health information technology extension center of los angeles · what is meaningful use? defined...

A project of L.A. Care Health PlanA project of L.A. Care Health Plan

Health Information Technology Extension Center of Los Angeles

Meaningful Use: a Primer

Mary MitchellDirector of Meaningful Use

A project of L.A. Care Health Plan

What is Meaningful Use?Defined as:

A. Use of a certified EHR in a meaningful manner (e.g.: clinical documentation, e-prescribing, etc.)

B. Use of certified EHR technology for electronic exchange of health information

C. Use of certified EHR technology to submit clinical quality and other measures

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Practical Approach:Meaningful Use IS Health Care Transformation

Meaningful Use

Quality Reporting

Clinical Decision Support

Improving Care Coordination

Engaging Patients

Managing Population Health

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3 Stages of Meaningful Use2

01

1

Stage I

Data Capture and Sharing

*20

12

Stage II

Advanced Clinical Processes

*20

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Stage III

Improved Outcomes

* to be defined in future rulemaking

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Improved Outcomes

Increased Efficiency

What It Means for Providers

Challenges

- - - - - - - -

Records Conversion

Change

- - - - - - - -

Access

Adaptation

- - - - - - - -

Responsiveness

Practice

- - - - - - - -

Patient Involvement

Investment of

Time and Money$

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How Do I Achieve Meaningful Use?

✔

Good News: You are already achieving many of these measures!

Medicare:

• Demonstrate in 1 year• Initiate by 2014• Payments begin in 2011• Fee schedules reduced beginning 2015 if not

achieving meaningful EHR use

Medicaid:

• Adopt/implement/upgrade option 1st year• Initiate by 2016• No payment reductions• Last year of payments is 2021

✔

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Implementation Phases & Criteria

• Phase 1: Objectives & Measures

• Meet 15 Core Objectives

• Meet 5 of 10 Menu Set Core Objectives

• Satisfy 3 Core Clinical Quality Measures (CQMs)

• Satisfy 3 of 38 Additional Set CQMs

• Submit by attestation

• Phase 2 : Advanced Clinical Process

• Phase 3 : Improved Outcomes

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A project of L.A. Care Health Plan8

15 Core Objectives for Eligible Providers (meet all)

• Computerized Provider Order Entry

• E-Prescribing

• Report ambulatory clinical quality measures to CMS/States

• Implement one clinical decision support rule

• Provide patients with an electronic copy of their health information, upon request

• Provide clinical summaries for patients for each office visit

• Check for drug-drug and drug-allergy interactions

• Record demographics

• Maintain an up-to-date problem list of current and active diagnoses

• Maintain active medication list

• Maintain active medication allergy list

• Record and chart changes in vital signs

• Record smoking status for patients 13 years or older

• Capability to exchange key clinical information among providers of care

• Protect electronic health information


Menu Set Core Objectives for Eligible Providers (meet 5 of the 10)

• Drug-formulary checks

• Incorporate clinical lab test results as structured data

• Generate lists of patients by specific conditions

• Send reminders to patients per patient preference for preventive/follow up care

• Provide patients with timely electronic access to their health information

• Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate

• Reconcile medications

• Summary of care record for each transition of care/referral

• Capability to submit electronic data to immunization registries/systems*

• Capability to provide electronic surveillance data to public health agencies*

* At least 1 public health objective must be selected


Core Clinical Quality Measures (CQMs)(satisfy 3)

1. Hypertension blood pressure measurement

2. Preventive care and screening measure pair

• Tobacco use assessment• Tobacco cessation intervention

3. Adult weight screening and follow up

4. Weight assessment and counseling for children and adolescents

5. Preventive care and screening

• Influenza immunization for patients > 50 years old

6. Childhood immunization status


Additional Set of CQMsEPs must complete 3 of 381. Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b) Effective Continuation Phase

Treatment2. Appropriate Testing for Children with Pharyngitis3. Asthma Assessment4. Asthma Pharmacologic Therapy 5. Breast Cancer Screening6. Cervical Cancer Screening7. Chlamydia Screening for Women 8. Colorectal Cancer Screening9. Controlling High Blood Pressure 10. Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)11. Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol12. Coronary Artery Disease (CAD): Oral Anti-platelet Therapy Prescribed for Patients with CAD13. Diabetes: Blood Pressure Management14. Diabetes: Eye Exam15. Diabetes: Foot Exam16. Diabetes: Hemoglobin A1c Control (<8.0%)17. Diabetes: Hemoglobin A1c Poor Control 18. Diabetes: Low Density Lipoprotein (LDL) Management and Control 19. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care20. Diabetic Retinopathy: Documentation of Presence/Absence of Macular Edema and Level of Severity of

Retinopathy

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Additional Set of CQMsEPs must complete 3 of 38 (continued)21. Diabetes: Urine Screening22. Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB)

Therapy for Left Ventricular Systolic Dysfunction (LVSD) 23. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)24. Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation25. Ischemic Vascular Disease (IVD): Blood Pressure Management 26. Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control 27. Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 28. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement29. Low Back Pain: Use of Imaging Studies 30. Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor

(ER/PR) Positive Breast Cancer 31. Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients32. Pneumonia Vaccination Status for Older Adults33. Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)34. Prenatal Care: Anti-D Immune Globulin35. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation 36. Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients37. Smoking 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

38. Use of Appropriate Medications for Asthma

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Regional Extension Centers are Formed…

• Neutral, Not-For-Profit organizations established to provide training, support and technical assistance to help primary care providers select, implement and use EHRs

• Selection, purchase & implementation of EHR

• Workflow redesign

• Connection to health information exchange

• Attainment of Meaningful Use

• Compliance with privacy and security

• Goal is for 100,000 priority primary care providers across the country to become meaningful users of EHRs within four years

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HITEC-LA Goals

• Establish L.A. Care’s REC program as a trusted brand providing objective, high quality information and assistance to providers

• Deliver technical assistance to priority primary care providers and other members by April 2012

• Create 3,000 meaningful EHR users by April 2012

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Are You Eligible for REC Services andCMS Meaningful Use Payments?

Provider Type/License Eligible for subsidized REC Services

Eligible for Medi-Cal Incentives1 Eligible for Medicare Incentives

Medical Doctor (MD) YES2 YES3 YES3

Doctor of Osteopathy (DO) YES2 YES3 YES3

Psychiatrists (MD) NO4 YES3 YES3

Dentist NO4 YES YES

Nurse Practitioner (NP) YES2 YES3 NO

Certified Nurse Midwife (CNM) YES2 YES3 NO

Chiropractor NO4 NO YES

Physician Assistant (PA) YES2 YES5 NO

Psychologists NO4 NO NO

Optometrists NO4 YES YES

Podiatrists (DPM) NO4 NO YES

Residents NO YES3 YES3

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1Must meet Medi-Cal Patient volume criteria: 3Non-Hospital based: if more than 90% or the provider’s services are performed in a hospital in-patient or emergency room

Minimum 30% Medicaid patient volume setting, that provider is Hospital-Based and not eligible for the EHR incentive program

Minimum 20% Medicaid patient volume and is a pediatrician 4May be eligible for REC services on a Fee for Service basis

Practice predominantly in a Federally Qualified Health Center or Rural Health Clinic and have a minimum 30%

patient volume of needy individuals

5Physician Assistants are only eligible if practicing in FQHC or RCH that is “Physician Assistant-led”

2Non-Hospital based, certified in Internal Medicine, Family Practice, Pediatrics, Adolescent Medicine, OB/GYN, or Family

Practice practicing in one of the following settings:

Physician Practices of 10 providers or less

Community health centers, primary care clinics and rural health clinics

Ambulatory care clinics associated with public hospitals, critical access hospitals, or rural hospitals

Other medically underserved settings

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First Calendar Year in Which Eligible Provider Receives a Medicaid Incentive Payment

Calendar Year 2011 2012 2013 2014 2015 2016

2011 $21,250

2012 $8,500 $21,250

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

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

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

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

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

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

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

2020 $8,500 $8,500

2021 $8,500

Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750

• Eligible Providers are those that see 30% Medicaid, Medicaid HMO or uninsured patients over any 90 day period during the year.

• Pediatricians must see 20% Medicaid, Medicaid HMO or uninsured patients.

• To qualify for the first payment, an EP must implement, upgrade or acquire an EHR.

• Payout occurs over 6 years with the last payment year being 2021.

• EPs can receive entire incentive payment even if they don’t implement a system until 2016.

Medicaid Incentives


First Calendar Year in Which Eligible Provider Receives a Medicare Incentive Payment

Calendar Year 2011 2012 2013 2014 2015 +

2011 $18,000

2012 $12,000 $18,000

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

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

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

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

Total $44,000 $44,000 $39,000 $24,000 $0

• Eligible Providers are those that receive a minimum of $25,000 in Medicare reimbursement for the entire year.

• During 2011, EPs only have to demonstrate Meaningful Use for 90 days.

• During 2012+, EPs must demonstrate Meaningful Use for entire year.

Medicare Incentives


Incentives: Time Is Money for Providers

$ $

$ $

$ $

$

$

$$

$$

$$$

2011/2012 2013 2014 2015

Medicare* $44,000 $39,000 $24,000 $0

Medicaid** $63,750 $63,750 $63,750 $63,750

* Eligible for payments up to 75% of Medicare billings (min. $25K to qualify for full amount)

** 30% of patients visits must be Medicaid to qualify for full amount (20% for pediatricians)

OR

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Differences BetweenMedicare and Medicaid Incentives

Medicare Medicaid

Federal Government will implement Voluntary for States to implement (may not be an option in every State)

Claims payment reductions begin in 2015 for providers that do not demonstrate Meaningful Use

No Medicaid payment reductions

Must demonstrate MU in Year 1 Adopt/Implement/Upgrade option for 1st participation year

Maximum incentive is $44,000 for EPs Maximum incentive is $63,750 for EPs

MU definition is common for Medicare States can adopt certain additional requirements for MU

Last year a provider may initiate program is 2014Last year to register is 2016Payment adjustments begin in 2015

Last year a provider may initiate program is 2016Last year to register is 2016

Only physicians, subsection(d) hospitals and CAHs Five types of EPs, acute care hospitals (including CAHs) and children’s hospitals


Who Does HITEC-LA Serve?

• Our members only

• Membership is free to all

• Some free services to all members; subsidized services for PPCPs.

• Providers do not have to be L.A. Care Health Plan Providers

• 7,800 Priority Primary Care Providers in L.A. County including anyone with prescribing privileges.

– Practices of less than 10

– Community health centers

– Public hospitals

• Specialists are welcome

• 3,000 meaningful users

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HITEC-LA and other RECs in the Big Picture

• Medicare and MedicaidIncentives & Penalties

• State Grants for HIE• Standards &

Certification Framework• Privacy & Security

Framework

$19.2B HITECH Program: How the Pieces Fit Together

Improved Individual & Population Health

Outcomes

Increased Transparency &

Efficiency

Improved Ability to Study & Improve Care

Delivery

ADOPTION

MEANINGFUL USE

EXCHANGE

Health IT Practice Research

• Regional Extension Centers

• Workforce Training

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Providing Skilled, Subsidized Assistance toEligible Providers from Start to Finish

ReadinessAssessment

PracticeWorkflowRedesign

EHRImplementation

AchievingMeaningful

Use

Preparefor Future

Pay forPerformance

Partneringwith stateand local

HIEs

HITEducation& Training

EHRSystem

Selection

1. Plan 2. Transition 3. Implement 4. Operate & Maintain

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Added Benefits of Working with a REC• Experienced

• Knowledge & technical expertise

• Allow you to make fully educated choices

• Learn about all your options

• Access group volume discounts

• Free or discounted services

• Peer-to-Peer Network

• Impartial advocate

• No cost to join

• Not “us or them” it’s “we”

• Assistance in meeting critical deadlines

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HITEC-LA Can Help You Reap the Benefits

You have an EHR?

• Stage 1 MU

• MU Assessment

• MU Gap Analysis

• Workflow Redesign

• Optimize System

• Training

• Support

No EHR?

• Stage 1 MU

• MU Assessment

• System Selection

• Workflow Design

• Implementation

• Training

• Support

• MU Gap Analysis

Focus on Stage 1 Clinical Measures

It all starts with

Meaningful Use!

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A Big Change Brings A Lot of Questions

Right EHR?

Timelines?

How?

Scanning?

Configuration?

Productivity loss?

Use Hospital EHR?

Necessary?

Urgent?

Use IPA/MSO?

Buy?

Will I miss out?

Workflow?

Test runs?

Patient impact?

Staff training?

Meaningful Use? Cash flow?

Incentives?

Out of pocket costs?

Penalties?

Pay for Performance?

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TOP 10 EHR LESSONS LEARNED

1. The transition takes longer than you’ll expect; it’s too hard to scan charts as patients come in

2. Scanning/organizing/sorting take time to do it right, especially for cross-referencing systems

3. Data conversion from my old system (e.g. medical billing company) can come with a substantial cost (as much as $10k) if buying from a new or different vendor

4. I didn’t have an IT person with my old system; now I need one

5. I need support for both my internal network and software

6. I need to clarify and access the ongoing support I’ll need (e.g. response time)

7. Staff learning curve varies by person; some take much longer to adapt

8. Your EHR vendor will pursue your loyalty for their products & services, and solid implementation will make or break your investment

9. I need to check the financial stability of my EHR vendor before signing

10. It will take longer to break even on the cost than expected

Benefits of our Peer-to-Peer Network

We can help you with proper planning & implementation to avoid learning the hard way!

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Where to Start

• Contact HITEC-LA

• Register to begin your free enrollment with our unbiased experts who will help you learn about:

– defining your needs, options and alternatives

– vendor selection, group purchasing discounts

– practice assessment process

– achieving meaningful use, qualifying for incentives

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Important Dates

Important Dates

• January 1, 2011 – Reporting year begins for eligible professionals

• January 3, 2011 – Registration for the Medicare EHR Incentive Program begins

• March 1, 2011 – Registration begins for Medi-Cal eligible professionals

• April 2011 – Attestation for the Medicare EHR Incentive Program begins

• May 2011 – EHR Incentive Payments expected to begin

• October 1, 2011 – Last day for eligible professionals to begin their 90-day reporting period for calendar year 2011 for the Medicare EHR Incentive Program

• December 31, 2011 – Reporting year ends for eligible professionals

• February 29, 2012 – Last day for eligible professionals to register and attest to receive an Incentive Payment for calendar year (CY) 2011

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Important Links

CMS Official EHR Incentive Program website:

http://www.cms.gov/EHRIncentivePrograms

Medi-Cal EHR Provider Incentive Portal website:

http://www.medi-cal.ehr.ca.gov/

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Meaningful Use Made Easier

www.hitecla.org

1 (888) 524-4832

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http://www.hitecla.org/

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