rec support is. provided under cooperative agreement 90rc0025/01 from the office of the national...

REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services


S1MU Part 1: An Overview of Core

Requirements and Big Changes Ahead

Moderator:

Mary Zile, BSN, MHSA

Presenters:

Nathan Diller, MBA, MHSA

Marty Larson, MS

Stefanie Strinko, MBA, CPHIMS


Agenda

• Overview of Meaningful Use

• Contrasting Stage 1 Meaningful Use (S1MU) to Stage

2 Meaningful Use (S2MU)

• Deep Dive: S2MU Core Measures

• Question & Answers

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Overview of Meaningful Use

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HITECH: Policy Framework

Better care for individuals, better health for populations, and lower per-capita costs. IHI-Triple Aim Initiative


Pillars of Meaningful Use

Improve quality, safety, efficiency, and reduce health disparities• Provide access to comprehensive patient health data for patient’s health care team • Use evidence-based order sets and CPOE• Apply clinical decision support at the point of care• Generate lists of patients who need care and use them to reach out to patients

Engage patients and families• Provide patients and families with timely access to data, knowledge, and tools to

make informed decisions and to manage their health

Improve care coordination• Exchange meaningful clinical information among professional health care team

Improve population and public health • Submit immunization, syndromic surveillance and reportable disease data to public

health agencies

Ensure privacy and security protection for personal health information• Protect confidential information through operating policies, procedures, and

technologies• Provide transparency of data sharing to patient


Definition of Meaningful Use

• Use of ONC-HIT Certified Electronic Health Records (EHR)

• Electronic Exchange of Health Information

• Quality Reporting

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Why S2MU Matters

• Stage 2 Meaningful Use serves as a foundation for other health care innovation initiatives

• S2MU is a glide path to:• Accountable care organizations• Medical home• Payment reform initiatives

8


Stages of Meaningful Use

http://www.cms.gov/EHRIncentivePrograms

http://www.cms.gov/EHRIncentivePrograms


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11

For Medicare Hospitals:


Meaningful Use – Potential Penalties

• Penalties apply to Medicare only

• You must begin your first 90-day reporting period no later than July 3, 2014

• EPs must attest to Meaningful Use no later than October 1, 2014

• AIU for year one Medicaid does not count as attestation

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The Penalty

• Adjustments will be applied as a percentage of Medicare Part B Professional Fee Schedule Charges

• Penalties scheduled to begin in Jan 1, 2015, and continue as follows:• 2015: 1%• 2016: 2%• 2017: 3%• 2018-2019: may increase 1% per year at discretion of HHS Secretary

• You cannot wait until 2015 to be Meaningful User if you are concerned about penalties

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Medicare Payment Adjustments

EPs who first demonstrated meaningful use in 2011 or 2012 must demonstrate meaningful use

for a full year in 2013 to avoid payment adjustments in 2015. They must continue to

demonstrate meaningful use every year to avoid payment adjustments in subsequent years.

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Hardship Exceptions for Medicare EPs

EPs can apply for hardship exceptions in the following categories:• Infrastructure• New EPs• Unforeseen circumstances• By specialist/provider type

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Contrasting S1MU to S2MUAn Overview


Meaningful Use – Who is eligible for incentives?

Eligible Providers in Medicare

Eligible Providers in Medicaid

Eligible Professionals (EPs) Eligible Professionals (EPs)Doctor of Medicine or Osteopathy Physicians (Pediatricians have

special eligibility & payment rules)

Doctor of Dental Surgery or Dental Medicine

Nurse Practitioners (NPs)

Doctor of Podiatric Medicine Certified Nurse-Midwives (CNMs)Doctor of Optometry DentistsChiropractor Physician Assistants (PAs) who

practice in a Federally Qualified Health Center (FQHC) or rural health clinic (RHC) that is led by a PA

Eligible Hospitals Eligible HospitalsAcute Care Hospitals Acute Care HospitalsCritical Access Hospitals (CAHs) Children’s Hospitals

No Changes from Stage 1 Meaningful

Use


Stage 2 Meaningful Use Overview

Stage 2 Meaningful Use (S2MU) Final Rule was published on August 23, 2012.

Beginning in 2014, providers participating in the EHR Incentive Programs who have met Stage 1 for 2 or 3 years will need to meet S2MU criteria.


What is in the Rule

• Changes to Stage 1 of Meaningful Use• Stage 2 of Meaningful Use• New clinical quality measures (CQMs)• New CQM reporting mechanisms• Medicaid program changes


S2MU Change in Total Objectives Required

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Stage 1 MU – Eligible Professionals Stage 2 MU – Eligible Providers

15 core objectives 17 core objectives

5 of 10 menu objectives 3 of 6 menu objectives

20 total objectives 20 total objectives

Stage 1 MU – Eligible Hospitals & CAHs

Stage 2 MU – Eligible Hospitals & CAHs

14 core objectives 16 core objectives

5 of 10 menu objectives 3 of 6 menu objectives

19 total objectives 19 total objectives


How to Get to S2MU

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17 Core Objectives3 of 6 Menu Objectives

9 Clinical Quality

Measures

Meaningful Use


Key Changes to Stage 1 Meaningful Use

Menu Objective Exclusion– While you can continue to claim exclusions if applicable for menu objectives, starting in 2014 these exclusions will no longer count towards the number of menu objectives needed.


Medicaid Eligibility Changes

The definition of what constitutes a Medicaid patient encounter has changed.

A Medicaid encounter now includes anyone enrolled in a Medicaid program, including:

• Medicaid expansion encounters (excluding stand alone Title 21)

• Zero-pay claims

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Medicaid Eligibility Changes

States have the option to allow providers to calculate Medicaid patient volume across 90-day period in last 12 months preceding a provider’s attestation.

This also applies to needy patient volume and patient panel methodology with at least one Medicaid encounter taking place in the 24 months prior to the 90-day period.

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2014 Changes

EHRs Meeting ONC 2014 Standards – starting in 2014, all EHR Incentive Programs participants will have to adopt certified EHR technology that meets ONC’s Standards & Certification Criteria 2014 Final Rule


2014 Changes

Reporting Period Reduced to Three Months – to allow providers time to adopt 2014 certified EHR technology and prepare for Stage 2, all participants will have a three-month reporting period in 2014.

All providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a three-month EHR reporting period.

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2014 Changes

For Medicare providers, this 3-month reporting period is fixed to the quarter of either the fiscal (for eligible hospitals and CAHs) or calendar (for EPs) year in order to align with existing CMS quality measurement programs, such as the Physician Quality Reporting System (PQRS) and Hospital Inpatient Quality Reporting (IQR).

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2014 Changes

For Medicaid providers only eligible to receive Medicaid EHR incentives, the 3-month reporting period is not fixed, where providers do not have the same alignment needs. CMS is permitting this one-time three-month reporting period in 2014 only so that all providers who must upgrade to 2014 Certified EHR Technology will have adequate time to implement their new Certified EHR systems.

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Stage 2: Batch Reporting

Stage 2 MU rules allows for batch reporting:

Starting in 2014, groups will be allowed to submit attestation information for all of their individual EPs in one file for upload to the Attestation System, rather than having each EP individually enter data.


How do CQMs relate to the CMS Incentive Programs?

Although reporting CQMs is no longer a core objective of the EHR Incentive Programs, all providers are required to report on CQMs in order to demonstrate Meaningful Use.

In 2014 and beyond, reporting programs (i.e., PQRS, eRx reporting) will be streamlined in order to reduce provider burden.


Reporting CQMs in 2014 and Beyond

Beginning in 2014, all Medicare-eligible providers in their second year and beyond of demonstrating meaningful use must electronically report their CQM data to CMS.

Medicaid providers will electronically report their CQM data to their state.


Clinical Quality Measures

Provider Prior to 2014 2014 and Beyond*

EPs

Complete 6 out of 44:

3 core or 3 alt. core +

3 menu

Complete 9 out of 64 Choose at least 1 measure in 3 NQS domains

Recommended core CQMs include:

9 CQMs for the adult population 9 CQMs for the pediatric population Prioritize NQS domains

Eligible Hospitals and CAHs

Complete 15 out of 15 Complete 16 out of 29 Choose at least 1 measure in 3 NQS domains


Deep Dive: S2MU Core Measures

33


Stage 2 MU EP Core ObjectivesCore

Objective Measure

1. CPOE Use CPOE for more than 60% of medication, 30% of laboratory, and 30% of radiology

2. E-Rx E-Rx for more than 50%

3. Demographics Record demographics for more than 80%

4. Vital Signs Record vital signs for more than 80%

5. Smoking Status Record smoking status for more than 80%

6. Interventions Implement 5 clinical decision support interventions + drug/drug and drug/allergy

7. Labs Incorporate lab results for more than 55%

8. Patient List Generate patient list by specific condition

9. Preventive Reminders

Use EHR to identify and provide reminders for preventive/follow-up care for more than 10% of patients with two or more office visits in the last 2 years


Stage 2 MU EP Core ObjectivesCore Objective Measure

10. Patient Access Provide online access to health information for more than 50% with more than 5% actually accessing

11. Visit Summaries Provide office visit summaries for more than 50% of office visits

12. Education Resources Use EHR to identify and provide education resources more than 10%

13. Secure Messages More than 5% of patients send secure messages to their EP

14. Rx Reconciliation Medication reconciliation at more than 50% of transitions of care

15. Summary of Care

Provide summary of care document for more than 50% of transitions of care and referrals with 10% sent electronically and at least one sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR

16. Immunizations Successful ongoing transmission of immunization data

17. Security Analysis Conduct or review security analysis and incorporate in risk management process


EP Core Requirements

Objective Stage 1 MU Stage 2 MU Summary of Change

Use of computerized provider order

entry

More than 30% of unique patients with at least one

medication in their medication list seen by the EP have at

least one medication order

entered using CPOE.

More than 60% of medication, 30% of

laboratory and 30% of radiology orders

created by the EP during the reporting period are recorded

using CPOE.

Revised Threshold

Revised

Requirement

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37


Generate and transmit permissible

prescriptions electronically

(eRx)

More than 40% of all prescriptions

written are transmitted

electronically using certified

EHR technology (CEHRT).

More than 50% of all

permissible prescriptions or all prescriptions written by the

EP and queried for a drug

formulary and transmitted

electronically using CEHRT.

Increased Threshold

Revised Requirement




Record the following

demographics:

• Preferred language

• Gender• Race• Enthnicity• Date of

birth

More than 50% of all unique patients

seen by the EP have

demographics recorded as

structured data.

More than 80% of all unique

patients seen by the EP during the

EHR reporting period have

demographics recorded as

structured data.

Increased Threshold

38



39


Record and chart changes in the following vital

signs:

• Height/length and weight

• Blood pressure• Calculate and

display BMI• Plot and

display growth charts for patients 0-20 years (incl. BMI)

More than 50% of all unique patients’

age 2 and over seen by the EP

height, weight and blood pressure are

recorded as structured data.


seen by the EP during the EHR reporting period

have blood pressure (for

patients age 3 and over only) and

height/length and weight (for all ages)

recorded as structured data.

Increased Threshold

Revised Requirement



40


Record smoking status for patients

13 years old or older


13 years old or older seen by the EP have smoking status recorded as

structured data.


13 years old or older seen by the EP have smoking status recorded as

structured data.

Increased Threshold



41


Use clinical decision

support to improve

performance on high

priority health conditions

Implement one clinical decision

support rule relevant to

specialty or high clinical priority along with the ability to track

compliance with that rule.

Implement five clinical decision support

interventions related to four or more clinical

quality measures at a relevant point in patient care for the entire EHR

reporting period.

The EP has enabled and implemented the

functionality for drug-drug and drug-allergy

interaction checks for the entire EHR reporting

period.

Revised Requirement

Increased Threshold



42


Incorporate clinical lab-test results into CEHRT as structured

data

More than 40% of all clinical lab tests results ordered by the EP during the

EHR reporting period whose

results are either in a positive/negative or numerical format are incorporated in

certified EHR technology as

structured data.

More than 55% of all clinical lab tests ordered

by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are

incorporated in a CEHRT as structured data.

Menu to Core

Increased Threshold



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Generate lists of patients by

specific conditions to

use for quality improvement, reduction of disparities, research or

outreach

Generate at least one report listing patients of the EP

with a specific condition.

Generate at least one report listing patients of the EP with a specific

condition.

Menu to Core



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Use clinically relevant

information to identify patients

who should receive reminders

for preventive/follow-up care and send these patients the

reminder, per patient preference

More than 20% of all unique patients 65

years or older or 5 years old

or younger were sent an appropriate

reminder during the EHR

reporting period.

More than 10% of all unique patients who have

had two or more office visits with the EP within

the 24 months before the beginning of the EHR reporting period were sent a reminder, per

patient preference when available.

Menu to Core

Decreased Threshold



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Provide patients the ability to view online, download and transmit their health information within 4 business

days of the information being available to the

EP

More than 10% of all unique

patients seen by the EP are

provided timely electronic access

to their health information.

More than 50% of all unique patients seen by the EP are provided timely electronic

access to their health information.

More than 5% of all unique patients seen by the EP during the EHR reporting period (or their authorized

representatives) view, download or transmit to a

third party their health information.

Menu to Core

Revised Requirement



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Provide clinical summaries for

patients for each office visit

Clinical summaries provided to patients for

more than 50% of all office

visits within 3 business days.

Clinical summaries provided to patients within 1 business day for more than 50% of office visits.

Revised Requirement



47


Use CEHRT to identify patient-

specific education resources and provide those

resources to the patient


seen by the EP during the EHR reporting period

are provided patient-specific

education resources.

Patient-specific education resources

identified by CEHRT are provided to patients for more than 10% of all office visits by the EP.

Menu to Core

Revised Requirement



48


Use secure electronic

messaging to communicate with

patients on relevant health information

N/A

A secure message was sent using the electronic messaging function of

CEHRT by more than 5% of unique patients seen by

the EP during the EHR reporting period.

New Requirement



49


The EP who receives a patient

from another setting of care or

provider of care or believes an encounter is

relevant should perform medication

reconciliation

The EP performs medication

reconciliation for more than 50% of transitions of care

in which the patient is

transitioned into the care of the

EP.

The EP performs medication reconciliation

for more than 65% of transitions of care in which the patient is

transitioned into the care of the EP.

Increased Threshold

Menu to Core



50


The EP who transitions their

patient to another setting of care or

provider of care or refers their patient to another provider of care provides a

summary care record for each

transition of care or referral

The EP who transitions their

patient to another setting of care or provider of care

provides a summary of care record for more

than 50% of transitions of care

and referrals.

The EP who transitions their patient to another setting of care

or provider of care provides a summary of care record for

more than 50% of transitions of care and referrals.

10% of such transitions or referrals are electronically

transmitted.

One or more successful exchanges of a summary of

care document with a recipient on a different EHR technology.

Menu to Core

Revised Requirement



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Capability to submit electronic

data to immunization registries or

immunization information

systems except where prohibited,

and in accordance with applicable law and practice

Performed at least one test of certified EHR

technology’s capacity to submit electronic data

to immunization registries and follow up submission if the test is successful (unless the immunization registries

do not have the capacity to receive the

information electronically).

Successful ongoing submission of

electronic immunization data from CEHRT to an

immunization registry or immunization

information system for the entire EHR

reporting period.

Revised Requirement

Menu to Core



52


Protect electronic

health information created or maintained

by the CEHRT

through the implementati

on of appropriate technical

capabilities

Conduct or review a security risk

analysis per 45 CFR 164.308 (a)

(1) and implement security updates as necessary and correct identified

security deficiencies as part of its risk management.

Conduct or review a security risk analysis in accordance with the

requirements under 45 CFR 164.308(a)(1), including

addressing the encryption/security of data stored in CEHRT in

accordance with requirements under 45 CFR 164.312 (a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as

necessary and correct identified security deficiencies as part of the

provider’s risk management process.

Revised Requirement


Stage 2 MU EP Menu Objectives

Menu Objective Measure

1. Imaging Results More than 20% of imaging results are accessible through Certified EHR Technology

2. Family History Record family health history for more than 20% of unique patients

3. Syndromic Surveillance Successful ongoing transmission of syndromic surveillance data

4. Cancer Successful ongoing transmission of cancer case information

5. Specialized Registry

Successful ongoing transmission of data to a specialized registry

6. Progress Notes Enter an electronic progress note for more than 30% of unique patients


Q&A Session

54


Additional MU Information

Tri-State Regional Extension Center

www.tristaterec.org/S2MU

CMS EHR Incentive Program Home Page

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

Office of National Coordinator for Health IT

http://healthit.gov/

55

http://www.tristaterec.org/S2MU

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

http://healthit.gov/

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