hitc attestation webinar 1.11.12

©2012 The HIT Community, LLC. All Rights Reserved. 1

Meaningful Use Attestation

January 11, 2012


Welcome!


Michael Levinger• President, CEO and Cofounder of The HIT

Community • 30+ years of experience in the successful

use of mission-critical software including EHRs and Health Information Technology

• On the faculty of Boston University teaching a masters degree course on Electronic Health Records

• Serves as the Health IT “Ask the Expert” for Pri-Med

• Member of Massachusetts REC workgroup on Health IT Workforce Development


Agenda

• Overview of Federal EHR Incentive Program• Three Steps to get Federal Incentives

1. Registration

2. Meaningful Use

3. Attestation

• Critical Success Factors for Attestation


Poll Question # 1?

Where are attendees in the implementation process?


• The Federal government will pay for – Meaningful Use– Of a Certified EHR

• What is Meaningful Use?– A set of government definitions

of how to use an EHR– Defines the impact of EHRs on

Healthcare Delivery and Quality• What is Certification?

– Government specifications– Indicate whether an HER

can support Meaningful Use• Certification and Meaningful Use

work together

Federal EHR Program SummaryOne Hundred Eleventh

Congress of the

United States of America

AT THE FIRST SESSION

Begun and held at the City of Washington on Tuesday,

the sixth day of January, two thousand and nine

An Act


Government ARRA Incentives for EHR

As much as $44,000 per provider• Must be eligible professionals (NOT

hospital-based) that are meaningful

EHR users

• Paid over five years

• Disincentives if don’t deploy EHR

system, payments will be cut

– 1% in 2015

– 2% in 2016

– 3% in 2017

As much as $63,750 per provider• Eligible professionals (NOT hospital-

based) that are meaningful EHR users

• Must meet Medicaid volume levels

• Payment for up to six years

• Up to 85% of the costs for certified EHR

technology and support services

• Pediatricians can receive up to $42,500 at

lower thresholds

• Maximum of $21,250 in the first year,

$8,500 in subsequent years, up to a total

of $63,750 over total time frame

• No payments after 2021Lots of “fine print”


Who is Eligible for Payment?

Medicaid• Professionals

– Physicians (non-hospital affiliated)

– Nurse Practitioners– Physician Assistants (PA) in

FQHC or rural health clinic led by PA

• Hospitals– Acute Care Hospitals– Critical Access Hospitals– Children’s Hospitals

Medicare• Professionals

– Doctor of Medicine– Osteopathy– Dental Surgery, Dental

Medicine– Podiatric Medicine– Optometry– Chiropractor

• Hospitals– Acute Care Hospitals– Critical Access Hospitals


Meaningful Use Goals

The use of Health IT to:• Improve quality, safety, efficiency, and reduce health disparities• Engage patients and families• Improve care coordination• Improve population and public health• Further the goal of information exchange among health

professionals• Ensure adequate privacy and security protections for personal

health information

Defined by Centers for Medicare and Medicaid Services (CMS)


Three Stages of Meaningful Use

Stage 1 - 2011-2012• Data Capture &

Sharing.• Concentration on

electronic capture and sharing of health information in a structured format

Stage 2 - 2013• Advanced Clinical

Processes• Builds upon Stage

1• Focused on data

aggregation and quality improvement at the point of care and electronic exchange of information

Stage 3 – 2015• Final Stage• Focus is data use

to impact outcomes

• Providers will demonstrate improvement in quality, safety and efficiency

• Clinical decision support

• Patient management tools


Certification

• A defined process to ensure that EHR technologies meet the technical requirements to achieve meaningful use.

• Includes:– Security– Data confidentiality– Can work with other systems to share information– Can perform a set of well-defined

functions needed for Meaningful Use

• Administered by the Federal Office of the National Coordinator of HIT (ONCHIT)


Poll Question # 2?

Where are attendees in the attestation process?


What do I need to do to receive my Medicare /Medicaid Incentive Payment?

1. Register for the EHR Incentive Program;

2. Meet Meaningful Use criteria using certified EHR technology; and

3. Attest that have met meaningful use.


Registration

1. See if your state is ready to participate

2. Decide whether to participate in the Medicare or

Medicaid program

3. Register

State must be ready to register for Medicaid program

Most states are ready by Jan. 2012

EPs can switch once before 2015

If eligible, Medicaid provides a higher potential payment

Some hospitals are dually-eligible for both Programs

Register at: https://ehrincentives.c

ms.gov/

Requires Standard CMS Registration

Information

See Appendix for Details of Information

Required


Information Needed to Register

Eligible Professionals• National Provider Identifier (NPI).• National Plan and Provider Enumeration System (NPPES) User ID and

Password.• Payee Tax Identification Number (if you are reassigning your benefits).• Payee National Provider Identifier (NPI) (if you are reassigning your

benefits).• An EP can designate a third party to register and attest on their behalf

Eligible Hospitals and Critical Access Hospitals (CAHs)• CMS Identity and Access Management (I&A) User ID and Password.• CMS Certification Number (CCN).• National Provider Identifier (NPI).• Hospital Tax Identification Number


Achieve Meaningful Use

Stage 1 Criteria for Meaningful Use Focus On:Stage 1 Criteria for Meaningful Use Focus On:

Electronically capturing

health information

Using that information to

track key clinical

conditions

Communicating that information

for care coordination

purposes

Reporting of clinical quality measures and public health information


Meaningful Use Stage 1 Summary

Eligible ProfessionalsMeet 20 of 25 objectives plus 6-9 quality measures

Eligible Hospitals and Critical Access HospitalsMeet 19 of 24 objectives plus 15 quality measures

15 required core objectives.

5 objectives chosen from a list of 10 menu

set objectives.

6 total Clinical Quality Measures (3 core or

alternate core, and 3 out of 44 from alternate set)

14 required core objectives.

5 objectives chosen from a list of 10 menu

set objectives.

15 clinical quality measures


Example Quality Measure


Poll Question # 3?

Have attendees defined the meaningful use measures they are using?


Medicaid Attestation – Varies by State

Illinois Attestation is via MEDI https://secure.myhfs.illinois.gov/login/AuthenticateUserRoamingEPF.html

For more on Illinois Medicaid payments see: http://hfs.illinois.gov/ehr/path.html

Register using the CMS system described earlier. Use CMS' web-based Registration and Attestation System at https://ehrincentives.cms.gov/

https://secure.myhfs.illinois.gov/login/AuthenticateUserRoamingEPF.html

https://secure.myhfs.illinois.gov/login/AuthenticateUserRoamingEPF.html

http://hfs.illinois.gov/ehr/path.html

https://ehrincentives.cms.gov/


Critical Success Factors

• Issue: Need the right information to attest– What measures?– How computed?– Where does the information come from?– GIGO

• Action Recommendation– Define which measures you are using– Understand the calculations for each measure - CMS has detailed

definitions– Insure revised workflow captures this information– Must train staff to know what information you need and that they must

capture it



• Issue: Your EHR system must support tracking the information for attestation– EHR must have the right fields– Not all vendors have all the MU measures in place – especially quality

measures– Must be easy to enter the right information into those fields– Must be able to get reports with the right information

• Action Recommendation– Meaningful Use information requirements must be part of EHR selection– Meaningful Use information requirements must be part of EHR

implementation– Work with vendor or any consultants or REC to make sure the correct

reports are available– Train users on how to enter and access information in your EHR



• Issue: Can get “caught” by attestation details– The CMS Medicare attestation rules have some tricky details.– Some examples

• You are asked to provide an EHR Certification number - which is not the same as the Certified Health IT Product List (CHPL) Product number assigned during the certification process, EHR Provider Number

• A hospital must decide if it is using the observation services method for calculating emergency department (ED) visits or if all visits were counted

• Computing the core and quality measures can be tricky

• Action Recommendation– Clearly define your Meaningful Use information requirements– Define a process to access, compute and review the information– Have the information ready and completed before going online– Use the CMS Attestation User Guides and Worksheets



• Issue: Timing is important to maximizing payment– When you attest will affect the timing of incentive payments…– … and could also impact when you must attest for stage 2– Medicare schedule – the schedule is subject to change

• Action Recommendation– Understand when you can realistically start implementing an EHR– Don’t underestimate how long and complex implementation can

be– Start by 2013 to assure full payment– Keep informed about rule changes


What do I need to do to receive my Medicare/Medicaid EHR incentive payment?

Successfully register for the EHR Incentive Program

Meet meaningful use criteria using certified EHR technology

Successfully attest that you have met meaningful use criteria using certified EHR technology

http://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp

http://www.cms.gov/EHRIncentivePrograms/30_Meaningful_Use.asp

http://www.cms.gov/EHRIncentivePrograms/30_Meaningful_Use.asp


APPENDIX

Detailed Attestation Information

Meaningful Use Objectives

Quality Measures


Information Needed to Register

Eligible Professionals• National Provider Identifier (NPI).• National Plan and Provider Enumeration System (NPPES) User ID and

Password.• Payee Tax Identification Number (if you are reassigning your benefits).• Payee National Provider Identifier (NPI) (if you are reassigning your

benefits).• An EP can designate a third party to register and attest on their behalf

Eligible Hospitals and Critical Access Hospitals (CAHs)• CMS Identity and Access Management (I&A) User ID and Password.• CMS Certification Number (CCN).• National Provider Identifier (NPI).• Hospital Tax Identification Number


Medicare Attestation Details1. Use CMS' web-based Registration and Attestation System at https://ehrincentives.cms.gov/2. Currently you attest for the Medicare EHR Incentive Program in your first year of participation

• Need to have met meaningful use for a consecutive 90-day reporting period• If initial attestation fails, you can select a different 90-day reporting period that may partially overlap with a previously reported 90-day

period.• To attest for the Medicare EHR Incentive Program in subsequent years, you will need to have met meaningful use for a full year. • The reporting period for eligible professionals must fall within the calendar year, • The reporting period for eligible hospitals and critical access hospitals must fall during the Federal fiscal year.• At some point (likely in 2012), submission will be directly from an EHR system

3. To attest• Fill in numerators and denominators for the meaningful use objectives and clinical quality measures, Note: EHR system will provide a

report of the numerators, denominators and other information to enter that data into our online Attestation System. • indicate if they qualify for exclusions to specific objectives, and • legally attest that they have successfully demonstrated meaningful use. • Provide a CMS EHR Certification ID that identifies the certified EHR technology being used to demonstrate meaningful use. This can

be obtained by entering the certified EHR technology product information at the Certified Health IT Product List (CHPL) on the ONC website: http://healthit.hhs.gov/chpl

• Providers will qualify for a Medicare EHR incentive payment upon completing a successful online submission through the Attestation System—immediately after submitting results you will see a summary of your attestation, and whether or not it was successful.

4. Payment• Payments for the Medicare EHR Incentive Program will be made approximately four to eight weeks after successfully attesting.• Payments will be held for eligible professionals until eligible professionals meet the $24,000 threshold in allowed charges.• Payments to Medicare providers will be made to the taxpayer identification number (TIN) selected at registration• Payment will be check or electronic funds transfer the same as Medicare payments• CMS will deposit payment in the first bank account on file. It will appear on your bank statement as "EHR Incentive Payment”• Medicare Administrative Contractors (MACs), carriers and fiscal intermediaries will not be making these payments. CMS has contracted

with a Payment File Development Contractor to make these payments.• Payments can be for taxes or nontax offsets• Payments are subject to audit

https://ehrincentives.cms.gov/

http://healthit.hhs.gov/chpl


Eligible Professional Core Objectives1. Use CPOE for medication orders

2. Implement drug-drug and drug-allergy interaction checks.

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

4. Generate and transmit permissible prescriptions electronically (eRx).

5. Maintain active medication list.

6. Maintain active medication allergy list.

7. Record specified demographics

8. Record specified vital signs

9. Record smoking status for patients 13 years old or older.

10. Report ambulatory clinical quality measures to CMS or, in the case of Medicaid EPs, the States.

11. Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule.

12. Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, medication allergies) upon request.

13. Provide clinical summaries for patients for each office visit.

14. Capability to exchange key clinical information among providers of care and patient authorized entities electronically.

15. Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.


Eligible Professional Menu Objectives1. Implement drug formulary checks.

2. Incorporate clinical lab-test results into EHR as structured data.

3. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.

4. Send patient reminders per patient preference for preventive/follow-up care.

5. Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP.

6. Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate.

7. 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.

8. The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral.

9. Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice.

10. Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice.

Must Achieve Five!


Eligible Professional Quality MeasuresMust report on 6 total measures:•3 required core measures (substituting alternate core measures where necessary) and•3 additional measures.•A maximum of 9 measures would be reported if the Eligible Provider needed to attest to the 3 required core, the three alternate core, and the 3 additional measures.

Core Measures:• Hypertension: Blood Pressure Measurement• Tobacco Use Assessment and Tobacco Cessation Intervention• Adult Weight Screening and Follow-up (BMI)

Alternative Core Measures:•If the denominator for one or more of the Core Measures is zero, Eligible Providers will be required to report results for up to three Alternate Core Measures.

•The Measures are Weight Assessment and Counseling for Children and Adolescents (BMI)• Preventive Care and Screening: Influenza Immunization for Patients ≥ 50 Years Old• Childhood Immunization Status

Clinical Quality Measures - Eligible Providers must choose 3 of 44. Next slide summarizes the 44.

Measure Recommended Measure TitleMeasure Developer Title0001 AMA Asthma Assessment0002 NCQA Appropriate Testing for Children with Pharyngitis0004 NCQA Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: (a) Initiation, (b) Engagement0012 AMA Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)0013 AMA Hypertension: Blood Pressure Measurement0014 AMA Prenatal Care: Anti-D Immune Globulin0018 NCQA Controlling High Blood Pressure0024 NCQA Weight Assessment and Counseling for Children and Adolescents0027 NCQA 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 Strategies0028a AMA Preventive Care and Screening Measure Pair: a.Tobacco Use Assessment0028b AMA Preventive Care and Screening Measure Pair: b.Tobacco Cessation Intervention0031 NCQA Breast Cancer Screening0032 NCQA Cervical Cancer Screening0033 NCQA Chlamydia Screening for Women0034 NCQA Colorectal Cancer Screening0036 NCQA Use of Appropriate Medications for Asthma0038 NCQA Childhood immunization Status0041 AMA Preventive Care and Screening: Influenza Immunization for Patients ≥ 50 Years Old0043 NCQA Pneumonia Vaccination Status for Older Adults0047 AMA Asthma Pharmacologic Therapy0052 NCQA Low Back Pain: Use of Imaging Studies0055 NCQA Diabetes: Eye Exam0056 NCQA Diabetes: Foot Exam0059 NCQA Diabetes: HbA1c Poor Control0061 NCQA Diabetes: Blood Pressure Management0062 NCQA Diabetes: Urine Screening0064 NCQA Diabetes: LDL Management & Control0067 AMA Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD0068 NCQA Ischemic Vascular Disease (IVD): Use of Aspirin or another Antithrombotic0070 AMA Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)0073 NCQA Ischemic Vascular Disease (IVD): Blood Pressure Management0074 AMA Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol0075 NCQA Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control0081 AMA Heart Failure (HF) : Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)0083 AMA Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)0084 AMA Heart Failure (HF) : Warfarin Therapy Patients with Atrial Fibrillation0086 AMA Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation0088 AMA Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy0089 AMA Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care0105 NCQA Anti depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment‐0385 AMA Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients0387 AMA Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer0389 AMA Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients0421 QIP Adult Weight Screening and Follow-Up 0575 NCQA Diabetes: HbA1c Control (<8%)

Eligible Professional Quality Measures


Detailed Information & Help• htttp://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAtt

estation.asp• Contact: EHR Information Center

Hours of Operation: 7:30 a.m. – 6:30 p.m. (CT)Monday through Friday, except federal holidays. 888-734-6433 (primary number)888-734-6563 (TTY Number)

• Contact your HIT Regional Extension Center



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