Welcome to the PAHCOM/CMS Webinar Series on EHR Incen5ves

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1 Welcome to the PAHCOM/CMS Webinar Series on EHR Incen5ves Topic: CMS and PAHCOM Presents: EHR Incen5ve Programs Speaker: Robert Anthony - Health Specialist in the Office of E- Health Standards and Services at the Centers for Medicare & Medicaid Services. He contributes to policy development and implementa5on of the Medicare and Medicaid Electronic Health Record Incen5ve Programs. Start Time: 130PM Eastern, 1230PM Central, 1130AM Mountain or 1030AM Pacific CMS is a neutral government en7ty. Our training partnership is not to be construed as an endorsement.

2 Video Recordings of the PAHCOM/CMS Webinar Series on EHR Incen5ves The video recordings are be0er than the live performance in several ways. Many medical office managers tell us they have gathered their staff to view the webinar video and the recorded version allows for: breaks going over areas of interest for your going back to review a more than once skipping you're not interested in The recordings are videos of the presenter's slides and his audio of each slide synchronized as it was in the Each slide is flipped with the sound and can be paused at (rewind, fast forward, etc.) The recordings can be found at: PAHCOM.com > > CMS Webinar Series Also be sure to visit pahcom.webex.com for upcoming webinars in this series. CMS is a neutral government en7ty. Our training partnership is not to be construed as an endorsement.

3 Don t miss CMS presen0ng at the 24 th Annual PAHCOM Conference! October 16-18, 2012 Clearwater Beach, FL Get more at: PAHCOM.com > Conference Latest updates and news about CMS EHR incen7ve programs Speaker: Ethan W. Moore, MA, MAgS This session addresses changes and progress in the EHR Incen7ve Programs as eligible professionals, hospitals and cri7cal access hospitals adopt, implement, upgrade or demonstrate meaningful use of cer7fied EHR technology.

4 Today s presentation is delivered in partnership with PAHCOM and is focused on what Medical Office Managers need to know. Medicare and Medicaid EHR Incentive Programs: Stage 1 Meaningful Use Robert Anthony Office of E- Health Standards and Services Centers for Medicare & Medicaid Services 4

5 What are the Three Main Components of Meaningful Use? The Recovery Act specifies the following 3 components of Meaningful Use: 1. Use of certified EHR in a meaningful manner (e.g., e-prescribing) 2. Use of certified EHR technology for electronic exchange of health information to improve quality of health care 3. Use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by the Secretary 5

6 What is Meaningful Use? Meaningful Use is using certified EHR technology to Improve quality, safety, efficiency, and reduce health disparities Engage patients and families in their health care Improve care coordination Improve population and public health All the while maintaining privacy and security Meaningful Use mandated in law to receive incentives 6

7 What are the Requirements of Stage 1 Meaningful Use? = MU Eligible Professionals must complete: 15 core objectives 5 objectives out of 10 from menu set 6 total Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from menu set) 7

8 What are the Requirements of Stage 1 Meaningful Use? Basic Overview of Stage 1 Meaningful Use: Reporting period is 90 days for first year and 1 year subsequently Reporting through attestation Objectives and Clinical Quality Measures Reporting may be yes/no or numerator/denominator attestation To meet certain objectives/measures, 80% of patients must have records in the certified EHR technology 8

9 EP Core Objectives 15 Core Objectives 1. Computerized provider order entry (CPOE) 2. E-Prescribing (erx) 3. Report ambulatory clinical quality measures to CMS/States 4. Implement one clinical decision support rule 5. Provide patients with an electronic copy of their health information, upon request 6. Provide clinical summaries for patients for each office visit 7. Drug-drug and drug-allergy interaction checks 8. Record demographics 9. Maintain an up-to-date problem list of current and active diagnoses 10. Maintain active medication list 11. Maintain active medication allergy list 12. Record and chart changes in vital signs 13. Record smoking status for patients 13 years or older 14. Capability to exchange key clinical information among providers of care and patient-authorized entities electronically 15. Protect electronic health information 9

10 EP Menu Objectives 5 of 10 Menu Objectives 1. Drug-formulary checks 2. Incorporate clinical lab test results as structured data 3. Generate lists of patients by specific conditions 4. Send reminders to patients per patient preference for preventive/follow up care 5. Provide patients with timely electronic access to their health information 6. Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate 7. Medication reconciliation 8. Summary of care record for each transition of care/referrals 9. Capability to submit electronic data to immunization registries/systems* 10. Capability to provide electronic syndromic surveillance data to public health agencies* * At least 1 public health menu objective + 4 others 10

11 Meaningful Use Spec Sheets You can find detailed information on all the meaningful use objectives and measure in our Meaningful Use Specification Sheets. To find the specification sheets: Visit our website ( EHRIncentivePrograms) Click on the CMS EHR Meaningful Use Overview tab Scroll to the bottom Select either Eligible Professional or Eligible Hospital 11

12 Exclusions for Meaningful Use Objectives Some MU objectives not applicable to every provider s clinical practice, thus they would not have any eligible patients or actions for the measure denominator. Exclusions do not count against the 5 deferred measures In these cases, the eligible professional, eligible hospital or CAH would be excluded from having to meet that measure Eg: Dentists who do not perform immunizations; Chiropractors do not e-prescribe 12

13 Clinical Quality Measures 3 Core CQMs (or 3 Alternate Core CQMs) Choose 3 CQMs (from a list of 38) Things you should know: There are no thresholds to meet for CQMs Always report directly out of your certified EHR Reporting zeros is acceptable There may not be CQMs applicable to everyone (e.g., specialists) 13

14 Primary Barriers to AIU/MU Knowledge Gaps Technical Support 45 States now have programs, with the others expected to onboard in State Onboarding ROI and Produc5vity Specialty Info Vendor Support 14

15 Technical Support Knowledge gap about certified EHRs Product selection What do I look for in an EHR? Which EHR should I buy? How do I use my EHR effectively? 15

16 Vendor Support Vendor support for technical/mu issues Onboarding delay for software implementation 16

17 FAQs 17

18 FAQs Nearly 200 FAQs on our website ( Basic to advanced Learn about new FAQs from our listserv (sign up on our website) 18

19 The CMS Top 10 List 10. How should an EP who orders meds infrequently calculate CPOE? (formerly FAQ #10639) Prescribe more than 100 meds during the reporting period Maintain med list that includes meds they didn t order Orders meds for less than 30 percent of patients with a med in their med list If all the above apply, limit the denominator to patients for whom EP has previously ordered meds. 19

20 The CMS Top 10 List 9. How do you determine whether a patient has been seen by the EP? (formerly FAQ #10664) All cases where EP-patient physical encounter Telemedicine = seen by the EP When an EP does not have face-to-face or telemedicine encounters, EP should establish a consistent definition for the denominator 20

21 The CMS Top 10 List 8. If I see patients in a setting without EHR, can I enter their info into the EHR once I get back to my practice? (formerly FAQ #10475) Yes, but... CPOE CPOE must be entered before action can be taken on the order 21

22 The CMS Top 10 List 7. Can I exchange key clinical information electronically using a CD-ROM, USB, or a printout? (formerly FAQ #10638) NO 22

23 The CMS Top 10 List 6. OK... so what methods can I use to electronically exchange information? (formerly FAQ #10691) Must do 2 things: 1. Use certified EHR to generate the CCD/CCR 2. Electronically transmit the CCD/CCR 23

24 The CMS Top 10 List 5. If I share an EHR with another EP, can I exchange information with her? (formerly FAQ #10270) Different legal entities Distinct certified EHR 24

25 The CMS Top 10 List 4. Do you have to capture all of the clinical data for CQMs to meet the requirements of the program? (formerly FAQ #10839) Although we encourage providers to capture complete clinical data... CMS does not require providers to record all clinical data in their certified EHR technology at this time. CMS requires providers to report the CQM data exactly as it is generated as output from the certified EHR technology 25

26 The CMS Top 10 List 3. Who can enter information? Who can enter CPOE medication orders? (formerly FAQs #10071 and #10134) Any licensed healthcare professional if allowed per state, local, and professional guidelines Someone who can exercise clinical judgment in case of an alert CPOE must happen when order first becomes part of the record and before any action can be taken on the order. 26

27 The CMS Top 10 List 2. If I don t regularly perform an objective as part of my practice, can I be excluded from meeting it? (formerly FAQ #10151) Exclusions are available only when our regulations specifically provide for an exclusion. EPs may be excluded from meeting an objective if they meet the circumstances of the exclusion. If an EP is unable to meet a Meaningful Use objective for which no exclusion is available, then that EP would not be able to successfully demonstrate Meaningful Use 27

28 The CMS Top 10 List 1. Can drug-drug and drug-allergy interaction alerts also be used to meet the clinical decision support measure? NO 28

29 New FAQs! How can I change my attestation information after I have attested and/or received an incentive payment? (FAQ #10982) For Incorporate clinical lab-test results, how should a provider attest if the numerator displayed by their certified EHR technology is larger than the denominator? (FAQ #10981) For Provide summary care record for each transition of care or referral, should transitions of care between EPs within the same practice who share certified EHR technology be included in the numerator or denominator of the measure? (FAQ #10980) 29

30 New FAQs! For objectives that require a provider to test the transfer of data, such as "capability to exchange key clinical information" and testing submission of data to public health agencies, if multiple EPs are using the same certified EHR technology across several physical locations, can a single test serve to meet the measures of these objectives? For meaningful use objectives that require a provider to test the transfer of data can the provider conduct the test from a test environment or test domain? For the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, how should an eligible professional (EP), eligible hospital, or critical access hospital (CAH) that sees patients in multiple practice locations equipped with certified EHR technology calculate numerators and denominators for the meaningful use objectives and measures? 30

31 Newest FAQs! Does a capital lease for Certified EHR Technology count as a reasonable cost for Critical Access Hospitals (CAHs)? NO YES Can an EP use inpatient Certified EHR technology to achieve MU? YES... BUT Inpatient CEHRT is not complete for all EP MU Objectives and no CQMs 31

32 Audits Basic Principles: Catch the obvious Focus on substantial non-compliance Employ smart risk-profiling Find the balance between cost of oversight and total incentive payment Find the balance between hi-tech and hands-on approaches (cost and LOE) Maximize existing/3 rd party data sources where appropriate 32

33 Audits What You Can Do: Check and double-check Retain all relevant supporting documentation for 6 years post-attestation Electronic and paper documentation CQM documentation 33

34 Helpful Resources CMS EHR Programs website to EHR Programs Frequently Asked (FAQs) Meaningful Use Calculator & User Guides Listserv HHS Office of Coordinator Health IT - EHR technology list hlp://healthit.hhs.gov/chpl PAHCOM.com > > CMS Webinar Series training.html 34

35 User Guides and Other Resources New Screens in the CMS Registration & Attestation Module User Guides have been updated with the new screens 35

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