kareo - the ins & outs of meaningful use stage 2

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Listen. Learn. Implement.The Ins & Outs of Meaningful Use

Stage 2


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Elizabeth WoodcockMBA, FACMPE, CPC

Lea ChathamContent Marketing Manager, Kareo


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Elizabeth Woodcock, MBA, FACMPE, CPC

Professional Speaker, Trainer, & Author

Specializing in Medical Practice Management

Author of 12 Best-Selling Practice Management Books

Fellow in the American College of Medical Practice Executives

Certified Professional Coder

MBA in Healthcare Management from The Wharton School of Business

BA from Duke University

Elizabeth W. Woodcock, MBA, FACMPE, CPCWoodcock & Associates

Speaker, Trainer, AuthorAtlanta, Georgia404.373.6195

[email protected]


Background

February 2009American Recovery and Reinvestment Act

“TITLE XIII—HEALTH INFORMATION TECHNOLOGY”

HITECH Act

“Eligible professionals” will be paid for “demonstrating use of a qualified electronic health record in a meaningfulmanner.”

Logo: CMS.gov


Background

Meaningful Use

Stage One

Stage Two

Stage Three

September 4, 2012 Federal Register 21050Final Rule: Medicare and Medicaid Programs; Electronic Health Record Incentive Program – Stage 2


Background

Vendors received the “Final Rule” on the constitution of CEHRT systems

Certified EHR

Technology (CEHRT)Photo: Teenspeak.org


Background

In order to allow time for vendors to create and physicians to implement…

Stage Two 2014


Background

1st Year

Stages of Meaningful Use2011 2012 2013 2014 2015 2016 2017

2011 1 1 1 2 2 3 32012 1 1 2 2 3 32013 1 1 2 2 32014 1 1 2 22015 1 1 22016 1 12017 1

Year One: 90 DaysSubsequent Years: 365 Days


Background

1st Year

Meaningful Use Annual Incentive Payments2011 2012 2013 2014 2015 2016 [….] TOTAL

2011 MCR $18,000 $12,000 $8,000 $4,000 $2,000 $0 $0 $44,000 MCD $21,250 $8,500 $8,500 $8,500 $8,500 $8,500 $0 $63,750

2012 MCR $18,000 $12,000 $8,000 $4,000 $2,000 $0 $44,000 MCD $21,250 $8,500 $8,500 $8,500 $8,500 $8,500 $63,750

2013 MCR $15,000 $12,000 $8,000 $4,000 $0 $39,000 MCD $21,250 $8,500 $8,500 $8,500 $17,000 $63,750

2014 MCR $12,000 $8,000 $4,000 $0 $24,000 MCD $21,250 $8,500 $8,500 $25,500 $63,750

2015 MCR $0 $0 $0 $0 MCD $21,250 $8,500 $34,000 $63,750

2016 MCR $0 $0 $0 MCD $21,250 $ 42,500 $63,750

MCR = Medicare; MCD = Medicaid. MCD participants must begin participation by 2016.


Background

20143-month reporting period

First‐time Stage TwoSecond‐year Stage OneFor Medicare, must correspond with the fiscal quarter four chances


Meaningful Use: Stage One

Core Measures

15Menu

Measures

5CQMs*

6 MUMeaningful

Use

Meaningful Use: Stage Two

Core Measures

17Menu

Measures

3CQMs

9 MUMeaningful

Use

Stage Two

*One of the “core measures”; CQM: clinical quality measure


•Maintain core-menu structure– 17 core objectives– 3 of 6 menu– Retain exclusions, but can’t use them to disqualify

•9 clinical quality measures (CQMs)– No longer one of the criteria– Considered part and parcel of MU

Stage Two


Stage Two

Criteria Old (MU1) Threshold

New (MU2) Threshold

CPOE 30% (med) 60% (med); 30% (lab/rad)

eRx 40% 50%

Demographic info 50% 80%

Vitals 50% 80%

Smoking status 50% 80%

Clinical summaries 50% (3 days) 50% (1 day)

Patient education 10% (menu) 10% (core)CPOE: Computerized Physician Order Entry


Stage Two

In addition to higher measure thresholds…

• Completely new criteria

• Stage One menu-based criteria now core

• Multi-layer criteria

Cartoon: Doug Savage


Stage Two


Objective: Record smoking status for patients 13+ years old

Measure: >80% of all unique patients 13+ years old seen by the EP have smoking status recorded as structured data

Stage Two: Sample MU Core Criteria


Objective: Provide clinical summaries for patients for each office visit

Measure: Clinical summaries provided to patients or patient-authorized representatives for >50% of office visits



Objective: Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference

Measure: >10% of all unique patients who have had 2+ office visits with the EP within the past 24 months before the beginning of the EHR reporting period were sent a reminder, per patient preference




Objective: Provide patients the ability to view online, download and transmit their health information with 4 business days of the information being available to the EP

*for both measures, only patients seen by the eligible professional (EP) during the reporting period

Measure: (1) >50% of all unique patients are provided timely online access (4 business days) to their health information; and (2) >5% of all unique patients (or authorized representative) view, download or transmit to a third party their health information*


Objective: Use electronic messaging to communicate with patients on relevant health information

CEHRT: certified electronic health record technology

Measure: A secure message was sent using the electronic messaging function of CEHRT by >5% of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period


Appendix


Stage Two: Menu-based Criteria

•Capability to submit electronic syndromicsurveillance data to public health agencies

•Record electronic notes in patient records• Imaging results accessible through CEHRT•Record patient family health history• Identify and report cancer cases to a public health central cancer registry

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

CEHRT: Certified Electronic Health Record Technology


Meaningful Use: Stage Two

Core Measures

17Menu

Measures

3CQMs

9 MUMeaningful

Use

Stage Two

*One of the “core measures”; CQM: clinical quality measure

Out of 6


Clinical quality measures– 9 measures out of 64– None are “required” but some are recommended– Electronic submission as of 2014, in Year Two+– Alignment with existing quality programs▪PQRS▪Shared Savings Program (ACOs)▪NCQA Patient-Centered Medical Home Recognition

PQRS: Physician Quality Reporting System; ACO: accountable care organization; NCQA: National Committee for Quality AssuranceCMS: Centers for Medicare & Medicaid Services

Stage Two: Clinical Quality Measures


Stage Two: Clinical Quality Measures

CQM domains• Patient and family engagement• Patient safety• Care coordination• Population and public health• Efficient use of healthcare resources• Clinical processes/effectiveness

9 required measures must come from at least three different domains


Confirmation that penalties begin in 2015

Avoidance of penalties1. Ineligible for program2. Successful participant in 20133. At minimum, successful participant by October 1,2014

▪ Register by July 1, 2014▪ Attest by the end of September 2014

…or meet one of the criteria for exclusion

Medicare Payment Adjustments



Criteria for Exclusion▪ Infrastructure: Lack Internet availability/barriers to

obtaining IT infrastructure

▪ New eligible professional (2 years)

▪ Unforeseen circumstances (e.g., natural disasters)

▪ Particular specialty/physician▪ Limited interaction with patients

▪ Lack of control of EHR access

▪ Taxonomy codes: 30 (Diagnostic Rad); 36 (Nuclear Med); 94 (Interventional Rad*); 30 (Anesthesiology); and 22 (Pathology)

*Exclusion under review by CMS (1/2/13)


•Important– Adjustments will be applied to all Medicare

reimbursement– Medicaid reimbursement will not be affected– Medicaid participants need to demonstrate

meaningful use to avoid Medicare adjustments– Must continue to demonstrate meaningful use




Year eRx PQRS EHR Total2012 -1.0% - - -1.0%2013 -1.5% - - -1.5%2014 -2.0% - - -2.0%2015 -2.0% -1.5% -1.0% -4.5%2016 -2.0% -2.0% -4.0%2017 -2.0% -3.0% -5.0%2018 -2.0% up to -5% up to -7%2019 -2.0% up to -5% up to -7%


Question & Answer Session

Listen. Learn. Implement.The Ins & Outs of

Meaningful UseStage 2

Your Questions…


Source

September 4, 2012 Federal Register 21050Final Rule: Medicare and Medicaid Programs; Electronic Health Record Incentive Program –Stage 2

http://www.gpo.gov/fdsys/pkg/FR-2012-09-04/pdf/2012-21050.pdf


Appendix: Remaining MU Core Criteria

• Incorporate clinical lab-test results into CEHRT as structured data

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

• Use clinically relevant information from CEHRT to identify patient-specific education resources and provide those resources to the patient

• The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation


Appendix : Remaining MU Core Criteria

• The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral

• Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with application law and practice

• Use CPOE for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines

• Generate and transmit permissible prescriptions electronically (eRx)


Appendix : Remaining MU Core Criteria

• Record the following demographics: preferred language, sex, race, ethnicity, date of birth

• Record and chart changes in vital signs• Use clinical decision support to improve performance on

high priority health conditions• Protect electronic health information created or maintained

by the CEHRT through the implementation of appropriate technical capabilities


Elizabeth W. Woodcock, MBA, FACMPE, CPCWoodcock & AssociatesSpeaker, Trainer, Author

Atlanta, Georgia404.373.6195

[email protected]

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