Proposed Meaningful Use Content and Comment Period

What the American Recovery and Reinvestment Act Means to Medical Practices

Session Objectives

• Gain a basic understanding of CMS EHR

Incentive Program.

• Learn the criteria for meaningful use and how

it applies to your practice.

• Devise strategies to obtain incentive

payments and avoid penalties.

Part 1:

ARRA Stimulus, Keywords

Part 2:

Meaningful Use

Part 3:

What you can do now

Why Promote EHR/ HIE?

According to the ARRA, broad use of health IT will:

• Improve health care quality

• Prevent medical errors

• Reduce health care costs

• Increase administrative efficiencies

• Decrease paperwork

• Expand access to affordable care

Proposed Rules from 12/30/2009

On December 30, 2009 HHS released two proposed rules surrounding CMS EHR incentives. This presentation is based on those proposed rules. Final rules will be made later in 2010.

Public comment is being accepted on both rules until March 15th. The public is highly encouraged to comment.

HITECH Act• Health Information Technology for Economic

and Clinical Health Act is the HIT component of the American Recovery and Reinvestment Act signed into law on February 17, 2009

• 17.2 billion dollars for EHR use and information exchange

• Medicare and Medicaid Incentives for eligible professionals who have adopted a certified EHR and can demonstrate “meaningful use”; Penalties for non-adopters

Keyword: Eligible Professional (EP)

Medicare Eligibility Criteria:

• A doctor of: medicine, osteopathy, dental surgery or medicine, podiatry, optometry, or a chiropractor

• Non-hospital based, i.e., provider bills less than 90% to place of service codes 21, 22 or 23

• See Medicare population.

Keyword: Eligible Professional (EP)

Medicaid Eligibility Criteria:

• Physicians, dentists, certified nurse-midwives, nurse practitioners, and physician assistants working in FQHC/RHC that are PA led

• Non-hospital based, i.e., provider bills less than 90% to place of service codes 21, 22 or 23

• 30% of patient encounters attributed to Medicaid patients; 20% for Peds; “needy” patients count towards 30% in FQHC/RHC

Keyword: Certified EHR

The ONC published the interim final rule “Initial Set

of Standards, Implementation Specifications, and

Certification Criteria for Electronic Health Record

Technology” but did not address the certification

process in this rule. Another, separate rule will be

published in February with more information.

Keyword: Incentives

• Medicare Incentives

• Medicaid Incentives

Providers must select ONE method—No double dipping

Double Dipping Rules

• EPs may switch programs one time prior to 2015

• Medicare e-Rx program counts towards duplicate payments.

• Providers practicing in multiple states can only participate in one states’ program

• Onus is on the state to ensure EPs are not double dipping

Medicare Incentive

Beginning January 2011: EPs who adopt and have meaningful use of the EHR as early as 2011 or 2012 may be eligible for up to $44,000 in Medicare incentive payments spread out over five years (increased by 10% for EPs who predominantly furnish services in a health professional shortage area).

Medicare Incentives Payout Table

Amount You May Receive Each Year Year EHR Use is first demonstrated 2011 2012 2013 2014 2015 2016 TOTAL

2011 $18,000 $12,000 $8,000 $4,000 $2,000 $0 $44,0002012 $0 $18,000 $12,000 $8,000 $4,000 $2,000 $44,0002013 $0 $0 $15,000 $12,000 $8,000 $4,000 $39,0002014 $0 $0 $0 $12,000 $8,000 $4,000 $24,0002015/Later $0 $0 $0 $0 $0 $0 $0

Medicaid Incentive

• Medicaid payments also begin January 2011 and continue for 6 years. Unlike Medicare, Medicaid continues full payment thru 2016.

• EPs may receive up to a maximum of $63,750

• “Upfront payment” of $21, 250 for providers who are engaged in efforts to “adopt, implement or upgrade” to certified technology.

Medicaid Incentives Payout Table

Amount You May Receive Each Year Year EHR MU is first Shown

Yr 1 Yr 2 Yr 3 Yr 4 Yr 5 Yr 6 TOTAL2011 $ 21,250 $ 8,500 $ 8,500 $ 8,500 $ 8,500 $ 8,500 $63,7502012 $ 21,250 $ 8,500 $ 8,500 $ 8,500 $ 8,500 $ 8,500 $63,7502013 $ 21,250 $ 8,500 $ 8,500 $ 8,500 $ 8,500 $ 8,500 $63,7502014 $ 21,250 $ 8,500 $ 8,500 $ 8,500 $ 8,500 $ 8,500 $63,7502015 $ 21,250 $ 8,500 $ 8,500 $ 8,500 $ 8,500 $ 8,500 $63,7502016 $ 21,250 $ 8,500 $ 8,500 $ 8,500 $ 8,500 $ 8,500 $63,7502017/Later $0 $0 $0 $0 $0 $0 $0

Payment Clarification for Pediatricians

Pediatricians with a Medicaid population of 20% may participate; however their incentive payments are limited to 2/3 of the maximum amount or $42,500. Pediatricians with 30% Medicaid population are eligible for the maximum payout of $63, 750.

Keyword: Penalty

• Medicare Penalties: Providers who do not demonstrate meaningful use by 2015 will have a 1% decrease, in 2016 2%, in 2017 3% Up to a maximum decrease of 5%

• CMS will issue another proposed rule addressing penalties prior to 2015

• Medicaid Penalties: None determined yet

Keyword: Meaningful Use

Source: ONC, HIT Policy Committee 2009

Part 2:

Meaningful Use

Medicare vs. Medicaid

• Medicare meaningful use is defined by the ONC HIT Policy Committee and approved by the Secretary.

• Medicaid meaningful use is demonstrated through a means that is approved by the State and accepted by the Secretary.

• The proposed rule suggests a shared minimum definition of meaningful use for Medicare and Medicaid. States may request CMS approval to implement meaningful use measures above the minimum but not below the minimum

Meaningful Use Table-Stage 1

Meaningful Use Overview

HIT Measures

• 25 HIT measures for eligible professionals

Clinical Measures

• 15 specialty groups

• 3 “core” measures for all providers

• Based on PQRI and NQF measures (See Proposed Rule page 123 for the measures table)

Providers must meet all the measures

Core Clinical Measures

• Inquiry regarding tobacco use

• BP measurement

• Elderly patients who receive one or two drugs to be avoided (two different numbers)

HIT Measures

25 measures

• 3 “HIE”

• 4 “Patient Communication”

• 7 “Documentation”

• 11 “Functionality”

HIE Measures

• Capability to exchange key clinical information with other providers/patient approved entities (test)

• Capability to submit electronic data to immunization registries (test)

• Capability to provide electronic syndromic surveillance data to public health agencies (test)

Patient Communication Measures

• Send reminders to patients per preference for preventive/follow-up services (50%)

• Provide patients w/electronic copy of health information upon request w/in 48 hours (80%)

• Provide patients w/electronic access to health information w/in 96 hours (10%)

• Provide clinical summaries for each patient office visit (80%)

Documentation Measures

• Maintain up to date problem list (80%)

• Maintain active medication list (80%)

• Maintain active medication allergy list (80%)

• Record: pref language, ins type, gender, race, ethnicity, date of birth (80%)

Documentation Measures

• Record/chart changes in vitals: height, weight, BP, calculate/display BMI, plot and display growth charts for children 2-20, including BMI (80%)

• Record smoking status (80%)

• Incorporate lab test results in structured fields (50%)

Functionality Measures

• Use CPOE (80%)

• Implement interaction checking (drug, allergy, formulary (enable)

• Generate and transmit e-rx (75%)

• Generate list of patients w/specific conditions (attest to ability)

• Report measures to CMS (2011 attest; 2012 electronically submit)

Functionality Measures

• Implement 5 clinical decision support rules (attest)

• Check insurance eligibility (80%)

• Submit claims electronically (80%)

• Perform medication reconciliation at encounter and transition of care (80%)

Functionality Measures

• Provide care summary record for each transition in care (80%)

• Protect electronic health information created and maintained by the EHR (conduct review)

Demonstrating Meaningful Use

• For 2011, results for all objectives and measures, including clinical quality measures will be reported via attestation to CMS or the State.

• For 2012, measures will be sent electronically via certified EHR technology to CMS or the State.

Meaningful Use Reporting Period

• In the provider’s first year of participation the reporting period will be any 90 day period that occurs within the calendar year

• For subsequent years of participation the reporting period will be the entire calendar year

EHR Incentive Payments

• Medicare payments will be made via Medicare Administrative Contractors (MACs). Payments made to the Tax Id Number given by the provider

• Medicaid payments will be made through the State. Payments made to the Tax Id Number given by the provider

For More InformationInterim Final Rule: Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology

• http://healthit.hhs.gov/portal/server.pt?open=512&objID=1153&mode=2

• Follow “Provide public comment” link

• Search for: CMS-2009-0117-0002

Public comment period ends March 15, 2010

For More Information

Proposed Rule: Medicare and Medicaid Programs; Electronic Health Record Incentive Program

• http://healthit.hhs.gov/portal/server.pt?open=512&objID=1153&mode=2

• Follow “Provide public comment” link

• Search for: HHS-OS-2010-0001-0002

Public comment period ends March 15, 2010

Part 3: What can you do NOWto get your incentive?

Practices with an EHR

Stage 1 Strategies for 2011 Payout

Starting NOW, focus on these things:

• Review reporting requirements and work

backwards to ensure documentation

supports required reports.

• Implement a bi-directional lab interface and

e-Rx w/interaction checking

• Create a process for medication

reconciliation and HIPAA security analysis

Stage 1 Strategies for 2011 Payout

• Perform documentation gap analysis: meds,

problem, and allergy lists, vitals, BMI, etc

• Submit electronic claims, check eligibility

• Create lists of patients within the EHR using

clinical decision support rules and send

patient reminders

• Create clinical summary w/basic health

information

Stage 1 Strategies for 2011 Payout

• Implement a patient portal

• Develop a source of statewide information on

community HIE and test one exchange of key

health data to other providers, health dept, or

immunization registry.

• Begin using order entry

Practices with NO EHR

EHR Implementation Strategy

• Pre-Work: Getting your bearings

• Assessment: Discovering where you are now

• Planning: Deciding where you want to be in the future and how to get there

• System Selection: Evaluating which vendor meets your needs

• Implementation: Effectively installing the EHR

• Post-Live Evaluation: Evaluating if you are where you want to be

Pre-work

• Perform financial assessment/ROI calculation• Assign a physician champion• Select members of EHR implementation team

Assessment

• Readiness assessment

• Computer skills evaluation

• Workflow analysis

• Hardware and software analysis

Plan

• Define EHR goals and measurements

• Learn how to manage change

• Keep lines of communication open

• Draft internal project plan for implementation

EHR Selection

• Possible Help: Regional Extension Center

• *Check CCHIT site for certified products

• Contact vendors and schedule demonstrations

• Request RFI/RFPs if appropriate

• Visit vendor references sites

• Negotiate contract

EHR Implementation• Receive/review vendor implementation plan

• Work with vendor on system customization

• Test system and interfaces

• System training

• Practice using EHR in exam room (without patients)

• System backup and testing

• Establish downtime procedures

Post-Implementation Evaluation

• Goals review

• Meaningful use review

• Clinical Measure Reports

• Planning for subsequent phases

Contact Me

Gary Balser

EHR Consultant

The Carolinas Center for Medical Excellence

919-380-9860, ext 2004

Gbalser@thecarolinascenter.org

Or EHRServices@thecarolinascenter.org