Meaningful Use: At the Crossroads between Stage 1 and Stage 2. Presented by: Bruce Eckert, National Practice Director Date: April 19, 2013

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1 Meaningful Use: At the Crossroads between Stage 1 and Stage 2 Presented by: Bruce Eckert, National Practice Director Date: April 19, 2013

2 Heading Agenda Ariel 40 Stage 2 Major Changes Payment Adjustments When is Your Reporting Period? Choices and Recommendations 2013 versus 2014 How Beacon Can Help 2

3 Stage 2 Major Changes

4 Heading Stage 1 and Ariel Stage 40 2 Overview Core Set Menu Set Stage 1 EP 15 5 of 10 Hospital 14 5 of 10 Stage 2 EP 17 3 of 6 9 carry overs, 7 from menu set, 1 new 1 carry over, 5 new Hospital 16 3 of 6 7 carry overs, 8 from menu set, 1 new 1 carry-over, 5 new 4

5 Heading Multiple Versions Ariel 40 of Stage 1 Stage The current rule Stage Required 2013 modifications Stage 1.2 Required 2013 modifications plus optional 2013 modifications Stage 1.3 Required 2014 modifications (with one option) Initial Attestation 1 ST YEAR 2 ND YEAR 3 RD YEAR or or 1.2 Stage or Stage & later Stage 2

6 Heading Clinical Quality Ariel 40 Measures Beginning 2013, no longer a meaningful use objective Instead, part of the definition of meaningful user Allows the separation of Meaningful Use stages and CQMs Thus, beginning in 2013, regardless of the Meaningful Use stage EPs report on 9 of 64 approved CQMs Hospitals (EH and CAH) report on 16 of 29 CQMs 2014 electronic reporting of CQMs begins

7 Heading Stage 1.1 Ariel Required EP, EH and CAH Clinical Quality Measures Removed as an objective (but still required) Exchange of clinical data eliminated as an objective Public health data submission objectives now say, except where prohibited EP Only New exclusion for eprescribing (no pharmacies or no e-capable pharmacies within 10 miles)

8 Heading Stage 1.2 Ariel Optional Required Stage 1.1 changes PLUS EP, EH and CAH Alternative CPOE denominator Vital Signs: BP age changed to 3 EP Only Vital Signs: Expanded exclusions

9 Heading Stage 1.3 Ariel Required Required 2013 changes (Stage 1.1) PLUS EP, EH and CAH Providing patients with electronic copies of health information and discharge instructions is replaced with the Stage 2 Patient Online Access objective Meeting an exclusion for a menu set item no longer counts as meeting the objective Vital Signs: BP age changed to 3 EP Only Vital Signs: Additional exclusions And alternative CPOE denominator continues as an option for Stage 1 indefinitely

10 Heading Stage 2 Major Ariel 40 Changes Objective CPOE (EP, EH, CAH) Clinical Decision Support (EP, EH, CAH) Summary of Care Record (EP, EH, CAH) Major Change 60% Meds, 30% Labs, 30% Imaging PLUS change in denominator Five rules tied to four CQMs PLUS drugdrug and drug-allergy interactions For 50% of care transitions, send electronic CDA-formatted summary. 10% of these must be sent via NwHIN compatible HIE. At least one exchange (or a test) with a different EHR system

11 Heading Stage 2 Major Ariel 40 Changes Objective Security Risk Assessment (EP, EH, CAH) Public Health Data Transmissions (EP, EH, CAH) Major Change Includes addressing the encryption/security of data at rest 1. EH and CAH: Immunizations, labs and syndromic surveillance 2. EP: required: Immunizations; menu set: syndromic surveillance, cancer registry and specialty registry 3. HL , not Ongoing submission throughout the reporting period

12 Heading Stage 2 Major Ariel 40 Changes Objective Patient Online Access (EP, EH, CAH) Major Change 50% of unique patients are provided online access to health information; 5% of unique patients make use of it Secure Messaging (EP) 5% of unique patients communicate with the provider using secure electronic messaging that is part of the CEHRT emar (EH and CAH) 10% of medication orders have all administrations tracked by emar using barcode, RFID, etc.

13 Payment Adjustments 13

14 Heading Hospital Payment Ariel 40 Adjustments Critical Access Hospitals Critical Access Hospital Payment Adjustment Medicare cost reimbursement percentage % % 100% Federal Register, Vol. 77, No. 171

15 Heading Provider Payment Ariel 40 Adjustments Federal Register, Vol. 77, No. 171

16 Heading Incentive Example Ariel 40 Discharges 5,000 Patient Days 20,000 Medicare 50% Medicaid 10% Charity 1% Maximum Medicare Incentive $ 3,462,500 Maximum Medicaid Incentive $ 693,500 Maximum Total Incentive $ 4,156,000

17 Heading Payment Adjustment Ariel 40 Example Total Medicare Reimbursements $ 75 million Annual Payment Increase 2% 2015 Payment Adjustment $ 375, Payment Adjustment $ 750, Payment Adjustment $ 1,125, Payment Adjustment $ 1,125, Payment Adjustment $ 1,125,000 Total 5-year Payment Adjustment $ 4,500,000

18 Hospital Payment Adjustment Schedule Heading Ariel 40 Federal Register, Vol. 77, No. 171

19 Heading CAH Payment Ariel Adjustment 40 Schedule

20 When is Your 2014 Reporting Period? 20

21 Heading Your Meaningful Ariel 40 Use Journey Incentive Program Hospital Medicare Only Hospital or CAH Medicaid Only Hospital Medicare and Medicaid CAH Medicare Only CAH Medicare and Medicaid Provider Medicare Provider Medicaid Not Eligible Meaningful Use Status Class of 2011 Class of 2012 Class of 2013 Prospective Class of 2013 AIU Not yet attested

22 Heading 2014 Reporting Ariel 40 Periods 1 st Year on Stage 1 EH, CAH, EP Medicare and/or Medicaid Any 90-day continuous period

23 Heading 2014 Reporting Ariel 40 Periods (2) Stage 2 or 2 nd Year on Stage 1 EH or CAH Medicare and/or Medicaid Three-Month Reporting Period Oct 1, 2013 Dec 31, 2013 Jan 1, 2014 March 31, 2014 April 1, 2014 June 30, 2014 July 1, 2014 Sept 30, 2014

24 Heading 2014 Reporting Ariel 40 Periods (3) Stage 2 or 2 nd Year on Stage 1: EP Medicare Only Three-Month Reporting Period Jan 1, 2014 March 31, 2014 April 1, 2014 June 30, 2014 July 1, 2014 Sept 30, 2014 Oct 1, 2014 Dec 31, 2014

25 Heading 2014 Reporting Ariel 40 Periods (4) Stage 2 or 2 nd Year on Stage 1 EP Medicaid Only State Option 3-Month Reporting Period Any continuous 90-day Period

26 Choices and Recommendations 26

27 Heading Three Cases Ariel Medicaid Only 2. Classes of 2011 and Class of 2013

28 Heading 2014 Timing Ariel Considerations 40 All 2014 attestations (Stage 1.3 and Stage 2) require 2014 CEHRT As of April 17 Fiscal 2014 begins in 28 weeks Only 39 EHR products are 2014 certified Only 3 are complete EHRs Less than 1% of the EHRs certified under 2011 standards

29 Heading Medicaid Only Ariel 40 No penalties in Medicaid program But, Medicare penalties do apply Latest first incentive year is 2016 (AIU) Latest first Stage 1 attestation is 2017

30 Heading Medicaid Only Ariel 40 Today AIU Stage 1

31 Heading Class of 2011 Ariel and Today Stage 1.1 Year 2 or 3 Stage 2 Stage 2

32 Heading Class of 2013 Ariel 40 Today Stage 1.1 Stage 1.3 Stage 2

33 2013 versus 2014

34 As Heading of Feb Ariel 28, ,590 EPs Attested 25% of total 3,017 EHs Attested 73% of total 412 CAHs Attested 31% of total 34

35 Heading 2013 versus Ariel Incentive Impact EH: Forfeit 40% EP: Forfeit 39% CAH: Forfeit 33% Penalty Impact Avoids 2015 EP and EH: Avoids 2015* AND 2016 CAH: None Certification level Stage reporting period 3-Month 90-day 2015 Stage First Stage 2 reporting period Full year 2015 Full year 2016 * First three quarters of 2014 only

36 Is Attesting in 2013 still possible? Heading Ariel 40 Last Possible Reporting Period Start Hospital and CAH July 3, EP October 3, Remaining Calendar Days

37 Heading Accelerated Ariel Attestation 40 ED-Only option Exclusions Menu Set Selection Use the Reporting Period

38 Heading Exclusion Ariel Example 40 Objective Measure Denominator Exclusion (f)(11) Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, medication allergies) upon request. Subject to paragraph (c) of this section, more than 50 percent of all patients of the inpatient or emergency departments of the eligible hospital or CAH (POS 21 or 23) who request an electronic copy of their health information are provided it within 3 business days. Unique patients admitted to POS 21 and/or POS 23 during the reporting period with records maintained in the EHR who make a request. Any eligible hospital or CAH that has no requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period.

39 Heading Menu Set Ariel 40 Incorporate Lab Results List of Specific Conditions Immunization Registry Syndromic Surveillance Reportable Labs (EH/CAH only)

40 Heading Use the Reporting Ariel 40 Period 10% Measures Electronic Access (Menu Set EH/CAH only) Patient-specific education (Menu Set) 20% Measures Patient Reminders (Menu Set EP only) 30% Measures CPOE

41 Heading How Beacon Ariel Partners 40 Can Help

42 Heading Meaningful Ariel Use 40 Services Executive Advisory Gap Analysis Implementation Plans Project Management Implementations / Implementation Assistance Physician and Staff Training Audit Preparation

43 Heading Additional Ariel Services 40 of Interest ICD-10 Assessment and Remediation ACO Strategy and Execution Affiliate Physician EHR Strategy and Implementation HIE strategy and implementation Legacy system support and decommissioning

44 Thank You For more information please contact: Bruce Eckert BEACON BeaconPartners.com BOSTON CLEVELAND SAN FRANCISCO TORONTO 44

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