“No matter how dramatic the end result, the good to greattransformations never happened in one fell swoop.

There was no single defining action, no grand program, no onekiller innovation, no solitary lucky break, no wrenchingrevolution.

Good to great transformation comes about by acumulative process – step by step, action by action, decisionby decision, turn by turn, that adds up to sustained spectacularresults. “

Jim CollinsGood to Great

“No matter how dramatic the end result, the good to greattransformations never happened in one fell swoop.

There was no single defining action, no grand program, no onekiller innovation, no solitary lucky break, no wrenchingrevolution.

Good to great transformation comes about by acumulative process – step by step, action by action, decisionby decision, turn by turn, that adds up to sustained spectacularresults. “

Jim CollinsGood to Great

Meaningful Use Readiness

Getting Started: A Meaningful Use Checklist

Peter Cucchiara, BSMIS MBA

See the pathbefore we walk it

To Readiness

1

2

3

4

5

What is MUto you?

Placement&

Considerations

What is this

work?

Ways to Plan theProcess

Assessment ToolDemonstration

Do we have the right people in the right seatson the bus? Jim Collins

What is Meaningful Use

Using certified EHR technology in a meaningful

manner (which includes e-prescribing for

eligible providers and meeting the MU criteria)

Use

Connecting a certified EHR in a manner that provides for the electronic exchange of health information to improve the quality of care.

Connect

SubmitUsing the technology to submit information to CMS on clinical quality measures and other measures selected by CMS.

ARRA specifies three requirements for “meaningful use”

MU Grocery List

25 Requirements of which we need to fulfill 2015 Core, 5 Discretionary6 Clinical Measures16 Numerator/Denominator Calculations8 Attestation itemsDetermine our EPAdopt implement upgrade incentive opportunityVolume criteria

1

What is Meaningful Use – The First Cut

Goal A

Goal B

Goal C

Goal D

Goal E

Improve quality, safety, efficiency, & reduce health disparities

Engage Patients and Families

Improve Care Coordination

Improve Population and Public Health

Ensure adequate privacy and securityProtection for PHI

(15)

(4)

(3)

(2)

(1)

2

What is Meaningful Use – The Second Cut

Core

- Of the 25 objectives 15 are required

- Goal A (11) Goal B (2) Goal C (1)

- Goal D (?) Goal E (1)

DiscretionaryMenu

- 10 discretionary/menu requirements from which 5 must be chosen- Must choose 1 Goal D measure Improving Population & Public Health- Electronic access for patients (PHR, portal) is discretionary.

ClinicalMeasures

- 44 Measures for EP’s - Pick 6

- 3 Core required (BP, Tobacco status, adult weight) or…

- 3 Alternates plus additional 3 from remaining pool of 38

NumeratorsDenominators

- Of the 25 objectives 16 require N/D Calculations

- 10 Calculations require certified EMR technology

- 6 Calculations do not require certified EMR technology

Attests - Of the 25 objectives 8 require attestations

3

What is Meaningful Use – The Third Cut

4P’s

Adopt, Implement, Upgrade (AIU)

• In their first year of participation in the Medicaid incentive payment program, EPs may qualify for an incentive payment by demonstrating any of the following:

  – that they have adopted (acquired & installed),

• implemented (commenced utilization), or• upgraded (upgrade to a certified version or expanded

functionality, e.g. CDSS, e-prescribing)

Eligible Providers (EPs)

Medicare

Doctor of MedicineDoctor of OsteopathyDoctor of DentistryDoctor of Dental SurgeryDoctor of Podiatric MedicineDoctor of OptometryChiropractor

Medicaid

PhysiciansDentistsNurse MidwivesNurse PractitionersPAs in PA led FQHC*PAs in Rural Health Clinic

Volume Criteria

– General Rule: 30% patient encounters attributable to those receiving Medicaid. To be measured over any continuous 90-day period in the previous calendar year.

– 2 Exceptions:

1. If EP practices predominantly in an FQHC or RHC, must have 30% of patient encounters attributable to “needy individuals”

Definition of predominantly = over 50% of patient encounters over a period of 6 months occurs at an FQHC or RHC

Definition of needy individuals = receiving medical assistance from Medicaid or CHIP; receiving uncompensated care; or receiving care at no-cost or reduced cost based on a sliding-scale

2. Pediatricians may have at least 20% patient encounters attributable to those receiving Medicaid

Source: CMS, US DHHS

Summing Up So Far

25 Requirements of which we need to fulfill 2015 Core, 5 Discretionary6 Clinical Measures16 Numerator/Denominator Calculations8 Attestation itemsDetermine our EPAdopt implement upgrade incentive opportunityVolume criteria

?How much workHow much timeImpactCostReady

“Meaningful Use” Criteria a Focal Point Across Previously Disparate Initiatives

For example

PCMH MU

Is it just a matter of Oranges and Apples

Recognition/Documentation

Paid Per Patient (in NYS)

M‘caid, M‘care & Payers

State and Federal

9 standards 7 elements166 factors

Certification/Attestation

Paid Per Provider

Medicaid, Medicare

Federal

5 care goals 20 objectives (options and choices)

?

Medical HomeMeaningful Use

PPC1: Access and Communication

PPC2: Patient Tracking & Registry

PPC3: Care Management

PPC4: Pt Self Management Support

PPC5: Electronic Prescribing

PPC6: Test Tracking

PPC7: Referral Tracking

PPC8: Performance Rpt/Imprvmnt

PPC9: Advanced Electronic Comm

Goal A: Improve quality, safety, _______ efficiency, & reduce health _______ disparities

Goal B: Engage Patients and Families

Goal C: Improve Care Coordination

Goal D: Improve Population and Public Health

Goal E: Ensure Adequate Privacy & Security Protection for PHI

A Simple Comparison

How Much Overlap? PCMH Elements that relate to HIT (69%)

Ginsburg, Maxfield, O’Malley, Piekes, Pham, Making Medical Homes Work Moving from Concept to Practice Center for Studying Health System Change #1 December 2008

Home Sweet MeaningfulMedical Home

Patient Centered Care

The MU Assessment Tool

Some Assessment Tool Results

Milestone Map of the Journey

EMR Certification(Fall 2010)

Transformational Change

Assess NumeratorsAnd denominators

Adopt Implement Upgrade(Fall 2010 – 2011)

Stage I April 2011?

2012

Count EP’sAnd volume

criteria(now)

Choose MedicareOr medicaid andCalculate 5 yearReturn (now)

EMR Attestation$25K

(Late 2010/2011)

Stage II 2013 - 2014

Stage III 2014 - 2016

Achieving a balance between

RecognitionAttestation

Applied PrinciplesProcess Gains

Guiding Principle 1

MU Three Main Process Work Strands

Process HIT/MU/MHOrganizational

Questions

Thank You