Meaningful Use. Relevance. What is ARRA Meaningful Use? (American Recovery and Reinvestment Act of 2009)

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1 Meaningful Use First The What, Now The How S. Hughes Melton, MD President, C-Health, P.C. Relevance Speedometer, Consumer Reports Your Teenager Provider A and B Google: Rate your doctor The Wall of Shame? What is ARRA Meaningful Use? (American Recovery and Reinvestment Act of 2009) Part of Federal Economic Stimulus & HITECH Acts Began January stages Stage 1 (2011) Focus on electronically ll capturing health information Stage 2 (2013) Disease management, improved communication Stage 3 (2015) Decision support, increased quality measures What is ARRA Meaningful Use? (American Recovery and Reinvestment Act of 2009) Incentive period ends 2015 Goal All eligible providers and hospitals at stage 3 by 2015 Interoperability Penalties for those not meeting MU requirements (Medicare payment penalty) 1

2 Eligible Providers (EP s) Must use Certified EMR product Doctors of medicine, osteopathy, dental surgery, dental medicine, podiatry, optometry, and chiropractors Professionals who perform 90% or more of their services in the inpatient or emergency setting are considered hospital-based and are not eligible. Payments to Eligible Providers Year Maximum Benefit per Provider Total Medicare Payment Reduction if not using an EHR First Year $18,000 0% Second Year $12,000 0% Third Year $8,000 0% Fourth Year $4,000 0% Fifth Year $2, :1% Sixth Year $0 2016:2% 2017 $0 2017: 3% Beyond 3% (up to 5% in 2019) Significant reduction in payments occur if year one is not 2011 or 2012 Meaningful Use Goals Improve Quality and Safety, Efficiency and Reduce 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 Meaningful Use Eligible Providers and hospitals must use a certified EMR Must report both Objectives and Quality Measures ED is included in most hospital objectives 2

3 Meaningful Use 3 Stage/Components 1. Use the EMR in a meaningful manner Attestation Future years attestation vs. electronic exchange 2. Electronic exchange of health information 3. Submit clinical quality measures Progressively harder to quality Must report for 90 consecutive days to qualify for year one. For years 2-5 must report for 365 days. Non-Core Quality Measures Asthma Assessment Colorectal Cancer Screening Childhood immunization Status Prenatal Care: Anti-D Immune Globulin Use of Appropriate Medications for Asthma Asthma Pharmacologic Therapy Cervical Cancer Screening Diabetes: LDL Management & Control Diabetes: HbA1c Poor Control Breast Cancer Screening Diabetes: Urine Screening Diabetes: Blood Pressure Management Controlling High Blood Pressure Low Back Pain: Use of Imaging Studies Diabetes: Eye Exam Adult Weight Screening and Follow-Up Diabetes: HbA1c Control (<8%) Chlamydia Screening for Women Diabetes: Foot Exam Appropriate Testing for Children with Heart Failure (HF): Beta-Blocker Therapy for Left Pharyngitis Ventricular Systolic Dysfunction (LVSD) Oncology Colon Cancer: Chemotherapy Primary Open Angle Glaucoma (POAG): Heart Failure (HF) : Warfarin Therapy Patients with for Stage III Colon Cancer Patients Optic Nerve Evaluation Atrial Fibrillation Preventive Care and Screening Measure Preventive Care and Screening Measure Pair: Diabetic Retinopathy: Communication with the Pair: b.tobacco Cessation Intervention a.tobacco Use Assessment Physician Managing Ongoing Diabetes Care Weight htassessment and dcounseling for Pneumonia Vaccination Status t for Older Ischemic Vascular Disease (IVD): Complete Lipid id Children and Adolescents Adults Panel and LDL Control Prenatal Care: Screening for Human Preventive Care and Screening: Influenza Coronary Artery Disease (CAD): Drug Therapy for Immunodeficiency Virus (HIV) Immunization for Patients 50 Years Old Lowering LDL-Cholesterol Hypertension: Blood Pressure Ischemic Vascular Disease (IVD): Use of Ischemic Vascular Disease (IVD): Blood Pressure Measurement Aspirin or another Antithrombotic Management Diabetic Retinopathy: Documentation of Coronary Artery Disease (CAD): Oral Oncology Breast Cancer: Hormonal Therapy for Presence or Absence of Macular Edema Antiplatelet Therapy Prescribed for Patients Stage IC-IIIC Estrogen Receptor/Progesterone and Level of Severity of Retinopathy with CAD Receptor (ER/PR) Positive Breast Cancer Coronary Artery Disease (CAD): Beta- Initiation and Engagement of Alcohol and Anti-depressant medication management: (a) Blocker Therapy for CAD Patients with Other Drug Dependence Treatment: (a) Effective Acute Phase Treatment, (b) Effective Prior Myocardial Infarction (MI) Initiation, (b) Engagement Continuation Phase Treatment Smoking and Tobacco Use Cessation, Heart Failure (HF) : Angiotensin-Converting Prostate Cancer: Avoidance of Overuse of Bone Medical assistance: a. Advising Smokers Enzyme (ACE) Inhibitor or Angiotensin Scan for Staging Low Risk Prostate Cancer Patients and Tobacco Users to Quit, b. Discussing Receptor Blocker (ARB) Therapy for Left Smoking and Tobacco Use Cessation Ventricular Systolic Dysfunction (LVSD) Medications, c. Discussing Smoking and Tobacco Use Cessation Strategies How Meaningful Use is Roadmapped Advanced clinical processes Improved outcomes Data capture and sharing Achieving Meaningful Use of Health Data *From HIT Policy Comm. update The Recovery Act specifies the following 3 components (Stages) of Meaningful Use: 1. Use in a meaningful manner (e.g., e- prescribing) 2. Use for electronic exchange of health information to improve quality of health care 3. Use to submit clinical quality measures (CQM) and other such measures selected by the Secretary 3

4 Why an the EHR in the First Place? Complete a practice analysis to determine which ancillary services you need to implement E-Prescribing Portal Rule Manager CCD/CCR Lab Interface Steps of The How Register Know, Assign and Attain Objectives Self assess Attest Prepare for next year How to register for the Medicare EHR Incentive Program Started January 3, 2011 National Level Repository (NLR): and click on Registration and Attestation Office manager to watch video at p?file=16077 This is per EP (Eligible Provider)- NP s? Virginia Medicaid EHR Incentive Program? Know, Assign and Attain Stage 1 Objectives and Measures Reporting Objective Grid Handout Group composition Assign your master MU - Watch video, study handout, surf website Your Team, Your Software- Live demo of e-md s training module, will assign to the POC for that Objective 4

5 POC- Point of Contact You have to divide the work and assign it to right person on your team. How does your teamwork? MD- Provider RN- Nurses FO- Front Office BO- Back Office Know, Assign and Attain Stage 1 Objectives and Measures Reporting Eligible Professionals (and just EP s) must complete: 15 core set objectives 5 out of 10 menu set objectives 6 total Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from additional set) Meaningful Use Meaningful Use Objective Measures Objectives How we use the EMR Most have thresholds Quality Measures Clinical reporting No thresholds in year one Eligible Provider Eligible Hospital Core Items Menu Items Total There is almost 100% overlap in Core Measures, with the hospital not measured on e-prescribing because that is seen as an ambulatory activity. 5

6 Meaningful Use Goals Improve Quality and Safety, Efficiency and Reduce 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 Objective Measures Improve Quality and Safety, Efficiency and Reduce Health Disparities Objective Threshold Core Use CPOE for medication orders 30% Maintain an updated problem list 80% Maintain an active medication list 80% Maintain an active medication allergy list 80% Record Demographics 50% Record and Chart Vital Signs, BMI and growth charts 50% Record Smoking Status 50% Incorporate Clinical Lab Test Results 40% E-prescribing eligible prescriptions (Ambulatory) 40% Send Reminders to Patients 20% Advanced Directives 50% Implement CDS Drug Formulary Checks Drug/Drug interaction Generate Lists of Patients Report on Quality Measures Objective Measures Objective Measures Engage Patients and Families in their Health Care Objective Threshold Core Electronic Copy of Health Information 50% Patient Education 10% Clinical Summary 50% Improve Care Coordination Objective Threshold Core Exchange Key Clinical Information Electronically Medication Reconciliation 50% Summary of Care 50% Electronic Access for Patients 10% Electronic Copy of Discharge Instructions 50% 6

7 Objective Measures Objective Measures Improve Population and Public Health Objective Threshold Core Submit Data to Immunization Registries Send Syndromic Surveillance Data to Health Agencies Send Reportable Lab Results to Public Health Agencies Ensure Adequate Privacy and Security Protections for Personal Health Information Objective Threshold Core Protect Electronic Health Information Discussion of Core Set Objectives Refer to your Objective Grid Handout Which team member should do which? BO- Easy (5, 7, 14, 15), Hard (3) FO-Easy (8) MD- Easy (1, 2, 6) RN- Easy (9, 10, 11, 12, 13), Hard (4) Know, Assign and Attain Stage 1 Objectives and Measures Reporting Eligible Professionals (and just EP s) must complete: 15 core set objectives 5 t f 10 t bj ti 5 out of 10 menu set objectives 6 total Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from additional set) 7

8 Discussion of Menu Set Objectives Refer to your Objective Grid Handout Tougher so select the five that will be easiest for you based on software functionality, your interests, etc BO- Easy (1,2,4,5,9) FO-Easy(8) MD-Easy(6) RN- Easy (3), Hard (7) Know, Assign and Attain Stage 1 Objectives and Measures Reporting Eligible Professionals (and just EP s) must complete: 15 core set objectives 5 out of 10 menu set objectives 6 total Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from additional set) Meaningful Use: Clinical Quality Measures The measures used by CMS are drawn from National Quality Forum (NQF) 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 Eligible Professionals seeking to demonstrate Meaningful Use are required to electronically submit aggregate CQM numerator, denominator, and exclusion data to CMS or the States. You have to PROVE it. Details at: https://www.cms.gov/qualitymeasures/03_electronicspe cifications asp Hospital Quality Measures Must Report on all 15 3 Categories Stroke V Th b b li Venous Thromboembolism Emergency Department Throughput Measures 8

9 EH Quality Measures: Stroke EH Quality Measures: VTE Ischemic stroke: Discharge on anti-thrombotics Ischemic stroke: Anticoagulation for A-fib/flutter Ischemic stroke: Discharge on statins Ischemic stroke: Thrombolytic therapy for patients arriving within 2 hours of symptom onset Ischemic or hemorrhagic stroke: Stroke education Ischemic or hemorrhagic stroke: Rehabilitation assessment Ischemic or hemorrhagic stroke: Antithrombotic therapy by day 2 Prophylaxis within 24 hours of arrival ICU prophylaxis Anticoagulation overlap therapy Discharge instructions Incidence of potentially preventable VTE Platelet monitoring on unfractionated heparin EH Quality Measures: ED Median time from ED arrival to ED departure for admitted patients Admission decision time to ED departure time for admitted patients Eligible Provider Quality Measures Must report on 6 of 44 3 core or alternate core 3 additional quality measures 9

10 Core Quality Measures Inquiry Regarding Tobacco Use Blood pressure measurement Body Mass Index (BMI) Screening and Follow-Up Alternate Core Measures Influenza Immunization for Patients 50 Years Old Childhood Immunization Status Body Mass Index (BMI) 2 through h 18 years of age Discussion of CQM (Clinical Quality Measures) Woo Hoo! Clinical stuff. Refer to your Objective Grid- you can sort We aren t going to talk about each one Are you collecting them properly so you can prove it in 2012? Requires team approach- tougher Fun Part- Is your work improving care? Discussion of CQM (Clinical Quality Measures) Pick the Core or Alternate Core set of 3 Select 3 of the other 38 CQM s Based on CMS CQM Detailed Explanation sheets- Demo CMS NQF 0028 Software should have a CQM Reports Dictionary- Demo page 23 You run a report that looks like Sample Vitals Report 10

11 Self Assess PDSA cycle vementmethods/howtoimprove/ 2011 you have at least 3 months 2012 you needs to be up and going Jan 1st How to attest for the Medicare EHR Incentive Program Starts April 2011 True reporting process is yet to be determined for 2012 As of 1/13/11 there is no information on the attestation process! Answer ID: They are saying April Attest INDIVIDUALLY, not group average Prepare for the Future Stage 2 and 3. What CMS is saying. Master MU follows development Twitter, visit CMS website All 10 on Menu Set Objectives? They are listed in same order as the Goals of MU More Clinical Quality Measures required? I will see you next year! Local CMS Contact CMS Region 3 Philadelphia, PA PA, DE, WV, VA, DC, MD Public HITECH Inquiry Line: Address: Fax: Lead HITECH Point of Contact: Patrick Hamilton Regional Administrator: Nancy B. O Connor Chief Medical Officer: Barbara J. Connors, DO, MPH 11

12 Status of Virginia Medicaid Program gs/pr-arra.aspx Draft State Medicaid Health Information Technology Plan (SMHP) submitted 9/1/10 DMAS expects to begin reviewing applications in the second half of 2011 Or the Medicaid EP practices predominantly in an FQHC or RHC 30% needy individual patient volume threshold Regional Extension Center Contact Virginia: Phone: Website - E il t i h Tennessee:

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