meaningful use stage one overview
DESCRIPTION
Overview of Meaningful Use, Stage One. Presented to Georgetown's Graduate Health Information System's class on 10/9/10.TRANSCRIPT
Jessica Jacobs
October 8 2010
Meaningful Use
Stage One
Overview
2
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
THE BACK STORY
bull The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 was a part of ARRA
bull HITECH allocated funds to spur the adoption of electronic health records -approximately $208 Billion
bull While theyrsquore starting with carrots there will be sticks
It all started with ARRA
Money Talks hellip
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull ARRA gives out money with some caveats
1 Use of certified EHR in a meaningful manner
2 Use of certified EHR technology for electronic exchange of health information to improve quality of health care
3 Use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by the Secretary [of Health]
Why ldquoMeaningful Userdquo
The Five Pillars of Meaningful Use
Ensure Privacy and Security
Improve Population Health
Improve Safety and Quality
Engage Patients and Families
Coordinate Care
Basic Timeline
2009
bullFeb ARRAHITECH Become Law
bullDec NPRM on Display
2010
bullJan NPRM Published
bullMarch Comment Period Closes (2000 comments received)
bullJuly Final Rule
bullAugust Certifying Bodies
2011
bullJan States can begin to launch their programs
bull~Jan Registration
bull~March Attestation
bull~May Payments
bullNov 30th Last day for HospitalsCAH to register for FFY 2011
2012
bullFeb 29th Last day for EPs to registerattest for FFY 2011
2015
bullPayment Adjustments (Penalties) Begin for EPs and eligible hospitals
2016
bullLast year to receive Medicare Incentive Payment
2021
bullLast year to receive Medicaid Incentive Payment
7
DO I QUALIFY
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
Measures
Summary
Eligible Providers (EPs)
Medicare
Eligible Professionals (EPs)
bull Ambulatory MDDO
bull Doctor of Dental Surgery or Dental Medicine
bull Doctor of Podiatric Medicine
bull Doctor of Optometry
bull Chiropractors
bull Medicaid Advantage (20 hoursweek of patient-care services for employees 80 of time for partners)
Eligible Hospitals
bull Acute Care Hospitals
bull Critical Access Hospitals (CAHs)
Subsection (d) hospitals that are paid under the PPS and are located in the 50 States or DC
Medicaid
Eligible Professionals (EPs)
bull Ambulatory Physicians (Pediatricians have special eligibility amp payment rules)
bull Nurse Practitioners (NPs)
bull Certified Nurse-Midwives (CNMs)
bull Dentists
bull Physician Assistants (PAs) who lead a Federally Qualified Health Center (FQHC) or rural health clinic (RHC)
Eligible Hospitals
bull Acute Care Hospitals
bull Critical Access Hospitals
bull Childrenrsquos Hospitals
httpsquestionscmshhsgovappanswersdetaila_id9844~[ehr-incentive-program]-are-physicians-who-practice-in-hospital-based
Note Excludes radiologists pathologists anesthesiologists ER and all other hospital-based physicians
Medicaid Eligibility
Formula
Total Medicaid Encounters
in a 90-Day Period
_________________________
Total Encounters
in same 90-Day Period
EntityMinimum
Threshold
Physicians 30
Pediatricians 20
Dentists 30
CNMs 30
PAs (at FQHC) 30
NPs 30
Acute Care Hospitals 10
Childrens Hospitals --Source httpwwwcmsgovMLNProductsdownloadsEHR_Final_Rule-
Medicaidpdf
10
THE MONEY
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
ndash Medicare $44kphysician
bull Bonuses up to $4400 for EPs in Health Provider
Shortage Areas (HPSAs)
ndash Medicaid $63750kphysician
bull Switching between programs
ndash Allowed but only once
Ambulatory Incentive Structure
Year MUer 2011 2012 2013 2014
2011 $18000 - - -
2012 $12000 $18000 - -
2013 $8000 $12000 $15000 -
2014 $4000 $8000 $12000 $12000
2015 $2000 $4000 $8000 $8000
2016 - $2000 $4000 $4000
TOTAL $44000 $44000 $39000 $24000
Medicare EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014
2011 $1800 - - -
2012 $1200 $1800 - -
2013 $800 $1200 $1500 -
2014 $400 $800 $1200 $12000
2015 $200 $400 $800 $8000
2016 - $200 $400 $4000
TOTAL $4400 $4400 $3900 $2400
Medicare HPSA EP Bonuses
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014 2015 2016
2011 $21250 - - - - -
2012 $8500 $21250 - - - -
2013 $8500 $8500 $21250 - - -
2014 $8500 $8500 $8500 $21250 - -
2015 $8500 $8500 $8500 $8500 $21250 -
2016 $8500 $8500 $8500 $8500 $8500 $21250
2017 - $8500 $8500 $8500 $8500 $8500
2018 - - $8500 $8500 $8500 $8500
2019 - - - $8500 $8500 $8500
2020 - - - - $8500 $8500
2021 - - - - - $8500
TOTAL $63750 $63750 $63750 $63750 $63750 $63750
Medicaid EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Hospital Incentive Structurebull The Money
bull Two Million Dollar Base + Variable Based on Discharges (MedicareMedicaid Share)
bull The Timeline bull Medicare no payments after 2016 Sticks start in 2015
bull Medicaid canrsquot initiate payments after 2016
bull The Caveats ndash All Medicare Hospitals qualify as Medicaid Hospitals
ndash Hospitals eligible for Medicare dollars may be eligible for Medicaid dollars
15
16
ARE YOU LEGAL
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
Certification
bull Temporary Certification Program is in place (set to expire December 2011)
bull Handled by external bodies
bull Currently there are three certifying agencies
ndash CCHIT ndash Chicago IL (83010)
bull Had offered preliminary certification
ndash Drummond Group ndash Austin TX (83010)
ndash InfoGard ndash San Luis Obispo CA (91710)
Vendors Planning to Achieve Certification
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
18
THE HEART OF IT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull You Gotta Have
ndash Ambulatory Providers = 15
ndash Hospitals = 14
ndash All Hospital Criteria Overlap with Ambulatory
bull the only addition to the ambulatory provider list is e-
Prescribing
ndash Most measures must be reported as structured
data
The Core Objectives
Core Objectives ndash Gotta Do bdquoem All
MaintainRecord
bull Maintain an up-to-date problem list of current and active diagnoses (50)
bull Maintain active medication list (80)
bull Maintain active medication allergy list (80)
bull Record and chart changes in vital signs (50)
bull Record smoking status for patients 13 years or older (50)
bull Record demographics (50)
DoImplement
bull Computerized physician order entry (CPOE) (30)
bull E-Prescribing (Ambulatory Only 40)
bull Drug-drug and drug-allergy interaction checks (enabled whole period)
bull Clinical decision support (1 rule)
bull Protect electronic health information (whole period)
ProvideReport
bull Report clinical quality measures to CMS or States (2011 Attestation 2012 Electronically)
bull Provide Patients with an electronic copy of their health information upon request (50 within 3 days)
bull Provide clinical summaries for patients for each office visitat each discharge (50 within 3 days)
bull Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (perform at least one test)
Source httphealthpolicyandreformnejmorgattachment_id=3742
Menu Sets ndash Pick Five
MaintainRecord
bull Incorporate clinical lab test results (50)
bull Record advanced directives for patients 65 years or older (Acute Only 50)
DoImplement
bull Drug-formulary checks (whole period)
bull Medication reconciliation (50)
ProvideReport
bull Generate lists of patients by specific conditions (at least 1 list)
bull Summary of care record for each transition of carereferrals (50)
bull Capability to provide electronic syndromic surveillance data to public health agencies (1 test)
bull Capability to submit electronic data to immunization registriessystems (1 test)
bull Provide patient-specific education resources and provide to patient (10)
bull Send reminders to patients per patient preference for preventivefollow up care (Ambulatory Only 20 in the 65lt amp lt5 age groups)
bull Provide patients with timely electronic access to their health information (Ambulatory Only 10 within 4 days)
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
2
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
THE BACK STORY
bull The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 was a part of ARRA
bull HITECH allocated funds to spur the adoption of electronic health records -approximately $208 Billion
bull While theyrsquore starting with carrots there will be sticks
It all started with ARRA
Money Talks hellip
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull ARRA gives out money with some caveats
1 Use of certified EHR in a meaningful manner
2 Use of certified EHR technology for electronic exchange of health information to improve quality of health care
3 Use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by the Secretary [of Health]
Why ldquoMeaningful Userdquo
The Five Pillars of Meaningful Use
Ensure Privacy and Security
Improve Population Health
Improve Safety and Quality
Engage Patients and Families
Coordinate Care
Basic Timeline
2009
bullFeb ARRAHITECH Become Law
bullDec NPRM on Display
2010
bullJan NPRM Published
bullMarch Comment Period Closes (2000 comments received)
bullJuly Final Rule
bullAugust Certifying Bodies
2011
bullJan States can begin to launch their programs
bull~Jan Registration
bull~March Attestation
bull~May Payments
bullNov 30th Last day for HospitalsCAH to register for FFY 2011
2012
bullFeb 29th Last day for EPs to registerattest for FFY 2011
2015
bullPayment Adjustments (Penalties) Begin for EPs and eligible hospitals
2016
bullLast year to receive Medicare Incentive Payment
2021
bullLast year to receive Medicaid Incentive Payment
7
DO I QUALIFY
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
Measures
Summary
Eligible Providers (EPs)
Medicare
Eligible Professionals (EPs)
bull Ambulatory MDDO
bull Doctor of Dental Surgery or Dental Medicine
bull Doctor of Podiatric Medicine
bull Doctor of Optometry
bull Chiropractors
bull Medicaid Advantage (20 hoursweek of patient-care services for employees 80 of time for partners)
Eligible Hospitals
bull Acute Care Hospitals
bull Critical Access Hospitals (CAHs)
Subsection (d) hospitals that are paid under the PPS and are located in the 50 States or DC
Medicaid
Eligible Professionals (EPs)
bull Ambulatory Physicians (Pediatricians have special eligibility amp payment rules)
bull Nurse Practitioners (NPs)
bull Certified Nurse-Midwives (CNMs)
bull Dentists
bull Physician Assistants (PAs) who lead a Federally Qualified Health Center (FQHC) or rural health clinic (RHC)
Eligible Hospitals
bull Acute Care Hospitals
bull Critical Access Hospitals
bull Childrenrsquos Hospitals
httpsquestionscmshhsgovappanswersdetaila_id9844~[ehr-incentive-program]-are-physicians-who-practice-in-hospital-based
Note Excludes radiologists pathologists anesthesiologists ER and all other hospital-based physicians
Medicaid Eligibility
Formula
Total Medicaid Encounters
in a 90-Day Period
_________________________
Total Encounters
in same 90-Day Period
EntityMinimum
Threshold
Physicians 30
Pediatricians 20
Dentists 30
CNMs 30
PAs (at FQHC) 30
NPs 30
Acute Care Hospitals 10
Childrens Hospitals --Source httpwwwcmsgovMLNProductsdownloadsEHR_Final_Rule-
Medicaidpdf
10
THE MONEY
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
ndash Medicare $44kphysician
bull Bonuses up to $4400 for EPs in Health Provider
Shortage Areas (HPSAs)
ndash Medicaid $63750kphysician
bull Switching between programs
ndash Allowed but only once
Ambulatory Incentive Structure
Year MUer 2011 2012 2013 2014
2011 $18000 - - -
2012 $12000 $18000 - -
2013 $8000 $12000 $15000 -
2014 $4000 $8000 $12000 $12000
2015 $2000 $4000 $8000 $8000
2016 - $2000 $4000 $4000
TOTAL $44000 $44000 $39000 $24000
Medicare EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014
2011 $1800 - - -
2012 $1200 $1800 - -
2013 $800 $1200 $1500 -
2014 $400 $800 $1200 $12000
2015 $200 $400 $800 $8000
2016 - $200 $400 $4000
TOTAL $4400 $4400 $3900 $2400
Medicare HPSA EP Bonuses
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014 2015 2016
2011 $21250 - - - - -
2012 $8500 $21250 - - - -
2013 $8500 $8500 $21250 - - -
2014 $8500 $8500 $8500 $21250 - -
2015 $8500 $8500 $8500 $8500 $21250 -
2016 $8500 $8500 $8500 $8500 $8500 $21250
2017 - $8500 $8500 $8500 $8500 $8500
2018 - - $8500 $8500 $8500 $8500
2019 - - - $8500 $8500 $8500
2020 - - - - $8500 $8500
2021 - - - - - $8500
TOTAL $63750 $63750 $63750 $63750 $63750 $63750
Medicaid EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Hospital Incentive Structurebull The Money
bull Two Million Dollar Base + Variable Based on Discharges (MedicareMedicaid Share)
bull The Timeline bull Medicare no payments after 2016 Sticks start in 2015
bull Medicaid canrsquot initiate payments after 2016
bull The Caveats ndash All Medicare Hospitals qualify as Medicaid Hospitals
ndash Hospitals eligible for Medicare dollars may be eligible for Medicaid dollars
15
16
ARE YOU LEGAL
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
Certification
bull Temporary Certification Program is in place (set to expire December 2011)
bull Handled by external bodies
bull Currently there are three certifying agencies
ndash CCHIT ndash Chicago IL (83010)
bull Had offered preliminary certification
ndash Drummond Group ndash Austin TX (83010)
ndash InfoGard ndash San Luis Obispo CA (91710)
Vendors Planning to Achieve Certification
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
18
THE HEART OF IT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull You Gotta Have
ndash Ambulatory Providers = 15
ndash Hospitals = 14
ndash All Hospital Criteria Overlap with Ambulatory
bull the only addition to the ambulatory provider list is e-
Prescribing
ndash Most measures must be reported as structured
data
The Core Objectives
Core Objectives ndash Gotta Do bdquoem All
MaintainRecord
bull Maintain an up-to-date problem list of current and active diagnoses (50)
bull Maintain active medication list (80)
bull Maintain active medication allergy list (80)
bull Record and chart changes in vital signs (50)
bull Record smoking status for patients 13 years or older (50)
bull Record demographics (50)
DoImplement
bull Computerized physician order entry (CPOE) (30)
bull E-Prescribing (Ambulatory Only 40)
bull Drug-drug and drug-allergy interaction checks (enabled whole period)
bull Clinical decision support (1 rule)
bull Protect electronic health information (whole period)
ProvideReport
bull Report clinical quality measures to CMS or States (2011 Attestation 2012 Electronically)
bull Provide Patients with an electronic copy of their health information upon request (50 within 3 days)
bull Provide clinical summaries for patients for each office visitat each discharge (50 within 3 days)
bull Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (perform at least one test)
Source httphealthpolicyandreformnejmorgattachment_id=3742
Menu Sets ndash Pick Five
MaintainRecord
bull Incorporate clinical lab test results (50)
bull Record advanced directives for patients 65 years or older (Acute Only 50)
DoImplement
bull Drug-formulary checks (whole period)
bull Medication reconciliation (50)
ProvideReport
bull Generate lists of patients by specific conditions (at least 1 list)
bull Summary of care record for each transition of carereferrals (50)
bull Capability to provide electronic syndromic surveillance data to public health agencies (1 test)
bull Capability to submit electronic data to immunization registriessystems (1 test)
bull Provide patient-specific education resources and provide to patient (10)
bull Send reminders to patients per patient preference for preventivefollow up care (Ambulatory Only 20 in the 65lt amp lt5 age groups)
bull Provide patients with timely electronic access to their health information (Ambulatory Only 10 within 4 days)
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
bull The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 was a part of ARRA
bull HITECH allocated funds to spur the adoption of electronic health records -approximately $208 Billion
bull While theyrsquore starting with carrots there will be sticks
It all started with ARRA
Money Talks hellip
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull ARRA gives out money with some caveats
1 Use of certified EHR in a meaningful manner
2 Use of certified EHR technology for electronic exchange of health information to improve quality of health care
3 Use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by the Secretary [of Health]
Why ldquoMeaningful Userdquo
The Five Pillars of Meaningful Use
Ensure Privacy and Security
Improve Population Health
Improve Safety and Quality
Engage Patients and Families
Coordinate Care
Basic Timeline
2009
bullFeb ARRAHITECH Become Law
bullDec NPRM on Display
2010
bullJan NPRM Published
bullMarch Comment Period Closes (2000 comments received)
bullJuly Final Rule
bullAugust Certifying Bodies
2011
bullJan States can begin to launch their programs
bull~Jan Registration
bull~March Attestation
bull~May Payments
bullNov 30th Last day for HospitalsCAH to register for FFY 2011
2012
bullFeb 29th Last day for EPs to registerattest for FFY 2011
2015
bullPayment Adjustments (Penalties) Begin for EPs and eligible hospitals
2016
bullLast year to receive Medicare Incentive Payment
2021
bullLast year to receive Medicaid Incentive Payment
7
DO I QUALIFY
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
Measures
Summary
Eligible Providers (EPs)
Medicare
Eligible Professionals (EPs)
bull Ambulatory MDDO
bull Doctor of Dental Surgery or Dental Medicine
bull Doctor of Podiatric Medicine
bull Doctor of Optometry
bull Chiropractors
bull Medicaid Advantage (20 hoursweek of patient-care services for employees 80 of time for partners)
Eligible Hospitals
bull Acute Care Hospitals
bull Critical Access Hospitals (CAHs)
Subsection (d) hospitals that are paid under the PPS and are located in the 50 States or DC
Medicaid
Eligible Professionals (EPs)
bull Ambulatory Physicians (Pediatricians have special eligibility amp payment rules)
bull Nurse Practitioners (NPs)
bull Certified Nurse-Midwives (CNMs)
bull Dentists
bull Physician Assistants (PAs) who lead a Federally Qualified Health Center (FQHC) or rural health clinic (RHC)
Eligible Hospitals
bull Acute Care Hospitals
bull Critical Access Hospitals
bull Childrenrsquos Hospitals
httpsquestionscmshhsgovappanswersdetaila_id9844~[ehr-incentive-program]-are-physicians-who-practice-in-hospital-based
Note Excludes radiologists pathologists anesthesiologists ER and all other hospital-based physicians
Medicaid Eligibility
Formula
Total Medicaid Encounters
in a 90-Day Period
_________________________
Total Encounters
in same 90-Day Period
EntityMinimum
Threshold
Physicians 30
Pediatricians 20
Dentists 30
CNMs 30
PAs (at FQHC) 30
NPs 30
Acute Care Hospitals 10
Childrens Hospitals --Source httpwwwcmsgovMLNProductsdownloadsEHR_Final_Rule-
Medicaidpdf
10
THE MONEY
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
ndash Medicare $44kphysician
bull Bonuses up to $4400 for EPs in Health Provider
Shortage Areas (HPSAs)
ndash Medicaid $63750kphysician
bull Switching between programs
ndash Allowed but only once
Ambulatory Incentive Structure
Year MUer 2011 2012 2013 2014
2011 $18000 - - -
2012 $12000 $18000 - -
2013 $8000 $12000 $15000 -
2014 $4000 $8000 $12000 $12000
2015 $2000 $4000 $8000 $8000
2016 - $2000 $4000 $4000
TOTAL $44000 $44000 $39000 $24000
Medicare EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014
2011 $1800 - - -
2012 $1200 $1800 - -
2013 $800 $1200 $1500 -
2014 $400 $800 $1200 $12000
2015 $200 $400 $800 $8000
2016 - $200 $400 $4000
TOTAL $4400 $4400 $3900 $2400
Medicare HPSA EP Bonuses
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014 2015 2016
2011 $21250 - - - - -
2012 $8500 $21250 - - - -
2013 $8500 $8500 $21250 - - -
2014 $8500 $8500 $8500 $21250 - -
2015 $8500 $8500 $8500 $8500 $21250 -
2016 $8500 $8500 $8500 $8500 $8500 $21250
2017 - $8500 $8500 $8500 $8500 $8500
2018 - - $8500 $8500 $8500 $8500
2019 - - - $8500 $8500 $8500
2020 - - - - $8500 $8500
2021 - - - - - $8500
TOTAL $63750 $63750 $63750 $63750 $63750 $63750
Medicaid EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Hospital Incentive Structurebull The Money
bull Two Million Dollar Base + Variable Based on Discharges (MedicareMedicaid Share)
bull The Timeline bull Medicare no payments after 2016 Sticks start in 2015
bull Medicaid canrsquot initiate payments after 2016
bull The Caveats ndash All Medicare Hospitals qualify as Medicaid Hospitals
ndash Hospitals eligible for Medicare dollars may be eligible for Medicaid dollars
15
16
ARE YOU LEGAL
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
Certification
bull Temporary Certification Program is in place (set to expire December 2011)
bull Handled by external bodies
bull Currently there are three certifying agencies
ndash CCHIT ndash Chicago IL (83010)
bull Had offered preliminary certification
ndash Drummond Group ndash Austin TX (83010)
ndash InfoGard ndash San Luis Obispo CA (91710)
Vendors Planning to Achieve Certification
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
18
THE HEART OF IT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull You Gotta Have
ndash Ambulatory Providers = 15
ndash Hospitals = 14
ndash All Hospital Criteria Overlap with Ambulatory
bull the only addition to the ambulatory provider list is e-
Prescribing
ndash Most measures must be reported as structured
data
The Core Objectives
Core Objectives ndash Gotta Do bdquoem All
MaintainRecord
bull Maintain an up-to-date problem list of current and active diagnoses (50)
bull Maintain active medication list (80)
bull Maintain active medication allergy list (80)
bull Record and chart changes in vital signs (50)
bull Record smoking status for patients 13 years or older (50)
bull Record demographics (50)
DoImplement
bull Computerized physician order entry (CPOE) (30)
bull E-Prescribing (Ambulatory Only 40)
bull Drug-drug and drug-allergy interaction checks (enabled whole period)
bull Clinical decision support (1 rule)
bull Protect electronic health information (whole period)
ProvideReport
bull Report clinical quality measures to CMS or States (2011 Attestation 2012 Electronically)
bull Provide Patients with an electronic copy of their health information upon request (50 within 3 days)
bull Provide clinical summaries for patients for each office visitat each discharge (50 within 3 days)
bull Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (perform at least one test)
Source httphealthpolicyandreformnejmorgattachment_id=3742
Menu Sets ndash Pick Five
MaintainRecord
bull Incorporate clinical lab test results (50)
bull Record advanced directives for patients 65 years or older (Acute Only 50)
DoImplement
bull Drug-formulary checks (whole period)
bull Medication reconciliation (50)
ProvideReport
bull Generate lists of patients by specific conditions (at least 1 list)
bull Summary of care record for each transition of carereferrals (50)
bull Capability to provide electronic syndromic surveillance data to public health agencies (1 test)
bull Capability to submit electronic data to immunization registriessystems (1 test)
bull Provide patient-specific education resources and provide to patient (10)
bull Send reminders to patients per patient preference for preventivefollow up care (Ambulatory Only 20 in the 65lt amp lt5 age groups)
bull Provide patients with timely electronic access to their health information (Ambulatory Only 10 within 4 days)
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
bull ARRA gives out money with some caveats
1 Use of certified EHR in a meaningful manner
2 Use of certified EHR technology for electronic exchange of health information to improve quality of health care
3 Use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by the Secretary [of Health]
Why ldquoMeaningful Userdquo
The Five Pillars of Meaningful Use
Ensure Privacy and Security
Improve Population Health
Improve Safety and Quality
Engage Patients and Families
Coordinate Care
Basic Timeline
2009
bullFeb ARRAHITECH Become Law
bullDec NPRM on Display
2010
bullJan NPRM Published
bullMarch Comment Period Closes (2000 comments received)
bullJuly Final Rule
bullAugust Certifying Bodies
2011
bullJan States can begin to launch their programs
bull~Jan Registration
bull~March Attestation
bull~May Payments
bullNov 30th Last day for HospitalsCAH to register for FFY 2011
2012
bullFeb 29th Last day for EPs to registerattest for FFY 2011
2015
bullPayment Adjustments (Penalties) Begin for EPs and eligible hospitals
2016
bullLast year to receive Medicare Incentive Payment
2021
bullLast year to receive Medicaid Incentive Payment
7
DO I QUALIFY
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
Measures
Summary
Eligible Providers (EPs)
Medicare
Eligible Professionals (EPs)
bull Ambulatory MDDO
bull Doctor of Dental Surgery or Dental Medicine
bull Doctor of Podiatric Medicine
bull Doctor of Optometry
bull Chiropractors
bull Medicaid Advantage (20 hoursweek of patient-care services for employees 80 of time for partners)
Eligible Hospitals
bull Acute Care Hospitals
bull Critical Access Hospitals (CAHs)
Subsection (d) hospitals that are paid under the PPS and are located in the 50 States or DC
Medicaid
Eligible Professionals (EPs)
bull Ambulatory Physicians (Pediatricians have special eligibility amp payment rules)
bull Nurse Practitioners (NPs)
bull Certified Nurse-Midwives (CNMs)
bull Dentists
bull Physician Assistants (PAs) who lead a Federally Qualified Health Center (FQHC) or rural health clinic (RHC)
Eligible Hospitals
bull Acute Care Hospitals
bull Critical Access Hospitals
bull Childrenrsquos Hospitals
httpsquestionscmshhsgovappanswersdetaila_id9844~[ehr-incentive-program]-are-physicians-who-practice-in-hospital-based
Note Excludes radiologists pathologists anesthesiologists ER and all other hospital-based physicians
Medicaid Eligibility
Formula
Total Medicaid Encounters
in a 90-Day Period
_________________________
Total Encounters
in same 90-Day Period
EntityMinimum
Threshold
Physicians 30
Pediatricians 20
Dentists 30
CNMs 30
PAs (at FQHC) 30
NPs 30
Acute Care Hospitals 10
Childrens Hospitals --Source httpwwwcmsgovMLNProductsdownloadsEHR_Final_Rule-
Medicaidpdf
10
THE MONEY
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
ndash Medicare $44kphysician
bull Bonuses up to $4400 for EPs in Health Provider
Shortage Areas (HPSAs)
ndash Medicaid $63750kphysician
bull Switching between programs
ndash Allowed but only once
Ambulatory Incentive Structure
Year MUer 2011 2012 2013 2014
2011 $18000 - - -
2012 $12000 $18000 - -
2013 $8000 $12000 $15000 -
2014 $4000 $8000 $12000 $12000
2015 $2000 $4000 $8000 $8000
2016 - $2000 $4000 $4000
TOTAL $44000 $44000 $39000 $24000
Medicare EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014
2011 $1800 - - -
2012 $1200 $1800 - -
2013 $800 $1200 $1500 -
2014 $400 $800 $1200 $12000
2015 $200 $400 $800 $8000
2016 - $200 $400 $4000
TOTAL $4400 $4400 $3900 $2400
Medicare HPSA EP Bonuses
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014 2015 2016
2011 $21250 - - - - -
2012 $8500 $21250 - - - -
2013 $8500 $8500 $21250 - - -
2014 $8500 $8500 $8500 $21250 - -
2015 $8500 $8500 $8500 $8500 $21250 -
2016 $8500 $8500 $8500 $8500 $8500 $21250
2017 - $8500 $8500 $8500 $8500 $8500
2018 - - $8500 $8500 $8500 $8500
2019 - - - $8500 $8500 $8500
2020 - - - - $8500 $8500
2021 - - - - - $8500
TOTAL $63750 $63750 $63750 $63750 $63750 $63750
Medicaid EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Hospital Incentive Structurebull The Money
bull Two Million Dollar Base + Variable Based on Discharges (MedicareMedicaid Share)
bull The Timeline bull Medicare no payments after 2016 Sticks start in 2015
bull Medicaid canrsquot initiate payments after 2016
bull The Caveats ndash All Medicare Hospitals qualify as Medicaid Hospitals
ndash Hospitals eligible for Medicare dollars may be eligible for Medicaid dollars
15
16
ARE YOU LEGAL
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
Certification
bull Temporary Certification Program is in place (set to expire December 2011)
bull Handled by external bodies
bull Currently there are three certifying agencies
ndash CCHIT ndash Chicago IL (83010)
bull Had offered preliminary certification
ndash Drummond Group ndash Austin TX (83010)
ndash InfoGard ndash San Luis Obispo CA (91710)
Vendors Planning to Achieve Certification
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
18
THE HEART OF IT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull You Gotta Have
ndash Ambulatory Providers = 15
ndash Hospitals = 14
ndash All Hospital Criteria Overlap with Ambulatory
bull the only addition to the ambulatory provider list is e-
Prescribing
ndash Most measures must be reported as structured
data
The Core Objectives
Core Objectives ndash Gotta Do bdquoem All
MaintainRecord
bull Maintain an up-to-date problem list of current and active diagnoses (50)
bull Maintain active medication list (80)
bull Maintain active medication allergy list (80)
bull Record and chart changes in vital signs (50)
bull Record smoking status for patients 13 years or older (50)
bull Record demographics (50)
DoImplement
bull Computerized physician order entry (CPOE) (30)
bull E-Prescribing (Ambulatory Only 40)
bull Drug-drug and drug-allergy interaction checks (enabled whole period)
bull Clinical decision support (1 rule)
bull Protect electronic health information (whole period)
ProvideReport
bull Report clinical quality measures to CMS or States (2011 Attestation 2012 Electronically)
bull Provide Patients with an electronic copy of their health information upon request (50 within 3 days)
bull Provide clinical summaries for patients for each office visitat each discharge (50 within 3 days)
bull Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (perform at least one test)
Source httphealthpolicyandreformnejmorgattachment_id=3742
Menu Sets ndash Pick Five
MaintainRecord
bull Incorporate clinical lab test results (50)
bull Record advanced directives for patients 65 years or older (Acute Only 50)
DoImplement
bull Drug-formulary checks (whole period)
bull Medication reconciliation (50)
ProvideReport
bull Generate lists of patients by specific conditions (at least 1 list)
bull Summary of care record for each transition of carereferrals (50)
bull Capability to provide electronic syndromic surveillance data to public health agencies (1 test)
bull Capability to submit electronic data to immunization registriessystems (1 test)
bull Provide patient-specific education resources and provide to patient (10)
bull Send reminders to patients per patient preference for preventivefollow up care (Ambulatory Only 20 in the 65lt amp lt5 age groups)
bull Provide patients with timely electronic access to their health information (Ambulatory Only 10 within 4 days)
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
The Five Pillars of Meaningful Use
Ensure Privacy and Security
Improve Population Health
Improve Safety and Quality
Engage Patients and Families
Coordinate Care
Basic Timeline
2009
bullFeb ARRAHITECH Become Law
bullDec NPRM on Display
2010
bullJan NPRM Published
bullMarch Comment Period Closes (2000 comments received)
bullJuly Final Rule
bullAugust Certifying Bodies
2011
bullJan States can begin to launch their programs
bull~Jan Registration
bull~March Attestation
bull~May Payments
bullNov 30th Last day for HospitalsCAH to register for FFY 2011
2012
bullFeb 29th Last day for EPs to registerattest for FFY 2011
2015
bullPayment Adjustments (Penalties) Begin for EPs and eligible hospitals
2016
bullLast year to receive Medicare Incentive Payment
2021
bullLast year to receive Medicaid Incentive Payment
7
DO I QUALIFY
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
Measures
Summary
Eligible Providers (EPs)
Medicare
Eligible Professionals (EPs)
bull Ambulatory MDDO
bull Doctor of Dental Surgery or Dental Medicine
bull Doctor of Podiatric Medicine
bull Doctor of Optometry
bull Chiropractors
bull Medicaid Advantage (20 hoursweek of patient-care services for employees 80 of time for partners)
Eligible Hospitals
bull Acute Care Hospitals
bull Critical Access Hospitals (CAHs)
Subsection (d) hospitals that are paid under the PPS and are located in the 50 States or DC
Medicaid
Eligible Professionals (EPs)
bull Ambulatory Physicians (Pediatricians have special eligibility amp payment rules)
bull Nurse Practitioners (NPs)
bull Certified Nurse-Midwives (CNMs)
bull Dentists
bull Physician Assistants (PAs) who lead a Federally Qualified Health Center (FQHC) or rural health clinic (RHC)
Eligible Hospitals
bull Acute Care Hospitals
bull Critical Access Hospitals
bull Childrenrsquos Hospitals
httpsquestionscmshhsgovappanswersdetaila_id9844~[ehr-incentive-program]-are-physicians-who-practice-in-hospital-based
Note Excludes radiologists pathologists anesthesiologists ER and all other hospital-based physicians
Medicaid Eligibility
Formula
Total Medicaid Encounters
in a 90-Day Period
_________________________
Total Encounters
in same 90-Day Period
EntityMinimum
Threshold
Physicians 30
Pediatricians 20
Dentists 30
CNMs 30
PAs (at FQHC) 30
NPs 30
Acute Care Hospitals 10
Childrens Hospitals --Source httpwwwcmsgovMLNProductsdownloadsEHR_Final_Rule-
Medicaidpdf
10
THE MONEY
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
ndash Medicare $44kphysician
bull Bonuses up to $4400 for EPs in Health Provider
Shortage Areas (HPSAs)
ndash Medicaid $63750kphysician
bull Switching between programs
ndash Allowed but only once
Ambulatory Incentive Structure
Year MUer 2011 2012 2013 2014
2011 $18000 - - -
2012 $12000 $18000 - -
2013 $8000 $12000 $15000 -
2014 $4000 $8000 $12000 $12000
2015 $2000 $4000 $8000 $8000
2016 - $2000 $4000 $4000
TOTAL $44000 $44000 $39000 $24000
Medicare EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014
2011 $1800 - - -
2012 $1200 $1800 - -
2013 $800 $1200 $1500 -
2014 $400 $800 $1200 $12000
2015 $200 $400 $800 $8000
2016 - $200 $400 $4000
TOTAL $4400 $4400 $3900 $2400
Medicare HPSA EP Bonuses
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014 2015 2016
2011 $21250 - - - - -
2012 $8500 $21250 - - - -
2013 $8500 $8500 $21250 - - -
2014 $8500 $8500 $8500 $21250 - -
2015 $8500 $8500 $8500 $8500 $21250 -
2016 $8500 $8500 $8500 $8500 $8500 $21250
2017 - $8500 $8500 $8500 $8500 $8500
2018 - - $8500 $8500 $8500 $8500
2019 - - - $8500 $8500 $8500
2020 - - - - $8500 $8500
2021 - - - - - $8500
TOTAL $63750 $63750 $63750 $63750 $63750 $63750
Medicaid EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Hospital Incentive Structurebull The Money
bull Two Million Dollar Base + Variable Based on Discharges (MedicareMedicaid Share)
bull The Timeline bull Medicare no payments after 2016 Sticks start in 2015
bull Medicaid canrsquot initiate payments after 2016
bull The Caveats ndash All Medicare Hospitals qualify as Medicaid Hospitals
ndash Hospitals eligible for Medicare dollars may be eligible for Medicaid dollars
15
16
ARE YOU LEGAL
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
Certification
bull Temporary Certification Program is in place (set to expire December 2011)
bull Handled by external bodies
bull Currently there are three certifying agencies
ndash CCHIT ndash Chicago IL (83010)
bull Had offered preliminary certification
ndash Drummond Group ndash Austin TX (83010)
ndash InfoGard ndash San Luis Obispo CA (91710)
Vendors Planning to Achieve Certification
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
18
THE HEART OF IT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull You Gotta Have
ndash Ambulatory Providers = 15
ndash Hospitals = 14
ndash All Hospital Criteria Overlap with Ambulatory
bull the only addition to the ambulatory provider list is e-
Prescribing
ndash Most measures must be reported as structured
data
The Core Objectives
Core Objectives ndash Gotta Do bdquoem All
MaintainRecord
bull Maintain an up-to-date problem list of current and active diagnoses (50)
bull Maintain active medication list (80)
bull Maintain active medication allergy list (80)
bull Record and chart changes in vital signs (50)
bull Record smoking status for patients 13 years or older (50)
bull Record demographics (50)
DoImplement
bull Computerized physician order entry (CPOE) (30)
bull E-Prescribing (Ambulatory Only 40)
bull Drug-drug and drug-allergy interaction checks (enabled whole period)
bull Clinical decision support (1 rule)
bull Protect electronic health information (whole period)
ProvideReport
bull Report clinical quality measures to CMS or States (2011 Attestation 2012 Electronically)
bull Provide Patients with an electronic copy of their health information upon request (50 within 3 days)
bull Provide clinical summaries for patients for each office visitat each discharge (50 within 3 days)
bull Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (perform at least one test)
Source httphealthpolicyandreformnejmorgattachment_id=3742
Menu Sets ndash Pick Five
MaintainRecord
bull Incorporate clinical lab test results (50)
bull Record advanced directives for patients 65 years or older (Acute Only 50)
DoImplement
bull Drug-formulary checks (whole period)
bull Medication reconciliation (50)
ProvideReport
bull Generate lists of patients by specific conditions (at least 1 list)
bull Summary of care record for each transition of carereferrals (50)
bull Capability to provide electronic syndromic surveillance data to public health agencies (1 test)
bull Capability to submit electronic data to immunization registriessystems (1 test)
bull Provide patient-specific education resources and provide to patient (10)
bull Send reminders to patients per patient preference for preventivefollow up care (Ambulatory Only 20 in the 65lt amp lt5 age groups)
bull Provide patients with timely electronic access to their health information (Ambulatory Only 10 within 4 days)
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
Basic Timeline
2009
bullFeb ARRAHITECH Become Law
bullDec NPRM on Display
2010
bullJan NPRM Published
bullMarch Comment Period Closes (2000 comments received)
bullJuly Final Rule
bullAugust Certifying Bodies
2011
bullJan States can begin to launch their programs
bull~Jan Registration
bull~March Attestation
bull~May Payments
bullNov 30th Last day for HospitalsCAH to register for FFY 2011
2012
bullFeb 29th Last day for EPs to registerattest for FFY 2011
2015
bullPayment Adjustments (Penalties) Begin for EPs and eligible hospitals
2016
bullLast year to receive Medicare Incentive Payment
2021
bullLast year to receive Medicaid Incentive Payment
7
DO I QUALIFY
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
Measures
Summary
Eligible Providers (EPs)
Medicare
Eligible Professionals (EPs)
bull Ambulatory MDDO
bull Doctor of Dental Surgery or Dental Medicine
bull Doctor of Podiatric Medicine
bull Doctor of Optometry
bull Chiropractors
bull Medicaid Advantage (20 hoursweek of patient-care services for employees 80 of time for partners)
Eligible Hospitals
bull Acute Care Hospitals
bull Critical Access Hospitals (CAHs)
Subsection (d) hospitals that are paid under the PPS and are located in the 50 States or DC
Medicaid
Eligible Professionals (EPs)
bull Ambulatory Physicians (Pediatricians have special eligibility amp payment rules)
bull Nurse Practitioners (NPs)
bull Certified Nurse-Midwives (CNMs)
bull Dentists
bull Physician Assistants (PAs) who lead a Federally Qualified Health Center (FQHC) or rural health clinic (RHC)
Eligible Hospitals
bull Acute Care Hospitals
bull Critical Access Hospitals
bull Childrenrsquos Hospitals
httpsquestionscmshhsgovappanswersdetaila_id9844~[ehr-incentive-program]-are-physicians-who-practice-in-hospital-based
Note Excludes radiologists pathologists anesthesiologists ER and all other hospital-based physicians
Medicaid Eligibility
Formula
Total Medicaid Encounters
in a 90-Day Period
_________________________
Total Encounters
in same 90-Day Period
EntityMinimum
Threshold
Physicians 30
Pediatricians 20
Dentists 30
CNMs 30
PAs (at FQHC) 30
NPs 30
Acute Care Hospitals 10
Childrens Hospitals --Source httpwwwcmsgovMLNProductsdownloadsEHR_Final_Rule-
Medicaidpdf
10
THE MONEY
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
ndash Medicare $44kphysician
bull Bonuses up to $4400 for EPs in Health Provider
Shortage Areas (HPSAs)
ndash Medicaid $63750kphysician
bull Switching between programs
ndash Allowed but only once
Ambulatory Incentive Structure
Year MUer 2011 2012 2013 2014
2011 $18000 - - -
2012 $12000 $18000 - -
2013 $8000 $12000 $15000 -
2014 $4000 $8000 $12000 $12000
2015 $2000 $4000 $8000 $8000
2016 - $2000 $4000 $4000
TOTAL $44000 $44000 $39000 $24000
Medicare EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014
2011 $1800 - - -
2012 $1200 $1800 - -
2013 $800 $1200 $1500 -
2014 $400 $800 $1200 $12000
2015 $200 $400 $800 $8000
2016 - $200 $400 $4000
TOTAL $4400 $4400 $3900 $2400
Medicare HPSA EP Bonuses
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014 2015 2016
2011 $21250 - - - - -
2012 $8500 $21250 - - - -
2013 $8500 $8500 $21250 - - -
2014 $8500 $8500 $8500 $21250 - -
2015 $8500 $8500 $8500 $8500 $21250 -
2016 $8500 $8500 $8500 $8500 $8500 $21250
2017 - $8500 $8500 $8500 $8500 $8500
2018 - - $8500 $8500 $8500 $8500
2019 - - - $8500 $8500 $8500
2020 - - - - $8500 $8500
2021 - - - - - $8500
TOTAL $63750 $63750 $63750 $63750 $63750 $63750
Medicaid EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Hospital Incentive Structurebull The Money
bull Two Million Dollar Base + Variable Based on Discharges (MedicareMedicaid Share)
bull The Timeline bull Medicare no payments after 2016 Sticks start in 2015
bull Medicaid canrsquot initiate payments after 2016
bull The Caveats ndash All Medicare Hospitals qualify as Medicaid Hospitals
ndash Hospitals eligible for Medicare dollars may be eligible for Medicaid dollars
15
16
ARE YOU LEGAL
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
Certification
bull Temporary Certification Program is in place (set to expire December 2011)
bull Handled by external bodies
bull Currently there are three certifying agencies
ndash CCHIT ndash Chicago IL (83010)
bull Had offered preliminary certification
ndash Drummond Group ndash Austin TX (83010)
ndash InfoGard ndash San Luis Obispo CA (91710)
Vendors Planning to Achieve Certification
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
18
THE HEART OF IT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull You Gotta Have
ndash Ambulatory Providers = 15
ndash Hospitals = 14
ndash All Hospital Criteria Overlap with Ambulatory
bull the only addition to the ambulatory provider list is e-
Prescribing
ndash Most measures must be reported as structured
data
The Core Objectives
Core Objectives ndash Gotta Do bdquoem All
MaintainRecord
bull Maintain an up-to-date problem list of current and active diagnoses (50)
bull Maintain active medication list (80)
bull Maintain active medication allergy list (80)
bull Record and chart changes in vital signs (50)
bull Record smoking status for patients 13 years or older (50)
bull Record demographics (50)
DoImplement
bull Computerized physician order entry (CPOE) (30)
bull E-Prescribing (Ambulatory Only 40)
bull Drug-drug and drug-allergy interaction checks (enabled whole period)
bull Clinical decision support (1 rule)
bull Protect electronic health information (whole period)
ProvideReport
bull Report clinical quality measures to CMS or States (2011 Attestation 2012 Electronically)
bull Provide Patients with an electronic copy of their health information upon request (50 within 3 days)
bull Provide clinical summaries for patients for each office visitat each discharge (50 within 3 days)
bull Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (perform at least one test)
Source httphealthpolicyandreformnejmorgattachment_id=3742
Menu Sets ndash Pick Five
MaintainRecord
bull Incorporate clinical lab test results (50)
bull Record advanced directives for patients 65 years or older (Acute Only 50)
DoImplement
bull Drug-formulary checks (whole period)
bull Medication reconciliation (50)
ProvideReport
bull Generate lists of patients by specific conditions (at least 1 list)
bull Summary of care record for each transition of carereferrals (50)
bull Capability to provide electronic syndromic surveillance data to public health agencies (1 test)
bull Capability to submit electronic data to immunization registriessystems (1 test)
bull Provide patient-specific education resources and provide to patient (10)
bull Send reminders to patients per patient preference for preventivefollow up care (Ambulatory Only 20 in the 65lt amp lt5 age groups)
bull Provide patients with timely electronic access to their health information (Ambulatory Only 10 within 4 days)
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
7
DO I QUALIFY
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
Measures
Summary
Eligible Providers (EPs)
Medicare
Eligible Professionals (EPs)
bull Ambulatory MDDO
bull Doctor of Dental Surgery or Dental Medicine
bull Doctor of Podiatric Medicine
bull Doctor of Optometry
bull Chiropractors
bull Medicaid Advantage (20 hoursweek of patient-care services for employees 80 of time for partners)
Eligible Hospitals
bull Acute Care Hospitals
bull Critical Access Hospitals (CAHs)
Subsection (d) hospitals that are paid under the PPS and are located in the 50 States or DC
Medicaid
Eligible Professionals (EPs)
bull Ambulatory Physicians (Pediatricians have special eligibility amp payment rules)
bull Nurse Practitioners (NPs)
bull Certified Nurse-Midwives (CNMs)
bull Dentists
bull Physician Assistants (PAs) who lead a Federally Qualified Health Center (FQHC) or rural health clinic (RHC)
Eligible Hospitals
bull Acute Care Hospitals
bull Critical Access Hospitals
bull Childrenrsquos Hospitals
httpsquestionscmshhsgovappanswersdetaila_id9844~[ehr-incentive-program]-are-physicians-who-practice-in-hospital-based
Note Excludes radiologists pathologists anesthesiologists ER and all other hospital-based physicians
Medicaid Eligibility
Formula
Total Medicaid Encounters
in a 90-Day Period
_________________________
Total Encounters
in same 90-Day Period
EntityMinimum
Threshold
Physicians 30
Pediatricians 20
Dentists 30
CNMs 30
PAs (at FQHC) 30
NPs 30
Acute Care Hospitals 10
Childrens Hospitals --Source httpwwwcmsgovMLNProductsdownloadsEHR_Final_Rule-
Medicaidpdf
10
THE MONEY
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
ndash Medicare $44kphysician
bull Bonuses up to $4400 for EPs in Health Provider
Shortage Areas (HPSAs)
ndash Medicaid $63750kphysician
bull Switching between programs
ndash Allowed but only once
Ambulatory Incentive Structure
Year MUer 2011 2012 2013 2014
2011 $18000 - - -
2012 $12000 $18000 - -
2013 $8000 $12000 $15000 -
2014 $4000 $8000 $12000 $12000
2015 $2000 $4000 $8000 $8000
2016 - $2000 $4000 $4000
TOTAL $44000 $44000 $39000 $24000
Medicare EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014
2011 $1800 - - -
2012 $1200 $1800 - -
2013 $800 $1200 $1500 -
2014 $400 $800 $1200 $12000
2015 $200 $400 $800 $8000
2016 - $200 $400 $4000
TOTAL $4400 $4400 $3900 $2400
Medicare HPSA EP Bonuses
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014 2015 2016
2011 $21250 - - - - -
2012 $8500 $21250 - - - -
2013 $8500 $8500 $21250 - - -
2014 $8500 $8500 $8500 $21250 - -
2015 $8500 $8500 $8500 $8500 $21250 -
2016 $8500 $8500 $8500 $8500 $8500 $21250
2017 - $8500 $8500 $8500 $8500 $8500
2018 - - $8500 $8500 $8500 $8500
2019 - - - $8500 $8500 $8500
2020 - - - - $8500 $8500
2021 - - - - - $8500
TOTAL $63750 $63750 $63750 $63750 $63750 $63750
Medicaid EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Hospital Incentive Structurebull The Money
bull Two Million Dollar Base + Variable Based on Discharges (MedicareMedicaid Share)
bull The Timeline bull Medicare no payments after 2016 Sticks start in 2015
bull Medicaid canrsquot initiate payments after 2016
bull The Caveats ndash All Medicare Hospitals qualify as Medicaid Hospitals
ndash Hospitals eligible for Medicare dollars may be eligible for Medicaid dollars
15
16
ARE YOU LEGAL
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
Certification
bull Temporary Certification Program is in place (set to expire December 2011)
bull Handled by external bodies
bull Currently there are three certifying agencies
ndash CCHIT ndash Chicago IL (83010)
bull Had offered preliminary certification
ndash Drummond Group ndash Austin TX (83010)
ndash InfoGard ndash San Luis Obispo CA (91710)
Vendors Planning to Achieve Certification
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
18
THE HEART OF IT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull You Gotta Have
ndash Ambulatory Providers = 15
ndash Hospitals = 14
ndash All Hospital Criteria Overlap with Ambulatory
bull the only addition to the ambulatory provider list is e-
Prescribing
ndash Most measures must be reported as structured
data
The Core Objectives
Core Objectives ndash Gotta Do bdquoem All
MaintainRecord
bull Maintain an up-to-date problem list of current and active diagnoses (50)
bull Maintain active medication list (80)
bull Maintain active medication allergy list (80)
bull Record and chart changes in vital signs (50)
bull Record smoking status for patients 13 years or older (50)
bull Record demographics (50)
DoImplement
bull Computerized physician order entry (CPOE) (30)
bull E-Prescribing (Ambulatory Only 40)
bull Drug-drug and drug-allergy interaction checks (enabled whole period)
bull Clinical decision support (1 rule)
bull Protect electronic health information (whole period)
ProvideReport
bull Report clinical quality measures to CMS or States (2011 Attestation 2012 Electronically)
bull Provide Patients with an electronic copy of their health information upon request (50 within 3 days)
bull Provide clinical summaries for patients for each office visitat each discharge (50 within 3 days)
bull Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (perform at least one test)
Source httphealthpolicyandreformnejmorgattachment_id=3742
Menu Sets ndash Pick Five
MaintainRecord
bull Incorporate clinical lab test results (50)
bull Record advanced directives for patients 65 years or older (Acute Only 50)
DoImplement
bull Drug-formulary checks (whole period)
bull Medication reconciliation (50)
ProvideReport
bull Generate lists of patients by specific conditions (at least 1 list)
bull Summary of care record for each transition of carereferrals (50)
bull Capability to provide electronic syndromic surveillance data to public health agencies (1 test)
bull Capability to submit electronic data to immunization registriessystems (1 test)
bull Provide patient-specific education resources and provide to patient (10)
bull Send reminders to patients per patient preference for preventivefollow up care (Ambulatory Only 20 in the 65lt amp lt5 age groups)
bull Provide patients with timely electronic access to their health information (Ambulatory Only 10 within 4 days)
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
Eligible Providers (EPs)
Medicare
Eligible Professionals (EPs)
bull Ambulatory MDDO
bull Doctor of Dental Surgery or Dental Medicine
bull Doctor of Podiatric Medicine
bull Doctor of Optometry
bull Chiropractors
bull Medicaid Advantage (20 hoursweek of patient-care services for employees 80 of time for partners)
Eligible Hospitals
bull Acute Care Hospitals
bull Critical Access Hospitals (CAHs)
Subsection (d) hospitals that are paid under the PPS and are located in the 50 States or DC
Medicaid
Eligible Professionals (EPs)
bull Ambulatory Physicians (Pediatricians have special eligibility amp payment rules)
bull Nurse Practitioners (NPs)
bull Certified Nurse-Midwives (CNMs)
bull Dentists
bull Physician Assistants (PAs) who lead a Federally Qualified Health Center (FQHC) or rural health clinic (RHC)
Eligible Hospitals
bull Acute Care Hospitals
bull Critical Access Hospitals
bull Childrenrsquos Hospitals
httpsquestionscmshhsgovappanswersdetaila_id9844~[ehr-incentive-program]-are-physicians-who-practice-in-hospital-based
Note Excludes radiologists pathologists anesthesiologists ER and all other hospital-based physicians
Medicaid Eligibility
Formula
Total Medicaid Encounters
in a 90-Day Period
_________________________
Total Encounters
in same 90-Day Period
EntityMinimum
Threshold
Physicians 30
Pediatricians 20
Dentists 30
CNMs 30
PAs (at FQHC) 30
NPs 30
Acute Care Hospitals 10
Childrens Hospitals --Source httpwwwcmsgovMLNProductsdownloadsEHR_Final_Rule-
Medicaidpdf
10
THE MONEY
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
ndash Medicare $44kphysician
bull Bonuses up to $4400 for EPs in Health Provider
Shortage Areas (HPSAs)
ndash Medicaid $63750kphysician
bull Switching between programs
ndash Allowed but only once
Ambulatory Incentive Structure
Year MUer 2011 2012 2013 2014
2011 $18000 - - -
2012 $12000 $18000 - -
2013 $8000 $12000 $15000 -
2014 $4000 $8000 $12000 $12000
2015 $2000 $4000 $8000 $8000
2016 - $2000 $4000 $4000
TOTAL $44000 $44000 $39000 $24000
Medicare EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014
2011 $1800 - - -
2012 $1200 $1800 - -
2013 $800 $1200 $1500 -
2014 $400 $800 $1200 $12000
2015 $200 $400 $800 $8000
2016 - $200 $400 $4000
TOTAL $4400 $4400 $3900 $2400
Medicare HPSA EP Bonuses
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014 2015 2016
2011 $21250 - - - - -
2012 $8500 $21250 - - - -
2013 $8500 $8500 $21250 - - -
2014 $8500 $8500 $8500 $21250 - -
2015 $8500 $8500 $8500 $8500 $21250 -
2016 $8500 $8500 $8500 $8500 $8500 $21250
2017 - $8500 $8500 $8500 $8500 $8500
2018 - - $8500 $8500 $8500 $8500
2019 - - - $8500 $8500 $8500
2020 - - - - $8500 $8500
2021 - - - - - $8500
TOTAL $63750 $63750 $63750 $63750 $63750 $63750
Medicaid EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Hospital Incentive Structurebull The Money
bull Two Million Dollar Base + Variable Based on Discharges (MedicareMedicaid Share)
bull The Timeline bull Medicare no payments after 2016 Sticks start in 2015
bull Medicaid canrsquot initiate payments after 2016
bull The Caveats ndash All Medicare Hospitals qualify as Medicaid Hospitals
ndash Hospitals eligible for Medicare dollars may be eligible for Medicaid dollars
15
16
ARE YOU LEGAL
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
Certification
bull Temporary Certification Program is in place (set to expire December 2011)
bull Handled by external bodies
bull Currently there are three certifying agencies
ndash CCHIT ndash Chicago IL (83010)
bull Had offered preliminary certification
ndash Drummond Group ndash Austin TX (83010)
ndash InfoGard ndash San Luis Obispo CA (91710)
Vendors Planning to Achieve Certification
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
18
THE HEART OF IT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull You Gotta Have
ndash Ambulatory Providers = 15
ndash Hospitals = 14
ndash All Hospital Criteria Overlap with Ambulatory
bull the only addition to the ambulatory provider list is e-
Prescribing
ndash Most measures must be reported as structured
data
The Core Objectives
Core Objectives ndash Gotta Do bdquoem All
MaintainRecord
bull Maintain an up-to-date problem list of current and active diagnoses (50)
bull Maintain active medication list (80)
bull Maintain active medication allergy list (80)
bull Record and chart changes in vital signs (50)
bull Record smoking status for patients 13 years or older (50)
bull Record demographics (50)
DoImplement
bull Computerized physician order entry (CPOE) (30)
bull E-Prescribing (Ambulatory Only 40)
bull Drug-drug and drug-allergy interaction checks (enabled whole period)
bull Clinical decision support (1 rule)
bull Protect electronic health information (whole period)
ProvideReport
bull Report clinical quality measures to CMS or States (2011 Attestation 2012 Electronically)
bull Provide Patients with an electronic copy of their health information upon request (50 within 3 days)
bull Provide clinical summaries for patients for each office visitat each discharge (50 within 3 days)
bull Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (perform at least one test)
Source httphealthpolicyandreformnejmorgattachment_id=3742
Menu Sets ndash Pick Five
MaintainRecord
bull Incorporate clinical lab test results (50)
bull Record advanced directives for patients 65 years or older (Acute Only 50)
DoImplement
bull Drug-formulary checks (whole period)
bull Medication reconciliation (50)
ProvideReport
bull Generate lists of patients by specific conditions (at least 1 list)
bull Summary of care record for each transition of carereferrals (50)
bull Capability to provide electronic syndromic surveillance data to public health agencies (1 test)
bull Capability to submit electronic data to immunization registriessystems (1 test)
bull Provide patient-specific education resources and provide to patient (10)
bull Send reminders to patients per patient preference for preventivefollow up care (Ambulatory Only 20 in the 65lt amp lt5 age groups)
bull Provide patients with timely electronic access to their health information (Ambulatory Only 10 within 4 days)
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
Medicaid Eligibility
Formula
Total Medicaid Encounters
in a 90-Day Period
_________________________
Total Encounters
in same 90-Day Period
EntityMinimum
Threshold
Physicians 30
Pediatricians 20
Dentists 30
CNMs 30
PAs (at FQHC) 30
NPs 30
Acute Care Hospitals 10
Childrens Hospitals --Source httpwwwcmsgovMLNProductsdownloadsEHR_Final_Rule-
Medicaidpdf
10
THE MONEY
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
ndash Medicare $44kphysician
bull Bonuses up to $4400 for EPs in Health Provider
Shortage Areas (HPSAs)
ndash Medicaid $63750kphysician
bull Switching between programs
ndash Allowed but only once
Ambulatory Incentive Structure
Year MUer 2011 2012 2013 2014
2011 $18000 - - -
2012 $12000 $18000 - -
2013 $8000 $12000 $15000 -
2014 $4000 $8000 $12000 $12000
2015 $2000 $4000 $8000 $8000
2016 - $2000 $4000 $4000
TOTAL $44000 $44000 $39000 $24000
Medicare EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014
2011 $1800 - - -
2012 $1200 $1800 - -
2013 $800 $1200 $1500 -
2014 $400 $800 $1200 $12000
2015 $200 $400 $800 $8000
2016 - $200 $400 $4000
TOTAL $4400 $4400 $3900 $2400
Medicare HPSA EP Bonuses
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014 2015 2016
2011 $21250 - - - - -
2012 $8500 $21250 - - - -
2013 $8500 $8500 $21250 - - -
2014 $8500 $8500 $8500 $21250 - -
2015 $8500 $8500 $8500 $8500 $21250 -
2016 $8500 $8500 $8500 $8500 $8500 $21250
2017 - $8500 $8500 $8500 $8500 $8500
2018 - - $8500 $8500 $8500 $8500
2019 - - - $8500 $8500 $8500
2020 - - - - $8500 $8500
2021 - - - - - $8500
TOTAL $63750 $63750 $63750 $63750 $63750 $63750
Medicaid EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Hospital Incentive Structurebull The Money
bull Two Million Dollar Base + Variable Based on Discharges (MedicareMedicaid Share)
bull The Timeline bull Medicare no payments after 2016 Sticks start in 2015
bull Medicaid canrsquot initiate payments after 2016
bull The Caveats ndash All Medicare Hospitals qualify as Medicaid Hospitals
ndash Hospitals eligible for Medicare dollars may be eligible for Medicaid dollars
15
16
ARE YOU LEGAL
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
Certification
bull Temporary Certification Program is in place (set to expire December 2011)
bull Handled by external bodies
bull Currently there are three certifying agencies
ndash CCHIT ndash Chicago IL (83010)
bull Had offered preliminary certification
ndash Drummond Group ndash Austin TX (83010)
ndash InfoGard ndash San Luis Obispo CA (91710)
Vendors Planning to Achieve Certification
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
18
THE HEART OF IT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull You Gotta Have
ndash Ambulatory Providers = 15
ndash Hospitals = 14
ndash All Hospital Criteria Overlap with Ambulatory
bull the only addition to the ambulatory provider list is e-
Prescribing
ndash Most measures must be reported as structured
data
The Core Objectives
Core Objectives ndash Gotta Do bdquoem All
MaintainRecord
bull Maintain an up-to-date problem list of current and active diagnoses (50)
bull Maintain active medication list (80)
bull Maintain active medication allergy list (80)
bull Record and chart changes in vital signs (50)
bull Record smoking status for patients 13 years or older (50)
bull Record demographics (50)
DoImplement
bull Computerized physician order entry (CPOE) (30)
bull E-Prescribing (Ambulatory Only 40)
bull Drug-drug and drug-allergy interaction checks (enabled whole period)
bull Clinical decision support (1 rule)
bull Protect electronic health information (whole period)
ProvideReport
bull Report clinical quality measures to CMS or States (2011 Attestation 2012 Electronically)
bull Provide Patients with an electronic copy of their health information upon request (50 within 3 days)
bull Provide clinical summaries for patients for each office visitat each discharge (50 within 3 days)
bull Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (perform at least one test)
Source httphealthpolicyandreformnejmorgattachment_id=3742
Menu Sets ndash Pick Five
MaintainRecord
bull Incorporate clinical lab test results (50)
bull Record advanced directives for patients 65 years or older (Acute Only 50)
DoImplement
bull Drug-formulary checks (whole period)
bull Medication reconciliation (50)
ProvideReport
bull Generate lists of patients by specific conditions (at least 1 list)
bull Summary of care record for each transition of carereferrals (50)
bull Capability to provide electronic syndromic surveillance data to public health agencies (1 test)
bull Capability to submit electronic data to immunization registriessystems (1 test)
bull Provide patient-specific education resources and provide to patient (10)
bull Send reminders to patients per patient preference for preventivefollow up care (Ambulatory Only 20 in the 65lt amp lt5 age groups)
bull Provide patients with timely electronic access to their health information (Ambulatory Only 10 within 4 days)
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
10
THE MONEY
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
ndash Medicare $44kphysician
bull Bonuses up to $4400 for EPs in Health Provider
Shortage Areas (HPSAs)
ndash Medicaid $63750kphysician
bull Switching between programs
ndash Allowed but only once
Ambulatory Incentive Structure
Year MUer 2011 2012 2013 2014
2011 $18000 - - -
2012 $12000 $18000 - -
2013 $8000 $12000 $15000 -
2014 $4000 $8000 $12000 $12000
2015 $2000 $4000 $8000 $8000
2016 - $2000 $4000 $4000
TOTAL $44000 $44000 $39000 $24000
Medicare EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014
2011 $1800 - - -
2012 $1200 $1800 - -
2013 $800 $1200 $1500 -
2014 $400 $800 $1200 $12000
2015 $200 $400 $800 $8000
2016 - $200 $400 $4000
TOTAL $4400 $4400 $3900 $2400
Medicare HPSA EP Bonuses
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014 2015 2016
2011 $21250 - - - - -
2012 $8500 $21250 - - - -
2013 $8500 $8500 $21250 - - -
2014 $8500 $8500 $8500 $21250 - -
2015 $8500 $8500 $8500 $8500 $21250 -
2016 $8500 $8500 $8500 $8500 $8500 $21250
2017 - $8500 $8500 $8500 $8500 $8500
2018 - - $8500 $8500 $8500 $8500
2019 - - - $8500 $8500 $8500
2020 - - - - $8500 $8500
2021 - - - - - $8500
TOTAL $63750 $63750 $63750 $63750 $63750 $63750
Medicaid EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Hospital Incentive Structurebull The Money
bull Two Million Dollar Base + Variable Based on Discharges (MedicareMedicaid Share)
bull The Timeline bull Medicare no payments after 2016 Sticks start in 2015
bull Medicaid canrsquot initiate payments after 2016
bull The Caveats ndash All Medicare Hospitals qualify as Medicaid Hospitals
ndash Hospitals eligible for Medicare dollars may be eligible for Medicaid dollars
15
16
ARE YOU LEGAL
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
Certification
bull Temporary Certification Program is in place (set to expire December 2011)
bull Handled by external bodies
bull Currently there are three certifying agencies
ndash CCHIT ndash Chicago IL (83010)
bull Had offered preliminary certification
ndash Drummond Group ndash Austin TX (83010)
ndash InfoGard ndash San Luis Obispo CA (91710)
Vendors Planning to Achieve Certification
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
18
THE HEART OF IT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull You Gotta Have
ndash Ambulatory Providers = 15
ndash Hospitals = 14
ndash All Hospital Criteria Overlap with Ambulatory
bull the only addition to the ambulatory provider list is e-
Prescribing
ndash Most measures must be reported as structured
data
The Core Objectives
Core Objectives ndash Gotta Do bdquoem All
MaintainRecord
bull Maintain an up-to-date problem list of current and active diagnoses (50)
bull Maintain active medication list (80)
bull Maintain active medication allergy list (80)
bull Record and chart changes in vital signs (50)
bull Record smoking status for patients 13 years or older (50)
bull Record demographics (50)
DoImplement
bull Computerized physician order entry (CPOE) (30)
bull E-Prescribing (Ambulatory Only 40)
bull Drug-drug and drug-allergy interaction checks (enabled whole period)
bull Clinical decision support (1 rule)
bull Protect electronic health information (whole period)
ProvideReport
bull Report clinical quality measures to CMS or States (2011 Attestation 2012 Electronically)
bull Provide Patients with an electronic copy of their health information upon request (50 within 3 days)
bull Provide clinical summaries for patients for each office visitat each discharge (50 within 3 days)
bull Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (perform at least one test)
Source httphealthpolicyandreformnejmorgattachment_id=3742
Menu Sets ndash Pick Five
MaintainRecord
bull Incorporate clinical lab test results (50)
bull Record advanced directives for patients 65 years or older (Acute Only 50)
DoImplement
bull Drug-formulary checks (whole period)
bull Medication reconciliation (50)
ProvideReport
bull Generate lists of patients by specific conditions (at least 1 list)
bull Summary of care record for each transition of carereferrals (50)
bull Capability to provide electronic syndromic surveillance data to public health agencies (1 test)
bull Capability to submit electronic data to immunization registriessystems (1 test)
bull Provide patient-specific education resources and provide to patient (10)
bull Send reminders to patients per patient preference for preventivefollow up care (Ambulatory Only 20 in the 65lt amp lt5 age groups)
bull Provide patients with timely electronic access to their health information (Ambulatory Only 10 within 4 days)
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
ndash Medicare $44kphysician
bull Bonuses up to $4400 for EPs in Health Provider
Shortage Areas (HPSAs)
ndash Medicaid $63750kphysician
bull Switching between programs
ndash Allowed but only once
Ambulatory Incentive Structure
Year MUer 2011 2012 2013 2014
2011 $18000 - - -
2012 $12000 $18000 - -
2013 $8000 $12000 $15000 -
2014 $4000 $8000 $12000 $12000
2015 $2000 $4000 $8000 $8000
2016 - $2000 $4000 $4000
TOTAL $44000 $44000 $39000 $24000
Medicare EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014
2011 $1800 - - -
2012 $1200 $1800 - -
2013 $800 $1200 $1500 -
2014 $400 $800 $1200 $12000
2015 $200 $400 $800 $8000
2016 - $200 $400 $4000
TOTAL $4400 $4400 $3900 $2400
Medicare HPSA EP Bonuses
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014 2015 2016
2011 $21250 - - - - -
2012 $8500 $21250 - - - -
2013 $8500 $8500 $21250 - - -
2014 $8500 $8500 $8500 $21250 - -
2015 $8500 $8500 $8500 $8500 $21250 -
2016 $8500 $8500 $8500 $8500 $8500 $21250
2017 - $8500 $8500 $8500 $8500 $8500
2018 - - $8500 $8500 $8500 $8500
2019 - - - $8500 $8500 $8500
2020 - - - - $8500 $8500
2021 - - - - - $8500
TOTAL $63750 $63750 $63750 $63750 $63750 $63750
Medicaid EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Hospital Incentive Structurebull The Money
bull Two Million Dollar Base + Variable Based on Discharges (MedicareMedicaid Share)
bull The Timeline bull Medicare no payments after 2016 Sticks start in 2015
bull Medicaid canrsquot initiate payments after 2016
bull The Caveats ndash All Medicare Hospitals qualify as Medicaid Hospitals
ndash Hospitals eligible for Medicare dollars may be eligible for Medicaid dollars
15
16
ARE YOU LEGAL
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
Certification
bull Temporary Certification Program is in place (set to expire December 2011)
bull Handled by external bodies
bull Currently there are three certifying agencies
ndash CCHIT ndash Chicago IL (83010)
bull Had offered preliminary certification
ndash Drummond Group ndash Austin TX (83010)
ndash InfoGard ndash San Luis Obispo CA (91710)
Vendors Planning to Achieve Certification
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
18
THE HEART OF IT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull You Gotta Have
ndash Ambulatory Providers = 15
ndash Hospitals = 14
ndash All Hospital Criteria Overlap with Ambulatory
bull the only addition to the ambulatory provider list is e-
Prescribing
ndash Most measures must be reported as structured
data
The Core Objectives
Core Objectives ndash Gotta Do bdquoem All
MaintainRecord
bull Maintain an up-to-date problem list of current and active diagnoses (50)
bull Maintain active medication list (80)
bull Maintain active medication allergy list (80)
bull Record and chart changes in vital signs (50)
bull Record smoking status for patients 13 years or older (50)
bull Record demographics (50)
DoImplement
bull Computerized physician order entry (CPOE) (30)
bull E-Prescribing (Ambulatory Only 40)
bull Drug-drug and drug-allergy interaction checks (enabled whole period)
bull Clinical decision support (1 rule)
bull Protect electronic health information (whole period)
ProvideReport
bull Report clinical quality measures to CMS or States (2011 Attestation 2012 Electronically)
bull Provide Patients with an electronic copy of their health information upon request (50 within 3 days)
bull Provide clinical summaries for patients for each office visitat each discharge (50 within 3 days)
bull Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (perform at least one test)
Source httphealthpolicyandreformnejmorgattachment_id=3742
Menu Sets ndash Pick Five
MaintainRecord
bull Incorporate clinical lab test results (50)
bull Record advanced directives for patients 65 years or older (Acute Only 50)
DoImplement
bull Drug-formulary checks (whole period)
bull Medication reconciliation (50)
ProvideReport
bull Generate lists of patients by specific conditions (at least 1 list)
bull Summary of care record for each transition of carereferrals (50)
bull Capability to provide electronic syndromic surveillance data to public health agencies (1 test)
bull Capability to submit electronic data to immunization registriessystems (1 test)
bull Provide patient-specific education resources and provide to patient (10)
bull Send reminders to patients per patient preference for preventivefollow up care (Ambulatory Only 20 in the 65lt amp lt5 age groups)
bull Provide patients with timely electronic access to their health information (Ambulatory Only 10 within 4 days)
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
Year MUer 2011 2012 2013 2014
2011 $18000 - - -
2012 $12000 $18000 - -
2013 $8000 $12000 $15000 -
2014 $4000 $8000 $12000 $12000
2015 $2000 $4000 $8000 $8000
2016 - $2000 $4000 $4000
TOTAL $44000 $44000 $39000 $24000
Medicare EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014
2011 $1800 - - -
2012 $1200 $1800 - -
2013 $800 $1200 $1500 -
2014 $400 $800 $1200 $12000
2015 $200 $400 $800 $8000
2016 - $200 $400 $4000
TOTAL $4400 $4400 $3900 $2400
Medicare HPSA EP Bonuses
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014 2015 2016
2011 $21250 - - - - -
2012 $8500 $21250 - - - -
2013 $8500 $8500 $21250 - - -
2014 $8500 $8500 $8500 $21250 - -
2015 $8500 $8500 $8500 $8500 $21250 -
2016 $8500 $8500 $8500 $8500 $8500 $21250
2017 - $8500 $8500 $8500 $8500 $8500
2018 - - $8500 $8500 $8500 $8500
2019 - - - $8500 $8500 $8500
2020 - - - - $8500 $8500
2021 - - - - - $8500
TOTAL $63750 $63750 $63750 $63750 $63750 $63750
Medicaid EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Hospital Incentive Structurebull The Money
bull Two Million Dollar Base + Variable Based on Discharges (MedicareMedicaid Share)
bull The Timeline bull Medicare no payments after 2016 Sticks start in 2015
bull Medicaid canrsquot initiate payments after 2016
bull The Caveats ndash All Medicare Hospitals qualify as Medicaid Hospitals
ndash Hospitals eligible for Medicare dollars may be eligible for Medicaid dollars
15
16
ARE YOU LEGAL
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
Certification
bull Temporary Certification Program is in place (set to expire December 2011)
bull Handled by external bodies
bull Currently there are three certifying agencies
ndash CCHIT ndash Chicago IL (83010)
bull Had offered preliminary certification
ndash Drummond Group ndash Austin TX (83010)
ndash InfoGard ndash San Luis Obispo CA (91710)
Vendors Planning to Achieve Certification
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
18
THE HEART OF IT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull You Gotta Have
ndash Ambulatory Providers = 15
ndash Hospitals = 14
ndash All Hospital Criteria Overlap with Ambulatory
bull the only addition to the ambulatory provider list is e-
Prescribing
ndash Most measures must be reported as structured
data
The Core Objectives
Core Objectives ndash Gotta Do bdquoem All
MaintainRecord
bull Maintain an up-to-date problem list of current and active diagnoses (50)
bull Maintain active medication list (80)
bull Maintain active medication allergy list (80)
bull Record and chart changes in vital signs (50)
bull Record smoking status for patients 13 years or older (50)
bull Record demographics (50)
DoImplement
bull Computerized physician order entry (CPOE) (30)
bull E-Prescribing (Ambulatory Only 40)
bull Drug-drug and drug-allergy interaction checks (enabled whole period)
bull Clinical decision support (1 rule)
bull Protect electronic health information (whole period)
ProvideReport
bull Report clinical quality measures to CMS or States (2011 Attestation 2012 Electronically)
bull Provide Patients with an electronic copy of their health information upon request (50 within 3 days)
bull Provide clinical summaries for patients for each office visitat each discharge (50 within 3 days)
bull Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (perform at least one test)
Source httphealthpolicyandreformnejmorgattachment_id=3742
Menu Sets ndash Pick Five
MaintainRecord
bull Incorporate clinical lab test results (50)
bull Record advanced directives for patients 65 years or older (Acute Only 50)
DoImplement
bull Drug-formulary checks (whole period)
bull Medication reconciliation (50)
ProvideReport
bull Generate lists of patients by specific conditions (at least 1 list)
bull Summary of care record for each transition of carereferrals (50)
bull Capability to provide electronic syndromic surveillance data to public health agencies (1 test)
bull Capability to submit electronic data to immunization registriessystems (1 test)
bull Provide patient-specific education resources and provide to patient (10)
bull Send reminders to patients per patient preference for preventivefollow up care (Ambulatory Only 20 in the 65lt amp lt5 age groups)
bull Provide patients with timely electronic access to their health information (Ambulatory Only 10 within 4 days)
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
Year MUer 2011 2012 2013 2014
2011 $1800 - - -
2012 $1200 $1800 - -
2013 $800 $1200 $1500 -
2014 $400 $800 $1200 $12000
2015 $200 $400 $800 $8000
2016 - $200 $400 $4000
TOTAL $4400 $4400 $3900 $2400
Medicare HPSA EP Bonuses
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Year MUer 2011 2012 2013 2014 2015 2016
2011 $21250 - - - - -
2012 $8500 $21250 - - - -
2013 $8500 $8500 $21250 - - -
2014 $8500 $8500 $8500 $21250 - -
2015 $8500 $8500 $8500 $8500 $21250 -
2016 $8500 $8500 $8500 $8500 $8500 $21250
2017 - $8500 $8500 $8500 $8500 $8500
2018 - - $8500 $8500 $8500 $8500
2019 - - - $8500 $8500 $8500
2020 - - - - $8500 $8500
2021 - - - - - $8500
TOTAL $63750 $63750 $63750 $63750 $63750 $63750
Medicaid EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Hospital Incentive Structurebull The Money
bull Two Million Dollar Base + Variable Based on Discharges (MedicareMedicaid Share)
bull The Timeline bull Medicare no payments after 2016 Sticks start in 2015
bull Medicaid canrsquot initiate payments after 2016
bull The Caveats ndash All Medicare Hospitals qualify as Medicaid Hospitals
ndash Hospitals eligible for Medicare dollars may be eligible for Medicaid dollars
15
16
ARE YOU LEGAL
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
Certification
bull Temporary Certification Program is in place (set to expire December 2011)
bull Handled by external bodies
bull Currently there are three certifying agencies
ndash CCHIT ndash Chicago IL (83010)
bull Had offered preliminary certification
ndash Drummond Group ndash Austin TX (83010)
ndash InfoGard ndash San Luis Obispo CA (91710)
Vendors Planning to Achieve Certification
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
18
THE HEART OF IT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull You Gotta Have
ndash Ambulatory Providers = 15
ndash Hospitals = 14
ndash All Hospital Criteria Overlap with Ambulatory
bull the only addition to the ambulatory provider list is e-
Prescribing
ndash Most measures must be reported as structured
data
The Core Objectives
Core Objectives ndash Gotta Do bdquoem All
MaintainRecord
bull Maintain an up-to-date problem list of current and active diagnoses (50)
bull Maintain active medication list (80)
bull Maintain active medication allergy list (80)
bull Record and chart changes in vital signs (50)
bull Record smoking status for patients 13 years or older (50)
bull Record demographics (50)
DoImplement
bull Computerized physician order entry (CPOE) (30)
bull E-Prescribing (Ambulatory Only 40)
bull Drug-drug and drug-allergy interaction checks (enabled whole period)
bull Clinical decision support (1 rule)
bull Protect electronic health information (whole period)
ProvideReport
bull Report clinical quality measures to CMS or States (2011 Attestation 2012 Electronically)
bull Provide Patients with an electronic copy of their health information upon request (50 within 3 days)
bull Provide clinical summaries for patients for each office visitat each discharge (50 within 3 days)
bull Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (perform at least one test)
Source httphealthpolicyandreformnejmorgattachment_id=3742
Menu Sets ndash Pick Five
MaintainRecord
bull Incorporate clinical lab test results (50)
bull Record advanced directives for patients 65 years or older (Acute Only 50)
DoImplement
bull Drug-formulary checks (whole period)
bull Medication reconciliation (50)
ProvideReport
bull Generate lists of patients by specific conditions (at least 1 list)
bull Summary of care record for each transition of carereferrals (50)
bull Capability to provide electronic syndromic surveillance data to public health agencies (1 test)
bull Capability to submit electronic data to immunization registriessystems (1 test)
bull Provide patient-specific education resources and provide to patient (10)
bull Send reminders to patients per patient preference for preventivefollow up care (Ambulatory Only 20 in the 65lt amp lt5 age groups)
bull Provide patients with timely electronic access to their health information (Ambulatory Only 10 within 4 days)
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
Year MUer 2011 2012 2013 2014 2015 2016
2011 $21250 - - - - -
2012 $8500 $21250 - - - -
2013 $8500 $8500 $21250 - - -
2014 $8500 $8500 $8500 $21250 - -
2015 $8500 $8500 $8500 $8500 $21250 -
2016 $8500 $8500 $8500 $8500 $8500 $21250
2017 - $8500 $8500 $8500 $8500 $8500
2018 - - $8500 $8500 $8500 $8500
2019 - - - $8500 $8500 $8500
2020 - - - - $8500 $8500
2021 - - - - - $8500
TOTAL $63750 $63750 $63750 $63750 $63750 $63750
Medicaid EPs
Source httpswwwcmsgovEHRIncentiveProgramsDownloadsEHR_Incentive_Program_Agency_Training_v8-20pdf
Hospital Incentive Structurebull The Money
bull Two Million Dollar Base + Variable Based on Discharges (MedicareMedicaid Share)
bull The Timeline bull Medicare no payments after 2016 Sticks start in 2015
bull Medicaid canrsquot initiate payments after 2016
bull The Caveats ndash All Medicare Hospitals qualify as Medicaid Hospitals
ndash Hospitals eligible for Medicare dollars may be eligible for Medicaid dollars
15
16
ARE YOU LEGAL
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
Certification
bull Temporary Certification Program is in place (set to expire December 2011)
bull Handled by external bodies
bull Currently there are three certifying agencies
ndash CCHIT ndash Chicago IL (83010)
bull Had offered preliminary certification
ndash Drummond Group ndash Austin TX (83010)
ndash InfoGard ndash San Luis Obispo CA (91710)
Vendors Planning to Achieve Certification
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
18
THE HEART OF IT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull You Gotta Have
ndash Ambulatory Providers = 15
ndash Hospitals = 14
ndash All Hospital Criteria Overlap with Ambulatory
bull the only addition to the ambulatory provider list is e-
Prescribing
ndash Most measures must be reported as structured
data
The Core Objectives
Core Objectives ndash Gotta Do bdquoem All
MaintainRecord
bull Maintain an up-to-date problem list of current and active diagnoses (50)
bull Maintain active medication list (80)
bull Maintain active medication allergy list (80)
bull Record and chart changes in vital signs (50)
bull Record smoking status for patients 13 years or older (50)
bull Record demographics (50)
DoImplement
bull Computerized physician order entry (CPOE) (30)
bull E-Prescribing (Ambulatory Only 40)
bull Drug-drug and drug-allergy interaction checks (enabled whole period)
bull Clinical decision support (1 rule)
bull Protect electronic health information (whole period)
ProvideReport
bull Report clinical quality measures to CMS or States (2011 Attestation 2012 Electronically)
bull Provide Patients with an electronic copy of their health information upon request (50 within 3 days)
bull Provide clinical summaries for patients for each office visitat each discharge (50 within 3 days)
bull Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (perform at least one test)
Source httphealthpolicyandreformnejmorgattachment_id=3742
Menu Sets ndash Pick Five
MaintainRecord
bull Incorporate clinical lab test results (50)
bull Record advanced directives for patients 65 years or older (Acute Only 50)
DoImplement
bull Drug-formulary checks (whole period)
bull Medication reconciliation (50)
ProvideReport
bull Generate lists of patients by specific conditions (at least 1 list)
bull Summary of care record for each transition of carereferrals (50)
bull Capability to provide electronic syndromic surveillance data to public health agencies (1 test)
bull Capability to submit electronic data to immunization registriessystems (1 test)
bull Provide patient-specific education resources and provide to patient (10)
bull Send reminders to patients per patient preference for preventivefollow up care (Ambulatory Only 20 in the 65lt amp lt5 age groups)
bull Provide patients with timely electronic access to their health information (Ambulatory Only 10 within 4 days)
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
Hospital Incentive Structurebull The Money
bull Two Million Dollar Base + Variable Based on Discharges (MedicareMedicaid Share)
bull The Timeline bull Medicare no payments after 2016 Sticks start in 2015
bull Medicaid canrsquot initiate payments after 2016
bull The Caveats ndash All Medicare Hospitals qualify as Medicaid Hospitals
ndash Hospitals eligible for Medicare dollars may be eligible for Medicaid dollars
15
16
ARE YOU LEGAL
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
Certification
bull Temporary Certification Program is in place (set to expire December 2011)
bull Handled by external bodies
bull Currently there are three certifying agencies
ndash CCHIT ndash Chicago IL (83010)
bull Had offered preliminary certification
ndash Drummond Group ndash Austin TX (83010)
ndash InfoGard ndash San Luis Obispo CA (91710)
Vendors Planning to Achieve Certification
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
18
THE HEART OF IT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull You Gotta Have
ndash Ambulatory Providers = 15
ndash Hospitals = 14
ndash All Hospital Criteria Overlap with Ambulatory
bull the only addition to the ambulatory provider list is e-
Prescribing
ndash Most measures must be reported as structured
data
The Core Objectives
Core Objectives ndash Gotta Do bdquoem All
MaintainRecord
bull Maintain an up-to-date problem list of current and active diagnoses (50)
bull Maintain active medication list (80)
bull Maintain active medication allergy list (80)
bull Record and chart changes in vital signs (50)
bull Record smoking status for patients 13 years or older (50)
bull Record demographics (50)
DoImplement
bull Computerized physician order entry (CPOE) (30)
bull E-Prescribing (Ambulatory Only 40)
bull Drug-drug and drug-allergy interaction checks (enabled whole period)
bull Clinical decision support (1 rule)
bull Protect electronic health information (whole period)
ProvideReport
bull Report clinical quality measures to CMS or States (2011 Attestation 2012 Electronically)
bull Provide Patients with an electronic copy of their health information upon request (50 within 3 days)
bull Provide clinical summaries for patients for each office visitat each discharge (50 within 3 days)
bull Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (perform at least one test)
Source httphealthpolicyandreformnejmorgattachment_id=3742
Menu Sets ndash Pick Five
MaintainRecord
bull Incorporate clinical lab test results (50)
bull Record advanced directives for patients 65 years or older (Acute Only 50)
DoImplement
bull Drug-formulary checks (whole period)
bull Medication reconciliation (50)
ProvideReport
bull Generate lists of patients by specific conditions (at least 1 list)
bull Summary of care record for each transition of carereferrals (50)
bull Capability to provide electronic syndromic surveillance data to public health agencies (1 test)
bull Capability to submit electronic data to immunization registriessystems (1 test)
bull Provide patient-specific education resources and provide to patient (10)
bull Send reminders to patients per patient preference for preventivefollow up care (Ambulatory Only 20 in the 65lt amp lt5 age groups)
bull Provide patients with timely electronic access to their health information (Ambulatory Only 10 within 4 days)
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
16
ARE YOU LEGAL
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
Certification
bull Temporary Certification Program is in place (set to expire December 2011)
bull Handled by external bodies
bull Currently there are three certifying agencies
ndash CCHIT ndash Chicago IL (83010)
bull Had offered preliminary certification
ndash Drummond Group ndash Austin TX (83010)
ndash InfoGard ndash San Luis Obispo CA (91710)
Vendors Planning to Achieve Certification
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
18
THE HEART OF IT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull You Gotta Have
ndash Ambulatory Providers = 15
ndash Hospitals = 14
ndash All Hospital Criteria Overlap with Ambulatory
bull the only addition to the ambulatory provider list is e-
Prescribing
ndash Most measures must be reported as structured
data
The Core Objectives
Core Objectives ndash Gotta Do bdquoem All
MaintainRecord
bull Maintain an up-to-date problem list of current and active diagnoses (50)
bull Maintain active medication list (80)
bull Maintain active medication allergy list (80)
bull Record and chart changes in vital signs (50)
bull Record smoking status for patients 13 years or older (50)
bull Record demographics (50)
DoImplement
bull Computerized physician order entry (CPOE) (30)
bull E-Prescribing (Ambulatory Only 40)
bull Drug-drug and drug-allergy interaction checks (enabled whole period)
bull Clinical decision support (1 rule)
bull Protect electronic health information (whole period)
ProvideReport
bull Report clinical quality measures to CMS or States (2011 Attestation 2012 Electronically)
bull Provide Patients with an electronic copy of their health information upon request (50 within 3 days)
bull Provide clinical summaries for patients for each office visitat each discharge (50 within 3 days)
bull Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (perform at least one test)
Source httphealthpolicyandreformnejmorgattachment_id=3742
Menu Sets ndash Pick Five
MaintainRecord
bull Incorporate clinical lab test results (50)
bull Record advanced directives for patients 65 years or older (Acute Only 50)
DoImplement
bull Drug-formulary checks (whole period)
bull Medication reconciliation (50)
ProvideReport
bull Generate lists of patients by specific conditions (at least 1 list)
bull Summary of care record for each transition of carereferrals (50)
bull Capability to provide electronic syndromic surveillance data to public health agencies (1 test)
bull Capability to submit electronic data to immunization registriessystems (1 test)
bull Provide patient-specific education resources and provide to patient (10)
bull Send reminders to patients per patient preference for preventivefollow up care (Ambulatory Only 20 in the 65lt amp lt5 age groups)
bull Provide patients with timely electronic access to their health information (Ambulatory Only 10 within 4 days)
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
Certification
bull Temporary Certification Program is in place (set to expire December 2011)
bull Handled by external bodies
bull Currently there are three certifying agencies
ndash CCHIT ndash Chicago IL (83010)
bull Had offered preliminary certification
ndash Drummond Group ndash Austin TX (83010)
ndash InfoGard ndash San Luis Obispo CA (91710)
Vendors Planning to Achieve Certification
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
18
THE HEART OF IT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull You Gotta Have
ndash Ambulatory Providers = 15
ndash Hospitals = 14
ndash All Hospital Criteria Overlap with Ambulatory
bull the only addition to the ambulatory provider list is e-
Prescribing
ndash Most measures must be reported as structured
data
The Core Objectives
Core Objectives ndash Gotta Do bdquoem All
MaintainRecord
bull Maintain an up-to-date problem list of current and active diagnoses (50)
bull Maintain active medication list (80)
bull Maintain active medication allergy list (80)
bull Record and chart changes in vital signs (50)
bull Record smoking status for patients 13 years or older (50)
bull Record demographics (50)
DoImplement
bull Computerized physician order entry (CPOE) (30)
bull E-Prescribing (Ambulatory Only 40)
bull Drug-drug and drug-allergy interaction checks (enabled whole period)
bull Clinical decision support (1 rule)
bull Protect electronic health information (whole period)
ProvideReport
bull Report clinical quality measures to CMS or States (2011 Attestation 2012 Electronically)
bull Provide Patients with an electronic copy of their health information upon request (50 within 3 days)
bull Provide clinical summaries for patients for each office visitat each discharge (50 within 3 days)
bull Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (perform at least one test)
Source httphealthpolicyandreformnejmorgattachment_id=3742
Menu Sets ndash Pick Five
MaintainRecord
bull Incorporate clinical lab test results (50)
bull Record advanced directives for patients 65 years or older (Acute Only 50)
DoImplement
bull Drug-formulary checks (whole period)
bull Medication reconciliation (50)
ProvideReport
bull Generate lists of patients by specific conditions (at least 1 list)
bull Summary of care record for each transition of carereferrals (50)
bull Capability to provide electronic syndromic surveillance data to public health agencies (1 test)
bull Capability to submit electronic data to immunization registriessystems (1 test)
bull Provide patient-specific education resources and provide to patient (10)
bull Send reminders to patients per patient preference for preventivefollow up care (Ambulatory Only 20 in the 65lt amp lt5 age groups)
bull Provide patients with timely electronic access to their health information (Ambulatory Only 10 within 4 days)
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
18
THE HEART OF IT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull You Gotta Have
ndash Ambulatory Providers = 15
ndash Hospitals = 14
ndash All Hospital Criteria Overlap with Ambulatory
bull the only addition to the ambulatory provider list is e-
Prescribing
ndash Most measures must be reported as structured
data
The Core Objectives
Core Objectives ndash Gotta Do bdquoem All
MaintainRecord
bull Maintain an up-to-date problem list of current and active diagnoses (50)
bull Maintain active medication list (80)
bull Maintain active medication allergy list (80)
bull Record and chart changes in vital signs (50)
bull Record smoking status for patients 13 years or older (50)
bull Record demographics (50)
DoImplement
bull Computerized physician order entry (CPOE) (30)
bull E-Prescribing (Ambulatory Only 40)
bull Drug-drug and drug-allergy interaction checks (enabled whole period)
bull Clinical decision support (1 rule)
bull Protect electronic health information (whole period)
ProvideReport
bull Report clinical quality measures to CMS or States (2011 Attestation 2012 Electronically)
bull Provide Patients with an electronic copy of their health information upon request (50 within 3 days)
bull Provide clinical summaries for patients for each office visitat each discharge (50 within 3 days)
bull Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (perform at least one test)
Source httphealthpolicyandreformnejmorgattachment_id=3742
Menu Sets ndash Pick Five
MaintainRecord
bull Incorporate clinical lab test results (50)
bull Record advanced directives for patients 65 years or older (Acute Only 50)
DoImplement
bull Drug-formulary checks (whole period)
bull Medication reconciliation (50)
ProvideReport
bull Generate lists of patients by specific conditions (at least 1 list)
bull Summary of care record for each transition of carereferrals (50)
bull Capability to provide electronic syndromic surveillance data to public health agencies (1 test)
bull Capability to submit electronic data to immunization registriessystems (1 test)
bull Provide patient-specific education resources and provide to patient (10)
bull Send reminders to patients per patient preference for preventivefollow up care (Ambulatory Only 20 in the 65lt amp lt5 age groups)
bull Provide patients with timely electronic access to their health information (Ambulatory Only 10 within 4 days)
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
bull You Gotta Have
ndash Ambulatory Providers = 15
ndash Hospitals = 14
ndash All Hospital Criteria Overlap with Ambulatory
bull the only addition to the ambulatory provider list is e-
Prescribing
ndash Most measures must be reported as structured
data
The Core Objectives
Core Objectives ndash Gotta Do bdquoem All
MaintainRecord
bull Maintain an up-to-date problem list of current and active diagnoses (50)
bull Maintain active medication list (80)
bull Maintain active medication allergy list (80)
bull Record and chart changes in vital signs (50)
bull Record smoking status for patients 13 years or older (50)
bull Record demographics (50)
DoImplement
bull Computerized physician order entry (CPOE) (30)
bull E-Prescribing (Ambulatory Only 40)
bull Drug-drug and drug-allergy interaction checks (enabled whole period)
bull Clinical decision support (1 rule)
bull Protect electronic health information (whole period)
ProvideReport
bull Report clinical quality measures to CMS or States (2011 Attestation 2012 Electronically)
bull Provide Patients with an electronic copy of their health information upon request (50 within 3 days)
bull Provide clinical summaries for patients for each office visitat each discharge (50 within 3 days)
bull Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (perform at least one test)
Source httphealthpolicyandreformnejmorgattachment_id=3742
Menu Sets ndash Pick Five
MaintainRecord
bull Incorporate clinical lab test results (50)
bull Record advanced directives for patients 65 years or older (Acute Only 50)
DoImplement
bull Drug-formulary checks (whole period)
bull Medication reconciliation (50)
ProvideReport
bull Generate lists of patients by specific conditions (at least 1 list)
bull Summary of care record for each transition of carereferrals (50)
bull Capability to provide electronic syndromic surveillance data to public health agencies (1 test)
bull Capability to submit electronic data to immunization registriessystems (1 test)
bull Provide patient-specific education resources and provide to patient (10)
bull Send reminders to patients per patient preference for preventivefollow up care (Ambulatory Only 20 in the 65lt amp lt5 age groups)
bull Provide patients with timely electronic access to their health information (Ambulatory Only 10 within 4 days)
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
Core Objectives ndash Gotta Do bdquoem All
MaintainRecord
bull Maintain an up-to-date problem list of current and active diagnoses (50)
bull Maintain active medication list (80)
bull Maintain active medication allergy list (80)
bull Record and chart changes in vital signs (50)
bull Record smoking status for patients 13 years or older (50)
bull Record demographics (50)
DoImplement
bull Computerized physician order entry (CPOE) (30)
bull E-Prescribing (Ambulatory Only 40)
bull Drug-drug and drug-allergy interaction checks (enabled whole period)
bull Clinical decision support (1 rule)
bull Protect electronic health information (whole period)
ProvideReport
bull Report clinical quality measures to CMS or States (2011 Attestation 2012 Electronically)
bull Provide Patients with an electronic copy of their health information upon request (50 within 3 days)
bull Provide clinical summaries for patients for each office visitat each discharge (50 within 3 days)
bull Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (perform at least one test)
Source httphealthpolicyandreformnejmorgattachment_id=3742
Menu Sets ndash Pick Five
MaintainRecord
bull Incorporate clinical lab test results (50)
bull Record advanced directives for patients 65 years or older (Acute Only 50)
DoImplement
bull Drug-formulary checks (whole period)
bull Medication reconciliation (50)
ProvideReport
bull Generate lists of patients by specific conditions (at least 1 list)
bull Summary of care record for each transition of carereferrals (50)
bull Capability to provide electronic syndromic surveillance data to public health agencies (1 test)
bull Capability to submit electronic data to immunization registriessystems (1 test)
bull Provide patient-specific education resources and provide to patient (10)
bull Send reminders to patients per patient preference for preventivefollow up care (Ambulatory Only 20 in the 65lt amp lt5 age groups)
bull Provide patients with timely electronic access to their health information (Ambulatory Only 10 within 4 days)
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
Menu Sets ndash Pick Five
MaintainRecord
bull Incorporate clinical lab test results (50)
bull Record advanced directives for patients 65 years or older (Acute Only 50)
DoImplement
bull Drug-formulary checks (whole period)
bull Medication reconciliation (50)
ProvideReport
bull Generate lists of patients by specific conditions (at least 1 list)
bull Summary of care record for each transition of carereferrals (50)
bull Capability to provide electronic syndromic surveillance data to public health agencies (1 test)
bull Capability to submit electronic data to immunization registriessystems (1 test)
bull Provide patient-specific education resources and provide to patient (10)
bull Send reminders to patients per patient preference for preventivefollow up care (Ambulatory Only 20 in the 65lt amp lt5 age groups)
bull Provide patients with timely electronic access to their health information (Ambulatory Only 10 within 4 days)
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
22
CLINICAL QUALITY MEASURES
(CQM)
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Objectives
Clinical Quality
MeasuresSummary
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
bull Many selected from the Physician Quality Reporting Initiative (PQRI)ndash CMS intends to create an added incentive for EPs to adopt EHRs by leveraging the PQRI
measures and eventually integrate both programs
ndash CMS envisions a single reporting infrastructure for electronic submission in the future eliminating redundant or duplicative reporting
bull The HITECH Act required that in selecting clinical quality measures CMS give preference to those endorsed by the National Quality Forum
ndash NQF is a nonprofit organization that ensures clinical quality measures are developed and maintained through a consistent and collaborative process
ndash All clinical quality measures selected in the final rule are endorsed by NQF
bull Number of Measures ndash EPs ndash 3 core 3 pick
bull If your practice doesnrsquot have the 3 core to report on (pediatricians donrsquot have adult weight screenings) then you pick an ldquoalternaterdquo measure to report
ndash Hospitals ndash 15 all required
Source httpjournalahimaorg20100915clinical-quality-measures-for-providers-3
Clinical Reporting Measures
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
EP CQM bullCORE SET
bullPreventive Care and Screening Measure Pair a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028)
bullHypertension Blood Pressure Measurement (NQF 0013)
bullAdult Weight Screening and Follow-up (NQF 0421 PQRI 128)
bullALTERNATE SET
bullPreventive Care and Screening Influenza Immunization for Patients gt 50 Years old (NQF 0041 PQRI 110)
bullChildhood Immunization Status (NQF 0038)
bullWeight Assessment and Counseling for Children and Adolescents (NQF 0024)
bullPneumonia Vaccination Status for Older Adults
Prevention
bullHemoglobin A1c Poor Control
bullLow Density Lipoprotein (LDL) Management and Control
bullBlood Pressure Management
bullDiabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
bullDiabetic Retinopathy Communication with the Physician Managing Ongoing Diabetes Care
bullEye Exam
bullUrine Screening
bullFoot Exam
bullHemoglobin A1c Control (lt80)
Diabetes
bull Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Coronary Artery Disease (CAD) Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
bull Coronary Artery Disease (CAD) Oral Antiplatelet Therapy Prescribed for Patients with CAD
bull Heart Failure (HF) Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
bull Heart Failure (HF) Warfarin Therapy Patients with Atrial Fibrillation
bull Ischemic Vascular Disease (IVD) Blood Pressure Management
bull Ischemic Vascular Disease (IVD) Use of Aspirin or Another Antithrombotic
bull Coronary Artery Disease (CAD) Drug Therapy for Lowering LDL-Cholesterol
bull Ischemic Vascular Disease (IVD) Complete Lipid Panel and LDL Control
Cardiology
bullBreast Cancer Screening
bullColorectal Cancer Screening
bullOncology Breast Cancer Hormonal Therapy for Stage IC-IIIC Estrogen ReceptorProgesterone Receptor (ERPR) Positive Breast Cancer
bullOncology Colon Cancer Chemotherapy for Stage III Colon Cancer Patients
bullProstate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Cancer
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
bullPrenatal Care Screening for Human Immunodeficiency Virus (HIV)
bullPrenatal Care Anti-D Immune Globulin
bullPrenatal Care Controlling High Blood Pressure
bullCervical Cancer Screening
bullChlamydia Screening for Women
OBGYN
bullSmoking and Tobacco Use Cessation Medical assistance a) Advising Smokers and Tobacco Users to Quit b) Discussing Smoking and Tobacco Use Cessation Medications c) Discussing Smoking and Tobacco Use Cessation Strategies
bull Initiation and Engagement of Alcohol and Other Drug Dependence Treatment a) Initiation b) Engagement
bullAnti-depressant medication management (a) Effective Acute Phase Treatment(b)Effective Continuation Phase Treatment
Psychology
bullAsthma Pharmacologic Therapy
bullAsthma Assessment
bullUse of Appropriate Medications for Asthma
bullAppropriate Testing for Children with Pharyngitis
Respiratory
bullPrimary Open Angle Glaucoma (POAG) Optic Nerve Evaluation
bullLow Back Pain Use of Imaging Studies
Other
EP CQM
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
Hospital CQM Requirements
bull Ischemic stroke ndash Discharge on anti-thrombotics
bull Ischemic stroke ndash Anticoagulation for A-fibflutter
bull Ischemic stroke ndash Thrombolytic therapy for patients arriving within 2 hours of symptom onset
bull Ischemic or hemorrhagic stroke ndash Antithrombotic therapy by day 2
bull Ischemic stroke ndash Discharge on statins
bull Ischemic or hemorrhagic stroke ndash Stroke education
bull Ischemic or hemorrhagic stroke ndash Rehabilitation assessment
Stroke
bull Emergency Department Throughput ndash admitted patients Median time from ED arrival to ED departure for admitted patients
bull Emergency Department Throughput ndash admitted patients ndash Admission decision time to ED departure time for admitted patients
Throughput
bull VTE prophylaxis within 24 hours of arrival
bull Intensive Care Unit VTE prophylaxis
bull Anticoagulation overlap therapy
bull Platelet monitoring on unfractionated heparin
bull VTE discharge instructions
bull Incidence of potentially preventable VTE
Surgery
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
27
SO WHAT WAS THE POINT
HistoryMedicare
vs Medicaid
Incentives CertificationCore
Measures
Clinical Reporting Measures
Summary
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
OverviewMedicare Medicaid
Implementers Federal Level (CMS) States (Voluntary)
Initiate By 2014 2016
Carrots 2011-2016 2011-2021
Sticks 2015 (1) 2016 and on (2) None Federally Mandated
By year onehellip Demonstrate MU 90 days AIU (Adopt Implement Upgrade)
Maximum EP Incentive $44000 + (HPSA Bonus) $63750
Rule Variance None State Specific
Eligible Providers physicians subsection (d)
hospitals and CAHs
5 types of EPs acute care hospitals
CAHs and childrenrsquos hospitals
28
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
EPs
80 of Patient Records
Certified EHR
15 Core + 5 Menu
Objectives
3 Core + 3 Alternative
CQM
Meaningful Use
Hospitals
80 of Patient Records
Certified EHR
14 Core + 5 Menu
Objectives
15
CQM
Meaningful Use
Overview - Requirements
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
Overview - Pursuit and Achievement
Providers Planning to Pursue Providers who will Achieve
Graph Source HIMSS Analytics Survey September 2010
httpwwwhimssorgcontentfilesvantagepointvantagepoin
t_201009asppg=1
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip
bull This was only the first stagendash Stages Two expected 2011 menu set becomes core new parameters
more HIE
ndash Stage Three expected 2013 likely more patient access
bull Adjustments are being made by CMS and will be out shortly
bull Using Electronic Health Records Meaningfully will (hopefully) lead to ndash better clinical outcomes for patients
ndash Less waste
ndash Less fraud and abuse
ndash Better ROI
ndash Reduce health disparities and improve public health
ndash Engage patients and family
The Pointhellip