Meaningful Use – Moving Toward Stage 2Adele AllisonNational Director of Government Affairs, SuccessEHS

Background – ARRA/HITECH

• Signed 2/17/09 in Denver, CO• Purpose: Stimulate the

economy through investments in infrastructure, unemployment benefits, transportation, education, and healthcare.

• Health Care is in the Spotlight–Affordable Care Act - Health Care Reform

($828B)

– Fueling push for HIT ($54B per year savings)

–Rapid market movement and positioning

• Up to $45B for direct EHR adoption: –$20B in Medicare Incentives–$14B in Medicaid Incentives

HITECH Goals

1. Push Provider Adoption of approved (certified) EHR Technology

2. Capture DATA3. Move DATA – Interoperability4. Report DATA• $27B in “Carrots” - incentives:– Up to $48,400 through Medicare– Up to $63,750 through Medicaid

Meaningful Use: 3-part equation

• 3-Part Equation for MU:• Part 1: Certified EHR

Technology – The Tool • Part 2: Implementation –

Practice Reengineering / Redesign• Part 3: Support – Available,

Responsive and Ongoing

Meaningful Example

Stage 1 – Objectives & Measures

•Objectives are broad spanning goals/activities•Measures are specific task(s) requirements•Meeting the measures = meeting the Objectives for that Stage•Stage 1 MU–15 Core Measures required by all EP’s–10 Menu Measures from which EP’s choose 5

•13 Exclusion Clauses – Exclusions will reduce the number of Objectives required by EP

Stage 1 – Medicare Incentive

•Types of Providers - §495.100:Medicare: MD, DO, DDS, DMD, DPM, OD, DC

•Must have PECOS Number with CMS•Must register with CMS

Registration Website: cms.gov/EHRIncentivePrograms/

•Year 1: 15 Core + 5 Menu Objectives/Measures for continuous 90-days

Stage 1 – Medicare Incentive

•Year 2 and Beyond: Full Year of MU•CY2011-12 - Must gather data, run calculations, attest and send to CMS•CY2013 and Beyond – Electronic Submission of CQMs•Qualification is reviewed annually

Potential Medicare Incentives

Calendar Year

First Calendar Year in which the EP Receives an Incentive Payment

2011 2012 2013 20142015 and

subsequent years

2011 $18,000

2012 $12,000 $18,000

2013 $8,000 $12,000 $15,000

2014 $4,000 $8,000 $12,000 $12,000

2015 $2,000 $4,000 $8,000 $8,000 $0

2016 $2,000 $4,000 $4,000 $0

TOTAL $44,000 $44,000 $39,000 $24,000 $0Shortage Area

Totals* $48,400 $48,400 $42,900 $26,400 $0

* Providers practicing in a federally identified shortage area are eligible for a 10% increase.

Stage 1 – Medicaid Incentive•Types of Providers - §495.100:–Medicaid: Physicians, Dentists, Certified Nurse Midwives, Nurse Practitioners, Physician Assistants (in FQHC/RHC led by a PA)

•Year 1: Adopt, Implement, Upgrade - §495.302:–Acquire, purchase, or secure access to certified EHR technology;–Install/use certified EHR technology capable of MU; or–Expand functionality of certified EHR solution at the practice with:

•Staffing, Maintenance, Training, or Upgrading from existing EHR to certified EHR technology.

Stage 1 – Medicaid Incentive

•Year 2: MU for 90 continuous days

•Years 3 through 6: MU for full year

Potential Medicaid IncentivesCalendar

Year

First Calendar Year in which the EP Receives an Incentive Payment

2011 2012 2013 2014 2015 2016

2011 $21,250

2012 $8,500 $21,250

2013 $8,500 $8,500 $21,250

2014 $8,500 $8,500 $8,500 $21,250

2015 $8,500 $8,500 $8,500 $8,500 $21,250

2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,2502017 $0 $8,500 $8,500 $8,500 $8,500 $8,5002018 $0 $0 $8,500 $8,500 $8,500 $8,5002019 $0 $0 $0 $8,500 $8,500 $8,5002020 $0 $0 $0 $0 $8,500 $8,5002021 $0 $0 $0 $0 $0 $8,500

TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750

Forecasting Stage 2

Since Stage 1 Final Rule•ONC - Exit Dr. Blumenthal, Enter Dr. Farzad Mostashari •Stage 2 – Tactical Deployment•Rapid Market Positioning in HC Orgs•New Payment Models Developing–CMMI–ACOs–Bundled Payments → Revenue Cycle Mgmt (RCM) and Enterprise Resource Planning (ERP)

Since Stage 1 Final Rule•State Initiatives Challenged (RECs, HIEs)•Enter the iPad clinicians’ companion device•NHIN Direct Project launched Jan. 2011•Industry Hungry for Data

Since Stage 1 Final Rule•HITPC → Recommendations to CMS June 16th •Push Stage 2 Launch to CY2014•ONC NPRM for Vendors (Certification) → Q4 2011•CMS NPRM for Providers → Q1 2012 – Final Rule June, 2012

Since Stage 1 Final Rule•5 Categories for Stage 2 Recommendations:

o Static MeasuresoMenu Measures Converted to Coreo Expansion of Stage 1 Thresholds and

ScopeoNew Stage 2 MeasuresoRemoved Measures

Data Capture

Non-Structured Information•Example: Narrative Typing or Speech-to-Text•Pros: Personalized Note, Ultimate Flexibility, “The Patient is still a Human”•Cons: Not Reportable, Not Researchable, Not Machine Process-able, Non-Standard, ↑ Risk

Structured Data•Example: Combo or Drop-Down Boxes; User-defined Fields•Pros: Typically Customizable, Information Uniformity, Supports Reporting•Cons: Not conducive to Interoperability and Industry-wide Standards

Codified/Object-Oriented Data•Example: Vocabularies such as ICD9, SnoMed, LOINC•Pros: Very Reportable, Researchable, Machine Process-able, Standardize, Interoperable•Cons: Limits Flexibility in Documentation, “Cookie-Cutter” Notes

Meaningful Use – Stage 1 vs. Stage 2

Stage 1 – About Starting Adoption•No Encounter Note•Flexibility – Menu Measures•Flexibility – Clinical Quality Measures (CQMs)•“Tests” in Moving Data

Stage 2 – Tactical Use•Patient Engagement – “Behavioral Economics”•Production Mode for Moving Data – Focus on Transitions of Care•Increased Threshold and Measure Scope•Expansion through New Measures•Electronic Reporting of CQMs•CQMs broader in scope

Static Measures – Stage 2

• 80% of Patients have Active Problem Listo 1 entry as structured data; oro “No Known Problems” as structured data

• 80% of Patients have Active Medications Listo 1 entry as structured data; oro “No Medications” as structured data

• 80% of Patients have Active Medications Allergy Listo 1 entry as structured data; oro “No Known Allergies” as structured data

• Enable Alerting of Drug-Drug and Drug-Allergy Checks

Menu into Core Measures – Stage 2

• Implement Drug Formulary Checks• 40% of Lab Results Ordered in EHR as

Structured Datao Recorded as Positive / Negative, oro Numerical Format

• 50% of Transition in Care with Medications Reconciledo When receiving patient in transitiono Example: Hospital Discharge

• 50% of Transitions Show Provision of Care Record Summary Providedo Provided in Paper or Electronic

Expanded Stage 1 Measures – Stage 2

• 60% Patients with Rx – 1+ Rx Ordered through CPOE (↑ from 30%)

• 80% Patients with Demographics with ability to Stratify (↑ from 50%)

• 80% Patients with Vitals recorded (↑ from 50%)

• CDS for improvement on high-priority conditions (↑ from 1 CDS Rule)

• Patient Lists for multiple parameters (↑ from 1 list with specific condition)

• 10% Patient given Patient-Specific Education (“If Appropriate” Removed)

• Actual Immunization Data Submitted (No longer “Test” Data)

• CQMs Reported to CMS or State (Expanding)

• Attest to encryption/security “at rest” (↑ from simple assessment)

• 50% Patient Rx ePrescribed (↑ from 30%)

• 10% All Patients sent clinical reminder (↓ from 20%, but now “All” Patients)

• 50% Patients provided Clinical Summary in 24 hours (↑ 3 Business Days)

• 10% Patients/Family can view and download longitudinal health information within 24 hours of encounter (↑4 Business Days)

• Actual submission of Syndromic Surveillance Data

• Actual submission of Reportable Cancer Conditions

New Measures – Stage 2

• 60% Patients with Lab Results – 1+ Lab Ordered through CPOE• 1 Radiology Test Ordered through

CPOE• 10% Patients recorded Care Plans

(Including Goals and Instructions)• 10% Patients recorded Care Team

Members (Including PCP)• 25 Patients have Advance Directive

and ability to access

• 30% of Visits have an Electronic Note (no scanning/non-searchable)• 25 Patients have been sent Secured

Online Messages• 20% Patients have Communication

Preferences recorded• 25 Transactions of Electronic

Summary of Care Record sent

Removed Measures – Stage 2

•50% Patients requesting Electronic Copy of Record – provided in 3 Business Days•Perform 1 Test of

Exchanging Electronic Information

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