Meaningful Use Stage 2. Final Rule

Transcription

1 Meaningful Use Stage 2 Final Rule

2 AMA Credit Designation Statement: HRET designates this live activity for a maximum of 1 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

3 Objectives Timeline of Stage 2 of Meaningful Use Final Rule of Stage 2 Meaningful Use Changes to Stage 1 of Meaningful Use Changes to Clinical Quality Measures Reporting and Measures Changes to Medicaid Program

4 Timeline June 2011 HITPC Recommendations on Stage 2 February 2012 Stage 2 Proposed Rule August 2012 Stage 2 Final Rule October 4, 2012 Final Rule went in to Effect January 1, 2014 Proposed Stage 2 Start Dates

5 Important Facts Starting in 2014, providers who have already met Stage 1 for two or three years will have to meet Stage 2 Meaningful Use requirements. Providers should be on newly certified systems starting in 2014 regardless of the stage. Regardless of the stage providers will report only for 90 days in In 2014, Medicare providers will be choosing a 90 day quarter to report (For Example. Jan 1 to Mar 31) for Stage 2

6 Important Facts Exclusions no longer count towards satisfying the menu objectives in Stage 2. This applies to Stage 1 also starting Providers cannot report exclusions for Stage 2 unless the provider has more than 3 exclusions included in the Menu Measures. It is not allowed for an EP to create a record of the encounter without using CEHRT at the practice/location and then later input that information into CEHRT that exists at a different practice/location, starting from Starting in 2014, groups will be allowed to submit attestation information for all of their individual EPs in one file for upload for Medicare.

7 Medicare Incentive Payments by Stage

8 Changes to Stage 1 of Meaningful Use 1. CPOE Denominator: Number of orders during the EHR reporting period (Stage 2) or the current denominator (number of patients with an active medication list) 2013 onward optional, 2014 required 2. Vital Sign Age Limit: Age 3 for blood pressure, and no age limit for height/weight (Changed in 2013) 3. Vital Sign Exclusion: Allows BP to be separated from height/weight (Changed in 2013) 4. E Prescription: New exclusion starting 2013 for EPs that don t have access to a pharmacy within a 10 mile radius Added in 2013

9 Changes to Stage 1 of Meaningful Use Changes are required for Exchange Key Clinical Information Core: Removed from the core requirements (Removed in 2013) 5. Electronic Copy Core: Removed from the core requirements (Removed in 2014) 6. Electronic Access Menu: Removed from the menu requirements (Removed in 2014) All three measures will be replaced by view online, download, and transmit for 50% of the patients (2014 onward required)

10 Changes to Stage 1 of Meaningful Use 7. Public Health Measures: "except where prohibited added to the existing language (2013 onward) 8. Clinical Quality Measure: Removed beginning in 2014 for Stage 1 to conform with this change in the definition of a meaningful EHR user (2014 onward) 9. Exclusion Policy: Stage 2 exclusion policy will apply for Stage 1 also beginning 2014 (2014 onward)

11 The Transition from Stage 1 to Stage 2 Eligible Professionals 15 Core Objectives / 14 Core Objectives 5 of 10 Menu Objectives Eligible Professionals 17 Core Objectives 3 of 6 Menu Objectives

12 Core Objectives 1. Use CPOE for more than 60% of medication orders 30% Radiology and 30% Lab orders (Stage 1 / S1 30% Medication) 2. E Rx for more than 50% compared to formulary (S1 40%) 3. Record demographics for more than 80% (S1 50%) 4. Record vital signs for more than 80% (S1 50%) 5. Record smoking status for more than 80% (S1 50%) 6. Implement 5 clinical decision support (CQM) interventions + drug/drug and drug/allergy (S1 1 rule) 7. Incorporate lab results for more than 55% (S1 40%, Menu)

13 Core Objectives 8. Generate patient list by specific condition (S1 Menu) 9. Use EHR to identify and provide more than 10% of unique patients with reminders for preventive/follow up (S1 20%, Menu) 10. Provide online access to health information for more than 50% with more than 5% view, download or transmitting to a 3 rd party (S1 10%, Menu, combines Elec copy, Electronic access) 11. Provide office visit summaries for more than 50% within 1 Business day (S1 72 hours) 12. Use EHR to identify and provide education resources more than 10% unique patients with office visits(s1 Menu)

14 Core Objectives 13. More than 5% of patients send secure messages to their EP (New Requirement) 14. Medication reconciliation at more than 50% of transitions of care (S1 50%, Menu) 15. Provide summary of care document for more than 50% of transitions of care and referrals with 10% sent electronically, with at least one to a different vendor or test with CMS test EHR (S1 Menu, eliminates electronic exchange, includes care plan, 3 lists) 16. Successful ongoing transmission of immunization data (S1 Menu, Test was sufficient) 17. Conduct or review security analysis and incorporate in risk management process (S1 No change) stress encryption.

15 Menu Objectives 1. More than 10% of imaging results are accessible through Certified EHR Technology (New Requirement) 2. Record family health history for more than 20% Immediate Family (First degree relatives) (New Requirement) 3. Successful ongoing transmission of Syndromic Surveillance data unless Prohibited (S1 No change) 4. Successful ongoing transmission of cancer case information unless Prohibited (New Requirement) 5. Successful ongoing transmission of data to a specialized registry (i.e. birth defects. Etc..)(New Requirement) 6. Enter an electronic progress note for more than 30% of unique patients (New Requirement)

16 Clinical Quality Measures CQMs are no longer a Meaningful Use core objective, but reporting CQMs is still a requirement for meaningful use 3 Core OR 3 Alt. Core CQMs + 3 Menu CQMs 6 Total CQMs 9 out of 64 Measures Choose at least 1 measure in 3 NQS domains There are 6 NQS domains in total

17 Clinical Quality Measures Providers must choose at least 3 of the 6 National Quality Strategy domains Patient and Family Engagement Patient Safety Care Coordination Population and Public Health Efficient Use of Healthcare Resources Clinical Processes / Effectiveness CQMs must be reported electronically starting 2014

18 Clinical Quality Measures Other programs such as PQRS, CHIPRA and ACO will be aligned CMS published a set of recommended core measures Starting 2014 CQM will be uniform for Stage 1 and Stage 2

19 Medicaid EHR Incentive Program Changes Expanded Definition of a Medicaid Encounter to Include: To permit patient volume to be calculated from the most recent 12 months or previous calendar year, instead of on the previous calendar year only. To include zero pay Medicaid claims Inclusion of CHIP encounters for patients in Title XIX and Title XXI Medicaid expansion programs. The patient volumes for these programs will be incorporated into the automated CHIP proxy logic in NJMMIS in the attestation application, resulting in higher CHIP proxy values after this change is applied. CMS is providing additional guidance to states on these Medicaid changes and NJ HITEC along with its member providers will be kept abreast as they are being implemented.

20 Eligible Professional Hardships Infrastructure New EPs Unforeseen circumstances Meets a specific criteria Only telemedicine, lack of follow up needed with patients EPs practicing at multiple locations Lack of authority over availability of EHR for more than 50% of patient encounters

21 Final Rule for 2014 In 2015, all providers (except for providers starting the program) will have to achieve full year of Stage 1 or Stage 2 Meaningful Use. Providers will have to get their 2014 CEHRT upgrade before January 1, 2015 or they will have to forfeit next year s incentive payments. NJ HITEC strongly recommends that providers continue their implementation schedule and do not postpone their upgrade. If Stage 2 providers upgraded all the CEHRT components necessary for Stage 2 and have fully implemented the product, they will have to achieve Stage 2. The exception is if they could not meet the 10% requirement for Transition of Care due to the functional inability of the receiving provider to receive the summary of care document electronically. If providers did get 2014 CEHRT upgrade, but have not fully implemented (pending training, pending installation of a components like patient portal, Direct messaging, etc) then providers may fit in to the definition of "Not Fully Implemented". If so, they can report Stage definition instead of Stage 2. Providers using a combination of 2011 and 2014 systems have the option of achieving 2013 Stage 1, 2014 Stage 1, or 2014 Stage 2 requirements depending on where they are with the 2014 EHR Implementation.

22 Final Rule for 2014 Cont d Providers still using 2011 CEHRT system that are not due for an upgrade will have the option of achieving Stage 1 90 days of Meaningful Use based on 2013 definition. Medicare providers will still have to report in calendar quarters in 2014, except for the providers who are starting the program this year. Medicaid providers in New Jersey can still report Meaningful Use for any 90 days this year. Stage 3 has been pushed to Eligible providers can use the 2011 Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT for an EHR reporting period in 2014 for the Medicare and Medicaid EHR Incentive Programs; All eligible professionals, eligible hospitals, and CAHs are required to use the 2014 Edition CEHRT in The rule also finalizes the extension of Stage 2 through 2016 for certain providers and announces the Stage 3 timeline, which will begin in 2017 for providers who first became meaningful EHR users in 2011 or 2012.

23 Thank You!