Meaningful Use of EHR, the HITECH Act, EHR Incentives & the Final Rule White Paper

Transcription

1 An MTBC White Paper September, Clyde Road Somerset, NJ Meaningful Use of EHR, the HITECH Act, EHR Incentives & the Final Rule White Paper By Momina Ishtiaq Kaamil Ali, Marketing Communications Specialist 2010 MTBC Medical Transcription Billing Corp.

2 Contents Abstract 3 Introduction 3 An Overview of the HITECH Act 3 EHR Incentive Program 4 The Final Rule 5 Meaningful Use Objectives and Associated Measures 6 Meaningful Use - Core Set 6 Meaningful Use - Menu Set 8 About MTBC 10 References MTBC Medical Transcription Billing Corp.

3 Meaningful Use of EHR, the HITECH Act, EHR Incentives & the Final Rule Momina Ishtiaq Kaamil Ali, Marketing Communications Specialist Abstract This white paper explains the Health Information Technology for Economic and Clinical Health (HITECH) Act and provides an analysis of the requirements of meaningful use of an EHR. Introduction The U.S. government has focused its attention and major funding towards meaningful use of health information technology in accordance with the HITECH Act signed by President Obama, which sets aside a net $19.5 billion dollars to encourage the effective use and adoption of EMRs. Through the HITECH Act, the federal government has allocated and incredible amount of resources to support the adoption and use of EMRs. It will make incentive payments totaling up to $27 billion over a 10 year period, or $44,000 (through Medicare) and $63,750 (through Medicaid) per clinician. This funding will offer significant support for the creation of an EMR system nationwide. The term meaningful use is much debated, but it focuses on the enhanced adoption of electronic medical records and information exchange, incorporating a broad set of goals for improving patient-centric coordinated care. An Overview of the HITECH Act On February 17, 2009, President Obama signed into law the American Recovery & Reinvestment Act (ARRA). The health information technology part of the bill is the HITECH Act, which is designed to support healthcare practices and providers in adopting and meaningfully using electronic medical records (EMR) and establish health information exchange networks at a local level while ensuring that the systems deployed protect and safeguard the confidential personal health information at the core of the system. There are two components to the HITECH Act the first provides $2 billion immediately to the Department of Health & Human Services (HHS) and its sub-agency, the Office of the National Coordinator for Health IT (ONC), and directs the creation of standards and policy committees, as well as supportive programs. The second component allocates billions to be paid to healthcare providers who demonstrate meaningful use of electronic health records (EHR) MTBC Medical Transcription Billing Corp. 3

4 The goal of the HITECH Act is to put an end to the industry s resistance to accepting information technology. The funds, aimed at improving the quality, efficiency and safety of the nation s health, are available in the form of bonus payments to qualifying physicians and hospitals. Physicians have to confirm that they have put the system to meaningful use in their practices, a term that has been defined by the government. Those who fail to meet the terms within the estimated timeframe will face penalties in the form of reduced payments. EHR Incentive Program The HITECH Act, through Medicaid and Medicare, provides two incentive payments programs for eligible professionals (EP). Medicaid: Healthcare providers for whom more than 30% of their patients are paying with Medicaid (20% for pediatricians) are eligible for payments of up to $64,000 over six years. The incentives will be paid through a formula that will multiply 85% by amounts ranging from $25,000 in the first year to $10,000 in subsequent years. Additionally, those meeting the 30% threshold can begin earning the incentive payments even as they adopt, implement and upgrade their EMR software. They can begin proving meaningful use of the EMR in the second year of their program participation. Incentive Payments for Medicaid EPs Figure 1: Incentive Payments for Medicaid EPs; Source: "Medicare & Medicaid EHR Incentive Program Final Rule" 2010 MTBC Medical Transcription Billing Corp. 4

5 Medicare: Healthcare providers that accept Medicare can earn up to $44,000 over five years based on a calculation of submitted allowable charges multiplied by 75% up to the cap for the year. Moreover, physicians working in a health provider shortage area are eligible for an incremental increase of 10%. Healthcare providers delivering healthcare entirely in a hospital environment, such as anesthesiologists, pathologists and ED physicians, are ineligible. Incentive Payments for Medicare EPs Figure 2: Incentive Payments for Medicare EPs; Source: "Medicare & Medicaid EHR Incentive Program Final Rule" The Final Rule HITECH s goal is not limited to adoption only, but it also focuses on the meaningful use of EMR, or in other words EMR use by healthcare providers in order to achieve significant improvements in healthcare. Officials with CMS drafted the final rule and unveiled it on July 13, The ONC for Health IT also issued a final rule outlining the standards and criteria EMR vendors need to follow for their products to become certified for meaningful use. The term meaningful use is a key phrase in EMR-speak. It is the main objective of the final rule, which spells out exactly what capabilities EMR systems must have and what providers must do with them in order for those providers to be considered meaningful users MTBC Medical Transcription Billing Corp. 5

6 The meaningful use rule is a key part of a set of regulations created to help form a private and secure 21 st century electronic health information system. The rule maintains a balance between accepting the necessity of adopting EHRs to develop the U.S. health care system while recognizing the challenges that EHR adoption will create for healthcare providers. The final rule must be both ambitious and achievable. It divides the 25 meaningful use objectives into two categories: a core group of 15 mandatory objectives and a menu set of 10 objectives from which they can choose any five. For the first round of Medicare and Medicaid EMR bonuses in , each objective has a measure to determine if an EMR is used to perform its function for an appropriate number of opportunities. Core objectives comprise of fundamental functions that facilitate EMRs to maintain enhanced health care. Some of these include tasks necessary to create any medical record, including the entry of basic data: patients vital signs and demographics, active medications and allergies, up-to-date problem lists of current and active diagnoses, and smoking status. Additional core objectives consist of the usage of several software applications that begin to comprehend the true potential of EMRs to improve the safety, quality, and efficiency of care. These features enable clinicians to make enhanced clinical decisions and avoid preventable errors. Menu set contains capacities to execute drug-formulary checks, incorporate clinical laboratory results into EMRs, provide reminders to patients for needed care, assist in identifying and providing patient-specific health education resources, and support the patient s transitions between healthcare settings or personnel. Meaningful Use Objectives and Associated Measures The final rule released on July 13, 2010 by CMS outlines the final set of standards. For nearly all of the core and menu items, the regulation specifies the rates at which providers will have to use particular functions in order to be considered meaningful users. Meaningful Use Core Set 1. Record patient demographics (sex, race, ethnicity, date of birth, preferred language, and in the case of hospitals, date and preliminary cause of death in the event of mortality). Over 50% of patients demographic information must be recorded as structured data. 2. Record vital signs and chart changes (height, weight, blood pressure, body mass index, and growth charts for children). Over 50% of patients 2 years of age or older must have height, weight, and blood pressure recorded as structured data MTBC Medical Transcription Billing Corp. 6

7 3. Maintain up-to-date problem list of current and active diagnoses. Over 80% of patients must have at least one entry recorded as structured data. 4. Maintain an active medication list. Over 80% of patients must have at least one entry recorded as structured data. 5. Maintain an active medication allergy list. Over 80% of patients must have at least one entry recorded as structured data. 6. Record smoking status for patients 13 years of age or older. Over 50% of patients age 13 years or older must have smoking status recorded as structured data. 7. For professionals, provide patients with clinical summaries for each office visit; for hospitals, provide an electronic copy of hospital discharge instructions upon request. Clinical summaries must be provided to patients for over 50% of all visits within 3 business days. Over 50% of all patients who are discharged from an inpatient or ED of a hospital who request an electronic copy of their discharge instructions must be provided with that electronic copy. 8. Upon request, provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication list, medication allergies, and for hospitals, discharge summary and procedures). Over 50% of requesting patients must receive an electronic copy within 3 business days. 9. Generate and transmit permissible prescriptions electronically (does not apply to hospitals). Over 40% must be transmitted electronically using certified EHR technology. 10. Computerized Provider Order Entry (CPOE) for Medication Orders. Over 30% of patients with at least one medication in their medication list must have at least one medication ordered through CPOE MTBC Medical Transcription Billing Corp. 7

8 11. Implement drug-drug and drug-allergy interaction checks. Functionality must be enabled for these checks for the entire reporting period. 12. Implement capability to electronically exchange key clinical information among providers and patient-authorized entities. Must perform at least one test of the EHR s capacity to electronically exchange information. 13. Implement one clinical decision support rule and track compliance with that rule. One rule must be implemented. 14. Implement systems to protect privacy and security of patient data in the EHR. Must conduct or review a security risk analysis, implement security updates as necessary and correct identified security deficiencies. 15. Report clinical quality measures to CMS or states. For 2011, provide aggregate numerator and denominator through attestation. For 2012, electronically submit measures. Meaningful Use Menu Set 1. Implement drug formulary checks. EP has access to at least one internal or external drug formulary during the reporting period. 2. Incorporate clinical laboratory test results into EHRs as structured data. Over 40% of clinical laboratory test results must be in positive/negative or numerical format and be incorporated into EHRs as structured data. 3. Generate lists of patients by specific conditions for use for quality improvement, reduction of disparities, research or outreach. Must generate one listing of patients with a specific condition. 4. Use EHR technology to identify patient-specific education resources and provide those to the patient as appropriate. Over 10% of patients must be provided with patient specific education resources MTBC Medical Transcription Billing Corp. 8

9 5. Perform medication reconciliation between healthcare settings. Medication reconciliation must be performed for over 50% of transitions of healthcare. 6. Provide summary of healthcare record for patients referred or transitioned to another provider or setting. Summary of healthcare record must be provided for over 50% of patients transition or referrals. 7. Send reminders to patients (per patients preferences) for preventative and follow up healthcare. Over 20% of patients age 65 or older or age 5 or younger must sent appropriate reminders. 8. Submission of electronic immunization data to immunization registries or immunization information systems. Must perform at least one test of data submission and follow up submission (where registries can accept electronic submissions). 9. Submission of electronic syndromic surveillance data to public health agencies. Must perform at least one test of data submission and follow up submission (where public health agencies can accept electronic data). 10. For professionals provide patients with timely electronic access to their health information (including laboratory results, problem list, medication list, and medication allergies). Over 10% of patients must be provided with electronic access to information within 4 days of it being updated in the EHR MTBC Medical Transcription Billing Corp. 9

10 About MTBC Founded in 1999 and based in Somerset, N.J., MTBC performs revenue cycle and practice management services for healthcare providers across the country. Its end-toend medical billing and practice management solution presents a service suite that is unmatched in the marketplace for its scope and value. Features include MTBC EMR, V. 4.0 (a CCHIT Certified 2008 Ambulatory EHR), automated appointment reminders, real-time online insurance eligibility verification, a customized practice website with online patient scheduling, e-prescribing, lab connectivity and more. These features augment MTBC's web-based billing platform, which includes numerous practice management tools, financial reporting capabilities, online patient scheduling and secure online access to all claims and patient information. MTBC was recently recognized by Deloitte LLP as one of the fastest growing companies in North America. To learn more about MTBC's comprehensive medical billing and practice management solutions, visit or call (866) 266-MTBC (6822). Keywords: White paper, healthcare white paper, hitech act, ehr software, electronic healthcare records, software, incentive 2010 MTBC Medical Transcription Billing Corp. 10

11 References Blumenthal, D. and Tavenner, M. The Meaningful Use Regulation for Electronic Health Records. NEJM. July Geyer, John. Standards, Incentive Program for EHR Adoption Outlined. December 31, Rodriguez, Todd. HITECH Act Fact Sheet. June 30, Silva, Chris. Meaningful use Final Rule Offers Some Flexibility. July 19, Woodcock, E.W. Understanding the Meaningful Use Regulations. July 23, Medicare & Medicaid EHR Incentive Program Final Rule. A13D148F21D7CBA9/FinalDownload/DownloadId6B6E9D1E33BC04A0466B B/FD272A6F ACC-A13D- 148F21D7CBA9/dma/ehr/EHRRuleSummary.pdf Stimulus 101 Understanding the HITECH Act and Meaningful Use MTBC Medical Transcription Billing Corp. 11