Date post: | 11-Nov-2014 |
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Beyond Meaningful Use: Connecting quality data requirements to business
operational improvements
Linda ClenDening, MS, CMPEPYA
Agenda
• Data and quality clinical outcomes
• Regulatory information highlights and audits
• Meaningful Use (MU) implications for – Staffing/Roles– Alliances/Referrals– Meaningful data
Quality Outcomes
Quality Data in the Exam Room
xx% of my patients over 18 who have their tonsils removed experience post-surgical hemorrhaging.
These outcomes are less than the national average of yy% of patients over 18.
Quality DataWhat’s the source of the data?
Communicating About QualityIf he’s using clinical outcomes statistics in the exam room, where else is he using them?
Doctor’s LoungeCommunicating with referring physicians?
Board Table
Quality contractual requirements between hospitals and physicians
– Employment arrangements– Clinical co-management– ACOs– Other partnerships
Negotiating Table
Once quality metrics are operationalized for one payor, the provider can build on that strength to discuss quality with other contracting payors.
WebsiteHow is he attracting patients to his practice based on quality outcomes?
Take Away #1
• What story are you telling about the physicians in your practice using the quality data collected in the MU process?
• Focus on a core measure metric or clinical quality metrics and develop the story.
MU Statistics as of June 2013
$-
$500,000,000
$1,000,000,000
$1,500,000,000
$2,000,000,000
$2,500,000,000
$3,000,000,000
2011 2012 2013 YTD
Medicare EP.s Medicaid EP.s
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/June_PaymentRegistration_Summary.pdf
Almost 6 billion
dollars to EP.s to-
date
Real World Impact of MU
• More than 458 million test results were entered into the EHR by 111,954 Eligible Providers (EP.s).
• Medication reconciliation was performed on over 40 million patient transitions of care by 83,035 EP.s.
• More than 4.3 million patient transitions of care summaries were generated by 24,827 EP.s.
By Robert Tagalicod, Director, Office of E-health Standards and Services http://www.cms.gov/eHealth/ListServ_RealWorldImpact_MeaningfulUse.html
Meaningful UseHeadlines• July 30, 2013 – AHA and AMA, as well as CHIME
(College of Healthcare Information Management Executives), request more time for Stage 2.
• July 30, 2013 –AHA report calls for a delay of Eligible Hospital Stage 2 deadline of October 1, 2013.
• September 24, 2013 – Senators call for one-year Stage 2 Meaningful Use extension.
As reported in HealthLeaders Media and EHRIntelligence.
Meaningful UseCurrent Details• Stage 2 Meaningful Use (MU) Attestation begins in calendar year
2014 for Eligible Providers (EP.s).– If a provider began MU in 2011, he/she will meet three consecutive
years of MU before beginning Stage 2 in 2014.– All other providers meet two years of MU before advancing to Stage 2
in their third reporting year.• For 2014 only, all providers – regardless of MU stage – are only
required to demonstrate MU for a 3 month reporting period.• Beginning in 2015, Medicare eligible professionals who do not
successfully demonstrate meaningful use will be subject to a payment adjustment.
Penalty ScenariosFirst Year of
MU
Requirement to Avoid Penalty
2015 2016 2017
2011 Achieve MU in 2013 (365 days)
Achieve MU in 2014 (One 3-month
quarter)Achieve MU in 2015
(365 days)
2012 Achieve MU in 2013 (365 days)
Achieve MU in 2014 (One 3-month
quarter)Achieve MU in 2015
(365 days)
2013Achieve MU in 2013
(Any 90-consecutive-day period)
Achieve MU in 2014 (One 3-month
quarter)Achieve MU in 2015
(365 days)
2014
Achieve MU in 2014 (Any 90-consecutive-day
period ending no later than 3 months before the
end of the reporting period)
Achieve MU in 2014 (One 3-month
quarter)Achieve MU in 2015
(365 days)
MU Role in New Care Model Development• Consolidation/M&A• ACOs• Clinically Integrated Networks• Private Payor Network
Development/Contracting• Others
MU & Consolidation
• Weathering the storm with a bigger ship:– From 2000 to 2010, hospital physician employment
rose 32%. – Hospitals directly employ about a quarter of all U.S.
physicians.– By 2013, two-thirds of physicians will work for
hospitals or large groups.• Strategic Consideration:
– Affiliate or merge with an organization without an MU plan or at risk of a penalty?
MU & Consolidation
• Transaction Due Diligence Consideration:– Meaningful Use due diligence now occurs in most
healthcare transactions. – Organizational readiness for Meaningful Use
Attestation requires detailed supporting documentation.
MU & ACOs
• Public Payor• Medicare• Medicaid
• Private Payor• Private Payors (Blue Cross, United, Cigna, Aetna)
• ACOs with private insurers in effect or development at four times the rate of Medicare ACOs
• Large Employers • Self-Insured Hospitals and Health Systems
MU & ACOs• ACO 33 Quality Measures include:
– Percent of PCPs who Successfully Qualify for MU Payment
– CQMs overlap with ACO measures
Clinical Quality Measure (CQM) Overlap with ACO and Other Programs
Stage 2 2014 CQM Measure Other CMS Program
Controlling High Blood Pressure Percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period.
ACO; EHR PQRS; Group Reporting PQRS
Use of High-Risk Medications in the Elderly PQRS
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
ACO; EHR PQRSGroup ReportingPQRS
Use of Imaging Studies for Low Back Pain
Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan
EHR PQRS; ACO; Group Reporting PQRS
Documentation of Current Medications in the Medical Record PQRS; EHR PQRS
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up
EHR PQRS; ACO; Group Reporting PQRS
2013 PQRS
• If you have EPs that meet MU, don’t leave money on the table:– 2013: 0.5% incentive– 2015: 1.5% penalty
• Assess crosswalk opportunities for quality reporting across programs.
MU & Private Payor Contracting
• A growing number of private payers have added the MU requirements to their P4P programs:– Aetna, United and WellPoint– Highmark modified "Quality Blue" program to include
MU:• Require copy of attestation• Incorporate CQM for physician practice best practice indicator
program
• Payors not setting up proprietary mini-MU programs– Rather use developed MU system– Similar to using DRGs as a reference price for rates
Take Away #2
• Incorporate MU into Compliance Program. – Compliance Officer involvement in attestation and annual
review.
• Ensure attestation documentation is consistent with CMS’s recommendations.
• Prepare for more oversight – not just from CMS.• Maximize MU attestation benefits with other payors
and alliances.
Operationalizing
to imperfect users.
Adapting a perfect program…
Much more about the people,
than the systems.
Operationalizing
Meaningful Use Progression
The systems need to carry the burden to prompt users to do the right
thing.
As Meaningful Use
requirements progress there
will be a higher volume
of data requirements
and more complexity.
We can only do so much.
MU Staffing Changes
Increased clerical staff
Increased clinical staff
No staffing changes made
Other
0% 10% 20% 30% 40% 50% 60%
Group 2Group 1
MU Staffing Changes?
• Increased data input demands on current staff.
• Hired dedicated quality manager.
• Shift in resources in IT department to focus on MU readiness.
• We used outside consultants for MU attestation.
MU Staffing Changes
Increased duties and responsibilities of
current staff, including Administrator/Director.
Use of consultants for MU implementation and attestation process.
New IT team members: Quality staff, EMR analysts, and EMR trainers
Yes
No
0% 20% 40% 60% 80%
Group 2Group 1
New IT Staff Positions
New IT Staff Positions for MU?
• Not yet, but we are discussing these.
• Hired a portal manager.
IT Staff Positions Added
Report/data specialist
Clinical data analyst
Training Other0%5%
10%15%20%25%30%35%40%45%50%
Group 1Group 2
IT Functional Roles Changing
Increase in support/
help desk
Increase in liaison/
networking support
Increase in leadership/
management
Other 0%
5%
10%
15%
20%
25%
30%
35%
40%
Group 1Group 2
Staffing Changes
Source: 7 Hottest IT Healthcare Skills http://www.cio.com/slideshow/detail/70112#slide1 www.CIO.com October 18, 2012
EMR Build Specialists
Healthcare Analytics
Project Management
Program Management
Application Development
Data Architecture
Quality Assurance
IT Functional Roles Changing
• Anticipate increased need of support for – New hardware– Networking– Remote access– Interoperability issues
2012 HIMSS Leadership Survey
Yes No Unknown0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Group 1Group 2
Strategic Partnerships based on Quality?
Referral partners asked about MU
Referral partners MU attested
MU not considered
Other (please specify)
0% 20% 40% 60% 80% 100%
Group 2Group 1
MU effect on Alliance Decisions
Take Away #3
• Re-assess staff skills and training for EHR usage.
• Determine possible staff duty changes.• Document process and workflow redesign for
EHR/MU implementation.• Update all affected policies and procedures.• Redesign monthly reports and dashboards to
include key MU metrics.
The Meaningful Use Goal
❝Language is the road map of a culture. It tells you where its people come from and where
they are going.❞‒Rita Mae Brown
Healthcare providers, executives, and staff are engaged in developing a new language.
Thank you!
Linda ClenDening, MS, CMPE
Manager
PYA
615-305-5218
865-684-2735