Transcript Slide 1

Meaningful Use
of Electronic Health Records
Tammy Geltmaker, RN, BSN, MHA
EHR Consulting Manager
November 17, 2010
Highlights
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Eligible Professionals (EP)
Financial Incentives
Meaningful Use (MU)
Stage One Measures
Kentucky Resources
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American Recovery and
Reinvestment Act (ARRA)
 A Massive Stimulus for Health Information
Technology (HIT) Adoption & Health Information
Exchange (HIE) Expansion
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Appropriations for HIT
Appropriations for HIE
New incentives for adoption
Community Health Centers
Broadband and Telehealth
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Eligible Professional (EP)
Eligible Providers- Medicare
Eligible Providers- Medicaid
Eligible Professionals (EPs)
 Eligible Providers- Medicare
Physicians (Pediatricians have special eligibility
Eligible Professionals (EPs)*
Doctor of Medicine or Osteopathy
Doctor of Dental Surgery or Dental
Medicine
Doctor of Optometry
Doctor of Podiatric Medicine
Chiropractor
Eligible Hospitals*
Acute Care Hospitals
Critical Access Hospitals (CAHs)
and payment rules)
Nurse Practitioners (NPs)
Certified Nurse-Midwives (CNMs)
Dentists
Physician Assistant (PAs) who lead a federally
qualified health center (FQHC) or Rural health
clinic
Eligible Hospitals
Acute Care Hospitals, Critical Access Hospitals
Children’s Hospitals
* Defined: Section 1861(r) Physician Definition
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Eligible Professional (EP)Medicare Advantage (MA)
 MA Eligible Professionals (EPs)
o Must furnish, on average, at least 20 hours/week of patient-care
services and . . .
o Be employed by the qualifying MA organization
Or . . .
o Must be employed by, or a partner of, an entity contracting with the
qualifying MA organization furnishing at least 80 percent of the entity’s
Medicare patient care services to enrollees of the qualifying MA
organization
 Qualifying MA-Affiliated Eligible Hospitals
o Will be paid under the Medicare Fee-for-service EHR incentive program
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Eligible Professional (EP)
 Patient volume requirements for Medicaid incentives
Entity
Minimum Medicaid Patient Volume Threshold
For Eligible Professionals (EPs)
Physicians
- Pediatricians
Dentists
CNMs
PAs when practicing at an FQHC/RHC also led by
a PA
NPs
30%
20%
30%
30%
30%
30%
Or the Medicaid EP practices predominantly in an FQHC or RHC— 30% needy individual patient
volume threshold
For Eligible Hospitals
Acute care hospitals
Children’s hospitals
10%
No requirement
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Registration Process
 Register through the EHR Incentive Program Web site
 Be enrolled in Medicare FFS, MA, or Medicaid (FFS or
managed care)
 Have a National Provider Identifier (NPI)
 Use certified EHR technology to demonstrate MU
- Medicaid providers may adopt, implement, or upgrade in
their first year
 All Medicare providers and Medicaid eligible hospitals
must be enrolled in Provider Enrollment, Chain and
Ownership System (PECOS)
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Registration: Medicaid
 States will connect to the EHR Incentive Program
Web site to verify provider eligibility and prevent
duplicate payments
 States will ask providers for additional information
to make accurate and timely payments
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Patient Volume
Licensure
A/I/U or Meaningful Use
Certified EHR Technology
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Financial Incentives
 Includes financial incentives for health care
providers who attain “meaningful use” with
their EHR systems.
o Medicare: Up to $44,000 per provider over
five years
o Medicaid: Up to $63,750 per provider over
six years
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Medicare Incentives
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Medicare Incentives (Cont’d)
Part B Annual Charges
Maximum Payment
 Pays 75% of “allowed
charges” based on claims
submitted to Medicare
$24,000
$18,000
$16,000
$12,000
$10,667
$ 8,000
$ 5,334
$ 4,000
$ 2,667
$ 2,000
 MA providers qualify
for the Medicare
incentives using MA
claims instead of part B
claims
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Medicaid Incentives
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Medicaid Incentives (Cont’d)
 EPs may receive up to 85 percent of the net average allowable costs
for certified EHR technology, including support and training, up to a
maximum level of $63,750.
 Pediatricians must have a Medicaid patient volume of at least 20%.
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Medicaid Only:
Adopt/Implement/Upgrade (A/I/U)
 First participation year only for Medicaid providers
 Adopted-Acquired and Installed
o e.g., Evidence of installation prior to incentive
 Implemented–Commended Utilization of
o e.g., Staff training, data entry of patient demographic information into EHR
 Upgraded–Expanded
o e.g., Upgraded to certified EHR technology or added new functionality to meet
the definition of certified EHR technology
 Must use certified EHR technology
 No EHR reporting period
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Meaningful Use Definition
 Meaningful use is defined as . . .
o Use of a certified EHR in a meaningful manner (ex:
e-prescribing)
o Use of certified EHR technology for electronic
exchange of health information
o Use of certified EHR technology to submit clinical
quality and other measures
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Meaningful Use Stages
* Stages 2 and 3 will be defined in future CMS rulemaking
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Meaningful Use Stages
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Stage One Priorities
 Electronically capture information in a coded
format
 Use electronic information to track key clinical
conditions
 Implement clinical decision support tools to
facilitate disease and medication management
 Report clinical quality measures and public health
information
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Stage One Measures
 HIT functionality measures
• Reported by attestation
 Clinical quality measures
• Reported by attestation for 2011
• Electronic submission to CMS for 2012
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HIT Functionality Measures
 EPs must report on 20 of 25 MU objectives with
associated measures
o Core set of 15
o Menu set of 10
 An EP must successfully meet the measure for each
objective in the core set and all but five in the menu
set
o Some MU objectives are not applicable to every provider’s clinical
practice. In this case, the EP would be excluded from having to
meet that measure.
 e.g., Dentists who do not perform immunizations and chiropractors who do not
have prescribing authority
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Meaningful Use: Core Set Objectives
EPs –15 Core Objectives
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Computerized physician order entry (CPOE)
E-Prescribing (eRx)
Report ambulatory clinical quality measures to CMS/States
Implement one clinical decision support rule
Provide patients with an electronic copy of their health information, upon request
Provide clinical summaries for patients for each office visit
Drug-drug and drug-allergy interaction checks
Record demographics
Maintain an up-to-date problem list of current and active diagnoses
Maintain active medication list
Maintain active medication allergy list
Record and chart changes in vital signs
Record smoking status for patients 13 years or older
Capability to exchange key clinical information among providers of care and patient-authorized
entities electronically
Protect electronic health information
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Meaningful Use: Menu Set Objectives
EPs – 10 Menu Objectives
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Drug-formulary checks
Incorporate clinical lab test results as structured data
Generate lists of patients by specific conditions
Send reminders to patients per patient preference for preventive/follow up care
Provide patients with timely electronic access to their health information
Use certified EHR technology to identify patient-specific education resources and
provide to patient, if appropriate
Medication reconciliation
Summary of care record for each transition of care/referrals
Capability to submit electronic data to immunization registries/systems*
Capability to provide electronic syndromic surveillance data to public health
agencies*
*At least 1 public health objective must be selected
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Clinical Quality Measures
 Ambulatory setting report on all (3) of the core
measures as applicable for their patients
o Inquiry regarding tobacco use
o Blood pressure measurement
o Adult weight screening and follow-up
 Alternate core measures if denominator is zero
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Preventative care and screening
Influenza immunization for patients ≥50 years old
Weight assessment and counseling for children and adolescents
Childhood Immunization status
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Clinical Quality Measures (Cont’d)
 Second required measure set for each EP to submit
information on three additional measures from at list
of 38 clinical quality measures
o Specifications for the measures are published in the final rule
 In sum, EPs must report on 6 total measures: 3
required core measures (substituting alternate core
measures where necessary) and 3 additional
measures
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Meaningful Use Reporting Period
 First Year Incentive Qualifications
o Any continuous 90-day period within a payment year in which an
EP successfully demonstrates meaningful use of certified EHR
o First opportunity to start demonstrating meaningful use is
January 1, 2011
o “Attestation methodology” proposed in 2011
o Electronic Reporting starting in 2012
 Subsequent years reporting period
o Entire 12 months (calendar year for EP) in the respective year
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Certification Process/Bodies
 Temporary Process
o Currently three certifying bodies
 Certification Commission for Health Information Technology
(CCHIT), Drummond Group Inc., InfoGard Laboratories Inc.
 Certification process has begun
o ONC is posting the certified EHR applications on its site
o To obtain Medicare incentive dollars, must be a CERTIFIED EHR
system
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Certification Process/Bodies
(Cont’d)
 Permanent Process
o Accreditation of bodies expected to be completed
through private entities with guidance from National
Institute of Standards and Technology (NIST)
o Expected timeframe for first bodies under permanent
program to be accredited by January 2012
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Certified EHR Technology
 Two Types of Certification of EHR Technology
o Complete EHR
EHR must certify all requirements to certify as
Complete EHR
o Certified EHR Module
“..any service, component, or combination thereof
that can meet the requirements of at least one
certification criterion adopted by the Secretary”
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What happens if you do
not adopt an EHR by
2015?
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Penalties
 No incentive money available for
implementation
 Medicare cuts begin
o 2015=1%
o 2016=2%
o 2017=3%
 Evaluation of adoption rate in 2018
 No Medicaid cuts associated with non-adoption
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EHR Incentive Programs
Milestone Timeline
Fall 2010
Winter 2011
Spring 2011
Fall 2011
Winter 2012
• Certified EHR technology available and listed on ONC Web site
• JANUARY 2011 – Registration for the EHR Incentive Programs
begins
• JANUARY 2011 – For Medicaid providers, States may launch their
programs if they so choose
• APRIL 2011 – Attestation for Medicare EHR Incentive Program
begins
• MAY 2011 – EHR Incentive Payments begin
• NOVEMBER 30, 2011 – Last day for eligible hospitals and CAHs to
register and attest to receive an incentive payment for FFY 2011
• FEBRUARY 29, 2012 – Last day for EPs to register and attest to
receive an incentive payment for CY 2011
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Comparison of Medicare and
Medicaid Programs
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Participation in Other Incentive
Programs
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Kentucky’s Efforts
Kentucky Health Information Exchange
 In 2005, Senate Bill 2 created the Kentucky eHealth
Network (KeHN) Board to oversee the development,
implementation, and operation of a statewide e-health
network.
 Kentucky also received a Medicaid Transformation Grant
to develop the foundational components for a statewide
health information exchange, the Kentucky Health
Information Exchange (KHIE), to be completed by the
second quarter of 2010.
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Kentucky’s Efforts (Cont’d)
Regional Extension Centers
 Providing basic resources for assisting practices with
adopting EHRs and achieving meaningful use
 Emphasis placed on
o small practices (fewer than10 prescribers; physicians, PAs,
ARNPs)
o community health centers
o rural clinicians that work with critical access hospitals
o practices and clinics that serve the underserved
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Additional Assistance
Kentucky Medical Association
 More information regarding “EHR Planning
Available for KMA Member Practices” on the
KMA Web site https://www.kyma.org/content.asp
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Questions ?
Tammy Geltmaker RN, BSN, MHA
(502) 454-5112, ext. 2201
[email protected]
For further details regarding information found in this
presentation, please visit
http://www.cms.gov/EHRIncentivePrograms
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