Meaningful Use 2014 Changes

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1 Meaningful Use 2014 Changes Lisa Sagwitz HIT Workflow & Implementation Coordinator September 4,

2 PA Reach Who are we? Designated by ONC as the PA East and PA West Regional Extension Center We have assisted over 5000 eligible MU providers across the state of PA to implement electronic health records and achieve meaningful use (MU) Providers meeting our definition of Priority Primary Care Providers receive our services at no cost (i.e. 100% subsidized) To learn more about our services, please contact Pat Weiss at

3 3 PA REACH Our Services Assist with PA Public Health3 Registry enrollment process Assist with EHR Incentive Program registration Experts on MU requirements and numerous different EHRs Conduct Privacy and Security Assessment Assist practices through the EHR Incentive Program audit process Patient Centered Medical Home assistance Assist Long Term Post Acute Care (LTPAC) and Behavioral Health (BH) facilities with workflows

4 Goals of Presentation Highlight changes/new requirements related to 2014 EHR MU Incentive Program - Reporting period requirements certified version requirement - Patient portal requirement (patient electronic access) - Vital signs - Menu measure exclusions - Public Health Reporting - Clinical Quality Measures (CQM) changes 4 This presentation is assuming providers are on a certified 2014 version and attesting for 2014 MU measures. We are aware of the modifications to the final rule that allow for some flexibility in 2014 MU reporting. If you require guidance on the modifications to the final rule, please contact PA REACH s Pat Weiss at

5 2014 Meaningful Use Overview The Medicare and Medicaid EHR Incentive Programs provide financial incentives for the meaningful use of certified EHR technology to improve patient care. To receive an EHR incentive payment, providers have to show that they are meaningfully using their EHRs by meeting thresholds for a number of objectives. The EHR Incentive Programs are phased in three stages with increasing requirements. Eligible professionals participate in the program on the calendar year with reporting periods of continuous 90-days (Medicaid or first time Medicare attester) or on the quarter or full year. Providers must attest to demonstrating meaningful use every year to receive a Medicare EHR incentive and avoid a Medicare payment adjustment. 5

6 Reporting Periods for 2014 Because all providers must upgrade or adopt newly certified EHRs in 2014, all providers, regardless of their MU stage, are only required to demonstrate MU for a 3-month (or continuous 90-day) EHR reporting period in 2014: Medicare EPs beyond their first year of MU must select a continuous 90-day reporting period fixed to the quarter of the calendar year for EPs. Providers must attest to these reporting periods no later than February 28, 2015 at 12:00 a.m. ET. Medicare EPs in their first year of MU may select any continuous 90-day reporting period. Medicaid EPs can select any continuous 90-day reporting period that falls within the 2014 calendar year. 6

7 Electronic Copy of Health Information Change: Removal of electronic copy of health information core objective for Stage 1 for all providers. Beginning in 2014, the objective for providing electronic copies of health information will no longer be required for Stage 1 for EPs. CMS is replacing this objective and electronic access to health information with objectives to provide patients the ability to view, download, or transmit their health information or hospital admission information online. This is your patient portal requirement. 7

8 Patient Electronic Access New EP Objective for Stage 1 & 2: 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. Additionally for Stage 2 More than 5% of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information. 8

9 Patient Electronic Access (Patient Portal) Measure: 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. Exclusion: Any EP who neither orders nor creates any of the information listed for inclusion, except for "Patient name" and "Provider's name and office contact information, may exclude the measure. 9

10 Patient Electronic Access The following information must be made available online: Patient Name Provider Name Office Contact Info. Problems, medications and Allergy List Procedures Lab Results Vitals Smoking Status Demographic information Care Plans (w/ goals & instructions Care Team member incl. PCP (if avail.) 10

11 Patient Electronic Access Exclusions: Any EP who: 1. Stage 1 & 2: Neither orders nor creates any of the information listed for inclusion as part of both measures, except for patient name" and provider's name and office contact information, may exclude both measures. 2. Stage 2: Conducts 50% or more of his or her patient encounters in a county that does not have 50% or more of its housing units with 3Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period may exclude only the second measure. 11

12 Secure Messaging (Stage 2 Only) Measure: A secure message was sent using the electronic messaging function of CEHRT by more than 5% of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period. Exclusion: Any EP who has no office visits during the EHR reporting period, or any EP who conducts 50% or more of his or her patient encounters in a county that does not have 50% or more of its housing units with 3Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period. 12

13 Vital Signs Change: Increase in age limit for recording blood pressure in patients from age 2 to age 3; removal of age limit requirement for height and weight. Additional exclusions on upcoming slides. 13

14 Vital Signs Measure For more than 50% of all unique patients seen by the EP during the EHR reporting period have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data. Record and chart changes in the following vital signs: a) Height b) Weight c) Blood pressure d) Calculate and display body mass index (BMI) e) Plot and display growth charts for children 0-20 years, including BMI 14

15 Vital Signs Exclusions were also modified to allow more flexibility in 2014 Vitals Reporting: Any EP who: Sees no patients 3 years or older is excluded from recording blood pressure; Believes that all three vital signs of height, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them; Believes that height and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure; or Believes that blood pressure is relevant to their scope of practice, but height and weight are not, is excluded from recording height and weight. 15

16 Menu Measures Exclusions for Menu Objectives Beginning in 2014, EPs will no longer be permitted to count an exclusion toward the minimum menu objectives on which they must report if there are other menu objectives which they can select. In other words, a provider cannot select a menu objective and claim an exclusion for it if there are other menu objectives they can meet. EPs will not be penalized for selecting a menu objective and claiming the exclusion if they would also qualify for the exclusions for all the remaining menu objectives. 16

17 Public Health Registry Changes The Stage 2 Final Rule (CMS-0044-F) changed the way shared Certified EHR Technologies are handled for testing, registration and onboarding of public health agencies for both Stage 1 and Stage 2. Previously if multiple EPs are using the same certified EHR technology in different physical locations/settings (e.g., different practice locations), there must be a single test performed for each physical location/setting Now providers within the same organization that use the same certified EHR technology and share a network for which their organization either has operational control of or license to use can conduct one test or one single effort to register and onboard that covers all providers in the organization. 17

18 Clinical Quality Measures (CQMs) Beginning in 2014, requirements for CQMs will change for all EPs, regardless of what year of EHR Incentive Program participation you are in. In 2014, everyone will be required to report on the 2014 CQMs finalized in the Stage 2 rule in order to demonstrate MU and receive an incentive payment. This means you will need to report 9 measures. CQMs may be reported electronically, or via attestation. Although CQM reporting has been removed as a core objective you are still required to report CQM data in order to demonstrate MU. 18

19 CQMs In 2014 only, you need to submit CQM data for a 3-month or continuous 90-day reporting period, regardless if you are demonstrating Stage 1 or Stage 2 of MU. Medicare beyond first year of MU: Select a 3-month reporting period fixed to the quarter of the calendar year. Medicare in first year of MU, and Medicaid: Select any continuous 90-day reporting period. To avoid the Medicare 2015 payment adjustment, begin reporting period by July 1 and attest by October 1. 19

20 CQMs In 2014, the CQMs reported must cover at least 3 of the 6 available National Quality Strategy domains, which represent the Department of Health and Human Services NQS priorities for health care quality improvement. THE 6 NQS DOMAINS ARE: Patient and Family Engagement Patient Safety Care Coordination Population/Public Health Efficient Use of Healthcare Resources Clinical Process/Effectiveness 20

21 CQMs 2014 Adult Recommended Core Measures Controlling high blood pressure Use of high-risk medications in the elderly Preventive care and screening - Tobacco Use: Screening and cessation intervention Use of imaging studies for low back pain Preventive care and screening: Screening for clinical depression and follow-up plan Documentation of current medications in the medical record Preventive care and screening: Body Mass Index (BMI) Screening and Follow-Up Closing the referral loop: receipt of specialist report Functional status assessment for complex chronic conditions 21

22 CQMs 2014 Pediatric Recommended Core Measures Appropriate Testing for Children with Pharyngitis Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents Chlamydia Screening for Women Use of Appropriate Medications for Asthma Childhood Immunization Status Appropriate Treatment for Children with Upper Respiratory Infection (URI) ADHD: Follow-Up Care for Children Prescribed Attention- Deficit/Hyperactivity Disorder (ADHD) Medication Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan Children who have dental decay or cavities 22

23 Additional Resources Stage 1 Changes 2014 Meaningful Use Attestation Calculator (version 1) Eligible Professional 2014 Definition Spec Sheets Stage 1 Eligible Professional Attestation Worksheet (2014 Definition) An Introduction to the EHR Incentive Programs for Medicaid Eligible Professionals An Introduction to the EHR Incentive Programs for Medicare Eligible Professionals Patient Electronic Access Tipsheet Public Health Registry Tipsheet Stage 1 Attestation User Guide for Medicare Eligible Professionals EHR Registration, Attestation, and PECOS Checklist Medicare Registration User Guide for Eligible Professionals 23

24 Additional Guidance from PA REACH There are many other elements of Meaningful Use not covered in this presentation such as: Who is eligible for MU Incentive Program? How much incentive can I receive if I achieve MU? What are the penalties for not achieving MU by 10/1/14? How do I register for the program? Which program do I register for, Medicare or Medicaid? What should I do if I m audited? What do the modifications to the Final Rule mean to me? Please contact PA REACH for additional MU guidance not covered in this presentation. Contact Pat Weiss at This project is made possible through a grant from the Office of the National Coordinator with Department of Health and Human Services support. Grant Nos. 90RC0061/01 & 90RC0041/01. Pub # DEREC-LF A.

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