meaningful use
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Meaningful Use. Indiana Association for Health Care Quality, May 2013. W hat’s all this Meaningful Use stuff?. The Compelling Why…..of HITECH. Why does America need to modernize using Health IT?. What is America doing to modernize its Healthcare System through Health IT?. - PowerPoint PPT PresentationTRANSCRIPT
Meaningful Use
Indiana Association for Health Care Quality, May 2013
What’s all this Meaningful Use stuff?
2012
3
What is America doing to modernize its Healthcare System through Health IT?
Why does America need to modernize using Health IT?
• Enable providers to securely and efficiently exchange patient health information.
• Give providers the right information, at the right time to offer their patients the right care.
• Give consumers tools to know their health information so that they can improve their health.
• Foundational to building a truly 21st century health system where we pay for the right care, not just more care.
Accelerating Meaningful
Use
Showing Outcomes
Protecting Privacy
and Security
Keeping Patients
Safe
Promoting Exchange
Engaging Consumers
Source: Doug Fridsma, MD, Chief Science Officer,Director, Office of Science & Technology, ONC
The Compelling Why…..of HITECH
2009 Hitech Act-ARRA
The Hitech Act of the American Recovery & Reinvestment Act (ARRA) was signed into law by President Obama in Feb. 2009
“It's an investment that will take the long overdue step of computerizing America's medical records, to reduce the duplication and waste that costs
billions of healthcare dollars and medical errors that cost thousands of lives each year. ... We have done more in 30 days to advance the cause of health-
care reform than this country has done in an entire decade.“ February 17, 2009
Appointed the Center for Medicare & Medicaid (CMS) to govern the clinical side of the program
The Office of the National Coordinator (ONC) governs the technical side: certification of the EHR at the code level.
Both sets of guidelines must be met to qualify for MUStage One Guidelines: Released July 2010. Stage Two Guidelines: Preliminary Release Feb. 2012, Final Release: Aug, 2012
2009 Hitech Act-ARRAThree progressive stages of “meaningful use” over next 5+
years– Stage 1: Capture and track basic data, communication and
coordination, sets stage for electronic quality reporting – Stage 2: Quality improvement at the point of care, clinical
data exchange– Stage 3: Advanced clinical decision support to promote
safety, quality and efficiency (e.g. national high priority conditions, patient access to self‐management tools, comprehensive patient data and improving population health)
Medicare $$ Incentives: payment for “Meaningful Use”(MU) of an electronic health record (EHR)-by Hospital or Physician
Medicaid $$ Incentives: Demonstrate “AIU” -Adoption, Implementation, Upgrade (first year only), or “Meaningful Use”
Eligibility
Medicare Fee for Service, Medicare Advantage and Medicaid providers
Eligible Professionals (EP) include: Doctors of Medicine or Osteopathy, Dentists, Podiatrists, Optometrists and Chiropractors. Medicaid also includes NPs, Certified Nurse Midwives & PAs.
Hospital based EPs are not included (90% or > services are provided on an Inpatient or ED setting).
Eligible Hospitals include: Acute Care Hospitals and Critical Access Hospitals, including Emergency Departments(pts being admitted or in an extended Observation status).
The Carrot….
•Eligible Providers: •Medicare Incentives: ~$44K/eligible provider/5 years •Medicaid Incentives: ~$64K/eligible provider/6 years
…….and the Stick
•Hospitals: Incentive calculated based on cost reporting to CMS•After 2015, Medicare penalties for Hospitals and EPs
Health Outcomes Priorities
• Improve quality, safety, efficiency
and reduce health disparities
• Engage patients and families in their health care
• Improve care coordination
• Improve population & public health
• Ensure adequate privacy and security protection of personal health information
Final Rulings-Stage 1
Stage 1: 1st Submission-90 days of data 2nd submission-12 consecutive
monthsMandatory Core Measures-15 for
Eligible Providers, 14 for Hospitals Menu Set-10 to choose from; 5 deferred
until Stage II. Total reporting requirements:
Eligible Providers: report on 20 of 25 MU Measures.
Hospitals: report on 19 of 24 MU Measures.
Stage 1 Core Measures-Mandatory
CPOE-1 med order >30% Hospital & Provider
ePrescribing-I med order >40% Provider
Drug/Drug, Drug/Allergy Checks ON Hospital & Provider
Problem List >80% Hospital & Provider
Medication List >80% Hospital & Provider
Medication Allergy >80% Hospital & Provider
Vital Signs: Ht, Wt, BP, >2yo >50% Hospital & Provider
Smoking Status, 13yo >50% Hospital & Provider
Demographic Data >50% Hospital & Provider
Stage 1 Core Measures-Mandatory
eCopy of Record, w/in 3 days >50% Hospital & Provider
Clinical Decision Support Rule 1 Hospital & Provider
E-Copy of Discharge Instruction >50% Hospital
Provide Clinic Summary >50% Provider
Information Exchange 1 test Hospital & Provider
Protect Pt Info, Security Analysis Conduct Hospital & Provider
Quality Measures: VTE, Stroke, ED 15 Hospital
Quality Measures: 3 core/3 menu + 38 options
6 Provider
Stage 1 Menu Measures-5 Optional
Incorporate Clinical Lab Results >40% Hospital & Provider
Patient List 1 Hospital & Provider
Patient Reminders >20% Provider
Pt Access to Information: 4days >10% Provider
ID Patient Education Needs >10% Hospital & Provider
Medication Reconciliation >50% Hospital & Provider
Drug Formulary Checks On Hospital & Provider
Transfer Summaries >50% Hospital & Provider
Record Advanced Directives >50% Hospital
Submit Syndromic Data to SDOH Test Hospital & Provider
Submit Lab Data to SDOH Test Hospital
Submit Immunizations to SDOH Test Hospital & Provider
What’s Coming with Stage 2?
• Goes into effect October 1, 2013. • Thresholds and complexity increases• Second year added to stage 2 with a 90
day quarterly measurement period; no change in payment model
• 2015 Payment adjustments confirmed (complete attestation by Oct 2014 to avoid penalties)
• Hospitals-Report on 19 out of 22 measures EPs-Report on 20 out of 23 measures
What’s Coming with Stage 2?
• Focus on Patient Engagement-Portal access; view, download or transmit
• Exclusions will not count toward Menu Items
• Batch reporting for EPs
• CPOE changes in denominator, addition of radiology and labs
• Addition of electronic notes, capturing care team, functional and cognitive status in the summary or care.
• Better Alignment of Quality measures against other CMS requirements: ACO, PQRS, CHIPRA etc
The Details
Core Objective Measure Hospital/Provider
CPOE Use of CPOE for >60% of medications, 30% of Laboratory and 30% of radiology Hospital/Provider
e-Prescribing E-Prescribing for >50% ProviderDemographics Record demographics for >80% Hospital/ProviderVital Signs Record Vital Signs for >80% Hospital/ProviderSmoking Status Record Smoking Status for >80% Hospital/Provider
Interventions Implement 5 clinical decision support interventions + drug/drug and drug/allergy Hospital/Provider
Labs Incorporate lab results for >55% Hospital/Provider
Patient Lists Generate patient lists by specific condition Hospital/Provider
Preventive Reminders
Use the EHR to identify and provide reminders for preventive/follow-up care for
>10% of pts with 2 or more office visits in last 2 years.
Provider
The Details
Core Objective Measure Hospital/Provider
eMar Implement eMar and use for > 10% of medication orders (bar code med admin) Hospital
Patient Access Provide online access to health information for > 50% with >5% actually accessing Hospital/Provider
Visit Summaries Provide office visit summars for >50% of office visits Provider
Education Resources Use the EHR to identify and provide education resources for >10% of the patients Hospital/Provider
Secure Messages >5% of patients send secure messages to the EP Provider
Meds Reconciliation Medication Reconciliation is completed at > 50% of the transitions of care Hospital/Provider
Summary of Care
Provide Summary of Care Document for >50% of the transitions of care and referrals with
10% sent electronically and at least 1 sent to recipient with a different EHR vendor
Hospital/Provider
The Details
Core Objective Measure Hospital/Provider
Immunizations Successful ongoing transmission of immunization data Hospital/Provider
Labs Ongoing submission of reportable lab results Hospital
Syndromic Surveillance Ongoing submission of electronic syndromic surveillance data Hospital
Security Analysis Conduct or review security analysis and incorporate risk management process Hospital/Provider
The DetailsMENU Objective Measure Hospital/Provider
Progress Notes Enter an electronic progress note for >30% of unique patients Hospital/Provider
E-Prescribing >10% of discharge medication orders are e-prescribed Hospital
Imaging Results >20% of imaging results are accessible through the certified EHR Hospital/Provider
Family History Record family health history for >20% Hospital/Provider
Advanced Directives Record AD for >50% of patients 65yo or older Hospital
Labs Provide structured lab results to EPs for >20% Hospital
Syndromic Surveillance Ongoing submission of electronic syndromic surveillance data Provider
Cancer Registry Successful ongoing transmission of cancer case information Provider
Specialized Registry Successful ongoing transmission of data to a specialized registry Provider
Other Related Initiatives; Similar…..but not quite!
• ICD-9 vs ICD-10 -DEADLINE OCTOBER 2014
-Dx Codes: from 14,315 to 69,099 (483%) -Px Codes: from 3,838 to 71,957 (1875%)
Angioplasty-Moving from 1 code to 854 codes based on site, device & approach!
• Value Based Purchasing
• Medical Home
• Impact of Hospital Acquired Conditions
• Payment cuts for readmissions
• PQRI
• ePrescribing
• Bundled payments
• Quality Bonus Payments for Medicare Advantage
• Accountable Care Organization Mandates……..
Take Home Concepts
Meaningful Use and EHR adoption is a clinical care initiative supported by IT, not an IT program. It will forever change how we provide service to our patients.
Our success or failure will depend in great part on our ability to define and standardize our best practice clinical workflows throughout our system.
Physician and clinical operation’s leadership will be crucial in each clinic’s, service line’s and facility’s success or failure.
Resources
• CMS Attestation resources (including Calculator) available at: http://www.cms.gov/EHRIncentivePrograms/32_Attestation.asp#TopOfPage
• Beginners guide for MU at: https://www.cms.gov/EHRIncentivePrograms/Downloads/Beginners_Guide.pdf
• http://www.cms.gov/EHRIncentivePrograms
• http://healthit.hhs.gov
• www.himss.org/economicstimulus
• http://www.himss.org/ASP/topics_meaningfuluse.asp
• Payment Webpage: https://www.cms.gov/EHRIncentivePrograms/56_DataAndReports.asp#TopOfPage
So, in a nutshell………
Thank You
Kathy Mathena, MSN, RN
Executive Director, Clinical Information Systems
Office: 317-963-7854