nymedicaid hitechehr incentive program james j. figge, m.d., m.b.a. medical director, office of...
Post on 14-Dec-2015
214 Views
Preview:
TRANSCRIPT
NY MedicaidHITECH EHR Incentive Program
James J. Figge, M.D., M.B.A.Medical Director, Office of Health Insurance Programs
September 2010
NY MedicaidHITECH EHR Incentive Program
Topics
• NY Medicaid programs that complement the federal Health Information Technology for Economic and Clinical Health (HITECH) program:– Electronic Prescribing (eRx) Incentive– Patient-Centered Medical Home (PCMH) Incentive
• NY Medicaid HITECH EHR incentive program
2
NY MedicaidHITECH EHR Incentive Program
Electronic Prescribing
• Nationwide: – In 2009, 12% of the
1.63B original prescriptions were transmitted electronically
• Accelerating trend:– 2007-2008: +130%– 2008-2009: +181%
3
Source: 2009 National Progress Report on E-Prescribing, Surescripts LLC.
NY MedicaidHITECH EHR Incentive Program
NY Medicaid eRx IncentiveProvides an incentive payment for dispensed
ambulatory Medicaid e-prescriptions
4
Eligible Practitioners
Physicians (M.D./D.O.)
Dentists
Nurse Practitioners
Podiatrists
Optometrists
Licensed Midwives
Prescriber Incentive
$0.80 per prescription/refill*
Pharmacy Incentive
$0.20 per prescription/refill*
* Max 1 original plus 5 refills per 180-day period.
NY MedicaidHITECH EHR Incentive Program
eRx Incentive Requirements
• Prescriber– must have an individual NPI, and – must be enrolled in Medicaid fee-for-service (FFS)
5
NY MedicaidHITECH EHR Incentive Program
eRx Incentive Requirements
• Incentive only applies to prescriptions created electronically, and transmitted via computer-to-computer electronic data interchange– faxed prescriptions are not eligible– [faxed prescription] ≠ eRx
6
NY MedicaidHITECH EHR Incentive Program
eRx Incentive Requirements
• Electronic transaction must comply with Medicare Part D standards– NCPDP SCRIPT 8.1 or 10.6– Includes prescriber's individual NPI
• Incentive only applies to prescription medications – No OTC medications or medical supplies– No controlled substances at this time
7
NY MedicaidHITECH EHR Incentive Program
Patient-Centered Medical Home
• PCMH is a care model where each patient has an ongoing relationship with a personal clinician who leads a team that takes collective responsibility for patient care
8
NY MedicaidHITECH EHR Incentive Program
Patient-Centered Medical Home
• Care is supported by electronic tools– patient registries, EHRs, e-prescribing, and health
information exchange (HIE)– goal is to improve care coordination, quality, and
patient safety
9
NY MedicaidHITECH EHR Incentive Program
NCQA PCMH Recognition Program
• National Committee for Quality Assurance (NCQA), Patient-Centered Medical Home program
– Three levels:
• Level 1 can be achieved without an EHR• Level 2 requires some electronic functions• Level 3 requires a fully functional EHR
10
NY MedicaidHITECH EHR Incentive Program
NY Medicaid PCMH Incentive
• Eligibility for enhanced payments:– Office-based practices (e.g., physicians and nurse
practitioners)– Federally Qualified Health Centers (FQHCs)– Diagnostic & Treatment Centers– Hospital Outpatient Departments (Medicaid
managed care program only)
11
NY MedicaidHITECH EHR Incentive Program
NY Medicaid PCMH Incentive
• Incentive payments available through Medicaid fee-for-service (FFS) and Medicaid managed care programs
• Incentive amount varies based on NCQA PCMH level achieved
12
NY MedicaidHITECH EHR Incentive Program
Medicaid EHR Incentive Program
• Created by the HITECH Act• Administered by the States under guidance
and oversight of the Centers for Medicare and Medicaid Services (CMS)
• Designed to provide financial incentives for adoption and meaningful use of certified EHRs
13
NY MedicaidHITECH EHR Incentive Program
Medicaid EHR Incentive Program
• Meaningful use of certified EHR technology includes:
– Electronic Prescribing– Electronic exchange of health information to
improve the quality of health care– Reporting of clinical quality measures
14
NY MedicaidHITECH EHR Incentive Program
Who Is Eligible?
• Physicians (M.D. and D.O.)• Nurse Practitioners• Certified Nurse-Midwives• Dentists• Physician Assistants, only if practicing in a
FQHC or Rural Health Clinic (RHC) led by a Physician Assistant
15
NY MedicaidHITECH EHR Incentive Program
Patient Volume Requirements
• Eligible professionals (EPs) must demonstrate that 30% of patient encounters are Medicaid
Exceptions:• Pediatricians may receive 2/3 incentive amount with
20% Medicaid patient volume
• EPs in FQHCs and RHCs may qualify by demonstrating 30% of encounters are “needy individuals”
16
NY MedicaidHITECH EHR Incentive Program
Calculating Patient Volume
• Standard formula uses number of Medicaid patient encounters relative to total encounters in any 90-day period in the preceding calendar year
• Alternate formula takes into account a practitioner's entire managed care or medical home patient panel
17
NY MedicaidHITECH EHR Incentive Program
Calculating Patient Volume
• Clinics and group practices may use overall clinic/practice patient volume as a proxy for each EP– Some limitations apply: 42 CFR 495.306(h)
• All methods include alternate 20% threshold for pediatricians and use of “needy individuals” criteria for FQHCs/RHCs
18
NY MedicaidHITECH EHR Incentive Program
How Much is Available?
19
All Practitioners (at least 30% Medicaid/needy)
Pediatricians (at least 20% but less than 30% Medicaid)
Year 1 $21,250 $14,167
Year 2 $8,500 $5,667
Year 3 $8,500 $5,667
Year 4 $8,500 $5,667
Year 5 $8,500 $5,667
Year 6 $8,500 $5,667
Total $63,750 $42,500Note: program participation years do not need to be contiguous.
NY MedicaidHITECH EHR Incentive Program
Restrictions on EP Eligibility• EPs may not be "hospital-based"
– defined as 90% or more of services rendered in inpatient hospital or emergency room settings
• Must select either the Medicare or Medicaid program (one-time option to switch)
• May only participate in one state
• Must demonstrate 15 percent financial contribution toward the "net average allowable costs" (NAAC) of certified EHR technology
20
NY MedicaidHITECH EHR Incentive Program 21
EP Financial Contribution• EPs must contribute 15% of the NAAC
– $3,750 first year for most EPs– $1,500 each subsequent year
• Many contributions count towards EP share:– Costs incurred by employer for implementing certified
EHR system (e.g., FQHC, RHC, or group practice)– Costs of training and workflow redesign– In-kind contributions (technology, support, etc.)
NY MedicaidHITECH EHR Incentive Program
Calculating the NAAC
• The first year "average allowable costs" were set by CMS at $54,000
• Cash received by the EP from most other sources (certain exceptions apply) must be deducted from the average allowable costs to yield the NAAC
• NAAC cannot exceed $25,000 (statutory limit)
22
NY MedicaidHITECH EHR Incentive Program
• Average allowable costs (first year): $54,000
• Cash received from other sources: $29,000
• Net average allowable costs: $25,000
• 15% EP contribution: $3,750
• 85% Incentive payment amount: $21,250
Incentive Calculation Example #1
23
$54,000
$25,000
$21,250
$29,000
NY MedicaidHITECH EHR Incentive Program
• Average allowable costs (first year): $54,000
• Cash received from other sources: $10,000
• Net average allowable costs: $25,000 (maximum = $25,000)
• 15% EP contribution: $3,750
• 85% Incentive payment amount: $21,250
Incentive Calculation Example #2
24
$54,000
$25,000
$21,250
$10,000
NY MedicaidHITECH EHR Incentive Program
• Average allowable costs (first year): $54,000
• Cash received from other sources: $32,000
• Net average allowable costs: $22,000
• 15% EP contribution: $3,300
• 85% Incentive payment amount: $18,700
Incentive Calculation Example #3
25
$54,000
$22,000
$18,700
$32,000
NY MedicaidHITECH EHR Incentive Program
Adoption, Implementation and/or Upgrading EHR Technology
• First year: – EPs must demonstrate adoption,
implementation, and/or upgrade• Adopt: Acquire and install system• Implement: Training, data migration, commence
utilization• Upgrade: Expand and improve existing system
to meet definition of certified EHR technology
26
NY MedicaidHITECH EHR Incentive Program
Meaningful Use of EHR Technology
• Subsequent years:– Meet meaningful use and clinical quality metric
reporting requirements
• For Stage 1 meaningful use (2011-2012), same core and menu set as Medicare*
27
* States may request permission from CMS to mandate certain public health reporting options
NY MedicaidHITECH EHR Incentive Program 28
Defining Meaningful Use
• HITECH Act specifies three components:
– Electronic prescribing
– Electronic exchange of health information
– Submission of clinical quality measures
NY MedicaidHITECH EHR Incentive Program
Stage 1 EP Meaningful Use Criteria
29
Core Set Menu Set
Meaningful Use Objectives 15 core objectives 5 of 10
menu set objectives
Clinical Quality Measures
3 core measures, or 3 alternate core measures
3 of 38 menu set measures
• Stage 1 meaningful use objectives and clinical quality measures include required core set and menu set choices
NY MedicaidHITECH EHR Incentive Program
EP Clinical Quality Measures
• EPs must submit six measures for Stage 1 MU:– 3 core or 3 alternate core– 3 of 38 from menu set
• Aligned with Physicians Quality Reporting Initiative (PQRI) and CHIPRA initial core set
• Submit by attestation for 2011– in 2012, EPs must submit electronically
30
NY MedicaidHITECH EHR Incentive Program
EP Clinical Quality Measures
31
NQF Measure Number/PQRI Implementation Number
EP Clinical Quality Measure(Core Set)
NQF 0013 Hypertension: Blood pressure measurement
NQF 0028Preventive Care and Screening Measure Pair:
a)Tobacco Use Assessmentb)Tobacco Cessation Intervention
NQF 0421PQRI 128 Adult Weight Screening and Follow-up
NY MedicaidHITECH EHR Incentive Program
EP Clinical Quality Measures
32
NQF Measure Number/PQRI Implementation Number
EP Clinical Quality Measure(Alternate Core Set)
NQF 0024 Weight Assessment and Counseling for Children and Adolescents
NQF0041PQRI 110
Preventive Care and Screening: Influenza Immunization for
Patients 50 Years Old or Older
NQF 0038 Childhood Immunization Status
NY MedicaidHITECH EHR Incentive Program
Hospital Eligibility• Acute Care Hospitals - at least 10% Medicaid
• Average Length of Stay ≤ 25 days• CCN in 0001–0879 or 1300–1399• Includes general short-term hospitals, cancer care
hospitals and critical access hospitals (CAHs)
• Children’s Hospitals – no Medicaid minimum• CCN in 3300–3399 (77 hospitals total)• Not children’s wings of larger hospitals
33
NY MedicaidHITECH EHR Incentive Program
Hospital Payment Overview• Overall incentive payment amount is based on
four-year calculation• Each year’s payment is a base amount ($2M) plus
a discharge volume adjustment (accounting for change over time), scaled by a yearly factor
• Overall incentive payment is then scaled based on Medicaid share
• Actual payment spread over 3–6 years
34
NY MedicaidHITECH EHR Incentive Program
Medicaid Share• Based on proportion of inpatient bed days
attributable to Medicaid (fee-for-service or managed care) to overall inpatient bed days
• “Extra credit” given for charity care (in the form of a reduction in overall bed days)
35
NY MedicaidHITECH EHR Incentive Program
Hospital Payment Schedule• State has flexibility to determine schedule
• No more than six years• No fewer than three years
• Fastest disbursement allowable by law:• 1st year - 50% of total incentive• 2nd year - 40% of total incentive• 3rd year - 10% of total incentive
36
NY MedicaidHITECH EHR Incentive Program
Stage 1 EH Meaningful Use Criteria
37
Core Set Menu Set
Meaningful Use Objectives 14 core objectives 5 of 10
menu set objectives
Clinical Quality Measures 15 core measures N/A
• Stage 1 objectives include required core set and menu set choices; clinical quality metrics are all required
NY MedicaidHITECH EHR Incentive Program
Enrollment Process (1)
• Login to National Level Repository (NLR) website:
– Supply demographic/financial information– Select program (Medicare/Medicaid)– Select state
38
NY MedicaidHITECH EHR Incentive Program
Enrollment Process (2)
• Login to NY Medicaid website:– Verify eligibility– Attest to adopt, implement, upgrade or
meaningful use of certified EHR technology, and– Attest to 15% contribution towards NAAC
39
NY MedicaidHITECH EHR Incentive Program
Medicaid EHR Incentive Timeline
• Registration for EHR Incentive Programs begins January 2011
• NY Medicaid attestation functions expected to begin mid-2011, dependent upon CMS and state approvals
40
NY MedicaidHITECH EHR Incentive Program
Medicaid EHR Incentive Timeline
• Last year to initiate participation is 2016
• Participants may skip a year, but no payments will be issued after 2021
41
NY MedicaidHITECH EHR Incentive Program
Appendices
• Contact Information• Meaningful Use Core Set of Objectives – EP• Meaningful Use Menu Set of Objectives – EP• Meaningful Use Core Set of Objectives – EH• Meaningful Use Menu Set of Objectives – EH• Clinical Quality Measures - EH
42
NY MedicaidHITECH EHR Incentive Program
Contact InformationJames J. Figge, MD, MBAMedical DirectorNYS Department of HealthOffice of Health Insurance ProgramsOne Commerce Plaza, Suite 826Albany, NY 12260(518) 474-8045jjf06@health.state.ny.us
43
NY MedicaidHITECH EHR Incentive Program
Stage 1 MU Criteria – EP Core Set (1)
44
Health Outcomes Policy Priority Stage 1 Meaningful Use Objective (EPs)
Improving quality, safety, and
efficiency, and reducing health
disparities
Use Computerized Provider Order Entry (CPOE) for medication orders
Implement drug-drug and drug-allergy interaction checks
Generate and transmit permissible prescriptions electronically (eRx)
Record patient demographics (preferred language, gender, race, ethnicity, DOB)
Maintain an up-to-date problem list of current and active diagnoses
NY MedicaidHITECH EHR Incentive Program
Stage 1 MU Criteria – EP Core Set (2)
45
Health Outcomes Policy Priority Stage 1 Meaningful Use Objective (EPs)
Improving quality, safety, and
efficiency, and reducing health
disparities
Maintain active medication list
Maintain active medication allergy list
Record and chart changes in vital signs (height, weight, blood pressure, BMI, growth charts)
Record smoking status (patients 13 and older)
Implement one clinical decision support rule
Report ambulatory clinical quality measures to CMS or the State
NY MedicaidHITECH EHR Incentive Program
Stage 1 MU Criteria – EP Core Set (3)
46
Health Outcomes Policy Priority Stage 1 Meaningful Use Objective (EPs)
Improve care coordination
Capability to exchange key clinical information electronically among providers of care and patient-
authorized entities
Ensure adequate privacy and security for personal health
information
Implement systems to protect privacy and security of patient data in the EHR
Engage patients and families in their
health care
On request, provide patients with an electronic copy of their health records
Provide patients with clinical summaries for each office visit
NY MedicaidHITECH EHR Incentive Program
Stage 1 MU Criteria – EP Menu Set (1)
47
Health Outcomes Policy Priority Stage 1 Meaningful Use Objective (EPs)
Improving quality, safety, and
efficiency, and reducing health
disparities
Implement drug-formulary checks
Incorporate clinical lab test results into certified EHRs as structured data
Generate lists of patients by specific conditions
Send reminders to patients (per patient preference) for preventive and follow-up care
Improve care coordination
Perform medication reconciliation between care settings
Provide summary of care record for patients referred or transitioned to another provider or setting
NY MedicaidHITECH EHR Incentive Program
Stage 1 MU Criteria – EP Menu Set (2)
48
Health Outcomes Policy Priority Stage 1 Meaningful Use Objective (EPs)
Engage patients and families in their
health care
Provide patients with timely electronic access to their health information
Use certified EHR technology to identify patient-specific education resources and provide to patient
as appropriate
Improve population and public health
Capability to submit electronic syndromic surveillance data to public health agencies (one test)
Capability to submit immunization data electronically to State immunization registry (one test)
NY MedicaidHITECH EHR Incentive Program
Stage 1 MU Criteria – EH Core Set (1)
49
Health Outcomes Policy Priority Stage 1 Meaningful Use Objective (EHs)
Improving quality, safety, and
efficiency, and reducing health
disparities
Use Computerized Provider Order Entry (CPOE) for medication orders
Implement drug-drug and drug-allergy interaction checks
Record patient demographics (preferred language, gender, race, ethnicity, DOB,
date/preliminary cause of death in the case of mortality in the hospital)
Maintain an up-to-date problem list of current and active diagnoses
NY MedicaidHITECH EHR Incentive Program
Stage 1 MU Criteria – EH Core Set (2)
50
Health Outcomes Policy Priority Stage 1 Meaningful Use Objective (EHs)
Improving quality, safety, and
efficiency, and reducing health
disparities
Maintain active medication list
Maintain active medication allergy list
Record and chart changes in vital signs (height, weight, blood pressure, BMI, growth charts)
Record smoking status (patients 13 and older)
Implement one clinical decision support rule
Report hospital clinical quality measures to CMS or the State
NY MedicaidHITECH EHR Incentive Program
Stage 1 MU Criteria – EH Core Set (3)
51
Health Outcomes Policy Priority Stage 1 Meaningful Use Objective (EHs)
Improve care coordination
Capability to exchange key clinical information electronically among providers of care
and patient-authorized entities
Ensure adequate privacy and security for personal health
information
Implement systems to protect privacy and security of patient data in the EHR
Engage patients and families in their
health care
On request, provide patients with an electronic copy of their health records
On request, provide patients with an electronic copy of their discharge instructions
NY MedicaidHITECH EHR Incentive Program
Stage 1 MU Criteria – EH Menu Set (1)
52
Health Outcomes Policy Priority Stage 1 Meaningful Use Objective (EHs)
Improving quality, safety, and
efficiency, and reducing health
disparities
Implement drug-formulary checks
Record advance directives for patients 65 years old or older
Incorporate clinical lab test results into certified EHRs as structured data
Generate lists of patients by specific conditions
Improve care coordination
Perform medication reconciliation between care settings
Provide summary of care record for patients referred or transitioned to another provider or setting
NY MedicaidHITECH EHR Incentive Program
Stage 1 MU Criteria – EH Menu Set (2)
53
Health Outcomes Policy Priority Stage 1 Meaningful Use Objective (EPs)
Engage patients and families in their
health care
Use certified EHR technology to identify patient-specific education resources and provide to patient
as appropriate
Improve population and public health
Capability to submit electronic syndromic surveillance data to public health agencies (one test)
Capability to submit immunization data electronically to State immunization registry (one test)
Capability to submit electronic data on reportable (as required by state or local law) lab results to public
health agencies (one test)
NY MedicaidHITECH EHR Incentive Program
EH Clinical Quality Measures
54
Measure Number Identifier
EH Clinical Quality Measure: Emergency Department (ED)
ED-1NQF 0495
Median time from ED arrival to time of departure from the emergency room for patients admitted to the facility
ED-2NQF 0497
Median time from admit decision time to time of departure from the emergency department of patients admitted to inpatient status
NY MedicaidHITECH EHR Incentive Program
EH Clinical Quality Measures
55
Measure Number Identifier
EH Clinical Quality Measure: Stroke
Stroke-2NQF 0435
Ischemic stroke patients prescribed antithrombotic therapy at discharge
Stroke-3NQF 0436
Ischemic stroke patients with atrial fibrillation/flutter who are prescribed anticoagulation therapy at hospital discharge
Stroke-4NQF 0437
Acute ischemic stroke patients who arrive within 2 hours and for whom IV t-PA was initiated within 3 hours of time last known well
Stroke-5NQF 0438
Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2
Stroke-6NQF 0439
Ischemic stroke patients with high or unmeasured LDL, or who were on a lipid lowering medication, who are discharged with statin prescription
Stroke-8NQF 0440
Ischemic or hemorrhagic stroke patients or their caregivers who were given appropriate educational materials during the hospital stay
Stroke-10NQF 0441
Ischemic or hemorrhagic stroke patients who were assessed for rehabilitation services
NY MedicaidHITECH EHR Incentive Program
EH Clinical Quality Measures
56
Measure Number Identifier
EH Clinical Quality Measure: Venous Thromboembolism (VTE)
VTE-1NQF 0371
Patients receiving VTE prophylaxis within 24 hours of admission or surgery, or have documentation why no prophylaxis was given
VTE-2NQF 0372
Patients who received timely VTE prophylaxis on admission or transfer to ICU, or have documentation why no prophylaxis was given
VTE-3NQF 0373
Patients diagnosed with confirmed VTE who received an overlap of parenteral anticoagulation and warfarin therapy
VTE-4NQF 0374
Patients diagnosed with confirmed VTE who received IV Unfractionated Heparin therapy dosages and had their platelet counts monitored
VTE-5NQF 0375
Patients diagnosed with confirmed VTE discharged on warfarin that are given appropriate written discharge instructions
VTE-6NQF 0376
Patients diagnosed with confirmed VTE during hospitalization (not present on arrival) who did not receive VTE prophylaxis
top related