meaningful use stage 2 2... · how to qualify 1 •use a certified ehr •certified hit product...
TRANSCRIPT
Meaningful Use
Stage 2
Physicians Offices
March 2014
Credit where credit is due
Long Road Traveled
How to Qualify
1 • Use a certified EHR
• Certified HIT Product List (CHPL)
2 • Register with CMS
• EHR Incentive Programs
3 • Meet ‘Meaningful Use’ Criteria
• Staged criteria based on year of participation
4 • Report to CMS
The REAL BENEFIT
• Presentation will not be summary of Meaningful Use
(you probably better have that).
• Will be about the questions you’ve asked us or the
things we’ve stumbled across.
ASK LOTS OF QUESTIONS
Checking Status
https://ehrincentives.cms.gov/hitech/login.action
Need NPPES ID and Password
CHPL Number
2011 (Stage 1) list of CHPL’s
Ambulatory (EP): 3737
Hospital (EP): 1200
2014 (Stage 2) list of CHPL’s (both ambulatory and
hospital)
CHPL
http://oncchpl.force.com/ehrcert?q=chpl
Edition (2011, 2014)
Project Name/Vendor Name
Complete/modular
Version Number
Required Software (IMPORTANT)
Certified for what (especially needed for CQM)
2014 Certified Code
Must have certified code the ENTIRE reporting period
2014 Certified Code
CHPL Number
http://oncchpl.force.com/ehrcert?q=chpl
CHPL Number
CHPL Number
• In 2014, you MUST have 2014 certified code in place
even if you are still in Stage 1 for the ENTIRE quarter
CHPL Number
Must have proof that you have each software listed
Multiple Versions
Complete
verses modular
Check what is
different (in
this case new
QM’s were
added)
Make sure you
select 2014
Multiple Locations
Copy this
“number”, do
not try to
type it in, 1
and l and L
are not easily
separated
Penalties
Penalties
Confusion in it’s Finest
Timing – AIU Medicaid
Example
Multiple stages in one practice
Timing – Medicare
Example
Depending on year, you may have 3 years in
Stage 1 and 3 years in Stage 2
Exception (if your vendor is not ready)
2014 CEHRT Hardship Exception Guidance
announced today
The Centers for Medicare & Medicaid Services today issued guidance for
eligible professionals, eligible hospitals and critical access hospitals that are
unable to implement the 2014 Edition of Certified Electronic Health Record
technology in time to successfully demonstrate meaningful use for the 2014
reporting year.
Visit the EHR Incentive Program webpage for the:
2014 CHERT Hardship Exception Guidance for Eligible Professionals,
http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Downloads/CEHRT2014_HEG
uidance_EPs.pdf
Exception (if your vendor is not ready)
There are no appeals, so make your case
Multiple Locations (What counts)
• Inpatient and ED does NOT count
• Counts:
• Urgent Care
• Free Clinics
• Surgery Center
• ½ of the year at practice A and ½ of the year at practice B
• Nursing Home Visits
• 50% encounters at location equipped with CEHR (Certified EHR)
• Core and Menu Items (add everything together from all locations)
Multiple Locations (Core and Menu)
• Combine numbers
of CEHR to attest
• Have to get the
numbers from
previous locations
• Residents may
count
• Obtain physician
signature
Practice at Multiple Places (CEHR)
Ask yourself: does the provider have more than 50%
of their encounters at a location equipped with a
CEHR
Practice at Multiple Places
Medicaid Expands Eligibility (2013+)
Medicaid - Avoid an audit
How does the state know
how many Medicaid
encounters you have
Stage of Meaningful Use
• Increased % for nearly all measures
• New Requirements
• Focus on electronic data exchange
• Patient portal required
• 2014 EHR certification
• =Upgrade needed
• =2014 Code
• =Check YOUR EHR 2014 version
• ~=ICD-10 ready
Stage 2 Key Facts
Requirement Stage
1
Stage
2
Comment
eRx 40% 50% Formulary search
Demographics 50% 80% Multiple race option
Vitals 50% 80% BP > 3 y.o.
Smoking Status 50% 80% SNOMED coding
Security Risk
Analysis
1 1 Include
encryption/security of
data at rest
Increased Requirements
Requirement Stage
1
Stage
2
Comment
Structured
Lab Results
40% 55% Interface
Patient
Education
10% 10% Measurement change
Medication
Reconciliation
50% 50% Transitions to the practice
Patient List 1 1
Menu Stage 1 = Core Stage 2
Core
Core
Core
CPOE
• Exclusions: < 100
• Different denominator
• New definition of licensed healthcare professional
CPOE
CPOE Licensed Professional
Any licensed healthcare professionals and
credentialed medical assistants, can enter
orders into the medical record for purposes of
including the order in the numerator for the
objective of CPOE if they can originate the
order per state, local and professional
guidelines. Credentialing for a medical
assistant must come from an organization
other than the organization employing the
medical assistant.
Interventions - Clinical Decision Support
Can be ANY 4 CQM’s, not the ones you are reporting
on
Interventions - Clinical Decision Support
• CMS/ONC didn’t like some CDS’s that were
selected in Stage 1 so they became more specific
• Make sure you document each CDS and which one
of these it relates to
• Makes sure one relates to a combination of two
• Most EHR’s have this nailed but you have to
document.
Interventions - Clinical Decision Support
• Make sure you document each CDS and what
reference you use
• Embed the reference right into you EHR (debate
able whether needed).
Clinical Decision Support
CDS - Document
Preventive Care/Patient Reminders
Patient portal, “robo dialer”, etc.
View, Download and Transmit
AKA: Patient Portal
View, Download and Transmit
Patient Portal
View, Download and Transmit
View, Download and Transmit
• Start early, it takes time
• Kiosk machines in waiting room or at checkout
• The excuse of “old people” doesn’t fly
• Make patient portal useful otherwise patients will
use at first and then not later
Secure Messaging
Secure Messaging - WHY
• Providers have seen reduction in time responding to inquires and less
time spend on the phone
• Secure messaging has also been shown to increase patient satisfaction
with their care.
• Research demonstrates that secure messaging has been shown to
improve patient adherence to treatment plans.
• While we recognize that EPs cannot directly
control whether patients use electronic
messaging, we continue to believe that EPs
are in a unique position to strongly influence
the technologies patients use to improve
their own care, including secure electronic
messaging.
• We believe that EPs’ ability to influence
patients coupled with the low threshold
make this measure achievable for all EPs
• Transitions into a practice
• Medication reconciliation (50%)
• Transitions to another site or provider
• Summary of care record (3 measures)
Transition of Care – What is it?
Transition of Care
Transition Out
Transition in
Medication Reconciliation
Requirement
Summary of Care
Document
Requirement
Summary of Care
Summary of Care
Summary of Care
Direct Emails Only
…if the provider does not have the information available to populate one or
more of the fields listed, either because they can be excluded from recording
such information (for example, vital signs) or because there is no
information to record (for example, laboratory tests), the provider may leave
the field(s) blank. The only exception to this is the problem list, medication
list, and medication allergy list.
Summary of Care
CCD / CCDa
Summary of Care
CCD / CCDa
Summary of Care
CCD / CCDa
Many are 26+
pages long
Summary of Care
CCD / CCDa
Summary of Care
CCD / CCDa
Munson Contact: Colleen DeBie, 231-935-7904,
Website: listing of all KNOWN Direct Trust emails
http://www.munsonhealthcare.org/meaningfuluse
Transition of Care
Transition Out
Transition in
Medication Reconciliation
Requirement
Summary of Care
Document
Requirement
Medication Reconciliation
• New patients
• Existing patients transitioning back if:
• 50%
Security Risk Analysis
Summary - Menu
Menu – what is your vendor certified for
Next Gen 5.8.0.77 eCw, V10
Family History
Family History
• Must be entered in Snomed
• Does not need to be collected every visit (just once)
• Should not be a problem
Syndromic Surveillance
Syndromic Surveillance
Syndromic Surveillance
http://mihin.org/wp-
content/uploads/2013/12/MSSS-Testing-and-
Submission-Guide.pdf
https://www.michiganhealthit.org/public-
health/msss/
Syndromic Surveillance
• Per the state of Michigan, any specialty
can participate in this.
• The submission must go through Sub
State HIE (MiHealth Connect). Must
have statement of work
• George Bosnjak (616) 588-4707
• You must receive an OID (organizational
ID), see link to the left
Syndromic Surveillance
• If you are on the hosted eCw system
or hosted Next Gen, Munson IS will
assist you with the submission.
Electronic Progress Notes
The text of the electronic note must be text-searchable and may
contain drawings and other content.
Electronic Progress Notes - OLD
Specialized Registry
• Munson Healthcare cannot find a specialized registry to
work with other than Pinnacle for Next Gen
• PHO registry will not count, MICR will not count PQRS
will not count
Quality Measures
Find your vendor certification
From CHPL list
• Fro
Clinical Quality Measures
CMS Recommended
2014 CQM issues
www.cms.gov/EHRIcentivePrograms
• ONC does not require vendors to configure their EHRs
to measure all 64 CQMs
• 2014 CQMs will be utilized for Stage 1 or Stage 2
reporting
• PFR not PFP
• Multiple reporting options
• CMS website
• PQRS
• Group option
• Medicaid-state reporting
Primary Care
1. Don’t panic
2. EHR 2014 certification for
specific CQMs
3. Select 9 CQMs
appropriate to practice
• >=3 Domains
4. Select 5 CDS associated
with 4 CQMs
5. Select reporting option.
Subspecialties
1. Fret but don’t‘ panic
2. EHR 2014 certification for
specific CQMs
3. Search for 9 CQMs
• Zero option
4. Search for 5 CDS
5. Read attestation and
reporting requirements
6. FAQ watch
7. Select reporting option.
CDS CQM Strategy
Meaningful Use Audits
Meaningful Use
Audits
Meaningful Use Audits
Meaningful Use
Audits
• Meaningful Use audits are a ‘when’ not an ‘if’
• Retain documentation for 6 years post-attestation
• If found to not be eligible for an EHR incentive
payment, payment will be recovered
• Medicare:
• Email (letter) from CMS email (make sure you
email address is accurate)
• http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Do
wnloads/EHR_SupportingDocumentation_Audits.
• Figliozzi & Company is contractor conduct the
audit
• Pre-audits have kicked in.
Meaningful Use
Audits • Relevant IT systems, system configurations, roles, and processes for
each MU criteria
• System certification documentation (versions, certification #s, etc.)
• Reports/data for each reporting period
• Confirmations or other communication for CMS or State
• A copy of (ONC) certification as well as licensing agreements with
the vendor or invoices from the system purchase
• Specific and concise documentation for all Core and Menu Criteria
(Numerator/Denominator & Yes/No)
• Reports from your CEHRT to document the numbers you attested to
for Numerator/Denominator criteria and Quality Measures
• Documentation that demonstrates how each criteria was met
• e.g., screen shots, training materials, reports, audit logs,
policies/procedures
• Be sure there are time/date stamps to prove screen shots, etc.
were taken during the reporting period
• Especially for Yes/No criteria
Questions
Pre-Payment Audits
Always ask
for Security
Risk Analysis
GT Surgery Audits
Where else do the
providers work:
• Surgery Center
• Hospital
outpatient
• Free Clinic
• Urgent Care
Do these locations
have CEHR
Audit Checklist
Audit Checklist
Reducing the Risk
Questions
gloSuite 8.1 (Menu)
gloSuite 8.1 (QM)