Navigating Meaningful Use Stage 2

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1 Navigating Meaningful Use Stage 2 Follow Justin Ask Questions & Follow Today s Conversation #askhit Justin T. Barnes VP, Greenway Medical Technologies Chairman Emeritus, EHR Association

2 Safe Harbor Safe harbor statement under the Private Securities Litigation Reform Act of 1995: In addition to historical information, this presentation includes certain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of Such statements include both implied and express statements regarding the company s financial condition, growth strategy, business development efforts, service offerings, and service delivery models. Such forward-looking statements are not guarantees of future performance and are subject to risks, uncertainties and other factors that may cause the actual results, performance or achievements of the company to differ materially from the historical results or from any results expressed or implied by such forward-looking statements. Risks that could affect the company s future performance include, but are not limited to, our ability to adapt to evolving technology and industry standards; our ability to implement our growth strategy; our ability to retain management and other qualified personnel; failure to prevent disruptions in service or damage to our third-party providers data centers; failure to avoid liability for the use of content we provide; regulation of the healthcare information technology industry; our ability to ensure our solutions meet industry and government standards; failure to maintain adequate security measures for our customers confidential information and personal identifiable information and their patients protected health information; our ability to obtain new provider clients; failure of the HITECH Act and other incentive programs to be fully implemented or funded by the government; our ability to implement our strategic relationships as currently intended; failure to establish, protect or enforce our intellectual property; restrictions in our credit facility and future indebtedness. The company operates in a continually changing business environment and new factors emerge from time to time. Greenway cannot predict such factors or assess the impact, if any, of such factors on our financial position or results of operations. The company undertakes no obligation or duty to update or modify these forward-looking statements.

3 The Current State of Healthcare Justin T. Barnes, VP of Industry & Government Affairs 3 Greenway Medical Technologies, Inc. All rights reserved. Confidential and proprietary. Not for distribution except to authorized persons.

4 State of Healthcare Healthcare Reform/Transformation MedPAC recommendations to realign fee schedules to support primary care, ACOs, bundled payments, capitated models, and shared savings programs Bipartisan support now in Congress for permanent SGR fix Maintains 3-phase approach: Repeal annual fix; period of stability; FFS overhaul EHR Meaningful Use Over $27B available with no cap. Protected in Medicare Trust Fund Stage 2 criteria well within expectations: 16 EH/17 EP Core Measures and 3 Menu Measures As of July, over 409,000 care providers registered for meaningful use Over $15.8 billion in incentives paid to eligible providers & hospitals Meaningful Use Stage 2 Overview Chart ~

5 The Evolution Meaningful Use EHR Adoption 30%+ have comprehensive EHRs Training & usability are key Established data liquidity 300,000+ providers est. to achieve incentive If you don t qualify, use criteria as a playbook MU Stage 2 = PCMH Foundation Value-based Medicine Quality Reporting Outcomes-based Payments ACO/APM These are essential building blocks for a sustainable healthcare system

6 The Goals of Meaningful Use To improve the quality, safety, and efficiency of care while reducing disparities To engage patients and families in their care To promote public and population health To improve care coordination To promote the privacy and security of EHRs

7 Key EHR Incentive Milestones Sec. 4101: Medicare Incentives for Eligible Professionals EHR Meaningful Use ~ Began 01/03/2011 Medicare MU Attestation ~ Began 04/18/2011 Pay Out ~ Began mid-may 2011 Sec. 4201: Medicaid Incentives for Eligible Professionals 1 st Pay Out Year ~ All state-based but 40+ states currently paying 1 st Medicaid Pay Year is for EHR Adoption, Implementation or Upgrade (AIU): No MU reporting required. (Much different than Medicare) 2 nd Pay Out Year ~ nd 6 th Medicaid Payment Years for EHR Meaningful Use & Reporting Section 4102/ 4201 Incentives for Hospitals Meaningful Use year ~ Began 10/01/2010 Pay Out ~ Began mid-may 2011

8 Medicare Meaningful Use Payment Schedule Due to sequestration, incentive funds issued after April 1, 2013 are subject to a 2% reduction, which ranges between $ For 2014 only, regardless of their stage, providers are only required to demonstrate meaningful use for a 3-month EHR reporting period.

9 Medicaid Eligible Professional Incentives for Meaningful Use of a Certified EHR $21,250 1 st Year $8.5k 2 nd Year $8.5k 3 rd Year $8.5k 4 th Year $8.5k 5 th Year $8.5k 6 th Year Incentives over 6 years No Medicaid Penalties 0% Penalty Reductions Up to $63,750 per provider Medicaid Incentives up to $63,750 for Providers/Eligible Professionals with a 30% Medicaid patient volume or Pediatricians with at least a 20% Medicaid patient volume. Pediatricians below 30% may be reimbursed at 2/3 s ($42,500) of the total allowable incentive.

10 Medicaid State Information Guidance/Legislation/EHRIncentivePrograms/MedicaidStateInfo.html

11 Stage 1 Extension and Attestation Stage 1 Medicare and Medicaid incentive funds extended through the end of 2013 for EPs EPs beginning program in 2011 can receive within Stage 1 measures: Medicare program incentives totaling $38,000 Medicaid program incentive totaling $38,250 Allow time for EHR providers to embed more sophisticated Stage 2 requirements and certification into their technology

12 Medicaid Eligibility Expansion Affects all stages of the Medicaid EHR Incentive Program New patient volume calculations ease eligibility requirements Billable services provided to a patient enrolled in Medicaid count toward meeting the minimum volume thresholds Previous non-reimbursable services to an enrolled patient may now be included in the Medicaid patient volume calculation Examples of newly eligible encounters might include: Behavioral health services and HIV/AIDS treatment Examples of newly eligible services: Oral health, immunization/vaccination and women s health Children Help Insurance Program (CHIP) encounters included in patient volume calculation Patients in Title 19 and Title 21 Medicaid expansion programs More information regarding CHIP and Medicaid can be found here

13 Meaningful Use Stage 2 Kevin Kornegay, Business Analyst

14 Meaningful Use Stage 2 Final Rule Overview Eligible professional Stage 2 begins Wednesday, January 1 st, 2014 Eligible hospitals are set to begin Stage 2 on Thursday, Oct. 31, 2013 Medicare EPs who are not meaningful users will be subject to payment adjustments beginning on January 1, 2015 EPs choose 9 from 64 potential Clinical Quality Measures (CQM) from at least 3 different domains, which now align closely with PQRS, Shared Savings, etc. Medicaid will allow any 90-day reporting period; Medicare allows a 3-month reporting period during a fixed quarter for all EPs and EHs in 2014

15 Meaningful Use Stage 2: Changes to Current Measures Changes to denominator of CPOE Now includes lab & radiology orders; measurement on orders instead of unique patients Changes to the age limitations for vital signs From 2 years old to 3 years old New exclusions for vital signs (height, weight and blood pressure) Elimination of the "exchange of key clinical information Replacing "provide patients with an electronic copy of their health information objective with a "view online, download and transmit

16 Meaningful Use Stage 2: Increased Thresholds The use of computerized provider order entry (CPOE) for medication orders increases from 30% to 60% Addition of labs and radiology to this measure with 30% threshold Generate and transmit permissible scripts electronically (erx) increases from 40% to 50% Threshold levels to increase from 50% to 80% for the following: Recording demographics Record and chart changes in vital signs (over age 3) Record smoking status for patients over 13 years of age

17 Meaningful Use Stage 2: Core Measures Secure electronic messaging is utilized by patients to communicate with providers on relevant health information > 5% of unique patients Provide clinical summaries for >50% of office visits within 1 business day Protect electronic health information by conducting or reviewing a security risk analysis and implement security updates as necessary Increase from one clinical decision support intervention to five, encompassing drug-drug and drug-allergy checks. CQM Stage 2 Link ~

18 Provide online access to their health information (via a web portal) to >50% of unique patients, while >5% unique patients actually view, download or transmit that data to a third party Successful ongoing submission of electronic immunization data to an immunization registry is now required for the entire EHR reporting period, previously only a test was required Provide a summary of care record for >50% of transitions of care and referrals, and electronically transmit 10% Meaningful Use Stage 2: Moving from Menu to Core Transmit at least one summary of care record to a different EHR system at a separate healthcare entity or to a CMS-designated test EHR Summary of care includes Stage 1 core items problem list, active medication list and active medication allergy list

19 Meaningful Use Stage 2: Moving from Menu to Core Incorporate >55% of clinical lab-test results into Certified EHR Generate at least one report listing patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach Use EHR to identify and provide reminders for preventive/followup care for >10% patients with two or more office visits in the last 2 years Provide patient-specific education resources identified by Certified EHR Technology to >10% of unique patients with an office visit When an EP receives a patient from another setting of care, they should perform medication reconciliation >50% of care transitions

20 Meaningful Use Stage 2: The EP Menu Set More than 10% of all scans and tests whose result is an image ordered by the EP during the reporting period are accessible through Certified EHR Technology Record patient family health history for more than 20% of all unique patients seen by the EP during the reporting period Ongoing submission of cancer cases to a state cancer registry Ongoing submission of specific cases to a specialized registry (other than cancer) Ongoing submission of electronic syndromic surveillance data to a public health agency Record >1 progress note in patient records for 30% unique patients

21 Meaningful Use Stage 3 Stage 3 set to begin in 2016 for EPs Many measures will require higher standards Many menu items will become core measures Threshold levels will increase as capabilities of HIT infrastructures grow HITPC has suggested new measures for Stage 3 EHR assists with follow-up on test results Further utilize CPOE for referrals/transition of care orders Provide patients the ability to request an amendment to their record Allow submission of patient-generated health information Implement an immunization recommendation system Query research enrollment systems to identify clinical trials

22 Example Dashboard

23 EHR MU Registration Page

24 Meaningful Use Best Practices Properly document patient information electronically; print/save copies of all important items Use a patient portal to provide quality care and timely access to patient medical records Develop an understanding of Clinical Quality Measures and their role in the EHR incentive program Be an activist throughout the entire process Use your resources Examine how adherence to MU measures could impact workflows and staff allocations

25 Meaningful Use Best Practices Greenway customers have attested for more than $87 million in meaningful use incentives with over $49 million received; these numbers continue to grow significantly Research before commencement, as it takes time and commitment to learn the process Participate in your EHR supplier s training; encourage entire staff to engage Appoint a meaningful use leader in your facility to act as a liaison and subject expert Implement and utilize a visual MU dashboard to help track core and menu set items

26 Meaningful Use Audits Overview Pre-payment and post-payment audits underway CMS conducting Medicare; individual states conducting Medicaid estimated 1 in 20 attesting to be selected Overall seeks EHR licensing and proof of MU certification Reporting methods utilized Documentation supporting affirmative ( yes ) measure compliance Tips: Assure certified EHR/version for complete duration of reporting period Risk analysis required per reporting year Assemble submitted CQMs with numerators and denominators Visit CMS.gov for additional guidance

27 Strategic Takeaways

28 Achieving Meaningful Use with a Certified EHR Assign a Meaningful Use Leader in your Facility Ensure review of MU Stage 1 Final Rule, CMS/ ONC Site & FAQs Review of MU Stage 2 Final Rules & new criteria Understand how it affects you today and tomorrow Seek a Trusted Advisor & Partner Ensure you partner with a company that is in expert in EHR meaningful use, certification, standards & accountable care Track record of being proactive in the evolution of healthcare EHR Certification, Standards Development & Interoperability Reassess MU Stage 2 Partners Functionality and criteria have increased substantially and it is important to ensure your current partners are certified for MU Stage 2 and share their product and strategic roadmap

29 Seize the Opportunity Today Begin Fostering the EHR Discussion with your Practice, Hospital or Facility Use the Meaningful Use Criteria as a Playbook to Navigate the Future of Healthcare Understand your Goals for EHR Adoption Financial, quality, patient satisfaction, clinical research, community leadership, accountable care, value-based medicine, all of the above, etc Begin EHR Product Review Process Today EHR Meaningful Use incentive program well underway It takes time to properly research, purchase, implement and meaningfully use an EHR so experts suggest you get your place in line now

30 Additional Resources Greenway s Government & Industry Affairs Updates Gov t Affairs ( EHR MU Navigation ( Interoperability ( Important Government & HHS Sites ONC Funding Opportunities ( HHS Breach Notification Rule ( HHS Privacy Rule ( CMS Educational Webpages CMS Stage 2 Final Rule ( CMS Meaningful Use Page ( CMS ACO/ Shared Savings Page (

31 Thank you

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