicesand HIE Development

www.OHIPonline.orgwww.OHIPonline.org

04/19/23 17

Priorities for Meaningful Use

04/19/23

Structured Lab Results

Care Summaries e-Prescribing

18

Medicaid

AdoptAdoptImplementImplement

UpgradeUpgrade

04/19/23 19

Notable Differences Between the Medicare & Medicaid Incentives

Medicare Medicaid

Reimbursement for eligible professionals

Based on Medicare Part B allowed charges

Based on patient mix (EHR cost assumed)

Types of eligible professionals

Physicians, dentists, podiatrists, optometrists, chiropractor

Physicians, dentists, nurse midwife, nurse practitioner and some PAs

First payment yearDemonstrate meaningful use over a continuous 90 days in the calendar year

Can be for adopt, implement or upgrade only

Subsequent payment years Must be consecutive Needn’t be consecutive for EPs

Payments No payments for years after 2016 Payments can start as late as 2016 and no payments after 2021

Penalties if not a MUser Yes No

Consistent across nation Yes States choose to implement

20

Medicaid: 1st Payment Year For “Adopt, Implement, Upgrade”

Eligible professionals can receive incentives for adoption, implementation and upgrade of certified EHR technology in their first year of participation

“Adopt, implement, or upgrade” means: – Install or commence utilization of certified EHR technology

capable of meeting meaningful use requirements; or– Expand the functionality of certified EHR technology capable of

meeting meaningful use requirements at the practice site, including staffing, maintenance, and training.

– Upgrade from existing EHR technology to certified EHR technology per the ONC EHR certification criteria.

21

Medicaid: 1st Payment Year For “Adopt, Implement, Upgrade”

All eligible Medicaid providers will be “deemed” to have met the cost-base of the Medicaid EHR incentives—need only to demonstrate that the EHR system is CMS certified under the ATCB certification program.

A practitioner can demonstrate that an EHR system is certified and the practitioner has Adopted/Implemented/Upgraded the system by uploading a copy of a: 1) Purchase order; 2) Contract; or 3) EHR software license to the Medicaid incentive program website during registration for the incentives.

04/19/23 22

Medicaid Eligible Professional Incentive

The Medicaid EHR incentive program reimbursement for eligible professionals is paid out over a six-year period. Professionals that meet Medicaid eligibility criteria will be paid the maximum incentive regardless of the cost of the certified EHR system that the professional is using.

Pediatricians that meet the Medicaid 20% patient volume threshold will be paid $14,160 for the first year with a total EHR incentive of $42,500. Pediatricians that meet the Medicaid 30% patient volume threshold will be paid $21,250 for the first year with a total EHR incentive of $63,750.

Pediatricians that fall between 20% and 30% Medicaid patient volume will be paid at the 20% threshold (i.e., $14,160 for the first year with a total incentive of $42,500).

04/19/23 23

Meaningful Use TimelineMedicaid Incentives

04/19/23 24

What is MPIP?

Ohio’s EHR program is the Medicaid Provider Incentive Program (MPIP)

– Who is eligible? Eligible Hospitals: (acute care, cancer, children’s) Eligible Professionals: (physician, dentist, certified nurse

midwives, nurse practitioners, Physician Assistants when practicing at an FQHC/RHC so led by a PA)

– The MPIP will be available through CY 2021, but participation in the program is for 6 years, which can be non-consecutive years.

25

Notes on Medicaid Incentive Program

Pediatricians (including subspecialists) that meet the eligibility requirements in Ohio will be eligible for Medicaid incentives at the 20% patient volume level. Must have pediatric board certification. All other physicians eligible at the Medicaid 30% patient volume level.

Patient volume will be calculated based on the Medicaid services rendered on any one day to an individual where Medicaid paid for part or all of the service.

04/19/23 26

Notes on Medicaid Incentive Program

Medicaid eligibility will be determined by a practitioner’s Medicaid patient volume over a 90 day period in the preceding calendar year. The practice can choose the 90 day period for eligibility, but it must be for 3 consecutive months (e.g., January 1 – March 31, 2010 Medicaid patient volume to draw down 2011 EHR incentives).

Medicaid will use an online attestation form that automatically calculates the eligibility based on patient volume totals entered by practitioner. There will be a slight adjustment to totals based on SCHIP population figures in the provider’s county.

04/19/23 27

MPIP will be open in June 2011

– In March, first milestone of the MPIP system build was the completion of testing of the interface between the federal system (the National Level Repository) and MPIP.

– In April, Ohio’s State Medicaid Health Information Technology Plan (SMHP) was approved by CMS.

– In May, ODJFS will be putting the finishing touches on the customized build of the MPIP system:Ohio now appears in the state drop down box on CMS’

website, allowing Ohio providers to begin registration for Ohio’s program.

In June, the launch of MPIP will occur, allowing providers to complete enrollment at Ohio’s MPIP site and upon approval, be eligible to receive their 1st payment.

28

What is needed to register federallyfor either Medicare or Medicaid?

Confirmed National Provider Identifier and NPPES account and password

https://nppes.cms.hhs.gov/NPPES/ CMS/National Level Repository registration

www.cms.gov/EHRIncentivePrograms/ PECOS (for dual hospitals)

29

National Provider Identifier

30

CMS Registration

31

What is needed to enroll in MPIP?

Once finished at the national registration website, providers will be sent to the Ohio site to begin MPIP enrollment. They will need:

• An active Medicaid provider agreement. – Providers without one will be directed to:

http://jfs.ohio.gov/OHP/provider.stm • MPIP uses only Electronic Funds Transfer (EFT). So providers

who get paper warrants will have to go to Ohio Shared Services to sign up for EFT.

32

First-time User Registration

33

First-time users will receive a link to

begin Registration

34

First-time User RegistrationEnter NPI, TIN, CMS Confirmation Number

Enter the NPI, TIN and CMS Confirmation Number and click

Register

35

First-time User RegistrationEstablish Password

Enter CMS Confirmation Number. Enter and

confirm Password. Click Save to Continue.

Welcome Page

36

Press Continue to proceed with the MPIP

enrollment process

After logging into MPIP the first

time, the user will see the Welcome

page

Adopt, Implement, Upgrade (AIU)

37

Select AIU Designation Enter the CMS EHR

Certification Number

Select Supporting Documentation

and Upload Upload AIU Documents

MPIP Registration

38

Stay in touch with Medicaid

Visit the ODJFS MPIP Website at: http://jfs.ohio.gov/OHP/HIT%20Program.stm

Send an email at MPIP@jfs.ohio.gov

39

Why Is This Work Important?

MOVING TOMOVING TOMEANINGFUL USEMEANINGFUL USE

04/19/23 40

Meaningful Use TimelineMedicare Incentives

04/19/23 41

Meaningful Use Tips

Use Meaningful Use Attestation Calculator before going to actually register: http://www.cms.gov/apps/ehr/

Print out calculator’s summary page to see how close you are to meeting meaningful use

Use the calculator as a guide for explaining the MU core and menu items and the exclusions

04/19/23 42

Core and Menu Criteria

• Professionals must complete each of the core criteria unless unable to, due to scope of practice, population served or number in the denominator. For example:– Chiropractor and e-prescribing– CAH and no patients have requested electronic access

• Professionals may defer up to 5 of the menu criteria until stage 2

43

Core Criteria (15):All Patients:•Record demographics•Maintain an up-to-date problem list•Maintain active medication list•Maintain active medication allergy listEHR Patients:•CPOE•E-Prescribing•Record and chart changes in vital signs•Record smoking status•Provide patients with an electronic copy of their health information•Provide clinical summaries for patients for each office visit

Implemented (Yes or No):•Report Clinical Quality Measures•Drug (D-A, D-D) Interactions•Implement one clinical decision support rule•Electronically exchange key clinical information•Protect electronic health information created or maintained by certified EHR

44

Menu Criteria

• Professionals and hospitals may defer up to 5 of the menu criteria until stage 2

• At least one of the criteria from population and public health must be included in order to qualify as a meaningful user

45

Menu Criteria (5 of 10):

All Patients:

•Provide patients timely electronic access to their health information.•Provide patient-specific education resources through the use of certified EHR technology.

EHR Patients:•Lab test results are stored as structured data•Send appropriate reminders for preventive/follow up care•Perform medication reconciliation on > 50% of transitions of care or relevant encounters.•Provide a summary of care record for transitions of care and referrals.

Implemented (Yes or No):•Implement drug -formulary checks•Generate at least one report of patients by specific condition•Perform at least one test of submission of electronic data to immunization registries/systems. *•Perform at least one test of providing electronic syndromic surveillance data to public health agencies. *

* At least 1 public health objective must be selected

46

Reporting of Clinical Quality Measures

• EPs would be required to provide clinical data on 2 measure groups:– A core set of 3 measures (or alternates) (3 of 6)– 3 additional measures selected from among 38 others (3 of 38)

• EHR must be certified for these measures (ONC ‘CHPL’ website for confirmation)http://onc-chpl.force.com/ehrcert

47

Core Quality Measures for EPsMeasure Number Clinical Quality Measure Title

NQF 0013Blood pressure measurement

Percentage of patient visits for patientsaged 18 years and older with a diagnosis of hypertension who have been seen for at least 2 office visits, with blood pressure (BP) recorded.

NQF 0028Tobacco use assessment and intervention

1. Percentage of patients aged 18 years and older who have been seen for at least 2 office visits who were queried about tobacco use one or more times within 24 months

2. Percentage of patients aged 18 years and older identified as tobacco users within the past 24 months and have been seen for at least 2 office visits, who received cessation intervention.

NQF 0421PQRI 128Adult Weight Screening and Follow-up

1. Percentage of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documented in the medical record AND

2. if the most recent BMI is outside parameters, a follow-up plan is documented.

48

Alternate Core Quality Measures for EPsMeasure Number Clinical Quality Measure Title

NQF 0024Weight Assessment and Counseling for Children and Adolescents

Percentage of patients 2 -17 years of age who had an outpatient visit with a Primary Care Physician (PCP) or OB/GYN and who had evidence of BMI percentile documentation, counseling for nutrition and counseling for physical activity during the measurement year.

NQF 0041, PQRI 110Influenza Immunization for Patients ≥ 50 Years Old

Percentage of patients aged 50 years and older who received an influenza immunization during the flu season (September through February).

NQF 0038Childhood Immunization Status

Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio(IPV), one measles,mumps and rubella (MMR); two H influenza type B (HiB); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); two hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and nine separate combination rates.

49

Menu Quality Measures

• 38 other measures addressing:– Diabetes– Cardiovascular disease– Prevention– Asthma– Appropriate use of teste– Smoking and Tobacco use– Alcohol and Drug dependence– Oncology– Depression management– Others

50

Resources

•“Meaningful Use” information on the Health and Human Services web site:

– http://healthit.hhs.gov/meaningfuluse/•“Meaningful Use” on the CMS web site:

– https://www.cms.gov/EHRIncentivePrograms/ •Testing criteria for each of the EHR modules:

– http://healthcare.nist.gov/use_testing/effective_requirements.html

•Quality Measure Specifications on the CMS web site:– http://www.cms.gov/QualityMeasures/

03_ElectronicSpecifications.asp

51

Questions?

Cathy Costello, JDccostello@OHIPonline.org

614.664.2607

04/19/23 52