Meaningful Use Update 2014 Stage 1 and Stage 2

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1 Meaningful Use Update 2014 Stage 1 and Stage 2 CHCANYS Health IT Program July

2 1. Do not use your HOLD button 2. If you are in an area with background noise, please mute your phone (press *6) 3. Dial #6 to un mute your phone 4. We are recording the call 7/24/2014

3 Agenda CMS Notice of Public Rule Making Stage Stage NY Registry Requirements General Items Medicare Hardship Requirements Tracking Tool MEIPASS Audits 7/24/

4 Speakers Community Health Care Association of NY State Lisa Perry Sr. Vice President, Quality & Technology Initiatives Natalya Malamud Health IT Project Manager Health Center Network of New York (HCNNY) Stephanie Rose Project Director 7/24/

5 Who Should Attend this Webinar CEOs CFOs CMOs Clinical Super Users Meaningful Use Super Users Staff responsible for entering data in MEIPASS 7/24/

6 Meaningful Use Stage 1 Data Capturing and Sharing Stage 2 Advanced Clinical Processes Stage 3 Improved Outcomes Stage 1: basic EHR functionalities, such as capturing data electronically and providing patients with electronic copies of health information. Stage 2: increases health information exchange between providers and promotes patient engagement by giving patients secure online access to their health information 7/24/

7 Medicaid Meaningful Use Eligible Providers $63,750 per Provider Physicians (MD and DO) No penalties Nurse Practitioners >30% Medicaid or Certified Nurse Midwives Needy Patients Dentists Physician Assistants (FQHC/RHC led by PA) 7/24/

8 Medicaid Stages Payment Year Requirements Incentive 1 Adopt, Implement, Upgrade (AIU) Certified EHR, Provider Prerequisites $21,250 2 Stage 1 90 Days of MU $8,500 3 Stage 1 1 Year of MU $8,500 4 Stage 2 1 Year of MU $8,500 5 Stage 2 1 Year of MU $8,500 6 Stage 3 1 Year of MU $8,500 7/24/

9 CMS NOTICE OF PUBLIC RULE MAKING (NPRM) 7/24/

10 NPRM CMS and ONC released a notice of proposed rulemaking (NPRM) on May 20 th that would allow providers participating in the MU Program to use the 2011 Certified EHR for calendar year 2014 and some other flexibility. The comment period is open from 5/23/14 7/22/14. Expected to become part of the final rule sometime in August. Beginning in 2015, all eligible professionals would need to report using the 2014 CEHRT. 7/24/

11 NPRM Stage 2 Extended The NPRM proposes that Stage 2 would be extended through The earliest a provider would attest to Stage 3 would be Read the NPRM at: inspection.federalregister.gov/ pdf 7/24/

12 *From CMS:

13 NPRM Adopt, Implement, and Upgrade (AIU) CMS proposes to amend the definition of Adopt, Implement, and Upgrade (AIU) for the Medicaid EHR Incentive Program. Providers may only use 2014 Edition CEHRT to attest to AIU this year. 7/24/

14 The proposal would allow providers, who attest that they are unable to fully implement 2014 Edition CEHRT because of issues related to CEHRT availability delays, to meet one of three CEHRT options

15 CMS CEHRT NPRM Decision Tool If you are unsure how the NPRM impacts you, you should use the CMS CEHRT NPRM Decision Tool and Guidance/Legislation/EHRIncentivePrograms/Downloads/CEHRT _NPRM_DecisionTool.pdf 7/24/

16 7/24/

17 Questions 7/24/

18 MEANINGFUL USE STAGE

19 Stage Core Requirements

20 What Vital Exclusions are Applicable? If you see no patients 3 years or older, you are excluded from recording blood pressure; If you believe that all three vital signs of height, weight, and blood pressure have no relevance to your scope of practice, you are excluded from recording them; If you believe that height and weight are relevant to your scope of practice, but blood pressure is not, you are excluded from recording blood pressure; or You believe that blood pressure is relevant to your scope of practice, but height and weight are not, you are excluded from recording height and weight. 7/24/

21 Stage Menu Requirements Stage 1 Specification Sheets: Guidance/Legislation/EHRIncentivePrograms/Downloads/EP_Stage1_SpecificationSheets_2014_06_04.zip

22 2014 Changes Eligible Providers must use 2014 certified EHR technology for Stage 1 and only Reporting period 90 days for all participants regardless of stage or payment year Changes in Objectives Elimination of Menu Exclusions Electronic Copy of Health Information Electronic Access to Health Information Clinical Quality Measures 7/24/

23 Certification Change All EHR Incentive Programs participants must adopt certified EHR technology that meets the Standards & Certification Criteria of the 2014 Final Rule. If you already have a certified product, you will need to upgrade to the 2014 certified version regardless of the stage. 7/24/

24 2014 Special Reporting Year To accommodate the upgrade to the 2014 certified version for all vendors and participants, CMS has reduced the reporting requirement to 90 days for 2014 for all participants regardless of stage or payment year. 7/24/

25 2014 Menu Measure Change Elimination of reporting menu measures that are excluded or have no denominator. Providers must still attest to 5 menu measures Beginning in 2014 you can no longer count a menu objective that has an exclusion towards the 5 required if there are other menu objectives you can meet. 7/24/

26 Menu Measure Example Menu Measure Numerator Denominator Benchmark Metric 2013 Use 2014 Use Lab % Excl Yes No Pt Reminders % 0.08 No No Portal % 0.02 No N/A Education % 0 No No Med Rec % Excl Yes No The provider will need to meet two additional measures in 2014 that are not excluded. Trans of Care Summary % Excl Yes No Drug formulary checks Attestation Yes Yes Yes List of Patients Attestation Yes Yes Yes Immunization Registry Attestation Yes Yes Yes Syndromic Registry Attestation Excl No No

27 Electronic Access CMS combined the original Core objective to provide patients an electronic copy of their health information upon request and the Menu objective for electronic access into one Core objective. Expanded requirements 7/24/

28 Electronic Copy of Health Information Upon Request New Stage Objective Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available to the EP. New Stage Core Measure: More than 50% of all unique patients seen by the provider during the reporting period have on line access to their health information within 4 business days after it is available subject to the provider s discretion to withhold certain information. 7/24/

29 2014 Clinical Quality Measures Must report using the new 2014 criteria Must report on 9 out of 64 measures Recommended Core Quality Measures are encouraged but not required 9 for Adult 9 for Pediatrics Selected CQMs must cover at least 3 of the National Quality Strategy domains Measures & Domains on CHCANYS website: ry=health%20care%20reform 7/24/

30 Core Quality Measures Rationale CMS selected the recommended core set of CQMs for EPs based on analysis of several factors: Conditions that contribute to the morbidity and mortality of the most Medicare and Medicaid beneficiaries Conditions that represent national public health priorities Conditions that are common to health disparities Conditions that disproportionately drive healthcare costs and could improve with better quality measurement Measures that would enable CMS, States, and the provider community to measure quality of care in new dimensions, with a stronger focus on parsimonious measurement Measures that include patient and/or caregiver engagement 7/24/

31 CQM Domains Patient and Family Engagement Patient Safety Care Coordination Population/Public Health Efficient Use of Healthcare Resources Clinical Process/Effectiveness 7/24/

32 Core Adult CQM 7/24/

33 Pediatric CQM 7/24/

34 Questions on 2014 Changes 7/24/

35 Meaningful Use Stage 2 7/24/

36 Stage 2 MU Specification Sheets CMS has Stage 2 meaningful use specification sheets for eligible professionals (EPs) Each specification sheet includes the objective, measure, and exclusion for the core and menu objectives, as well as a definition of terms, attestation requirements, additional information, and the corresponding standards and certification criteria. and Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_MeaningfulUseSpecSheet_TableC ontents_eps.pdf Toolkits and other resources on Meaningful are available at: and Guidance/Legislation/EHRIncentivePrograms/Stage_2.html 7/24/

37 Stage 2 Requirements 17 Core Objectives 7 moved from Menu; 1 new all more demanding 3 Menu Objectives Select from 6; 5 new 9 Clinical Quality Measures 7/24/

38 9 CQM 3 out of 6 Menu Measures 17 Core Measures 7/24/

39 Stage 2 Core Stage 2 Measure Objective C1 CPOE > 60% of medication, > 30% lab and > 30% radiology orders C2* eprescribe/formulary > 50% of permissible prescriptions are queried for a drug formulary and sent electronically C3 Demographics > 80% of patients (language, sex, race, ethnicity, DOB) C4* Vitals > 80% of patients (BP/HT/WT) C5 Smoking Status > 80% of patients C6 CDSS 5 CDSS implemented related to >4 CQM C7 Online Information C8 Clinical Summaries > 50% of office visits > 50% of patients are provided timely online access to their health information AND > 5% of patients view, download, or transmit their health information C9 Protect Health Information Risk Assessment and Encryption/Security of Data at rest C10 Lab Test Results > 55% of lab tests are recorded as structured data (positive/negative/numerical) C11 Patient List Generate at least one report per provider for a specific condition C12 Patient Reminders > 10% of patients per patient preference (all ages) C13 Patient Education > 10% of patients (identified by CEHR) C14 Medication Reconciliation > 50% of patients C15 Transition of Care > 50% of transitions of care/referrals AND > 10% are sent electronically AND Test exchange of summary of care with a different vendor or ONC Test System C16 Immunization Registry Ongoing Submissions for the reporting period C17 Secure Electronic Messaging > 5% of patients send a secure message

40 CPOE 7/24/

41 Drug Drug & Drug Allergy Interaction Eliminated/Moved 7/24/

42 eprescribing 7/24/

43 Demographics 7/24/

44 Problem List 7/24/

45 Active Medication List 7/24/

46 Medication Allergy 7/24/

47 Vitals 7/24/

48 Smoking Status 7/24/

49 Clinical Decision Support 7/24/

50 Clinical Quality Reporting Eliminated from Core 7/24/

51 Ability to view online, download & transmit 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. More than 50 percent 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, with the ability to view, download, and transmit to a third party.

52 Clinical Summaries 7/24/

53 Exchange Clinical Information Eliminated 7/24/

54 Risk Assessment 7/24/

55 Drug Formulary Checking Combined with eprescribing 7/24/

56 Lab Results 7/24/

57 List of Patients 7/24/

58 Timely Electronic Access becomes Ability to view online, download & transmit 7/24/

59 Patient Reminders 7/24/

60 Patient Education 7/24/

61 Medication Reconciliation 7/24/

62 Summary of Care for Referrals: Part 1 7/24/

63 Summary of Care for Referrals: Part 2 The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for > 10% of such transitions and referrals 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 in a manner consistent with an ONC-established governance mechanism to facilitate exchange. 7/24/

64 Summary of Care for Referrals: Part 3 The EP who transitions or refers their patient to another setting of care or provider of care must either a) conduct one or more successful electronic exchanges of a summary of care record with a recipient using technology that was designed by a different EHR developer than the sender's, or b) conduct one or more successful tests with the CMS-designated test EHR during the EHR reporting period 7/24/

65 Part 3 NIST Randomizer Conduct one or more successful tests with the CMSdesignated test EHR during the EHR reporting period Register with EHR Randomizer at randomizer.nist.gov/ehrrandomizer app/#/registration Send a CCD to the Test EHR for a test patient You will receive an within one day indicating if it was successful and the is proof of meeting the measure. For more information go to: randomizer.nist.gov/ehr randomizer app/#/home 7/24/

66 Immunization Registry 7/24/

67 Secure Messaging 7/24/

68 Questions on Stage 2 Core 7/24/

69 9 CQM 3 out of 6 Menu Measures 17 Core Measures 7/24/

70 Stage 2 Menu Measures Must select 3 out of 6 M1 Stage 2 Measure Syndromic Surveillance Objective Ongoing Submissions for the reporting period from CEHRT M2 Electronic Notes > 30% of patients M3 Imaging Results > 10% of imaging results accessible through CEHRT M4 Family Health History > 20% of patients M5 Cancer Registry Ongoing Submissions for the reporting period from CEHRT M6 Specialized Registry Ongoing Submissions for the reporting period from CEHRT 7/24/

71 Electronic Progress Note 7/24/

72 Image Results Accessible Through the CEHR 7/24/

73 Family Health History 7/24/

74 Syndromic Surveillance Registry 7/24/

75 State Cancer Registry 7/24/

76 Specialized Registry 7/24/

77 NY Public Health Options Stage 2 New York City (5 boroughs) Upstate New York (outside of NYC) Immunization (Core) Cancer Case Reporting (Menu) Syndromic Surveillance (Menu) Specialized Registry (Menu) Immunization (Core) Cancer Case Reporting (Menu) 7/24/

78 Registration of Intent for Public Health Eligible Professionals in New York State, including New York City, that intend to meet the Stage 2 Public Health Measures must register with the New York State Department of Health (DOH) within 60 days of the start of their reporting period. 7/24/

79 Public Health Registration Process 1. Obtain a Health Commerce System (HCS) account 2. Download the User Guide from DOH anual_professionals.pdf 3. Log into HCS: Click on the Applications tab Click on the letter M Click on Meaningful Use Registration for Public Health 7/24/

80 Registration of Intent Data Entry 1. Enter the Practice information Primary Contact Name, Address, Phone Number and HCS ID Practice Name, Address, NPI, EHR Vendor, Software, and Version. 2. Enter the Eligible Provider Information: Provider HCS ID (Optional) Provider name and address Provider NPI Provider CMS Registration ID The EHR Incentive Program the provider is participating in The provider s EHR Reporting Period Start Date and End Date The provider s Meaningful Use Stage/Year Which objectives the provider is registering for 3. Save and Submit 7/24/

81 7/24/

82 Meeting the Stage 2 Syndromic Surveillance Reporting Measure (New York City only) Registration of Intent Eligible Professionals will need to register their intent to submit data to the NYS Department of Health Please use the contact information below to indicate your intent to register for Syndromic Surveillance in NYC. 7/24/

83 Meeting the Stage 2 Syndromic Surveillance Reporting Measure (New York City only) DOH has a messaging guide that specifies the data to be reported as well as the HL7 message format. The messaging guide may be received by ing Note: The EHR vendor must build to the NYC specific CEHRT specification to qualify for this measure. Contact your vendor for Interface Development/Support nce/prof_nyc 7/24/

84 Cancer Case Registry entire State Eligible Provider must meet at least one of the following criteria: 1. Ongoing submissions originally achieved in a prior year that are continuing. 2. Registration of intent within 60 days of the beginning of the reporting period AND meet at least one of the following criteria: Awaiting an invitation to begin testing Engaged in testing Ongoing submissions 7/24/

85 Cancer Case Registry 1. Eligible Professionals who diagnose cancer or directly treat cancer may register their intent to submit cancer case data to the New York State Cancer Registry (NYSCR). 2. Cancer reporting will be accepted from the 2014 CEHR in accordance with the Implementation Guide using a batch upload application on HCS NYSCR will place all Eligible Providers who register their intent in a queue. The NYSCR will prioritize practices for testing. 7/24/

86 Cancer Case Registry Exclusions Eligible Provider must meet at least one of the following criteria to be excluded: The EP does not diagnose or directly treat cancer The EP operates in a jurisdiction for which no public health agency is capable of receiving electronic cancer case information The EP operates in a jurisdiction where no public health agency provides information timely on capability to receive electronic cancer case information. 7/24/

87 Specialized Registry (NYC only) Eligible Provider must meet at least one of the following criteria: 1. Ongoing submissions originally achieved in a prior year that are continuing. 2. Registration of intent within 60 days of the beginning of the reporting period AND meet at least one of the following criteria: Awaiting an invitation to begin testing Engaged in testing Ongoing submissions 7/24/

88 Specialized Registry (NYC only) Provider Notifiable Disease Reporting Registry Register Intent For more info send an List of Reportable Diseases: reporting.shtml 7/24/

89 Questions 7/24/

90 MEDICARE HARDSHIP EXEMPTIONS 7/24/

91 Who is affected by Medicare Penalties? Providers that treat Medicare patients AND are reimbursed under Medicare Part B on a PFS, would be subject to the Medicare payment penalty unless you file a hardship exemption. Note: Most FQHC payments are under Part A and not subject to the penalty. 7/24/

92 CMS FAQ #53 The payment adjustment applies to Medicare eligible professionals (EPs), subsection (d) hospitals and critical access hospitals (CAHs) who fail to successfully demonstrate meaningful use prior to The payment adjustment will impact Medicare and dual eligible providers who treat both Medicare and Medicaid patients, where the EP is reimbursed for Medicare Part B on a physician fee schedule (PFS). The payment adjustment does not apply to Medicaid EPs, including federally qualified health centers (FQHCs) and rural health centers (RHCs) that bill Medicare using revenue codes. and Guidance/Legislation/EHRIncentivePrograms/downloads/faqsremediatedandrevised.pdf 7/24/

93 MEIPASS Rejection MEIPASS is currently sending a rejection for providers attesting to AIU in If you are not subject to the Medicare penalty respond to them using SCENARIO 1: You do not bill Medicare, or are otherwise ineligible to participate in the Medicare EHR Incentive Program. ACTION REQUIRED: Send an to the NY Medicaid EHR Incentive Program Support at indicating that you do not bill Medicare and you wish for us to proceed with review of your Payment Year 2014 AIU attestation. You may want to send a letter with your AIU attestation indicating that the provider is part of an FQHC and is ineligible to participate in the Medicare incentive to avoid the delay. 7/24/

94 ADDITIONAL INFORMATION 7/24/

95 Tracking Tool

96 Medicaid MU Prerequisites Medicaid Enrollment as FFS Provider emedny EFT Payment Form epaces Enrollment/Account MEIPASS Full Access in epaces ETIN Enrollment CMS Registration n&category=health%20care%20reform 7/24/

97 Audits Provider Credential Validation Attestation Measure Proof Screen shots (Drug Interaction, Drug Formulary Checking, etc.) Copies of patient list Copy of Updated Risk Assessment and Mitigation Steps Vendor Meaningful Use Report used in the attestation MEIPASS Attestation 7/24/

98 Audits Proof of the Upgrade/Implementation Training Logs Proof that the provider logged on and used the CEHRT (logfiles) Invoices for the purchase or upgrade CEHRT Number plus CEHRT Version and dates Validation of >30% Medicaid/Needy Volume Patient level detail for all encounters used in the calculation Medicaid Encounter details for the prior year can be requested by the Organization Medicaid Administrator by sending an to and providing your TIN information. 7/24/

99 Questions 7/24/

100 Resources CHCANYS Steps for AIU Attestation Meaningful Use Stage 1 and Stage 2 MU Measures MEIPASS Website CMS Website HealthIT.Gov Certified EHR Product List (CHPL) Certification Notice of Proposed Rule Making May 2014 (NPRM) onc release nprm allowing cehrt flexibility extending stage 2/ releases/2014 Press releases items/ html inspection.federalregister.gov/ pdf 7/24/

101 Please send any additional questions to: Natalya Malamud Health IT Project Manager 7/24/

102 WE APPRECIATE YOUR FEEDBACK! PLEASE TAKE SURVEY USING THE LINK BELOW 7/24/ HEALTH CENTER NETWORK OF NEW YORK

103 7/24/2014 Thank you for attending

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