Meaningful Use 2014: Stage 2 MU Overview. Scott A. Jens, OD, FAAO October 16, 2013

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1 Meaningful Use 2014: Stage 2 MU Overview Scott A. Jens, OD, FAAO October 16, 2013

2 Overview General Overview of Stage 2 MU in 2014 Core Objectives for Stage 2 Menu Objectives for Stage 2 Complete summary of CQMs for Stage 2

3 Stages of MU Improving patient care through advanced clinical processes Saving money, time, and improving outcomes

4 Overview of Stage 2 Meaningful Use = Use of EHR in a way that positively affects patient care The move to Stage 2 always occurs in the doctor s 3 rd MU year Starts in 2014 for any Eligible Professional who started Stage 1 in 2011 or 2012 Starts in 2015 if Stage 1 was started in 2013

5 Stages of MU First Year With EHR Stage of MU

6 Medicare Incentive Payments First Year With EHR Maximum Incentive Payments (Medicare EP) 75% bonus on ME allowable charges for that year Total 2011 $18,000 $12,000 $8,000 $4,000 $2,000 $44, $18,000 $12,000 $8,000 $4,000 $2,000 $44, $15,000 $12,000 $8,000 $4,000 $39, $12,000 $8,000 $4,000 $24, Penalty Penalty **2% reduction due to sequester must be calculated

7 Medicaid Incentive Payments Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Adopt, Implement, Upgrade $21,250 $8,500 $8,500 $8,500 $8,500 $8,500 Medicaid EPs always begin in Stage 1; the last year of participation is 2016 and payments are made over 6 years

8 2014 Certified 2014 Certification will be required for Stage 2 MU The provider must update to the 2014 Certified version of the EHR product The value of being a RevolutionEHR customer All new versions will be released without any action required by the practice or provider No added cost for upgrades ever Training and support for use of new MU features will occur throughout Q1, plus a new Stage 2 MU INSIGHT page will be available. MAKE PLANS FOR STARTING on !!!

9 Registration Update Must update your EHR Certification Number on the ONC website RevolutionEHR v6.0 and higher, and as more versions are developed/tested/released, the EHR Certification Number will need to be updated as you combine use of versions of the product Reporting Period days in a calendar quarter Will be selecting at your own discretion MEDICAID: may select any 90 day period, not a quarter

10 Attestation Update Attestation for 2014 completed by Feb. 28, 2015 Automation of measure calculation and submission MU data will be automatically submitted CQM data will be automatically submitted

11 Finding Success Recommendation: Familiarize Q1, Attempt Q2 or Q3; leave Q4 as a fallback only if needed Check your MU Scorecard frequently through 90 days: Every 1-3 days for 2 weeks, then weekly at week 3 and 4 If after one month you are mostly on track, check again at week 6 and again at two months After 75 days, begin to check daily to stay on track If you begin to show significant shortcomings, you may need to defer MU to the next quarter

12 Stage 2 MU Objectives 17 Core Objectives Combines a number of Stage 1 Core and Menu objectives 3 out of 6 Menu Items 5 of 6 are new Menu items; one remains from Stage 1 Exclusions are not allowed to pass Menu items CQMs are stand-alone items

13 Overview of Stage 2 MU

14 Stage 2 Eliminates Stage 1 Objectives 1. Drug-drug, drug-allergy interactions (now in CDS) 2. Drug-formulary checks (now in e-prescribing) 3. Maintain lists Diagnoses, Meds, Med Allergies (now in Summary of Care Record) 4. Test electronic exchange (eliminated for 2013) 5. Timely access to electronic info (eliminated for 2014)

15 Core Objective Overview 1. Use CPOE for orders for meds, labs, and radiology 2. Generate and transmit prescriptions electronically 3. Record demographic information 4. Record and chart changes in vital signs 5. Record smoking status, age 13 and older 6. Use CDS on high-priority health conditions 7. Provide health information online, downloadable

16 Core Objective Overview 8. Provide clinical summaries for each office visit 9. Protect electronic health information 10. Incorporate lab-test results 11. Generate lists of patients with specific conditions 12. Use clinical info to identify patients for reminders 13. Use EHR to identify patient-specific education 14. Perform medication reconciliation

17 Core Objective Overview 15. Provide summary of care record for transition of care 16. Submit electronic data to immunization registries 17. Use secure electronic messaging with patients

18 CPOE Computerized Provider Order Entry Denominator = Medication, laboratory, and radiology orders created by EP in the reporting period Numerator = Those orders recording using CPOE Provider must keep track of any paper med orders Exclusion if fewer than 100 orders in reporting period New: 60% meds, 30% labs, 30% radiology; Old: 30% Patients

19 E-Prescribing Generate and transmit permissible prescriptions electronically Must write Rx and compare to at least one drug formulary Exclusion available for providers with no pharmacy that accepts electronic prescriptions within 10 miles, and if fewer than 100 Rxs created in reporting period New: 50% Rxs by e-prescribing; Old: 40%

20 Record Demographics Must have all five categories documented for Unique Patients DOB, Gender, Preferred Language, Race, Ethnicity New: 80% Unique Patients; Old: 50%

21 Record Vital Signs Record and chart changes in vital signs: BP over age 3, Height and Weight on all patients Exclusion from one or both parts of this objective if you determine that either BP or Ht/Wt is not relevant to your scope of practice New: 80% Unique Patients; Old: 50%

22 Record Smoking Status Must have smoking status documented for patients age 13 and older New: 80% Unique Patients; Old: 50%

23 Clinical Decision Support Goal is to use CDS to improve performance on highpriority health conditions 1. Implement 5 CDS rules related to 4 or more CQMs at a relevant point in patient care Certified EHRs include CDS alerts for patients with certain conditions or treatments, and you must implement the rules and utilize the alerts at a point in workflow where they can have a positive impact on patient care 2. Utilize automated functionality for drug-drug and drug-allergy interaction checks New: All rules in place for entire period; Old: One rule

24 Online Access to Health Info Provide patients the ability to view online, download, and transmit their health information 1. 50% of Unique Patients are provided timely online access to health information within 4 business days of the information being available to the provider 2. 5% of Unique Patients view, download, or transmit to a third party their health information Exclusion for practices in areas with low bandwidth availability As outlined above

25 Clinical Summaries Clinical Summary provided to patients within one business day New: 50% Office Visits; Old: 50% Patients w/in 3 days

26 Protect Health Information Conduct a Security Risk Analysis (SRA) including addressing the encryption/security of data at rest, and implement security updates as necessary Correct identified security deficiencies as part of the risk management process and develop policies and procedures based upon results of SRA May be a continuation of Stage 1 SRA, but updates should be done Conduct SRA and implement updates

27 Incorporate Lab Results For any clinical lab tests ordered by the provider, whose results that can be logged as positive/ negative or in numerical format, incorporate the results in the EHR If you don t order labs, you will report zeroes Exclusion if no lab tests are ordered New: 55% results; Old: Menu, 40%

28 Generate Patient List Goal of use of list is quality improvement, reduce health disparities, research, or outreach Patients should be selected based upon specific condition You are only measured on whether you generate the list New: Same, generate at least one list; Old: Menu

29 Send Patient Reminders More than 10% of Unique Patients who have had 2 or more office visits with the EP within 24 months before the beginning of the EHR reporting period were sent a reminder, per patient preference when available Use clinically relevant information to identify patients who should receive reminders for preventive/followup care Use EHR to identify and provide reminders New: 10% patients with 2 or more office visits receiving reminder from EHR; Old: 20% of 65+ and 5- patients receive a reminder of any type not nec. from EHR

30 Patient Education EHR identifies/recommends patient-specific education resources baed upon variables such as chronic conditions Doctor/practice decides on delivery of the resources they don t need to come directly out of the EHR New: Same, 10% Patients; Old: Menu

31 Medication Reconciliation A provider who receives a patient from another setting of care or provider of should perform medication reconciliation Review an external medication list from a patient, hospital, or other provider to update medication information in RevolutionEHR New: 50% Transitions; Old: Menu

32 Record Summary for Referrals A provider who transitions a patient to another setting of care or provider of care or refers a patient to another provider of care should provide a Summary of Care record for each transition of care or referral (Exclusion: fewer than 100 referrals) 1. Provide Summary for 50% of transitions out/referrals 2. Provide Summary for 10% of transitions, either electronically via Certified EHR; or via an ehealth Exchange 3. At least one exchange is done with another EHR (per #2) or to CMS-designated test EHR Old: Menu

33 Direct Secure, scalable, simple, standards-based Push-based transport: sender pushes information Direct addresses are used to route information, and are available for provider and practice HISP = Health Information Service Provider >> SES

34 Data to Immunization Registry Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission, except where prohibited and in accordance with applicable law and practice Must show successful ongoing submission of electronic immunization data for the entire reporting period Exclusions include this reference: EP does not administer immunizations to any of the populations for which data is collected Old: Same, Menu

35 Secure Messaging Use secure electronic messaging to communicate with patients on relevant health information Certified EHRs contain the capability to send secure messages between provider/practice and patients Have Unique Patients send the provider a secure message using electronic messaging function Exclusion for practices in areas with low bandwidth availability 5% Unique Patients Send Msg

36 Menu Objective Overview 1. Submit syndromic surveillance data to public health 2. Record electronic notes in patient records 3. Image results accessible through EHR 4. Record patient family health history 5. Report cancer cases to state registry 6. Report specific cases to registries

37 Data to Public Health Agency Capability to submit electronic syndromic surveillance data to public health agencies and actual submission, except where prohibited and in accordance with applicable law and practice Must show successful ongoing submission of electronic syndromic surveillance data for the entire reporting period Exclusions include this reference: EP is not in a category of providers that collect ambulatory syndromic surveillance information Old:, Same, Menu

38 Record Electronic Notes Enter at least one electronic progress note, created/ edited/signed by the provider Progress notes must be text-searchable Drawings and other content can be included with searchable text 30% Unique Patients

39 Imaging Results Accessible Tests that result in an image must result in the image any explanation or other accompanying information being accessible within the EHR or through the EHR (via a direct link that takes the viewer to the image) More than 10% of all tests ordered by the provider whose result is an image are incorporated into or accessible through the EHR Exclusion if you order less than 100 tests that yield an image, or if you don t have access to electronic imaging results 10% Images Ordered

40 Patient Family Health History Record the patient family health history as structured data More than 20% Unique Patients have a structured entry for one or more first-degree relatives or an indication that family history has been reviewed 20% Unique Patients

41 Data to Cancer Registry Capability to identify report cancer cases to a State cancer registry, except where prohibited and in accordance with applicable law and practice Must show successful ongoing submission of cancer case information to a cancer registry for the entire reporting period Exclusions include this reference: EP that does not diagnose or directly treat cancer

42 Data to Specialized Registry Capability to identify report specific cases to a specialized registry (other than a cancer registry), which is usually associated with a specific disese and is sponsored or maintained by a national speciality society and/or public health agency; except where prohibited and in accordance with applicable law and practice Must show successful ongoing submission of specific case information to a specialized registry for the entire reporting period Exclusions include this reference: EP does not diagnose or directly treat diseases associated with a specialized registry

43 Clinical Quality Measures All CQMs submitted automatically/electronically Option 1: Report through EHR, 9 CQMs in 3 different domains; for all patients without regard to payer; submit three months of data Option 2: Use PQRS EHR Reporting; data for full year using QRDA format Submit data directly from EHR; Medicaid submission directly to state Medicaid agency

44 Core CQMs Core set of CQMs that focus on high-priority health conditions and best-practices for care delivery 9 CQMs for adult populations 9 CQMs for pediatric populations Must choose 9 that cover at least 3 Domains Focus on conditions that contribute to the morbidity and mortality of most Medicare and Medicaid beneficiaries and also on areas that represent national public health priorities or disproportionately drive health care costs

45 Clinical Quality Measures CQM Domains 1. Patient and Family Engagement 2. Patient Safety 3. Care Coordination 4. Population/Public Health 5. Efficient Use of Healthcare Resources 6. Clinical Process/Effectiveness Submit data directly from EHR

46 Patient and Family Engagement Functional status assessment for complex chronic conditions

47 Patient Safety Cataracts: Complications within 30 days following cataract surgery requiring additional surgical procedures (NQF 0564) Use of high-risk medications in the elderly (NQF 0022) Falls: Screening for future fall risk (NQF 0101)

48 Care Coordination Closing the referral loop: receipt of specialist report

49 Population/Public Health Preventive Care and Screening: Tobacco Use: Screening and cessation intervention (0028) BMI: Screening and follow-up (0421)

50 Effective Use of Healthcare Resources None apply (pharyngitis, low back pain, upper respiratory infection, prostate cancer)

51 Clinical Process/Effectiveness Diabetes: Eye exam (0055) POAG: Optic nerve evaluation (0086) Diabetic retinopathy: Document +/- DME and severity of retinopathy (0088) Diabetic retinopathy: Communication with physician managing ongoing diabetes care (0089) Cataracts: 20/40 or better VA within 90 days following surgery (0565)

52 CQM Electronic Reporting Option to electronically report CQM for the full calendar year of 2014 to receive credit for both PQRS and the EHR Incentive Program for MU CQM e-file sent between 1/1/15 and 2/28/15 9 CQMs for pediatric populations Payment for MU would not be issued until the spring of 2015, regardless if Medicare Allowable Charges have been met during 2014 and MU attestation has been successfully accomplished

53 Q&A Scott Jens, OD, FAAO

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