2011 Patient Centered Medical Home Monthly Webinar Series

Electronic Health Record Utilization — Meaningful Use Criteria

Ashley Green –

HIT Specialist, WHITEC May 18, 2011

Objectives

1. Provide background about the American Recovery and Reinvestment Act (ARRA), specifically related to Meaningful Use and health information technology 2. Outline Meaningful Use measures 3. Discuss Eligibility for Medicare & Medicaid Incentive programs

Bipartisan Support

“… an Electronic Health Record for every American by the year 2014

.

“Computerize All health records within five years.”

By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.”

State of the Union address, Jan. 20, 2004 - George Mason University January 12, 2009

American Recovery and Reinvestment Act (ARRA) of 2009

• Signed February 17, 2009 by President Obama • Health Information Technology for Economic and Clinical Health (HITECH) Act

HITECH Act: Catalyst for Transformation Paper records HITECH Act EHRs & HIE Pre 2009

A system plagued by inefficiencies

2009

EHR Incentive Program and 60 Regional Extension Centers

2014

Widespread adoption and meaningful use of EHRs

Building an Interconnected, Patient-Centric Care System

• • • • •

Snapshot of EHR Benefits

•

For Providers:

• •

For Patients:

• • •

Dr. David Blumenthal, recent National Coordinator of HIT, emphasized:

“HIT is the means, but not the end. Getting an EHR up and running in health care is not the main objective behind the incentives provided by the federal government under ARRA. Improving health is. Promoting health care reform is.”

- At the National HIPAA Summit in Washington, D.C. on September 16, 2009

3 Major Components of Meaningful Use Specified in HITECH

1. Use of certified EHR in a meaningful manner (e.g., e-prescribing) 2. Use of certified EHR technology for electronic exchange of health information to improve quality of health care 3. Use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by the Secretary

HITECH Act Initiatives

Adoption of EHRs Medicare & Medicaid Incentives and penalties State grants for health Information exchange Standards & certification framework Privacy & Security framework Meaningful Use of EHRs Exchange of health information Blumenthal D. Launching HITECH. N Engl J Med. 2010 Jan 4.

Meaningful Use of EHRs Improved individual and population health outcomes Improved ability to study and improve care delivery Increased transparency and efficiency

Snapshot: Stage 1 MU for EPs

            Core Set: Must Do All 

Use CPOE

 

e-prescribing Drug-drug & drug allergy checks Medication list Allergy list Problem list Decision support Record demographics Smoking status Vital signs Clinical summaries to patient Electronic exchange Health info to patients Clinical quality measures Protect health information

     Menu Set: Must Do 5 of 10 

Incorporate clinical labs

 

Medication reconciliation Implement drug-formulary checks Generate patient list Patient electronic access Send reminder Patient-specific education Clinical summaries to provider



Submit electronic data to immunization registry*



Submit electronic syndromic surveillance data* *At least 1 public health objective must be selected.

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Meaningful Use

• 25 Objectives and Measures – Core set (15) – “Menu” (pick 5 of 10) – 6 Clinical Quality Measures • 3 core or alternate core • 3 out of 38 additional • Current rule applies for payment years 2011 and 2012 • Reporting Period is 90 days for the first year; one year subsequently • Will evolve over next several years

Meaningful Use: Three Stages

Stage 3: 2015 Stage 2: 2013 Stage 1: 2011

Origin of MU Goals

• Adapted from National Priorities and Goals of the National Priorities Partnership: – Improving quality, safety, efficiency, and reducing health disparities – Engage patients and families in their health care – Improve care coordination – Improve population and public health – Ensure adequate privacy and security protections for personal health information

Core Criteria

• Providers must complete each of the core criteria unless unable to due to scope of practice, population served or number in the denominator. For example: – Chiropractor and ePrescribing – CAH and no patients have requested electronic access

Core: Improving quality, safety, efficiency, and reducing health disparities

Core: Improving quality, safety, efficiency, and reducing health disparities

Core: Engage patients and families in their healthcare

Core: Improve care coordination

Core: Ensure adequate privacy and security protections for personal health information

Menu Criteria

• Providers and hospitals may defer up to 5 of the menu criteria until stage 2 • At least one of the criteria from population and public health must be included in order to qualify as a meaningful user

Menu: Improving quality, safety, efficiency, and reducing health disparities

Menu: Engage patients and families in their healthcare

Menu: Improve care coordination

Menu: Improve population and public health

Reporting of CQMs

• EPs would be required to submit clinical data on 2 measure groups: – A core set of 3 measures (or alternates) – 3 additional measures selected from among 38 others • EHs would be required to submit data on all 15 measures • All measures have specifications for electronic reporting • Patient information must be submitted regardless of payer

Clinical Quality Measures – Core Set NQF Measure Number & PQRI Implementation Number

NQF 0013 NQF 0028 NQF 0421 PQRI 128

Clinical Quality Measure Title

Hypertension: Blood Pressure Measurement Preventive Care and Screening Measure Pair: a) Tobacco Use Assessment, b) Tobacco Cessation Intervention Adult Weight Screening and Follow up

Clinical Quality Measures – Core Set NQF Measure Number & PQRI Implementation Number

NQF 0024 NQF 0041 PQRI 110 NQF 0038

Clinical Quality Measure Title

Weight Assessment and Counseling for Children and Adolescents Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or Older Childhood Immunization Status

Additional CQMs

• must complete 3 1. Diabetes: Hemoglobin A1c Poor Control 2. Diabetes: Low Density Lipoprotein (LDL) Management and Control 3. Diabetes: Blood Pressure Management 4. Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) 5. Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) 6. Pneumonia Vaccination Status for Older Adults 7. Breast Cancer Screening

Additional CQMs

8. Colorectal Cancer Screening 9. Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD 10. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) 11. Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment 12. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation

Additional CQMs

13. Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy 14. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care 15. Asthma Pharmacologic Therapy 16. Asthma Assessment 17. Appropriate Testing for Children with Pharyngitis 18. Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer

Additional CQMs

19. Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients 20. Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients 21. Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies 22. Diabetes: Eye Exam 23. Diabetes: Urine Screening

Additional CQMs

24. Diabetes: Foot Exam 25. Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol 26. Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation 27. Ischemic Vascular Disease (IVD): Blood Pressure Management 28. Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic

Additional CQMs

29. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement 30. Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) 31. Prenatal Care: Anti-D Immune Globulin 32. Controlling High Blood Pressure 33. Cervical Cancer Screening 34. Chlamydia Screening for Women

Additional CQMs

35. Use of Appropriate Medications for Asthma 36. Low Back Pain: Use of Imaging Studies 37. Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control 38. Diabetes: Hemoglobin A1c Control (<8.0%)

Reporting Process

– 2011 – Eligible Professionals seeking to demonstrate Meaningful Use are required to submit aggregate CQM numerator, denominator, and exclusion data to CMS or the States by ATTESTATION.

– 2012 – Eligible Professionals seeking to demonstrate Meaningful Use are required to electronically submit aggregate CQM numerator, denominator, and exclusion data to CMS or the States.

Applicability of Objectives & Measures

• Some MU objectives not applicable to every provider’s clinical practice; they would not have any eligible patients or actions for the measure denominator. Exclusions do not count against the 5 deferred measures • In these cases, the EP, eligible hospital, or CAH would be excluded from having to meet that measure – e.g., Dentists who do not perform immunizations; Chiropractors do not e-prescribe

Incentives

•

Pay you for meaningful use*

• Awarded by Medicare – Maximum: $44,000 per provider – $48,400 if in a HPSA – Penalties begin in 2015 – Attestation begins 4/11 – Payments begin 5/11 • Awarded by Medicaid – Maximum: $63,750 per provider – *First year is AIU $21,250

Medicare-only Eligible Professionals Medicaid-only Eligible Professionals Could be eligible for both Medicare & Medicaid incentives

EP Eligibility: Medicare Basics

• Must be a physician (defined as MD, DO, DDM/DDS, optometrist, podiatrist, chiropractor) • Must have Part B Medicare allowed charges • Must not be hospital-based • Must be enrolled in PECOS, living

EP Eligibility: Medicaid Basics

• Must be one of 5 types of EPs • Must either: – Have ≥ 30%

Medicaid

patient volume (≥ 20% for pediatricians only); or – Practice predominantly in an FQHC or RHC with ≥30%

needy individual

patient volume • Licensed, credentialed • No OIG exclusions, living • Must not be hospital-based

Incentive Payments for Medicare EPs

• First Calendar Year (CY) for which the EP Receives an Incentive Payment

Incentive Payments for Medicaid EPs

Meaningful Use Requirements

• A Medicare Eligible Professional who does NOT demonstrate meaningful use by 2015 will be subject to payment reductions in their Medicare reimbursement schedule • Medicaid-only EPs are not subject to payment reductions • Payment reductions may apply for any EP who accepts Medicare, even if you only participate in the Medicaid EHR incentive program

Additional Information

• HHS HIT (ONC) website: http://healthit.hhs.gov/portal/server.pt/community/healthit _hhs_gov__home/1204 • CMS Incentive Program website: http://www.cms.gov/ehrincentiveprograms/ • WI DHS website for eHealth Initiative: http://www.dhs.wisconsin.gov/ehealth/index.htm

Contact Information

Ashley Green HIT Specialist, WHITEC Desk: (608) 729-2705 Fax: (608) 274-5008 [email protected]

2909 Landmark Place Madison, WI 53713 www.whitec.org

Questions?

WHITEC, operated as a division of MetaStar, is funded through a cooperative agreement award from the Office of the National Coordinator, Department of Health and Human Services Award No. 90RC0011/01

Thank You

210 Green Bay Road, Thiensville, WI 53092 Phone: (262) 512-0606 Email: [email protected]

www.wafp.org/pcmh 50