It's Not Too Late! Getting Meaningful Use Dollars for Your Program. June 20, 2013

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1 It's Not Too Late! Getting Meaningful Use Dollars for Your Program June 20, 2013

2 Julie Hook, MPH Consultant, John Snow, Inc.

3 John Jessop, MHA Planned Parenthood of Southern New England & Susan Lane, BA Planned Parenthood of Southern New England

4 Intended Audiences Title X grantees and sub-recipient leadership interested in pursuing Meaningful Use Medicaid Electronic Health Record (EHR) Incentive Program funds

5 Learning Objectives Define Meaningful Use and the requirements for data collection within each stage Describe the benefits of achieving Meaningful Use Describe an effective process that was used to demonstrate Meaningful Use in a Title X setting

6 Why Should Family Planning Programs Care about Meaningful Use? Helps you meet the standards of future partners, payers, and stakeholders Medicaid EHR Incentive Program o Maximum incentive amount is $63,750 per eligible professional o Medicaid expansion through Affordable Care Act Source:

7 About the Medicaid EHR Incentive Program Voluntarily offered by 47 individual states and territories; CMS expects full adoption in the future Eligible providers include physicians, certified nursemidwives, or nurse practitioners For more information, go to: https://www.cms.gov/apps/files/statecontacts.pdf

8 A Closer Look: Meaningful Use (MU)

9 Meaningful Use: Main Ingredients Using Certified EHR Technology (CEHRT) Electronically exchanging health information to improve quality Using technology to report clinical quality and other measures

10 Data Reporting in All Stages of MU Core Measures Menu Measures Meaningful Use Clinical Quality Measures Source:

11 Stage 1 Meaningful Use: 15 Core Objectives 1. Computerized provider order entry (CPOE) Drug-drug and drug-allergy checks Maintain an up-to-date problem list of current/active diagnoses E-prescribing Maintain active medication list Maintain active medication allergy list Record demographics Record and chart changes in vital signs 9. Record smoking status for patients 13 years and older Report ambulatory clinical quality measures Implement clinical decision support Provide patients with an electronic copy of the health information, upon request Provide clinical summaries for patients for each office visit Capability to exchange clinical information Protect electronic health information Source: Guidance/Legislation/EHRIncentivePrograms/Downloads/EHR_Medicaid_Guide_Remediated_2012.pdf

12 Stage 1 Meaningful Use: 10 Menu Objectives At least one of the 5 you report on must be a Public Health objective: o Submit electronic data to immunization registries OR o Submit electronic syndromic surveillance data to public health agencies Other Stage 1 Menu Objectives Drug formulary checks Incorporate clinical lab-test results Generate lists of patients by specific conditions Patient-specific education resources Electronic access to health information for patients Medication reconciliation Send reminders to patients for preventive/followup care Summary of care record for transitions of care Source: Guidance/Legislation/EHRIncentivePrograms/Downloads/EHR_Medicaid_Guide_Remediated_2012.pdf

13 Attestation of EHR In your first year of participation you can: Adopt a certified EHR Implement a certified EHR Upgrade to a certified EHR In the second year and beyond, you will need to demonstrate and attest to Meaningful Use You ll need documentation proving A/I/U of a certified EHR

14 Stages of Meaningful Use Stage 1 ( *) Data capture and Stage 2 (2014*) sharing Advance clinical Stage 3 (2016*) 15 CORE + 5 MENU processes Improve outcomes 17 CORE + 3 MENU * Refers to Year Stage is Initiated + CLINICAL QUALITY MEASURES

15 Getting Help on EHRs and Meaningful Use: 62 Regional Extension Centers (RECs) Located in every region of the U.S. Fee-based, on-the-ground assistance for providers Funding model is shifting to self-sustaining Find your REC:

16 Core Measure Most Relevant to Family Planning Settings Patient Demographics Preferred language Gender Race/Ethnicity Date of birth Source:

17 Clinical Quality Measures Most Relevant to Family Planning Settings Tobacco % of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user Blood Pressure % of patients aged years of age with a diagnosis of hypertension whose blood pressure improved during the measurement period Source:

18 Clinical Quality Measures Most Relevant to Family Planning Settings Body Mass Index % of patients 3-17 years and 18+ of age who had an outpatient visit with a PCP or OB/GN and who had BMI, nutrition counseling, and physical activity Cervical Cancer % of women years of age, who received one or more Pap tests to screen for cervical cancer during measurement year or 2 years prior Source:

19 Clinical Quality Measures Most Relevant to Family Planning Settings HIV/AIDS % of patients, regardless of age, with a diagnosis of HIV/AIDS with at least two medical visits during the measurement year with a minimum of 90 days between each visit Chlamydia Screening % of women years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement period Source:

20 Clinical Quality Measures Most Relevant to Family Planning Settings Breast Cancer % of women years of age who had a mammogram to screen for breast cancer during the measurement year or the year prior Source:

21 Questions / Discussion

22 The PPSNE Experience: Why We Pursued Meaningful Use Financial incentives Competition in the marketplace Changes in payer demands Outcomes-driven payments Quality of care improvements

23 Financial Incentives EHRs are EXPENSIVE! Approximate cost to PPSNE for EHR - $3.1M o Software, hardware, interfaces, custom templates, network improvements, custom application development A/I/U Payment - $950K Estimated total payments for Years $1.75M Estimated total MU incentive - $2.7M So EHR only cost $400K!

24 Initial Meaningful Use Considerations Change management Data analysis Capabilities of EHR templates Education of key stakeholders, staff & clinicians General systems to support MU requirements

25 Change Management Underpins all aspects of the MU process Requires education of key stakeholders (clinical, finance, management) Needs to link MU to quality of care Focus on: o How MU is integrated with the use of the EHR o Potential to increase agency revenue

26 Data Analysis Capturing data needed for MU measures o Extracting the data from the EHR o Time o Person responsible What systems can help?

27 Capabilities of EHR Templates MU data capture through its templates Where/How is it being captured? Optimizing workflow

28 Key Stakeholders, Staff & Clinicians Need education Generally supported concept once understood Staff & clinicians: o Didn t understand why they had to do something that seemed unrelated to our core mission o Hated workflow disruption caused by new requirements and initially inefficient template design o Had to overcome individual practice patterns and personal habits based on 10+, 20+ years of experience working in a center

29 MU Systems and Related Capabilities Data extraction Is it possible? How? Who can do it? o Internal skillsets (reporting software, programming languages) o Turnaround time o Frequency Data validation of canned reports o Are the reports accurate? o Do they capture data from customized templates or from non-standard workflows? Are the reports easy to execute and aggregate?

30 Questions / Discussion

31 MU First Step: A/I/U Easiest of all MU steps to meet Very lucrative / found money Easy to establish a baseline of Medicaid patients Our A/I/U effort primarily involved two staff However, this step still requires preparation and planning o Waivers with cover letters o Data analysis o Registration

32 Preparation & Planning for A/I/U Prepared for A/I/U by reading about requirements o Learned how to attest at federal and state levels o Learned how to do bulk data uploads o Learned about waiver letter requirement Defined MU team (helped with communication to clinicians) Determined how to do a baseline analysis for A/I/U Reviewed new procedures/data collection activities

33 CMS Registration Attestation CMS Registration https://ehrincentives.cms.gov/hitech/login.action

34 MU Core Team Also known as Clinical Application Manager (IT) EHR Core Team Director of Medical Services (Clinical) Clinical Application Specialist (IT) Recommend that the Project Lead be in charge of your clinical staff Director of Quality Assurance and Improvement (Clinical) Project Lead Regional Manager, Special Projects Regional Manager (Clinical) (Clinical)

35 A/I/U Work Assessed patient & payer population Determined # of Eligible Providers Identified measurement period (any 90-day period) Saved all data for submission validation purposes (Medicaid will ask you for copies)

36 Preparation & Planning for MU Attestation State Registration o The following information will be required: 1. License number/npi 2. Information on provider practice if in multiple states 3. Office location (was location-specific in CT) 4. Medicaid or needy encounter data 5. Total encounter data 6. Specialty (taxonomy) 7. Contact name, phone number and address

37 Medicaid Population Calculations Determined Medicaid population

38 Software Certification

39 Collecting Waivers from Clinicians (Remainder of waiver omitted)

40 Questions / Discussion

41 Preparation & Planning for Stage 1 Determined requirements for Stage 1 Identified target Menu Measures and additional Clinical Quality Measures Reviewed new procedures/data collection activities Acquired and implemented a MU dashboard Evaluated EHR template changes Conducted staff education and training

42 Identified Target Measures from Menu Identified 5 of 10 Menu Measures Identified 6 of 38 additional CQMs *From 2011 requirements

43 New Procedures/Data Collection Activities Looked at EHR templates to see how the data was captured Determined where the reports are coming from Determined who would run reports and when Identified how much time and attention was required to run the reports and to aggregate the data Determined that it was too much for us to do manually!

44 Staff & Clinician Preparation Additional clinical effort required to achieve Stage 1 Learning sessions via conference calls Communications from CEO about steps toward MU Clinician conferences for clinical services Site visits Repeated and ongoing communication Answered questions about quality of care

45 The PPSNE Experience: MU Dashboard

46 Where We Are Today and What s Ahead In Stage 1 (90-day reporting period) Planning on Stage 1 for the full year (Stage 1, 2 nd year) o Some measures requirements change Working on connectivity requirements o RI ConnectCare o CT DPH Lab Preparing for Stages 2 and 3

47 Lessons Learned Change management is TOUGH! Understanding market trends and appreciating increased competition can help secure buy-in for MU Planning and preparation are critical to the transition Education of ALL stakeholders is critical to success Data analysis resources are critical to demonstrating MU EHR templates & MU data capture don t necessarily go hand-in-hand

48 Questions / Discussion

49 Thank You! National Training Center for Management and Systems Improvement Reesa Webb Ann Loeffler Tara Melinkovich Caitlin Hungate Jen Spezeski Adrienne Christy Paul Rohde

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