slide 1 regional care collaborative march 26, 2015

Regional Care CollaborativeMarch 26, 2015

Aligning Meaningful Use with Patient Centered Care

Presenter:

Deborah Johnson Ingram,

1. Overview of CMS EHR Incentive (MU stage 2) Program

2. Overview Patient Centered Care 3. Review MU and PC Care Overlap

AGENDA

Today’s Objective

• Understand MU & Patient Centered Care Basics • Learn MU stage 2 Requirements• Highlight difficult Stage 2 measures and discuss

solutions for achieving thresholds

Meaningful Use Basics

CMS EHR Incentive Program

• Federal and State incentive payment program for Eligible Professionals (EP’s) that either adopt, implement, upgrade or attest to usage of a Certified (ONC) EMR application

• If an EP qualifies, they will be able to receive payment from either CMS (Medicare providers) or the WV Bureau of Medical Services (Medicaid providers)

In 2009 ARRA* defined that MU is the use of:

• a certified EHR in a meaningful manner, such as e-prescribing

• certified EHR technology for electronic exchange of health information to improve quality of health care

• certified EHR technology to submit clinical quality and other measures

*American Recovering and Reinvestment Act

Simply put, “MU" means providers need to show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity

Show me how to get the money…

Medicaid EHR Incentive Payment Schedule for Eligible Professionals

Medicaid EP Qualifies to Receive First

Payment in 2011

Medicaid EP Qualifies to Receive First Payment in 2012

Medicaid EP Qualifies to Receive First Payment

in 2013


in 2014


in 2015


in 2016

2011 $21,250.00 $0.00 $0.00 $0.00 $0.00 $0.00

2012 $8,500.00 $21,250.00 $0.00 $0.00 $0.00 $0.00

2013 $8,500.00 $8,500.00 $21,250.00 $0.00 $0.00 $0.00

2014 $8,500.00 $8,500.00 $8,500.00 $21,250.00 $0.00 $0.00

2015 $8,500.00 $8,500.00 $8,500.00 $8,500.00 $21,250.00 $0.00

2016 $8,500.00 $8,500.00 $8,500.00 $8,500.00 $8,500.00 $21,250.00

2017 $0.00 $8,500.00 $8,500.00 $8,500.00 $8,500.00 $8,500.00

2018 $0.00 $0.00 $8,500.00 $8,500.00 $8,500.00 $8,500.00

2019 $0.00 $0.00 $0.00 $8,500.00 $8,500.00 $8,500.00

2020 $0.00 $0.00 $0.00 $0.00 $8,500.00 $8,500.00

2021 $0.00 $0.00 $0.00 $0.00 $0.00 $8,500.00

TOTAL Incentive Payments $63,750.00 $63,750.00 $63,750.00 $63,750.00 $63,750.00 $63,750.00

*

Medicare EHR Incentive Payment Schedule for Eligible Professionals

If a Medicare Eligible Professional Qualifies to Receive First Payment in

2011


2012


2013


2014


2015

2011 $18,000

2012 $12,000 $18,000

2013 $8,000 $12,000 $15,000

2014 $4,000 $8,000 $12,000 $12,000

2015 $2,000 $4,000 $8,000 $8,000

2016 $2,000 $4,000 $4,000

Total Payment Amount $44,000 $44,000 $39,000 $24,000

Sorry no

money for you!

Medicare EHR Incentive Program

• Eligible professionals, eligible hospitals, and critical access hospitals (CAHs) must successfully demonstrate meaningful use of certified electronic health record technology every year they participate in the program.

Medicaid Incentive Program• Eligible professionals may qualify for incentive

payments if they adopt, implement, upgrade or demonstrate meaningful use in their first year of participation.

• EP’s must successfully demonstrate meaningful use after year 1.*

In order to get the money…

Louisiana EHR Incentive Program

• Eligible Professionals (EPs) are: – physicians– nurse practitioners,– certified nurse-midwives, – dentists, – optometrists, – physician assistants (who furnish services in a FQHC or RHC that is led by a

physician assistant).

• Important Dates for EP Attestation– Tuesday, January 20, 2015 -- 1st Day to Attest Using Flexibility Rule– March 31, 2015 - End of Program Year 2014– April 1, 2015 - Start of Program Year 2015– March 31, 2017 - Deadline to begin participation in program

http://new.dhh.louisiana.gov/index.cfm/page/1159

2014 CEHRT Flexibility Rule

• Delays due to:– software development – certification– implementation – testing– delay in release of the

product by the EHR vendor

• You cannot use the Flex rule due to:– Financial Issues;– Inability to meet one or more

measures;– Staff turnover or change;– Provider waited too long to

engage a vendor;– Refusal to purchase the

requisite software;– Providers who fully

implemented 2014 Edition CEHRT and can report in 2014.

MEANINGFUL USE STAGE 2

What are the criteria's for MU Stage 2?• EP’s must complete 20 objectives

17 core objectives3 objectives out of 6 from menu set9 Clinical Quality Measures

• Hospitals must complete 19 objectives 16 core objectives 3 objectives out of 6 from menu set 16 Clinical Quality Measures

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html

Clinical Quality Measures• EPs must report on 9 of the 64 approved CQMs • Eligible Hospitals must report on 16 of the 29 approved CQMs • 9 recommended eCQMs for the adult population & pediatric

population • Selected CQMs must cover at least 3 of the 6 National Quality

Strategy domains:

• Medicaid EPs will electronically report their CQM data to their state

1. Patient and Family Engagement2. Patient Safety3. Care Coordination

4. Population/Public Health5. Efficient Use of Healthcare Resources6. Clinical Process/Effectiveness

MU Stage 2 Core Core EP Stage 2 Objective EP Stage 2 Measure

1

Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines

More than 60% of medication, 30% of laboratory, and 30% of radiology orders created by the EP during the EHR reporting period are recorded using CPOE

2

Generate and transmit permissible prescriptions electronically (eRx)

More than 50% of all permissible prescriptions written by the EP are compared to at least one drug formulary and transmitted electronically using Certified EHR Technology

3

Record the following demographics Preferred anguage Gender Race Ethnicity Date of birth

More than 80% of all unique patients seen by the EP have demographics recorded as structured data

4

Record and chart changes in vital signs: Height Weight Blood pressure (age 3 and over) Calculate and display BMI Plot and display growth charts for patients 0-2 years, including BMI

More than 80% of all unique patients seen by the EP have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data

5Record smoking status for patients 13 years old or older More than 80% of all unique patients 13 years old or older seen by the

EP have smoking status recorded as structured data

Core EP Stage 2 Objective EP Stage 2 Measure

6

Use clinical decision support to improve performance on high-priority health conditions

1. Implement 5 clinical decision support interventions related to 4 or more clinical quality measures, if applicable, at a relevant point in patient care for the entire EHR reporting period. 2. The EP, eligible hospital, or CAH has enabled the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period

7

Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP

i. More than 50% of all unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within 4 business days after the information is available to the EP) online access to their health information ii. More than 5% of all unique patients seen by the EP during the EHR reporting period (or their authorizedrepresentatives) view, download, or transmit to a third party their health information

8Provide clinical summaries for patients for each offi ce visit

Clinical summaries provided to patients within one business day for more than 50% of office visits

9

Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities.

Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308 (a)(1), including addressing the encryption/security of data at rest and implement security updates as necessary and correct identified security deficiencies as part of its risk management process

10

Incorporate clinical lab-test results into Certified EHR Technology as structured data

More than 55% of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in Certified EHR Technology as structured data

11Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach

Generate at least one report listing patients of the EP with a specific condition

12

Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care

Use EHR to identify and provide reminders for preventive/follow-up care for more than 10% of patients with two or more office visits in the last 2 years

Core EP Stage 2 Objective EP Stage 2 Measure

12

Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care

Use EHR to identify and provide reminders for preventive/follow-up care for more than 10% of patients with two or more office visits in the last 2 years

13

Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate

Patient-specific education resources identified by CEHRT are provided to patients for more than 10% of all unique patients with office visits seen by the EP during the EHR reporting period

14

The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation

The EP performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP

15

The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary of care record for each transition of care or referral

1. The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals 2. The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record either a) electronically transmitted to a recipient using CEHRT or b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or is validated through anONC‑ established governance mechanism to facilitate exchange for 10% of transitions and referrals

16

Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission except where prohibited and in accordance with applicable law and practice

Successful ongoing submission of electronic immunization data from Certified EHR Technology to an immunization registry or immunization information system for the entire EHR reporting period

17Use secure electronic messaging to communicate with patients on relevant health information

A secure message was sent using the electronic messaging function of Certified EHR Technology by more than 5% of unique patients seen

MU Stage 2 Menu

Menu EP Stage 2 Objective EP Stage 2 Measure

1

Capability to submit electronic syndromic surveillance data to public health agencies except where prohibited, and in accordance with applicable law and practice.

Successful ongoing submission of electronic syndromic surveillance data from Certified EHR Technology to a public health agency for the entire EHR reporting period

2Record electronic notes in patient records.

Enter at least one electronic progress note created, edited and signed by an EP for more than 30% of unique patients

3 Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT.

More than 10% of all scans and tests whose result is an image ordered by the EP for patients seen during the EHR reporting period are incorporated into or accessible through Certified EHR Technology

4

Record patient family health history as structured data.

More than 20% of all unique patients seen by the EP during the EHR reporting period have a structured data entry for one or more first-degree relatives or an indication that family health history has been reviewed

5

Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice.

Successful ongoing submission of cancer case information from Certified EHR Technology to a cancer registry for the entire EHR reporting period

6

Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice.

Successful ongoing submission of specific case information from Certified EHR Technology to a specialized registry for the entire EHR reporting period

PATIENT CENTERED CARE

Defining Patient Centered Care

Patient’s needs, safety, and interests must be the foundation of all care delivery

• Physician-directed • Personal physician/clinician- Empanelment• Team-based medical practice• Whole person orientation- patient centered• Coordinated and/or integrated care• Quality and safety are prioritized• Enhanced access is available• Payment appropriately recognizes the added value to patients who have a

PCMH

Defining Patient Centered Care

Patient Centered Care builds on the foundational structure

of the Chronic Care Model

http://www.improvingchroniccare.org/index.php?p=the_chronic_care_model&s=2

Safe services that avoid injuries to patientsTimely care delivery that reduces wait timesEffective and accessible high quality health care that’s based on scientific knowledge Efficient services that avoids waste of equipment, supplies, ideas & energyPatient-centered care that is respectful of and responsive to patient needsEquitable and unvaried care due to differences in gender,

ethnicity, location and socioeconomic status

IOM Quality Chasm Report definition of high quality care

Alignment of MU and Patient Centered Care

Patient Centeredness• Physician-directed • Personal physician/clinician-

Empanelment• Team-based medical practice• Whole person orientation-

patient centered• Coordinated and/or

integrated care• Quality and safety are

prioritized• Enhanced access is available

Meaningful Use• Safe • Timely • Effective and accessible• Patient-centered • Efficient • Equitable and unvaried

• Patient and Family Engagement• Patient Safety• Care Coordination• Population/Public Health• Efficient Use of Healthcare

Resources• Clinical Process/Effectiveness

Deep Dive on Patient Centered & MU ActivitiesYou’ve got questions?

We’ve got answers!

Deep Dive on Patient Centered & MU Activities

THANK YOU

Deborah Johnson Ingram, PCDCKelly Maggiore, LPHI

slide 1 regional care collaborative march 26, 2015

Documents

money slide

reinvestment act slide

pc care overlap agenda

end of program year

meaningful use basics

ep attestation

eligible hospitals

total incentive payments