Meaningful Use Overview for HIM Professionals Pat Gowan & JoAnne Hawkins Last Updated: June 11,...

transcript

Meaningful Use Overview

for HIM ProfessionalsPat Gowan & JoAnne

HawkinsLast Updated: June 11, 2012

Today’s Objectives

• Understand the Centers for Medicare and Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Program

• Understand and differentiate the Meaningful Use Performance Measures and Meaningful Use Clinical Quality Measures

• Review the current Meaningful Use performance Measures as they pertain to HIM Professionals

Medicare and Medicaid EHR Incentive Program Overview

The American Recovery and Reinvestment Act of 2009 provides incentive payments for Medicare and Medicaid Eligible Hospitals and Eligible Professionals that are meaningful users of certified EHR technology. The EHR incentive programs are part of the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009 which amended the Social Security Act.

Indian Health Service (IHS), Tribal and Urban Indian health programs (I/T/U) eligible hospitals and eligible professionals can receive EHR incentive payments if they meet requirements of the Medicare and/or Medicaid EHR incentive programs starting in 2011. For, Medicare they need to demonstrate meaningful use of certified EHR. For Medicaid, they need to adopt, implement and upgrade to a certified EHR in their first participation year.**Eligible hospitals and eligible professionals must take steps to receive payments.

The IHS Resource and Patient Management System (RPMS) successfully passed all tests required for certification as a complete EHR for ambulatory and inpatient use, based on criteria established by the Office of the National Coordinator for Health Information Technology. I/T/Us that do not use RPMS EHR must ensure that their EHR is certified separately.

MEANINGFUL USE

Meaningful Use: What is Meaningful Use?

• Meaningful Use is using certified EHR technology to:

• Improve quality, safety, efficiency, and reduce health disparities

• Engage patients and families in their health care

• Improve care coordination• Improve population and public health• All the while maintaining privacy and security

Meaningful Use: Stages of Meaningful Use

• 3 stages of Meaningful Use• Requirements will increase over time…more work

lies ahead

Stage 12011-2012

Stage 22013-2014

Stage 32015+

MEDICAREEHR Incentive Program

MEDICAIDEHR Incentive Program

Implemented by the Federal Government and started January 3, 2011

Voluntary for States to implement - Most are expected to start by late summer 2011

Must initiate participation by 2014Must participate by 2012 to receive the maximum incentive paymentProgram ends in 2016

Must initiate participation by 2016Must participate by 2016 to receive the maximum incentive payment Program ends in 2021

Must demonstrate MU in Year 1 over a consecutive 90-day report period

A/I/U option for Year 1

No patient volume requirement Must meet patient volume thresholds

Medicare payment reductions begin in 2015 for EH/EPs who do not demonstrate MU of certified EHR technology

No Medicaid payment reductions

Meaningful Use: Definition of A/I/U

• Adopt: Acquire, purchase, or secure access to certified EHR technology

• Implement: Install or commence utilization of certified EHR technology capable or meeting MU requirements

• Upgrade: Expand the available functionality of certified EHR technology capable of meeting MU requirements at the practice site, including staffing, maintenance, and training or upgrade from existing EHR technology to certified EHR technology per the ONC EHR certification criteria

EHR CERTIFICATION

Name Space

Package or Application Version Patch Release Date

AG Patient Registration 7.1 9 12/3/10APCL Export 3.0 27 11/10/10APSP Pharmacy MOD-ePrescribing (eRx) 7.0 1010 4/29/11BGP Clinical Reporting System (CRS) 11.0 3 6/22/11

BJMD C32 1.0 1 6/24/11BJPC PCC Mgmt Reporting 2.0 6 6/2/11BMC Referred Care Information System

(RCIS)4.0 7 5/12/11

BQI iCare 2.1 3/11/11BRN Release of Information (ROI) 2.0 3 4/13/11BYIM Immunization Exchange Message 2.0 01 2/24/11BGO Electronic Health Record (EHR) 1.1 8 06/10/11LR Lab 5.2 1027 or 372 or 334 12/07/10

PXRM EHR Reminders 1.5 1007 4/13/10BPHR Personal Health Record (PHR) 1.0 6/22/11

Central Ensemble 2009.1.6 921.0.10414 2011GuardianEdge/ Symantec 8.0 3/31/11IPSEC (Windows) 2010VanDyke (AIX) 2010WinHasher 1.6 2011Universal Client or HIE Viewer The URL to access the application is http://ditdev4.d1.na.ihs.gov:9090/DocViewer

1.0 4/27/11

EHR Certification: EHR Certification Number*

• Inpatient Certification #: 30000002ELL6EAI

• Ambulatory Certification #: 30000002EJKDEAI

*The number will be entered during CMS registration and attestation

ELIGIBLE PROFESSIONALS & HOSPITALS

Eligible Professionals: Medicare & Medicaid Comparison

Medicare-only Eligible Professionals

Could be eligible for both Medicare &

Medicaid incentives

Medicaid-only Eligible Professionals

Professionals may be eligible for both Medicare & Medicaid, but can only

participate in one program at a time

Hospitals only eligible for Medicare incentive

Could be eligible for both Medicare & Medicaid (most

hospitals)

Hospitals only eligible for Medicaid incentive

Eligible Hospitals: Medicare & Medicaid Comparison

Eligible Professional: Incentive Program Timeline

CY 2012

01/01/12 First day of calendar & EHR reporting year

09/30/12LAST day to establish clean-date for the Medicare Incentive

Program

10/01/12LAST day to begin 90-day reporting period for the

Medicare Incentive Program

12/31/12 Last day of calendar & EHR reporting year

02/28/13LAST day to register & LAST day to attest

Eligible Hospital: Incentive Program Timeline

FY 2012

10/01/11 First day of calendar & EHR reporting year

06/30/12 LAST day to establish clean-date for the Medicare Incentive Program

07/01/12 LAST day to begin 90-day reporting period for the Medicare Incentive Program

09/30/12 Last day of fiscal year & EHR reporting year

11/30/12 LAST day to register & LAST day to attest

MEDICAID FORELIGIBLE

PROFESSIONALS & HOSPITALS

Eligible Professionals & Medicaid: Patient Volume Threshold

Eligible Professional (EP)

If EP does not practice predominantly at

FQHC/RHC: Minimum Medicaid patient

volume thresholds

If EP does practice predominantly at

FQHC/RHC*: Minimum needy individual patient volume thresholds

Physicians 30% 30%

- Pediatricians 20% 30%

Dentists 30% 30%

Certified Nurse-Midwives

30% 30%

NPs 30% 30%

PAs practicing at an FQHC/RHC that is led by a PA

N/A 30%

* All Tribal clinics are deemed FQHC/RHC for the CMS incentive program

Eligible Hospital: Medicaid Patient Volume Requirement

Eligible Hospitals Minimum Medicaid patient volume threshold

Acute care hospitals, including Critical Access Hospitals

Medicare does not have a patient volume threshold

INCENTIVES

Eligible Professionals: Summary of Medicare & Medicaid Incentives

MEDICARE MEDICAID

Incentives Start

CY 2011 CY 2011

IncentivesEnd

CY 2016(max. 5 years, must start

by 2014)

2021(max. 6 years, must start

by 2016)

Incentive Amount

•Up to $44,000 total per provider

•Based on % Medicare claims

•Additional 10% bonus for EP’s in HPSAs

•Up to $63,750 total per provider

Reimbursement Reduced

CY 2015 No penalties

Eligible Professionals: Medicare Incentive Payment Example

Amount of Payment Each Year of Participation

Calendar Year EP Receives a Payment

CY 2011 CY 2012 CY 2013 CY2014CY 2015 and later

CY 2011 $18,000

CY 2012 $12,000 $18,000

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

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

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

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

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

Eligible Professionals: Medicaid Incentive Payment Example

Amount of Payment Each Year if Continues Meeting Requirements

1st Calendar Year EP Receives a Payment

CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016

CY 2011 $21,250

CY 2012 $8,500 $21,250

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

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

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

CY 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250

CY 2017 $8,500 $8,500 $8,500 $8,500 $8,500

CY 2018 $8,500 $8,500 $8,500 $8,500

CY 2019 $8,500 $8,500 $8,500

CY 2020 $8,500 $8,500

CY 2021 $8,500

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

Eligible Hospital: Medicare & Medicaid Incentive Summary

MEDICARE MEDICAID

Incentives Start

FY 2011 FY 2011

IncentivesEnd

FY 2016(max. 4 years, must start

by 2015)

2021(max. 6 years, must start

by 2016)

Incentive Amount

•Varies, depending on % Medicare inpatient bed days

•CAHs based on EHR costs & % Medicare inpatient bed days

•Varies, depending on % Medicaid inpatient bed days

Reimbursement Reduced

FY 2015 No penalties

PERFORMANCE MEASURES

Eligible Professionals: Meaningful Use Requirements

STAGE 1: Meaningful Use Requirements

• 20 total Performance Measures• 15 core performance measures*• 5 performance measures out of 10 from menu set*

• 6 total Clinical Quality Measures• 3 core or alternate core• 3 out of 38 from menu set

* Most measures require achievement of a performance target

Eligible Hospital: Meaningful Use Requirements

• 19 total Performance Measures• 14 core performance measures*• 5 performance measures out of 10 from menu set*

• 15 total Clinical Quality Measures

EP EH Target Measure

1. X >50%: Clinical Summaries

2. X >20%: Patient Reminders

3. X >50%: Transition of Care Summary

4. X >10%: Patient Electronic Access

5. X Yes/No Patient Lists

6. X X >50%: Electronic Copy of Health Information

7. X X >50%: Record demographics

8. X X >80%: Maintain Problem List

9. X X >80%: Active Medication List

10. X X >80%: Medication Allergy List

Performance Measures

EP EH Target Measure

11. X X >50%: Record Smoking Status

12. X X Yes/No: Clinical Quality Measures

13. X X Yes/No: Electronic Exchange of Clinical Information

14. X X Yes/No: Protect Electronic Health Information

15. X X >40%: Clinical Lab Test Results

16. X >50%: Electronic Copy of Discharge Instructions (upon request)

17. X >50%: Advance Directives

18. X X Yes/No: *Immunization Registries Data Submission

19. X X Yes/No: *Syndromic Surveillance Data Submission

20. X Yes/No: *Reportable Lab Results to Public Health Agencies

Performance Measures

MEANINGFUL USE REPORTS

Demonstrating Meaningful UseEligibility

Patient Volume Report

3rd Party Billing

Calculates:* EP Medicaid patient

volume rates* group practice rates in lieu

of calculating the rate for each individual EP

* EH Medicaid patient volume rates

Performance Measures Report

Calculates Performance Measures for EPs and EHs

1 out of 15 core Performance Measures: Submit CQMs to CMS

EPs: 15 coreEHs: 14 core

EPs & EHs: 5 out of 10 menu

No delay in data capture caused by data entry / coding

Stage 1 Meaningful Use Reports

Clinical Quality Measures Report

Clinical Reporting

Calculates Clinical Quality Measures for EPs and EHs

No targets for Stage 1

EPs: 6 total CQMs3 core or alternate core

3 out of 38 from menu setEHs: 15 total CQMs

Affects of Data Entry / Coding

Medicaid: Patient Volume Report - Coding must be up to date so that a claim can be generated and paid

Medicare : Allowable Charges

Clinical Quality Measures Report - If coding isn’t up to date, CQM report results may be low

Meaningful Use Reports Reference Sheet

MU Report Report Name

Relative path Keys Required Package Name space

Version Patch Release Date Links to related documents

EP Patient VolumePVP CORE>ABM>RPTP>

MURP>MUPVABMDZ MU PV SETUP

Third Party Billing

ABM 2.6 8 11/15/2011 http://www.ihs.gov/RPMS/PackageDocs/abm/abm_0260.07o.pdf

Clean Date ReportMUCD CORE > APC >

MANR > MUR PCC * BJPC 2 6 6/2/2011 http://www.ihs.gov/mean

ingfuluse/pdf/MUPerformanceMeasuresLogic.pdfEP MU Performance

MeasuresMU1P CORE > APC >

MANR > MURn/a PCC * BJPC 2 6 6/2/2011 http://www.ihs.gov/mean

ingfuluse/pdf/MUPerformanceMeasuresLogic.pdf

EP MU CQM Report

EP CORE>GPRA>CI11>RPT>MUP

BGPZMENU (required), BGPZ PATIENT LISTS (optional), BGPZ SITE PARAMETERS (optional), BGPZ TAXONOMY EDIT (optional), BGPZAREA (optional)

Clinical Reporting System

BGP 11.1 1 11/23/2011 http://www.ihs.gov/meaningfuluse/pdf/CRSMUCQMReportsSimpleLogicDocument.pdf

EH Patient VolumePVH CORE>ABM>RPTP>

MURP>MUPVABMDZ MU PV SETUP

Third Party Billing

ABM 2.6 8 11/15/2011 http://www.ihs.gov/RPMS/PackageDocs/abm/abm_0260.07o.pdf

Clean Date ReportMUCD CORE > APC >

MANR > MUR PCC * BJPC 2 6 6/2/2011 http://www.ihs.gov/mean

ingfuluse/pdf/MUPerformanceMeasuresLogic.pdf

InPatient Bed DaysFEIR CORE>ABM>RPTP>

MURP Third Party

BillingABM 2.6 8 11/15/2011 http://www.ihs.gov/RPM

S/PackageDocs/abm/abm_026u.pdf

EH MU Performance Measures

MU1H CORE > APC > MANR > MUR

n/a PCC * BJPC 2 6 6/2/2011 http://www.ihs.gov/meaningfuluse/pdf/MUPerformanceMeasuresLogic.pdf

EH MU CQM Report

CORE>GPRA>CI11>RPT>MUP

BGPZMENU (required), BGPZ PATIENT LISTS (optional), BGPZ SITE PARAMETERS (optional), BGPZ TAXONOMY EDIT (optional), BGPZAREA (optional)

Clinical Reporting System

BGP 11.1 1 11/23/2011 http://www.ihs.gov/meaningfuluse/pdf/CRSMUCQMReportsSimpleLogicDocument.pdf

* The Performance Measure report relies on a number of packages to collect the necessary data to run the report. Please refer to the EHR for Meaningful Use: Resource and Training Reference Tool for Eligible Professionals or Eligible Hospitals for which packages are needed for each measure.

http://www.ihs.gov/meaningfuluse/pdf/EHRforMeaningfulUseforEPsScavengerHunt.pdf

http://www.ihs.gov/meaningfuluse/pdf/EHRforMeaningfulUseforEHsCAHsScavengerHunt.pdf

MU Reports: EP & EH Performance Reports

MU Reports: Clinical Quality Measure Report

WHAT DOES HIM REALLY NEED TO KNOW

• Differences/commonalities between:

-CORE SET and MENU SETS

-PERFORMANCE MEASURES and CLINICAL QUALITY MEASURES

-MEASURES FOR EH/CAH versus EP

• Reports that demonstrate reaching meaningful use

• Measures that require attestation only

• Effects of accurate and timely completion of coding queue on MU

• Effects of inpatient coding and clinical documentation on reaching CQM

• Effects of PCC errors on MU

• Effects of complete and comprehensive patient registration on MU

STAGE 2

Stage 2 – Proposed Rule

• Proposed delay of Stage 2 until 2014• Proposed new Performance Measures• Proposed increase in targets for some

measures• Proposed moving menu set to core• Proposed new Patient Volume

methodology• Proposed changes to Stage 1

Proposed Stage 2 Delay

2011 2012 2013 2014 2015 2016

Stage1MU 90 Days

Stage 1MU 365 Days

Stage 2MU 365 Days

Stage TBDMU 365 Days

Stage1MU 90 Days

Stage 1MU 365 Days

Stage 2MU 365 Days

Stage1MU 90 Days

Stage 1MU 365 Days

Stage1MU 90 Days

Eligible Professionals: Meaningful Use Requirements

STAGE 1:

20 total Performance Measures

• 15 core performance measures*• 5 performance measures out of

10 from menu set*

• 6 total Clinical Quality Measures• 3 core or alternate core• 3 out of 38 from menu set

STAGE 2 (Proposed Rule)

• 17 core performance measures*

• 3 of 5 menu set measures

12 Total Clinical Quality Measures

Eligible Hospitals: Meaningful Use Requirements

• 5 performance measures out of 10 from menu set*

15 total Clinical Quality Measures

STAGE 2 (Proposed Rule)

• 2 of 4 menu set measures

24 Total Clinical Quality Measures

Stage 1 Core vs. Stage 2 NPRM

EP EH Target Stage 1 Core Measure EP EH Target Stage 2 NPRM Core Measure

X X >30% CPOE for Medication Orders X X >60%CPOE for Medication, Laboratory,

and Radiology Orders

X X Yes/No Drug Interaction Checks Incorporated into CDS

X X >80% Maintain Problem List Incorporated into summary of care

for transition of care

X >40% E-Prescribing X >65% E-Prescribing

X X >80% Active Medication List Incorporated into summary of care

X X >80% Medication Allergy List Incorporated into summary of care

X X >50%: Record demographics X X >80% Record demographics

X X >50% Record Vital Signs X X >80% Record Vital Signs

X X >50% Record Smoking Status X X >80% Record Smoking Status

X X Yes/No Clinical Quality Measures

CQM’s are included in the definition for demonstrating MU.

They are no longer included in the objectives. Reporting on CQM’s

will still be required.

Stage 1 Core vs. Stage 2 NPRM

EP EH Target Stage 1 Core Measure EP EH Target Stage 2 NPRM Core Measure

X X Yes/No Clinical Decision Support Rule X X Yes/NoClinical Decision Support Rule

(Implement 5)

X X >50%Electronic Copy of Health

Information

Replaced objective with View, download and transmit

X >50% Clinical Summaries X >50% Clinical Summaries

X >50%Electronic Copy of Discharge

Instructions

Replaced objective with View, download and transmit

X X Yes/NoElectronic Exchange of Clinical

Information

Objective removed. Electronic Exchange included in Transition of

Care Summary.

X X Yes/NoProtect Electronic Health

InformationX X Yes/No

Protect Electronic Health Information

New X >10% Secure Messaging

New X >10% E-MAR

New X X>50%>10%

Timely online access to health info Patients view, download, transmit

Stage 1 Menu moved to Stage 2 Core (NPRM)

EP EH Target Stage 1 Menu Set Measure EP EH TargetStage 2 NPRM Menu moved to Core Set

X >20% Patient Reminders X >10% Patient Reminders

X 10% Patient Electronic Access X >50%>10%

Provided info online accessPatients that view, download,

transmit

X X >10%Patient Specific Education

ResourcesX X >10%

Patient Specific Education Resources

X X >50% Medication Reconciliation X X >65% Medication Reconciliation

X X >50% Transition of Care Summary X X>65%>10%

Transition of Care SummaryTransitions to outside organization

with different CEHR

X X Yes/No*Immunization Registries Data

SubmissionX X Yes/No

*Immunization Registries Data Submission

X X Yes/No*Syndromic Surveillance Data

Submission

XYes/No

*Syndromic Surveillance Data Submission

X Yes/No*Reportable Lab Results to

Public Health Agencies X Yes/No

*Reportable Lab Results to Public Health Agencies

Stage 2 NPRM Menu Set

EP EH Target Stage 1 Menu Set Measure EP EH TargetStage 2 NPRM Menu Set

Measure

X X Yes/No Drug-Formulary Checks Incorporated objective into

X >50% Advance Directives X >50% Advance Directives

New X X >40% Imaging Results

New X X >20% Patient Family History

New X >10% eRx discharge

New X Yes/No*Report Cancer Cases to

State Cancer registry

New X Yes/No *Specialized Registry

Area Area MU Contact Email Phone Number

Aberdeen CAPT Scott Anderson Scott.Anderson@ihs.gov (605) 335-2504

Alaska

Richard HallKimi GosneyErika Wolter Karen Sidell

rhall@anthc.org kgosney@anthc.org

ewolter@anthc.orgksidell@anthc.org

(907) 729-2622(907) 729-2642(907) 729-3907(907) 729-2624

Albuquerque Jacque Candelaria Jacque.Candelaria@ihs.gov (505) 946-9311

Bemidji Jason Douglas Bevin Moon

Jason.Douglas@ihs.govBevin.Moon@ihs.gov

(218) 444-0550 (505) 377-7888

Billings CAPT James Sabatinos James.Sabatinos@ihs.gov (406) 247-7125

California Marilyn FreemanSteve Viramontes

Marilyn.Freeman@ihs.govSteve.Viramontes@ihs.gov

(916) 930-3981 x.362 (916) 930-3981 x.359

Nashville Robin Bartlett Robin.Bartlett@ihs.gov (615) 467-1577

Navajo CDR Michael BelgardeDonna Nicholls

Michael.Belgarde@ihs.govDonna.Nicholls@ihs.gov

(928) 871-1416(505) 205-9177

Oklahoma Amy Rubin Amy.Rubin@ihs.gov (405) 951-3732

Phoenix CAPT Lee SternKeith Longie, CIORick Bowman

Lee.Stern@ihs.govKeith.Longie@ihs.govRichard.Bowman@ihs.gov

(602) 364-5287(602) 364-5080(520) 254-2211

Portland Donnie Lee, MDAngela Boechler

Donnie.Lee@ihs.govAngela.Boechler@ihs.gov

(503) 326-2017(971) 221-8057

Tucson Scott Hamstra, MD Rick Bowman

Scott.Hamstra@ihs.govRichard.Bowman@ihs.gov

(520) 295-2532(520) 254-2211

Regional Extension CenterREC REC Contact Email Areas

NIHB Tom Kauley Tkauley@nihb.org; (505) 977-6053 All

ANTHC Richard HallKimi GosneyErika WolterKaren Sidell

RHall@anthc.org; (907) 729-2622KGosney@anthc.org; (907) 729-2642EWolter@anthc.org; (907) 729-3907 KSidell@anthc.org; (907) 729-2624

Alaska

CRIHB Tim CampbellRosario Arreola ProAmerita Hamlet

Tim.campbell@ihs.gov; (707)889-3009Rosario.arreolapro@crihb.net; (916)929-9761 x.1300Amerita.hamlet@crihb.net; (916)929-9761 x.1323

California

NPAIHB Katie Johnson Kjohnson@npaihb.org; (503) 416-3272 Portland

USET Vicki FrenchJames Chavez

Vicki.French@ihs.gov (615)-467-1578James.Chavez@ihs.gov (505) 977-1754

AberdeenAlbuquerqueBemidjiBillingsNashvilleNavajoOklahomaPhoenixTucson

IHS Meaningful Use: Contact Information

• Chris Lamer, Meaningful Use Project Lead, IHS Chris.Lamer@ihs.gov; (615) 669-2747

• Luther Alexander, MU Project Manager, DNC Luther.Alexander@ihs.gov; (301) 443-8114

• JoAnne Hawkins, MU Healthcare Policy Analyst, DNCJoAnne.Hawkins@ihs.gov; (505) 767-6600 x1525

• Cecelia Rosales, MU Requirements Manager, DNC Cecelia.Rosales@ihs.gov; (505) 767-6600 x1230

Questions?Discussion Time

Sign up for the MU Listserv!http://www.ihs.gov/listserver/index.cfm?module=signUpForm&list_id=168

More questions, contact us at:MeaningfulUseTeam@ihs.gov

Meaningful Use Overview for HIM Professionals Pat Gowan & JoAnne Hawkins Last Updated: June 11,...

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