Are You Ready for Stage 2

Meaningful Use ? Five Key Questions to Determine if You and Your EHR Vendor Are Prepared

Presented by:

Joe Dickason, Product Manager

Mary Givens, Program Manager of Meaningful Use

Joseph Naughton-Travers, Ed.M., Senior Associate, OPEN MINDS

OPEN MINDS Technology & Informatics Institute Wednesday October 17, 2012 – 11:15 AM

• The Medicare and Medicaid EHR Incentive Programs provide financial incentives for the “meaningful use” of certified EHR technology to improve patient care.

• To receive an EHR incentive payment, providers have to show that they are “meaningfully using” their EHRs by meeting thresholds for a number of objectives.

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• CMS has established the objectives for “meaningful use” that eligible professionals, eligible hospitals, and critical access hospitals (CAHs) must meet in order to receive an incentive payment.

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• Use of certified EHR in a meaningful manner (e.g., e-prescribing).

• Use of certified EHR technology for electronic exchange of health information to improve quality of health care.

• Use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by the Secretary.

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http://www.cms.gov/EHRIncentivePrograms/

A Conceptual Approach to

Meaningful Use

Data capture and sharing

Advanced clinical processes

Improved outcomes

• Stage 1: Data Capture & Sharing - Electronic capture of health information in a structured format, Stage 1 begins in 2011.

• Stage 2: Advanced Clinical Processes - Quality improvement at the point of care and electronic exchange of information, Stage 2 scheduled to begin in 2014.

• Stage 3: Improved Outcomes - Improvements in quality, safety, and efficiency clinical decision support & patient self-management tools, Stage 3 is scheduled to begin in 2016.

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Flow Chart to Help Eligible Professionals (EP) Determine Eligibility

for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs

How to Use this Flow Chart: A Medicaid eligible professional may also be eligible for the Medicare incentive and should follow the path of answering no to the question

of Medicaid patient volume to determine Medicare eligibility. An eligible professional who qualifies for both programs may only participate in one program. Eligible

Professionals eligible to receive EHR incentive payments under Medicare or Medicaid will maximize their payments by choosing the Medicaid EHR Incentive Program.

*Section 1903(t)(3)(F) of the Act defines needy individualsas individuals meeting any of the following three criteria:(1) They are receiving medical assistance from Medicaidor  the  C

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i ldren’s  Health  Insurance  Program  (CHIP);(2) they are furnished uncompensated care by the provider;or (3) they are furnished services at either no cost orreduced cost based on a sliding scale.

• Meaningful use includes both a core set and a menu set of objectives that are specific to eligible professionals or eligible hospitals and CAHs.

• For eligible professionals, there are a total of 25 meaningful use objectives. To qualify for an incentive payment, 20 of these 25 objectives must be met:

◦ 15 required core objectives.

◦ 5 objectives chosen from a list of 10 menu set objectives.

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• For eligible hospitals and critical access hospitals, there are a total of 24 meaningful use objectives. To qualify for an incentive payment, 19 of these 24 objectives must be met:

◦ 14 required core objectives.

◦ 5 objectives chosen from a list of 10 menu set objectives.

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• In addition to meeting the core and menu objectives, eligible professionals, eligible hospitals and CAHs are also required to report clinical quality measures. ◦ Eligible professionals must report on 6 total clinical

quality measures: 3 required core measures (or 3 alternate core measures) and 3 additional measures (selected from a set of 38 clinical quality measures).

◦ Eligible hospitals and CAHs must report on all 15 of their clinical quality measures.

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• Eligible professionals can receive up to $44,000 over five years under the Medicare EHR Incentive Program.

• Eligible professionals can receive up to $63,750 over the six years that they choose to participate in the Medicaid EHR Incentive Program.

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• CMS has delayed the onset of Stage 2 criteria. The earliest that the Stage 2 criteria will be effective is in fiscal year 2014 for eligible hospitals and CAHs or calendar year 2014 for EPs.

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• Note that providers who were early demonstrators of meaningful use in 2011 will meet three consecutive years of meaningful use under the Stage 1 criteria before advancing to the Stage 2 criteria in 2014.

• All other providers would meet two years of meaningful use under the Stage 1 criteria before advancing to the Stage 2 criteria in their third year.

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Report on all 17 Core Objectives: 1. Use computerized provider order entry (CPOE) for medication, laboratory

and radiology orders 2. Generate and transmit permissible prescriptions electronically (eRx) 3. Record demographic information 4. Record and chart changes in vital signs 5. Record smoking status for patients 13 years old or older 6. Use clinical decision support to improve performance on high-priority

health conditions 7. Provide patients the ability to view online, download and transmit their

health information 8. Provide clinical summaries for patients for each office visit 9. Protect electronic health information created or maintained by the

Certified EHR Technology 10. Incorporate clinical lab-test results into Certified EHR Technology

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11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach

12. Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care

13. Use certified EHR technology to identify patient-specific education resources

14. Perform medication reconciliation 15. Provide summary of care record for each transition

of care or referral 16. Submit electronic data to immunization registries 17. Use secure electronic messaging to communicate

with patients on relevant health information

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Report on all 16 Core Objectives:

1. Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders

2. Record demographic information

3. Record and chart changes in vital signs

4. Record smoking status for patients 13 years old or older

5. Use clinical decision support to improve performance on high-priority health conditions

6. Provide patients the ability to view online, download and transmit their health information within 36 hours after discharge.

7. Protect electronic health information created or maintained by the Certified EHR Technology

8. Incorporate clinical lab-test results into Certified EHR Technology

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9. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach

10. Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate

11. Perform medication reconciliation

12. Provide summary of care record for each transition of care or referral

13. Submit electronic data to immunization registries

14. Submit electronic data on reportable lab results to public health agencies

15. Submit electronic syndromic surveillance data to public health agencies

16. Automatically track medications with an electronic medication administration record (eMAR)

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Report on 3 of 6 Menu Objectives:

1. Record whether a patient 65 years old or older has an advance directive

2. Record electronic notes in patient records 3. Imaging results accessible through CEHRT

4. Record patient family health history

5. Generate and transmit permissible discharge prescriptions electronically (eRx)

6. Provide structured electronic lab results to ambulatory providers

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• Mary Givens, Meaningful Use Program Manager, Qualifacts Systems, Inc.

• Joe Dickason, Product Manager, Qualifacts Systems, Inc.

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Questions & Discussion

www.openminds.com openminds@openminds.com

717-334-1329 | 877-350-6463 163 York Street, Gettysburg , Pennsylvania 17325

The market intelligence to navigate. The management expertise to succeed.

Are You Ready for Stage 2

Meaningful Use ? Five Key Questions to Determine if You and Your EHR Vendor Are Prepared

Presented by:

Joe Dickason, Product Manager

Mary Givens, Program Manager of Meaningful Use

Question 1: How soon can a Medicaid EP collect the 2014 incentives?

• Depends on when the EP attested to Stage 1 year 1. Stage 1 year 2?

• Date certified technology is in EP’s production

• Date business process changes are stabilized

• The first day of the next calendar quarter

Open Minds October 2012 Stage 2 presentation

Example:

Open Minds October 2012 Stage 2 presentation

Question 2: How well do the EP’s current processes measure up to 2014?

• eRx increase 40% to 50%

(includes compare to at

least 1 drug formulary)

• Demographics increase

50% to 80%

• Vital Signs increase 50% to

80% (only BP in exclusion)

• Smoking Status increase

from 50% to 80%

• Lab results increase from

40% to 55% Open Minds October 2012 Stage 2 presentation

Question 2: How well do the EP’s current processes measure up to 2014?

• Patient list-no change

• Patient specific education resources-no change

• Risk Analysis-no change

• Medication reconciliation –no change

• Immunization Registry –no change

• Syndromic Surveillance-no change

• Clinical summary for each office visit-went from 3 business days to 1

Open Minds October 2012 Stage 2 presentation

Question 3: How prepared are your EPs for

the new processes?

• CPOE – expanded to include labs and imaging.

– Medications increased from 30% to 60%

– Labs 30%

– Radiology 30%

• Timely Access has been combined with electronic copy of health record

– changes from 10% in 3 business days to 50% in 4 business days.

– New measure for 5% must do view, download, or transmit.

• Clinical Decision Support Rules

– includes drug-drug & drug-allergy.

– changes from 1 rule to 5 rules.

– 4 of 5 rules related to CQM.

– 1 of 5 rules to healthcare efficiency.

Open Minds October 2012 Stage 2 presentation

• Patient Reminders

– decreased from 20% > 10%, but different population

• Transition of Care

– 50% to 10%, but must directly send (likely via Direct protocol)

• Secure Electronic Messaging

– Send message to more than 5% of unique patients

Question 3: How prepared are your EPs for

the new processes?

Open Minds October 2012 Stage 2 presentation

Question 3: How prepared are your EPs for

the new processes?

• Electronic Notes

– create, edit, sign for more than 30% of unique patients

• Imaging Results

– more than 10% of all scans & test are incorporated into or accessible through

• Family Health History - more than 20% have structured data for 1 or more first-degree relatives or indication of review

Open Minds October 2012 Stage 2 presentation

Question 4: How are your EPs preparing for reporting on clinical quality measures for 2014?

• Increase number of CQMs from 6 out of 44 to 9 out of 64

• Must cover 3 “National Quality Strategy Domains”

• Medicaid providers will have to electronically report their

CQMs to state

• Regardless of the stage of MU, all EPs

will have to complete this number of

CQMs in 2014.

Open Minds October 2012 Stage 2 presentation

Question 4: How are your EPs preparing for reporting on clinical quality measures for stage 2?

Open Minds October 2012 Stage 2 presentation

Question 4: How are your EPs preparing for reporting on clinical quality measures for 2014?

• NQF 0105 Title: Anti-depressant medication management: (a) Effective Acute Phase Treatment,(b)Effective Continuation Phase Treatment

• NQF 0004 Title: Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: (a) Initiation, (b) Engagement

• NQF 0028 Title: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

• 0022 Title: Use of High-Risk Medications in the Elderly

• 0101 Title: Falls: Screening for Fall Risk

• 0104 Title: Major Depressive Disorder (MDD): Suicide Risk Assessment

• 0108 Title: ADHD: Follow-Up Care for Children Prescribed Attention Deficit Hyperactivity Disorder (ADHD) Medication

• 0110 Title: Bipolar Disorder and Major Depression: Appraisal for alcohol or chemical substance use

• 0418 Title: Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan

• 0419 Title: Documentation of Current Medications in the Medical Record

• 0421 Title: Adult Weight Screening and Follow-Up

• 0710 Title: Depression Remission at Twelve Months

• 0712 Title: Depression Utilization of the PHQ-9 Tool

• 1365 Title: Child and Adolescent Major Depressive Disorder: Suicide

Risk Assessment

• Title: Dementia: Cognitive Assessment

• EPs will need to register with a service that support direct messaging.

– State HIE

– CMS

– Vendor

– Third Party

• Need to establish a relationship and process for transition of care that includes electronic transmission of transition of care/referral summary.

• Secure messaging between EP and consumer (to and from) must be integrated into patient engagement practices

Question 5: How is the EP preparing for health

information communication ?

Open Minds October 2012 Stage 2 presentation

Question 4: How are your EPs preparing for reporting on clinical quality measures for stage 2?

• Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders

• Generate and transmit permissible prescriptions electronically (eRx)

• Record Demographic information

• Record and chart changes in vital signs

• Record smoking status for patients 13 years or older

• Use clinical decision support to improve performance in high-priority health conditions

• Provide patients the ability to view online, download and transmit their health information

• Provide clinical summaries for patients for each office visit

• Protect Electronic health information created or maintained by the CEHRT

• Incorporate clinical lab test results into CEHRT

• Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.

• Use clinically relevant information to identify patients who should receive reminders for preventive /follow –up care

• Use CEHRT to identify patient-specific education resources.

• Perform medication reconciliation

• Provide summary of care record for each transition of care referral

• Submit electronic data to immunization registries

• Use secure electronic messaging to communicate with patients on relevant health information.

• Submit electronic surveillance data to public health agencies

• Record electronic notes in patient records

• Imaging results accessible through CEHRT

• Identify and report cancer cases to State cancer registry

• Identify and report specific cases to a specialized registry (other than cancer registry)

Open Minds October 2012 Stage 2 presentation

2014 Ambulatory Measures of Meaningful Use

CORE-Report on all 17 Objectives MENU- Report on 3 out of 6 objectives

Open Minds October 2012 Stage 2 presentation

Open Minds October 2012 Stage 2 presentation

A resource for behavioral health professionals seeking advice, guidance, and information on meeting Meaningful Use requirements.

www.MUforBH.com

• FAQs o Get quick answers to the most common Meaningful Use

questions • Forum

o Chat and exchange ideas with others in your community • Play the MU Game

o A step-by-step guide to claiming your Meaningful Use dollars • Videos and Webinars

o Access past Meaningful Use presentations for additional help or join our free live webinars

• MU State University o Meaningful Use Education State by State

Open Minds October 2012 Stage 2

presentation

Open Minds October 2012 Stage 2 presentation