Meaningful Use in 2016

Transcription

1 Meaningful Use in 2016 Jeffrey D. Lehrman, DPM, FASPS, FACFAS, MAPWCA APMA Coding Committee Expert Panelist, Codingline.com Fellow, American Academy of Podiatric Practice Management Board of Directors, ASPS Board of Directors, APWCA James R Christina, DPM

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4 Forgiveness! December 18, 2015 The Patient Access and Medicare Protection Act Grants "flexibility in applying the hardship exception for meaningful use for the 2015 EHR reporting period for 2017 payment adjustments Deadline: 7/1/16

5 Forgiveness! Application to avoid 2017 payment adjustment: Guidance/Legislation/EHRIncentivePrograms/Do wnloads/hardshipapplication.pdf Instructions to fill out above application: Guidance/Legislation/EHRIncentivePrograms/Do wnloads/hardshipinstructions.pdf

6 2016 Reporting Period Entire Calendar Year Other than first time reporters 90 consecutive days If attesting for the first time in 2016

7 Everyone is in Modified Stage 2 in 2016

8 Meaningful Use Modified Stage 2 All EPS are required to attest to a single set of objectives and measures Ten objectives NO Menu Options

9 MODIFIED STAGE 2 MEASURES

10 1. Protect Electronic Health Information Conduct or review a security risk analysis in accordance with the requirements in 45 CFR (a)(1), including addressing the security (to include encryption) of data stored in Certified EHR Technology in accordancewith requirements in 45 CFR (a)(2)(iv) and 45 CFR (d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the eligible provider (EP) risk management process.

11 Need. Documentation of: What they did What risks were identified What steps were taken to address these risks.you took steps

12 2. Clinical Decision Support Implement five clinical decision support interventions related to four or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. Enable and implement the functionality for drugdrug and drug-allergy interaction checks for the entire EHR reporting period.

13 Potential CQMs for Podiatrists Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention (Population and Public Health) Preventive Care and Screening: Influenza Immunization (Population and Public Health) Pneumonia Vaccination Status for Older Adults (Clinical Processes/Effectiveness) Diabetes: Eye Exam (Clinical Processes/Effectiveness) Diabetes: Foot Exam (Clinical Processes/Effectiveness) Diabetes: Hemoglobin A1c Poor Control (Clinical Processes/Effectiveness) Hemoglobin A1c Test for Pediatric Patients (Clinical Processes/Effectiveness) Diabetes: Urine Protein Screening (Clinical Processes/Effectiveness) Diabetes: Low Density Lipoprotein (LDL) Management (Clinical Processes/Effectiveness) Falls: Screening for Future Fall Risk (Patient Safety) Documentation of Current Medications in the Medical Record (Patient Safety) Closing the referral loop: receipt of specialist report (Care Coordination) Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up (Population and Public Health) Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented (Population and Public Health)

14 3. Computerized Physician Order Entry (CPOE) Eligible provider must meet all three: More than 60 percent of medication orders created by EP are recorded using computerized provider order entry. More than 30 percent of laboratory orders created by EP are recorded using computerized provider order entry. More than 30 percent of radiology orders created by EP are recorded using computerized provider order entry. Exclusions: Any EP who writes fewer than 100 medication orders (Measure 1), fewer than 100 laboratory orders (Measure 2), or fewer than 100 radiology orders (Measure 3) during the EHR reporting period.

15 4. Electronic Prescribing More than 50 percent of all permissible prescriptions written by the EP are queried for a drug formulary and transmitted electronically using Certified EHR Technology. Sate 2 Exclusions: EPs who: (1) write fewer than 100 permissible prescriptions during the EHR reporting period; or (2) do not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of their practice location at the start of their EHR reporting period.

16 5. Summary of Care The EP that transitions or refers their patient to another setting of care or provider of care : (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving provider for more than 10 percent of transitions of care and referrals. Stage 2 Exclusion: Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period.

17 5. Summary of Care Summary of Care Document contains:. Patient name Provider s name and office contact info Current problem list Current medication allergy list and medication allergy history Vital signs (height, weight, blood pressure, BMI, growth charts) PMH Procedures Laboratory test results Current medication list and medication history Smoking status Demographic information (preferred language, sex, race, ethnicity, date of birth) Care plan field(s), including goals and instructions; and any known care team members including the primary care provider of record.

18 6. Patient Specific Education Patient-specific education resources identified by Certified EHR Technology are provided to patients for more than 10 percent of all unique patients. Stage 2 Exclusion: Any EP who has no office visits during the EHR reporting period.

19 7. Medication Reconciliation The EP performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP. Stage 2 Exclusion: Any EP who was not the recipient of any transitions of care during the EHR reporting period.

20 8. Patient Electronic Access Measure 1: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (within 4 business days after the information is available to the EP) online access to their health information* subject to the EP's discretion to withhold certain information. Measure 2: At least one patient seen by the EP during the EHR reporting period (or their authorized representatives) views, downloads, or transmits his or her health information to a third party. Stage 2 Exclusions: Any EP who (a) Neither orders nor creates any of the information listed for inclusion as part of the measures; or (b) Conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the Federal Communications Commission (FCC) on the first day of the EHR reporting period.

21 Health Information to be Provided Patient name Provider s name and office contact info Current problem list PMH Procedures Laboratory test results Current medication list and medication history Current medication allergy list and medication allergy history Vital signs (height, weight, blood pressure, BMI, growth charts) Smoking status Demographic information (preferred language, sex, race, ethnicity, date of birth) Care plan field(s), including goals and instructions; and any known care team members including the primary care provider of record.

22 9. Secure Electronic Messaging Measure: During the EHR reporting period, the capability for patients to send and receive a secure electronic message with the provider was fully enabled. EP Exclusions: Any EP who--(a) Has no office visits during the EHR reporting period; or (b) Conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period.

23 Objective #10 Public Health Reporting Measure 1 Immunization Registry Reporting: The EP is in active engagement with a public health agency to submit immunization data. Exclusions: Any EP meeting one or more of the following criteria may be excluded from the immunization registry reporting measure if the EP-- Does not administer any immunizations to any of the populations for which data is collected by its jurisdiction's immunization registry or immunization information system during the EHR reporting period; Operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or Operates in a jurisdiction where no immunization registry or immunization information system has declared readiness to receive immunization data from the EP at the start of the EHR reporting period

24 Objective #10 Public Health Reporting Measure 2 Syndromic Surveillance Reporting: The EP is in active engagement with a public health agency to submit syndromic surveillance data. Exclusion for EPs: Any EP meeting one or more of the following criteria may be excluded from the syndromic surveillance reporting measure if the EP: Is not in a category of providers from which ambulatory syndromic surveillance data is collected by their jurisdiction's syndromic surveillance system; Operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data from EPs in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or Operates in a jurisdiction where no public health agency has declared readiness to receive syndromic surveillance data from EPs at the start of the EHR reporting period.

25 Objective #10 Public Health Reporting Measure 3 Specialized Registry Reporting: The EP is in active engagement to submit data to a specialized registry. Exclusions: Any EP meeting at least one of the following criteria may be excluded from the specialized registry reporting measure if the EP-- Does not diagnose or treat any disease or condition associated with, or collect relevant data that is collected by, a specialized registry in their jurisdiction during the EHR reporting period; Operates in a jurisdiction for which no specialized registry is capable of accepting electronic registry transactions in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or Operates in a jurisdiction where no specialized registry for which the EP is eligible has declared readiness to receive electronic registry transactions at the beginning of the EHR reporting period.

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28 Submitting a PQRS measure group through a registry does not satisfy the requirements of Meaningful Use Objective 10, Measure 3

29 Clinical Quality Measures (CQMs) Need to report 9 CQMs covering at least 3 National Quality Strategy (NQS) domains No threshold requirements!

30 Thank You!!

31 RESOURCES

32 PQRS in 2016 Jeffrey D. Lehrman, DPM, FASPS, FACFAS, MAPWCA APMA Coding Committee Expert Panelist, Codingline.com Fellow, American Academy of Podiatric Practice Management Board of Directors, ASPS Board of Directors, APWCA James R Christina, DPM

33 Reporting Versus Performance

34 Reporting Performance Value Based Modifier 2% penalty in 2018 for not reporting What if I don t do it? Solo no reporting = 2% penalty Group of 2-9 and you do not report = 2% penalty Group of 2-9 and 50% do not report = 2% penalty If in a group of 10+ and you do not report = 4% penalty If in a group of 10+ and 50% do not report = 4% penalty

35 Reporting Performance Value Based Modifier Avoid the 2% penalty Solo = 2% penalty to 2% bonus depending on quality What if I do it? Group of 2-9 = 2% penalty to 2% bonus depending on quality Group of 10+ = 4% penalty to 4% bonus

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37 Individual Reporting Available reporting mechanisms for 2016 program year: Claims Measure Group (via registry) EHR QCDR

38 Individual Reporting: Claims No change from 2015 for claims reporting for individual EPs: 9 measures covering at least 3 National Quality Strategy (NQS) Domains AND report each measure for at least 50% of the Medicare Part B Fee-for-Service (FFS) patients for which the measure applies If an EP sees one Medicare patient in a face-to-face encounter,they must report on at least 1 cross-cutting measure (included in the 9 measures) Measures with 0% performance rate will not count

39 Suggested individual measures to report using the claims method: Measure #1 (NQF 0059):Diabetes:HemoglobinA1c Poor Control National Quality Strategy Domain:Effective Clinical Care Measure #47 (NQF 0326):Care Plan National Quality Strategy Domain:Communication and Care Coordination Measure #110 (NQF 0041):Preventive Care and Screening:Influenza Immunization National Quality Strategy Domain: Community/Population Health Measure #111 (NQF 0043):PneumoniaVaccination Status for OlderAdults National Quality Strategy Domain: Community/Population Health Measure #128 (NQF 0421):Preventive Care and Screening:Body Mass Index (BMI) Screening and Follow-Up Plan National Quality Strategy Domain:Community/Population Health Measure #130 (NQF 0419):Documentation of Current Medications in the Medical Record National Quality Strategy Domain:Patient Safety Measure #131 (NQF 0420):PainAssessment and Follow-Up National Quality Strategy Domain:Communication and Care Coordination Measure #154 (NQF:0101):Falls:RiskAssessment National Quality Strategy Domain:Patient Safety Measure #155 (NQF:0101):Falls:Plan of Care National Quality Strategy Domain:Communication and Care Coordination Measure #226 (NQF 0028):Preventive Care and Screening:Tobacco Use:Screening and Cessation Intervention National Quality Strategy Domain:Community / Population Health Measure #317:Preventive Care and Screening:Screening for High Blood Pressure and Follow-Up Documented National Quality Strategy Domain:Community / Population Health

40 Individual Reporting: Measure Group via Registry No change from 2015 for measure group via registry reporting for individual EPs: One measure group for 20 applicable patients Majority of patients (at least 11 out of 20) must be must be Medicare Part B FFS Measure groups containing a measure with a 0% performance rate will not be counted

41 DIABETES MEASURES GROUP OVERVIEW MEASURES IN DIABETES MEASURES GROUP #1 Diabetes:HemoglobinA1c Poor Control #110 Preventive Care and Screening:Influenza Immunization #117 Diabetes:Eye Exam #119 Diabetes:MedicalAttention for Nephropathy #126 Diabetes Mellitus:Diabetic Foot andankle Care, Peripheral Neuropathy Neurological Evaluation #226 Preventive Care and Screening:Tobacco Use: Screening and Cessation Intervention

42 Measure #110 Measure #110 only needs to be reported a minimum of once during the reporting period when the patient s visit included in the patient sample population is between January and March for the influenza season OR between October and December for the influenza season. When the patient s office visit is between April and September, Measure #110 is not applicable and will not affect the eligible provider s reporting or performance rate.

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47 DENOMINATOR: All patients aged 18 years and older with a diagnosis of diabetes mellitus AND Diagnosis for diabetes (ICD-10-CM): E10.10,E10.11,E10.21,E10.22,E10.29,E10.311,E10.319,E10.321,E10.329,E10.331,E10.339, E10.341,E10.349,E10.351,E10.359,E10.36,E10.39,E10.40,E10.41,E10.42,E10.43,E10.44,E10.49, E10.51,E10.52,E10.59,E10.610,E10.618,E10.620,E10.621,E10.622,E10.628,E10.630,E10.638, E10.641,E10.649,E10.65,E10.69,E10.8,E10.9,E11.00,E11.01,E11.21,E11.22,E11.29,E11.311, E11.319,E11.321,E11.329,E11.331,E11.339,E11.341,E11.349,E11.351,E11.359,E11.36,E11.39, E11.40,E11.41,E11.42,E11.43,E11.44,E11.49,E11.51,E11.52,E11.59,E11.610,E11.618,E11.620, E11.621,E11.622,E11.628,E11.630,E11.638,E11.641,E11.649,E11.65,E11.69,E11.8,E11.9, E13.00,E13.01,E13.10,E13.11,E13.21,E13.22,E13.29,E13.311,E13.319,E13.321,E13.329, E13.331,E13.339,E13.341,E13.349,E13.351,E13.359,E13.36,E13.39,E13.40,E13.41,E13.42, E13.43,E13.44,E13.49,E13.51,E13.52,E13.59,E13.610,E13.618,E13.620,E13.621,E13.622, E13.628,E13.630,E13.638,E13.641,E13.649,E13.65,E13.69,E13.8,E13.9 AND Patient encounter during the reporting period (CPT):11042,11043,11044,11055, 11056,11057,11719,11720,11721,11730,11740,97001,97002,97597,97598,97802,97803, 99201,99202,99203,99204,99205,99212,99213,99214,99215,99304,99305,99306,99307, 99308,99309,99310,99324,99325,99326,99327,99328,99334,99335,99336,99337,99341, 99342,99343,99344,99345,99347,99348,99349,99350

48 NUMERATOR: Patients who had a lower extremity neurological exam performed at least once within 12 months Definition: Lower Extremity Neurological Exam Consists of a documented evaluation of motor and sensory abilities and should include:10-g monofilament plus testing any one of the following:vibration using 128-Hz tuning fork,pinprick sensation,ankle reflexes,or vibration perception threshold), however the clinician should perform all necessary tests to make the proper evaluation. Performance Met:Lower extremity neurological exam performed and documented (G8404) Performance Not Met:Lower extremity neurological exam not performed (G8405)

49 Inverse Measures: This measures group contains one or more inverse measures. An inverse measure is a measure that represents a poor clinical quality action as meeting performance for the measure. For these measures,a lower performance rate indicates a higher quality of clinical care. Composite codes for measures groups that contain inverse measures are only utilized when the appropriate quality clinical care is given.

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51 DIABETES MEASURES GROUP OVERVIEW MEASURES IN DIABETES MEASURES GROUP #1 Diabetes:HemoglobinA1c Poor Control #110 Preventive Care and Screening:Influenza Immunization #117 Diabetes:Eye Exam #119 Diabetes:MedicalAttention for Nephropathy #126 Diabetes Mellitus:Diabetic Foot andankle Care, Peripheral Neuropathy Neurological Evaluation #226 Preventive Care and Screening:Tobacco Use: Screening and Cessation Intervention

52 Thank You!!!

53 Meaningful Use in 2016 Jeffrey D. Lehrman, DPM, FASPS, FACFAS, MAPWCA APMA Coding Committee Expert Panelist, Codingline.com Fellow, American Academy of Podiatric Practice Management Board of Directors, ASPS Board of Directors, APWCA James R Christina, DPM

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