Understanding Meaningful Use: Helping Colorado Providers Navigate Federal EHR Incentive Programs

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1 Section Break 2 Understanding Meaningful Use: Helping Colorado Providers Navigate Federal EHR Incentive Programs Agenda What Is Meaningful Use - Simplified When Do I Start Who Can Participate How Much Incentives Can You Receive & How Do you Qualify for Incentives What are the Meaningful Use Objectives and Menu Set items Certified EHR Products Assistance available to Colorado providers 1

2 Programs Supporting Meaningful Use in Colorado American Recovery & Reinvestment Act passed in 2009 Stimulus Bill HIT Provisions designed to address adoption of health information technology & exchange of information CORHIO received HIE and REC grants Statewide REC & HIE activities REC Program is a collaborative initiative of 6 healthcare organizations across CO Beacon Community Grant in Western Colorado led by Rocky Mountain Health Plans, Mesa County Independent Physicians Practice Association, Quality Health Network and St. Mary s Regional Medical Center Workforce development programs through Community Colleges and higher level institutions Beacon REC Workforce Development HIE FACT: Meaningful Use and HITECH are not part of the Healthcare Reform Bill 3 CO-REC Can Help Collective goal of all 62 RECs across the country To provide the training and support services necessary for primary care providers in small practices, rural hospitals and Critical Access Hospitals to achieve Stage 1 Meaningful Use MU Adopt EHR Select & Implement EHR 1,730 Providers Participating in CO-REC Sign-Up Today! Determine HIT & EHR Readiness 4 2

3 Meaningful Use Simplified Three 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 What is Meaningful Use? Incentive funding for health care providers who demonstrate meaningful use of certified EHR technology by working towards the following goals 5 Pillars of Meaningful Use Improves Quality, Safety, Efficiency and Reduces Health Disparities Improves Care Coordination Engages Patients and Families in their Care Improves Population & Public Health Ensures adequate privacy and security protections for PHI 6 3

4 Meaningful Use: Laying the Foundation for Future Advances Meaningful Use Stage 3: Fully integrated systems, reductions in errors & duplications, improved cost effectiveness, better coordinated care Stage 3: Home is built Meaningful Use Stage 2: Exchanging clinical data with other sources, tracking clinical outcomes, targeted patient-care initiatives, patient access to self-management tools Stage 2: Walls & Windows Meaningful Use Stage 1: Using electronic systems, structured data, point-of-care protocols, improved care coordination, security protocols & HIPAA standards in place Stage 1 = Build Foundation 7 When Do I Start? The sooner you become a meaningful user the longer you can take to achieve Stage 3 Incentive Payment Year First Program Year Stage 1 Stage 1 Stage 2 Stage 2 Stage Stage 1 Stage 1 Stage 2 Stage Stage 1 Stage 2 Stage Stage 1 Stage Stage 3 8 4

5 Two EHR Incentive Programs Medicare Incentive Program Meaningful Use Medicaid Incentive Program 9 Who is Eligible for Medicare EHR Incentives? Eligible Providers - Medicare Eligible Professionals (EPs)* Doctor of Medicine or Osteopathy Doctor of Dental Surgery or Dental Medicine Doctor of Podiatric Medicine Doctor of Optometry Chiropractor To qualify for an incentive payment under the Medicare EHR Incentive Program, an eligible professional must : Bill Medicare FFS straight Medicare Medicare Provider in good-standing Hospital-based eligible professionals are not eligible for incentive payments.an eligible professional is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (Place Of Service code 21) or emergency room (Place Of Service code 23) setting. 10 5

6 How Much Incentive Is Available? Medicare Incentive is 75% of total allowed charges, based on a calendar year Calendar CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 Year and later 2011 $18, $12,000 $18, $8,000 $12,000 $15, $4,000 $8,000 $12,000 $12, $2,000 $4,000 $8,000 $8,000-1% 2016 $2,000 $4,000 $4,000-2% % % % TOTAL $44,000 $44,000 $39,000 $24, How Much Can You Receive? Run a billing report isolating Medicare FFS Allowable Charges by Physician What is an amount of allowable charges by an individual physician is it at least $24,000? Does your report show the timeframe of charges by month or quarter? Examples 1) Dr. Z has $24,000 a year in allowable charges to Medicare FFS as of May Incentive = $24,000 x 75% = $18,000 2) Dr. W has $12,000 a year in allowable charges for Medicare FFS but it takes the entire year to accrue those charges Incentive = $12,000 x 75% = $9,

7 What Must I Do in Year 1 for the Medicare Program? Register for the program Meet 100% of Objectives, selected Menu Set items and generate required quality reports for a consecutive 90- day period of time Report through Attestation Reporting may be yes/no or numerator/denominator To meet certain objectives/measures, 80% of patients seen in the reporting period must have records in the certified EHR system 13 Who is Eligible for Medicaid EHR Incentives? Eligible Providers - Medicaid Eligible Professionals (EPs)* Physicians Nurse Practitioners (NPs) Certified Nurse-Midwives (CNMs) Dentists Physician Assistants (PAs) who lead a FQHC or rural health clinic To qualify for an incentive payment under the Medicaid EHR Incentive Program, an eligible professional must meet one of the following criteria: Have a minimum 30% Medicaid patient volume* Have a minimum 20% Medicaid patient volume, and is a pediatrician* Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals * Children's Health Insurance Program (CHIP) patients do not count toward the Medicaid patient volume criteria. 14 7

8 Incentive Payments for Medicaid EPs Medicaid EPs can start receiving payments any time from CY 2011 through 2016, and there is no penalty for starting later Payments based on participation year, so EPs can have gaps in meeting Meaningful Use requirements and still receive max. $ No Medicaid payment reductions for not meeting Meaningful Use Calendar Year CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY $21, $8,500 $21, $8,500 $8,500 $21, $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $8,500 $21, $8,500 $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 $63,750 $63,750 $63, What Must I Do in Year 1 for the Medicaid Program? Register for the program Details to follow from Colorado Medicaid in Summer 2011 regarding Medicaid registration after CMS ADOPT: Acquire and Install certified EHR technology IMPLEMENT: Complete the implementation of certified EHR technology Staff training, data entry of patient demographic information UPGRADE: Upgrade existing systems to meet certification criteria All technology must be certified EHR technology No EHR reporting period 16 8

9 Meaningful Use in Practice: 15 Core Objectives Improve Quality, Safety, Efficiency & Reduce Health Disparities CPOE Implement Medication Checks Problem & Diagnosis List erx Medication Lists Medication Allergy Lists Patient Demographics Vital Signs Smoking Status Quality Measure Submission (6) Clinical Decision Support Electronic Copies of Medical Records to Patients Clinical Summaries to Patients Improve Care Coordination Electronic Exchange of Clinical Information (perform 1 test) Ensure Privacy & Security of PHI Security of Electronic Health Information (System Security Risk Analysis) 17 Meaningful Use in Practice: Menu Set - Select 5 Improving Quality, Safety, Efficiency Improve Care Coordination Engage Patients & Families in their Care Improve Population and Public Health Implement Drug Checks Incorporate Lab Test Results into EHR Lists of Patients by Specific Conditions Reminders to Patients for Preventive/Followup Care Medication Reconciliation after Transition of Care Summary of Care provided upon Transition of Care Timely Electronic Access to Health Information Use EHR to Identify Patientspecific Education Resources Submit Electronic Data to Immunization Registries Submit Electronic Syndromic Surveillance Data to Public Health Agencies 18 9

10 Meaningful Use: Clinical Quality Measures Eligible Providers Core Set CQMs NQF Measure Number & PQRI Implementation Number NQF 0013 NQF 0028 NQF 0421 PQRI 128 Clinical Quality Measure Title Hypertension: Blood Pressure Measurement Preventive Care and Screening Measure Pairs: a) Tobacco Use Assessment, b) Tobacco Cessation Intervention Adult Weight Screening and Follow-up CQM Requirements = Core + 3 Additional Measures for a Total of 6 Measures 19 Meaningful Use: Clinical Quality Measures Eligible Providers Alternate Set CQMs NQF Measure Number & PQRI Implementation Number NQF 0024 NQF 0041 PQRI 110 NQF 0038 Clinical Quality Measure Title Weight Assessment and Counseling for Children and Adolescents Preventive Care and Screening; Influenza Immunization for Patients 50 Years Old or Older Childhood Immunization Status Additional Set CQM Must pick 3 of 38 measures

11 What if none of the CQMs Apply to Me? 21 Two EHR Incentive Programs Medicare Medicaid Incentive based on Allowable Charges Must Meet Objectives & Menu Set Items all Program Years Open to Physicians Only Reduction in Fee Schedule for Not Participating Max of 5 Years of Incentive Incentives based on Costs of EHR System Program Year 1: Don t have to attest to Objectives (AIU) Physicians, NPs, CNMW & limited PAs Don t Penalty for Non- Participation Max of 6 Years of Incentives 11

12 EHR Programs & Other CMS Incentive Programs Other Medicare Incentive Program Medicare Physician Quality Reporting Initiative (PQRI) Medicare Electronic Health Record Demonstration (EHR Demo) Medicare Care Management Performance Demonstration (MCMP) Electronic Prescribing (erx) Incentive Program Eligible for HITECH EHR Incentive Program? Yes, if EP is eligible Yes, if EP is eligible MCMP ended 6/30/2010 Cannot participate in Medicare EHR Incentive Program and erx Incentive Program but you can participate in the Medicaid EHR Incentive Program and Medicare erx Incentive Program Resources from HHS/CMS Individual resource sheets on every Meaningful Use Measure 24 12

13 Key Milestones of CY Securing EHR Incentive Payments Starting 1/3/2011 Register via the EHR Incentive Program Be enrolled in Medicare FFS, MA, or Medicaid Have a National Provider Identifier (NPI) and an active National Plan and Provider Enumeration System (NPPES) web user account. Use your NPPES user ID and password to log into CMS EHR Registration System All Medicare providers and eligible hospitals must be enrolled in PECOS to receive an EHR Incentive Payment not to register Link to PECOS Attest you re using certified EHR technology to demonstrate Meaningful Use CMS and States will audit providers for compliance Medicaid providers may adopt, implement, or upgrade in their first year 26 13

14 Certified EHR Products Understanding the ONC Criteria & Products List Certified EHR Products List The Certified HIT Product List (CHPL) provides the authoritative, comprehensive listing of Complete EHRs and EHR Modules that have been tested and certified under the Temporary Certification Program maintained by the Office of the National Coordinator for Health IT (ONC). Each Complete EHR and EHR Module listed has been certified by an ONC-Authorized Testing and Certification Body (ONC-ATCB) and reported to ONC

15 Navigating the ONC List See whole list Or by your vendor Shows the Product Version # that is certified 30 15

16 31 Viewing the certified Clinical Quality Measures is key for Specialists that need additional reports outside of the Core and Alternate Core Measures Doesn t imply the reports aren t able to be run just can t be calculated according to certification standards 16

17 Attesting to Use of Certified EHR Technology Recap Meaningful Use is a Journey not a destination Starting your journey early allows for increased time to get to the final stages EHR Incentive payments are contingent upon meaningfully using a Certified EHR Product You don t have to use a product from the CORHIO/CO-REC list but we encourage every EHR vendor to work with us Meaningful Use Objectives & Menu Set items need to be reported for 90-day period for Medicare Incentives 80% of all patient s in the reporting period must have records in the EHR You re not in this alone 34 17

18 Questions? Robyn Leone Director, CO-REC Disclaimer: Robyn Leone has no relevant financial relationships. All others who were in control of the planning and content of this activity have no relevant financial relationships 18