meaningful use of electronic health records tammy geltmaker, rn, bsn, mha ehr consulting manager...
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Meaningful Use of Electronic Health Records
Tammy Geltmaker, RN, BSN, MHA EHR Consulting Manager
November 17, 2010
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Eligible Professionals (EP) Financial Incentives Meaningful Use (MU) Stage One Measures Kentucky Resources
Highlights
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American Recovery and Reinvestment Act (ARRA)
A Massive Stimulus for Health Information Technology (HIT) Adoption & Health Information Exchange (HIE) Expansiono Appropriations for HITo Appropriations for HIEo New incentives for adoptiono Community Health Centerso Broadband and Telehealth
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Eligible Professional (EP)
Eligible Providers- Medicare Eligible Providers- Medicare Eligible Providers- Medicaid
Eligible Professionals (EPs)* Doctor of Medicine or OsteopathyDoctor of Dental Surgery or Dental Medicine Doctor of OptometryDoctor of Podiatric MedicineChiropractor
Eligible Professionals (EPs) Physicians (Pediatricians have special eligibility and payment rules)Nurse Practitioners (NPs)Certified Nurse-Midwives (CNMs)DentistsPhysician Assistant (PAs) who lead a federally qualified health center (FQHC) or Rural health clinic
Eligible Hospitals*Acute Care HospitalsCritical Access Hospitals (CAHs)
Eligible HospitalsAcute Care Hospitals, Critical Access HospitalsChildren’s Hospitals
* Defined: Section 1861(r) Physician Definition
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Eligible Professional (EP)- Medicare Advantage (MA)
MA Eligible Professionals (EPs) o Must furnish, on average, at least 20 hours/week of patient-care
services and . . .o Be employed by the qualifying MA organization
Or . . .o Must be employed by, or a partner of, an entity contracting with the
qualifying MA organization furnishing at least 80 percent of the entity’s Medicare patient care services to enrollees of the qualifying MA organization
Qualifying MA-Affiliated Eligible Hospitalso Will be paid under the Medicare Fee-for-service EHR incentive program
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Eligible Professional (EP)
Entity Minimum Medicaid Patient Volume Threshold
For Eligible Professionals (EPs)
Physicians 30%- Pediatricians 20%Dentists 30%CNMs 30%PAs when practicing at an FQHC/RHC also led by a PA
30%
NPs 30%
Or the Medicaid EP practices predominantly in an FQHC or RHC— 30% needy individual patient volume threshold
For Eligible Hospitals
Acute care hospitals 10%Children’s hospitals No requirement
Patient volume requirements for Medicaid incentives
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Registration Process
Register through the EHR Incentive Program Web site Be enrolled in Medicare FFS, MA, or Medicaid (FFS or
managed care) Have a National Provider Identifier (NPI) Use certified EHR technology to demonstrate MU
- Medicaid providers may adopt, implement, or upgrade in their first year
All Medicare providers and Medicaid eligible hospitals must be enrolled in Provider Enrollment, Chain and Ownership System (PECOS)
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Registration: Medicaid
States will connect to the EHR Incentive Program Web site to verify provider eligibility and prevent duplicate payments
States will ask providers for additional information to make accurate and timely paymentso Patient Volumeo Licensureo A/I/U or Meaningful Useo Certified EHR Technology
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Financial Incentives
Includes financial incentives for health care providers who attain “meaningful use” with their EHR systems.o Medicare: Up to $44,000 per provider over
five yearso Medicaid: Up to $63,750 per provider over
six years
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Medicare Incentives
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Medicare Incentives (Cont’d)
Part B Annual Charges Maximum Payment
$24,000 $18,000
$16,000 $12,000
$10,667 $ 8,000
$ 5,334 $ 4,000
$ 2,667 $ 2,000
Pays 75% of “allowed charges” based on claims submitted to Medicare
MA providers qualify for the Medicare incentives using MA claims instead of part B claims
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Medicaid Incentives
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Medicaid Incentives (Cont’d)
EPs may receive up to 85 percent of the net average allowable costs for certified EHR technology, including support and training, up to a maximum level of $63,750.
Pediatricians must have a Medicaid patient volume of at least 20%.
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Medicaid Only: Adopt/Implement/Upgrade (A/I/U)
First participation year only for Medicaid providers Adopted-Acquired and Installed
o e.g., Evidence of installation prior to incentive
Implemented–Commended Utilization of o e.g., Staff training, data entry of patient demographic information into EHR
Upgraded–Expandedo e.g., Upgraded to certified EHR technology or added new functionality to meet
the definition of certified EHR technology
Must use certified EHR technology No EHR reporting period
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Meaningful Use Definition
Meaningful use is defined as . . . o Use of a certified EHR in a meaningful manner (ex:
e-prescribing)o Use of certified EHR technology for electronic
exchange of health information o Use of certified EHR technology to submit clinical
quality and other measures
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Meaningful Use Stages
* Stages 2 and 3 will be defined in future CMS rulemaking
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Meaningful Use Stages
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Stage One Priorities
Electronically capture information in a coded format
Use electronic information to track key clinical conditions
Implement clinical decision support tools to facilitate disease and medication management
Report clinical quality measures and public health information
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Stage One Measures
HIT functionality measures • Reported by attestation
Clinical quality measures• Reported by attestation for 2011• Electronic submission to CMS for 2012
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HIT Functionality Measures
EPs must report on 20 of 25 MU objectives with associated measureso Core set of 15 o Menu set of 10
An EP must successfully meet the measure for each objective in the core set and all but five in the menu set o Some MU objectives are not applicable to every provider’s clinical
practice. In this case, the EP would be excluded from having to meet that measure.
e.g., Dentists who do not perform immunizations and chiropractors who do not have prescribing authority
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Meaningful Use: Core Set Objectives
EPs –15 Core Objectives Computerized physician order entry (CPOE) E-Prescribing (eRx) 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 Drug-drug and drug-allergy interaction checks 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 and patient-authorized
entities electronically Protect electronic health information
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Meaningful Use: Menu Set Objectives
EPs – 10 Menu Objectives 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 Medication reconciliation Summary of care record for each transition of care/referrals Capability to submit electronic data to immunization registries/systems* Capability to provide electronic syndromic surveillance data to public health agencies*
*At least 1 public health objective must be selected
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Clinical Quality Measures
Ambulatory setting report on all (3) of the core measures as applicable for their patientso Inquiry regarding tobacco useo Blood pressure measurement o Adult weight screening and follow-up
Alternate core measures if denominator is zeroo Preventative care and screeningo Influenza immunization for patients ≥50 years oldo Weight assessment and counseling for children and adolescentso Childhood Immunization status
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Clinical Quality Measures (Cont’d)
Second required measure set for each EP to submit information on three additional measures from at list of 38 clinical quality measureso Specifications for the measures are published in the final rule
In sum, EPs must report on 6 total measures: 3 required core measures (substituting alternate core measures where necessary) and 3 additional measures
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Meaningful Use Reporting Period
First Year Incentive Qualificationso Any continuous 90-day period within a payment year in which an
EP successfully demonstrates meaningful use of certified EHRo First opportunity to start demonstrating meaningful use is
January 1, 2011o “Attestation methodology” proposed in 2011o Electronic Reporting starting in 2012
Subsequent years reporting period o Entire 12 months (calendar year for EP) in the respective year
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Certification Process/Bodies
Temporary Processo Currently three certifying bodies
Certification Commission for Health Information Technology (CCHIT), Drummond Group Inc., InfoGard Laboratories Inc.
Certification process has begun o ONC is posting the certified EHR applications on its siteo To obtain Medicare incentive dollars, must be a CERTIFIED EHR
system
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Certification Process/Bodies (Cont’d)
Permanent Processo Accreditation of bodies expected to be completed
through private entities with guidance from National
Institute of Standards and Technology (NIST)o Expected timeframe for first bodies under permanent
program to be accredited by January 2012
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Certified EHR Technology
Two Types of Certification of EHR Technologyo Complete EHR
EHR must certify all requirements to certify as Complete EHR
o Certified EHR Module“..any service, component, or combination thereof
that can meet the requirements of at least one certification criterion adopted by the Secretary”
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What happens if you do not adopt an EHR by
2015?
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Penalties
No incentive money available for implementation
Medicare cuts begin o 2015=1% o 2016=2%o 2017=3%
Evaluation of adoption rate in 2018
No Medicaid cuts associated with non-adoption
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EHR Incentive Programs Milestone Timeline
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Comparison of Medicare and Medicaid Programs
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Participation in Other Incentive Programs
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Kentucky’s Efforts
Kentucky Health Information Exchange In 2005, Senate Bill 2 created the Kentucky eHealth
Network (KeHN) Board to oversee the development, implementation, and operation of a statewide e-health network.
Kentucky also received a Medicaid Transformation Grant to develop the foundational components for a statewide health information exchange, the Kentucky Health Information Exchange (KHIE), to be completed by the second quarter of 2010.
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Kentucky’s Efforts (Cont’d)
Regional Extension Centers Providing basic resources for assisting practices with
adopting EHRs and achieving meaningful use
Emphasis placed on o small practices (fewer than10 prescribers; physicians, PAs,
ARNPs) o community health centers o rural clinicians that work with critical access hospitalso practices and clinics that serve the underserved
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Additional Assistance
Kentucky Medical Association
More information regarding “EHR Planning Available for KMA Member Practices” on the KMA Web site https://www.kyma.org/content.asp
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Questions ?
Tammy Geltmaker RN, BSN, MHA
(502) 454-5112, ext. [email protected]
For further details regarding information found in this presentation, please visit
http://www.cms.gov/EHRIncentivePrograms
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