MEANINGFUL USE, EHRS AND OTHER QUALITY- DRIVEN MEASURES

Transcription

1 MEANINGFUL USE, EHRS AND OTHER QUALITY- DRIVEN MEASURES UMMC Family Medicine Update March 5-8, 2013 AS MANDATED BY ACCME SPEAKERS ARE ASKED TO DISCLOSE ANY REAL OR APPARENT CONFLICT RELATED TO THE CONTENT OF THEIR PRESENTATION TODAY S SPEAKER HAS NO DISCLOSURE TO MAKE EHR ADOPTION & IMPLEMENTATION 1

2 RISE OF EHR ADOPTION AMONG FAMILY PHYSICIANS : ANNALS OF FAMILY MEDICINE, VOL. 11, NO. 1, JANUARY/FEBRUARY 2013 RESULTS: The EHR adoption rate by family physicians reached 68% nationally in NAMCS family physician adoptions rates and ABFM adoption rates ( ) were similar. Family physicians are adopting EHRs at a higher rate than other office-based physicians as a group; however, significant state-level variation exists, indicating gaps in EHR adoption. -- State ABFM NAMCS-FP NAMCS-Other Mississippi 53.3 % 66.8 % 51.3 % Louisiana 51.7 % 47 % 38 % Alabama 51.9 % 52 % 51.5 % Arkansas 74.1 % 60.3 % 51.6 % Minnesota 81.4 % 84.1 % 76.9 % RISE OF EHR ADOPTION AMONG FAMILY PHYSICIANS : ANNALS OF FAMILY MEDICINE, VOL. 11, NO. 1, JANUARY/FEBRUARY 2013 EHR ADOPTION BY STATE 2

3 WHO IS ADOPTING EHRS? SOURCE: NCHS Data Brief #98, published July, 2012, Physician Adoptions of Electronic Health Records Systems (United States, 2011), VIA 7 WHAT KIND OF SYSTEMS? SOURCE: NCHS Data Brief #98, published July, 2012, Physician Adoptions of Electronic Health Records Systems (United States, 2011), VIA 8 ADVANTAGES OF EHR SOURCE: NCHS Data Brief #98, published July, 2012, Physician Adoptions of Electronic Health Records Systems (United States, 2011), VIA 9 3

4 HOW WELL IS IT WORKING OUT? SOURCE: NCHS Data Brief #98, published July, 2012, Physician Adoptions of Electronic Health Records Systems (United States, 2011), VIA 10 SATISFACTION AND PRODUCTIVITY Most EHR owners (nearly 72 percent) said they are satisfied with their overall system. All EHR owners were split, however, over the ability for their EHRs to increase physician productivity, with 26.5 percent reporting that productivity had increased, 30.6 percent indicating that it had decreased, and 42.9 percent reporting that there was no change in productivity after implementation. When MGMA examined the 20.7 percent of EHR users who said that they had optimized their EHR since implementation, 41.1 percent reported that productivity had increased, 16.5 percent indicated that productivity had decreased, and 42.4 percent reported that there was no change in productivity. More than one in three (38.4 percent) of all EHR users said total practice operating costs increased following EHR implementation, while 25.9 percent said costs decreased and 35.7 percent reported no change in cost. Once again, when MGMA examined only those who said that they have optimized their EHR since implementation, 26.8 percent said total practice operating costs had increased, while 39.7 percent said costs had decreased and 33.5 percent reported no change in costs. 53 % of EHR users replied that they had significantly underestimated training time. Source: published 4/6/ SO, WHAT DO WE MEAN BY OPTIMIZED? Don t just half way implement your EHR. Go all the way! Product Selection is important! Planning is more important! Evaluate your practice Take time to analyze workflow and process. What do you do and how do you do it now? What could be improved? What processes will change with EHR? Training is just as important! So, is project management! System Build Customization Implementation Timeline, including training. BUT, Culture and Buy-in are the most important factor in a successful implementation. Peter Drucker : Culture eats Strategy for Breakfast! Buy-in has to be at all levels. There has to be a champion. Viewing EHR as an agent of change & improvement versus a mandated, thirdparty intrusion or necessary evil. Continually tweaking and improving EHR to meet YOUR goals. Know your own data. 12 4

5 PERSPECTIVE & CHANGE BIG STICK: THEY ARE MAKING ME DO THIS JUST THE COST OF PRACTICING THESE DAYS IT MAY MAKE SOME TASKS EASIER. IT MAY HELP WITH MANAGING MY PANEL. THIS EHR IS WILL GIVE ME A PRACTICE ADVANTAGE 13 WHAT DOES A EHR SYSTEM COST? Cost Description Congressional Budget Office (CBO) Medical Group Management Association (MGMA)** Initial EHR Cost per physician * $25,000 $45,000 $20,000 - $30,000 Annual maintenance $3,000 $9,000 $480 - $6,000 *Includes hardware, software, training, project management, implementation expenses. **Performance and Practices of Successful Medical Groups 2012 Report Based on 2011 Data, published by MGMA. 14 FAD or FATE? Cartoon reprinted with permissions under license agreement. 15 5

6 MISSISSIPPI REC (fax) 16 MEANINGFUL USE WHEN IS DATA MEANINGFUL? TO WHOM IS IT MEANINGFUL? Knowledge Information Data 18 6

7 ELIGIBLE PROFESSIONALS Medicare Medicaid Doctor of Medicine Doctor of Osteopathy Dentist Podiatrist Optometrist Chiropractor **Hospital-based physicians are excluded in as both a Medicare or Medicaid EP. Refer to Stage 2 changes. Physician Nurse Practitioner Certified Nurse Midwife Dentist Physician Assistant who leads a RHC or FQHC And: 30% Medicaid patient volume, OR 20% Medicaid volume, if pediatric, OR 30% patient volume in FQHC/RHC that are needy. 19 MEDICARE INCENTIVE PAYMENTS Calendar Year $18, $12,000 $18, ,000 $12,000 15, ,000 8,000 $12,000 $12, $2,000 $4,000 $8,000 $8, $4,000 $8,000 $8,000 Total $44,000 $44,000 $39,000 $24, MEDICAID INCENTIVE PAYMENTS Calendar Year $21, $8,500 $21, $8,500 $8,500 $21, $8,500 $8,000 $12,000 $12, $8,500 $8,500 $8,500 $8, $8,500 $8,500 $8,500 $8, $8,500 $8,500 $8, $8,500 $8, $8,500 Total $63,750 $63,750 $63,750 $63,

8 STEPS TO PAYMENT 1. Determine Eligibility 2. Select a Certified EHR Product (ONC/CCHIT) 3. Provider must first enrolled in PECOS 4. Register for EHR s (Not binding) 5. Demonstrate Meaningful Use 90 consecutive days during the first year (Medicare) Meet core objectives Meet menu objectives 6. Attest to Meaningful Use 7. made to EIN used in registration. 8. not made through FI or MAC. Made through a separate CMS contractor. age 22 STAGE 2 FINAL RULE Published August 23, Clarifies and Revises certain provisions in Stage 1. Defines Stage 2 criteria. Describes the Stage 2 clinical quality measures and the reporting mechanisms. Discusses payment adjustments (reductions) and hardship case exceptions. Outlines changes in Medicaid program NEW TIMELINE Extended the timeline so that providers demonstrating meaningful use in 2011 now have until 2014 to attest to Stage 2. The reporting period is reduced to three months in 2014 only to allow providers that are beyond the first demonstration year time to adopt new Stage 2 certified products. Both EP and Hospital Stage 1 Year TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD

9 MOVING AHEAD Stage 1 Focus = Exchange of Clinical Information Just a Baseline for Electronic Capture and Sharing of Information. System development/criteria Getting everyone on board Stage 2 Focus = Patient Engagement + Transition of Care Secure Messaging between patient and provider (EP) Summary of Care Documents Referrals Outside of vendor or MCO affiliation Stage 3: More clinical decision support features; more complex functionality. 25 ELIGIBLE PROFESSIONALS Stage 1 15 Core Objectives 5 of 10 Menu Objectives Exclusions counted as menu item. Excluded hospital-based physicians/providers Stage 2 17 Core Objectives 3 of 6 Menu Objectives Exclusions do NOT count Allows for Batch Reporting/Uploading for multiple eligible professionals. Redefined hospitalbased physician eligibility. Approval through an application process. 26 QUALITY REPORTING Eligible Professionals 9 out of 64 total quality measures (CQMs) Quality Measures must be selected from 3 of 6 domains: Patient & Family Engagement Patient Safety Care Coordination Efficient Use of Healthcare Resources Clinical Processes/Effectiveness In 2014, all Medicare Providers must submit CQMs electronically. Beyond first demonstration year, must submit EHR data and CQMs in Medicaid EHR Participants submit per state requirements. 27 9

10 PQRS RESOURCES AMA For each measure, the AMA provides a: Description of the measure A clinical worksheet for each measure A specification sheet for each measure with the appropriate ICD- 9,CPT, and Level II HCPCS Codes. CMS Instruments/PQRS/Electronic-Health-Record-Reporting.html INCENTIVES AND PENALTIES E-PRESCRIBING January 1, 2013 through June 30, 2013 is the last reporting period for E-RX to avoid the 2014 Payment Adjustment. Individual eligible professionals and group practices participating in the erx Group Practice Reporting Option (GPRO) who are not successful electronic prescribers will be subject to a 1.5% payment adjustment on their Medicare Part B services provided January 1, 2013 through December 31, Cannot receive EHR s from Medicare and E-RX s at the same time Payment Adjustment = -2.0% of MFS Instruments/ERx/Downloads/2013_eRx Program_Updates_ pdf 10

11 PQRS INCENTIVES & PAYMENT ADJUSTMENTS Eligible providers who fail to report PQRS Measures in 2013 will be subject to a payment adjustment of -1.5% of PFS in 2015 and -2.0% in the following years. Can receive PQRS s and EHR s at the same time. Instruments/PQRS/Downloads/2013MLNSE13 AvoidingPQRSPaymentA djustment_ pdf EHR PAYMENT ADJUSTMENTS Payment Adjustments will be effective in To Avoid Reductions in, hospitals and eligible professionals have to have attested to meaningful use in Fiscal year for hospitals; Calendar year for eligible professionals. Providers who register and attest to meaningful use for the first time in 2014, have until October 1, 2014 for EPs if they want to avoid payment adjustments. Medicaid EHR Participation at the AIU stage does not preclude the Medicare provider from payment adjustments. Adopt, Implement and Upgrade Meaningful Use There are hardship exceptions: new providers, lack of infrastructure, disasters, certain specialties. This will be determined through an application process. 32 SPEAKER INFO Patty Harper, RHIA AHIMA-Approved ICD-10-CM/PCS Trainer HIT-IM HIT-CW pharper@inquiseek.com Frazier Road Ruston, LA