Meaningful Use, Adoption Incentives and the EHR Adoption Process. Paul L Wilder Director, Health IT Adoption New York ehealth Collaborative

Transcription

1 Meaningful Use, Adoption Incentives and the EHR Adoption Process Paul L Wilder Director, Health IT Adoption New York ehealth Collaborative

2 What is Meaningful Use? Meaningful Use is a multi-stage process to cost-effectively improve the quality of healthcare in the US A key step in the process is adoption of an Electronic Health Record to replace paper records 3 Stages of Meaningful Use Improved quality of care Stage 3 Stage 2 Stage 1 Each stage gets progressively closer to the ultimate goal Improved Care

3 Information Technology (IT) Allows Both Higher Quality and Reduced Costs Often Quality and Profit are seen as tradeoffs Productivity improvements can often be gained while maintaining quality using information technology, breaking this seesaw effect Quality Profit

4 Debate over IT Investments in Healthcare Has a Long History What's Really Propping Up The Economy - BusinessWeek Cover Story Since 2001*, the health-care industry has added 1.7 million jobs. The rest of the private sector? None *Represents 5 years, article was published September 2006 But both sides can agree that more spending on information technology could reduce the need for so many health-care workers. It's a truism in economics that investment boosts productivity, and the U.S. lags behind other countries in this area. "Every other country has the payers paying for IT," says Johns Hopkins' Gerard Anderson, an expert on the economics of health care. Quality Profit What's Really Propping Up The Economy BusinessWeek, 25 September 2006

5 The Debate Ends: Meaningful Use EHR Incentives EHR Incentives (Meaningful Use payments) are a nationwide investment in the usage of IT to improve quality & reduce costs managed by CMS Medicaid Incentives Payments are fixed and not proportional to Medicaid billings. Up to $63,750 over 6 years If pediatricians qualify at 20%, only eligible for 67% (2/3) of payments Must participate by 2016 Medicare Incentives Payments are proportional to Medicare billings (75% of total billings up to a cap each year, including capitation and copayments) Up to $44,000 over 5 years Payments increased by 10% for physicians practicing in a Health Professional Shortage Area Must participate by 2012 to receive the maximum incentive payment

6 Eligible Professionals (EP) Medicare-only Eligible Professionals Medicaid-only Eligible Professionals Could be eligible for both Medicare & Medicaid incentives Note: You can only do one program, you can switch programs once

7 Eligible Provider (EP) Eligibility Medicaid Program Medicare Program Must be one of 5 types of EPs Have 30% Medicaid patient volume 1 ( 20% patient volume 1 for pediatricians) - or - Practice predominantly in an FQHC or RHC with 30% needy 1 individual patient volume Licensed, credentialed Not on the Office of Inspector General Exclusions List Living Cannot be hospital-based 1.Child Health Plus does not count in patient volume calculation 2.Needy = Medicaid, uninsured, free care, patients in sliding scale programs Must be a physician defined as MD, DO, DDM/DDS, optometrist, podiatrist, chiropractor Must have Part B Medicare allowed charges Must not be hospital-based Must be enrolled in PECOS Living Not Hospital-Based = <90% services furnished in inpatient or ED setting

8 Medicare EHR Incentive Program Incentive is based on: 1. How much the provider bills to Medicare Maximum is 75% of Allowable Charges billed under the Medicare Part B Physician Fee Schedule (limited each year on a sliding scale schedule per the chart below) 2. When the providers starts meeting Meaningful Use Starting by 2012 qualifies for the maximum incentive 3. The calendar year Payments decrease year after year There is no minimum payment

9 Medicaid EHR Incentive Program Qualification: adult patient mix must be at least 30% Medicaid beneficiaries (20% threshold for pediatricians) All Practitioners (at least 30% Medicaid/needy) Pediatricians (at least 20% but less than 30% Medicaid) Year 1 $21,250 $14,167 Year 2 $8,500 $5,667 Year 3 $8,500 $5,667 Year 4 $8,500 $5,667 Year 5 $8,500 $5,667 Year 6 $8,500 $5,667 Total $63,750 $42,500 2 types of payments First payment is based on adopting, implementing or upgrading EHR (up to $21,250 for this first payment) Remaining 5 payments are based on achieving meaningful use Last year to initiate participation is 2016 Participants may skip a year, but no payments will be issued after 2021

10 Medicare & Medicaid EP EHR Programs: Notable Differences Medicare Federal Government will implement (will be an option nationally) Payment reductions begin in 2015 for providers that do not demonstrate Meaningful Use Must demonstrate MU in Year 1 Maximum incentive is $44,000 for EPs (bonus for EPs in Health Professional Shortage Areas) MU definition is common for all Medicare EPs Last year a provider may initiate program is 2014; Last year to register is 2016; Payment adjustments (penalties) begin in 2015 Must meet Meaningful Use in contiguous years Medicaid Voluntary for States to implement (may not be an option in every State) No Medicaid payment reductions A/I/U option for 1 st participation year Maximum incentive is $63,750 for EPs States can adopt certain additional requirements for MU Last year a provider may initiate program is 2016; Last year to register is 2016 Can skip years and still receive the maximum benefit $42,500 $63,750 If you practice in multiple locations, at least 50% patients must be treated in locations that have certified EHRs that you use meaningfully. 10

11 Meaningful Use Stage 1 = Data Capture and Sharing Two Primary Goals of Stage 1: EHR Adoption Using EHRs in a Meaningful Way Stage 2 Stage 3 Stage 1

12 Stage 1 Meaningful Use Criteria (EPs) Stage 1 objectives and clinical quality metrics include a core set (the required set) and a menu set with choice Meaningful Use Objectives Clinical Quality Metrics Core Set 15 core objectives 3 core metrics, or 3 alternate core metrics Menu Set 5 of 10 menu set objectives (1 must be a public health option) 3 of 38 menu set metrics 12

13 The Structure of Meaningful Use Required vs Optional Core vs Menu Percentage based & yes/no measures 16 are based on a calculation Numerator / Denominator 9 are yes/no attestation Calculations are either based on: All patients/visits in your EHR Or All your patients/visits If an Exclusion Applies to you, you PASS the Objective

14 Stage 1 Meaningful Use Objective (EPs) The Core Set Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. Record and chart changes in the following vital signs: Height, Weight, Blood pressure, Calculate and display body mass index (BMI), Plot and display growth charts for children 2-20 years, including BMI Implement drug-drug and drug-allergy interaction checks. Maintain an up-to-date problem list of current and active diagnoses. Generate and transmit permissible prescriptions electronically (erx) Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule. Maintain active medication allergy list. Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. Record smoking status for patients 13 years old or older. Report ambulatory clinical quality measures to CMS. Maintain active medication list. Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies) upon request. Provide clinical summaries for patients for each office visit. Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, and diagnostic test results), among providers of care and patient authorized entities electronically. Record all of the following demographics: Preferred language, Gender, Race, Ethnicity, Date of birth 14

15 Stage 1 Meaningful Use Objective (EPs) The Menu Set Implement drug formulary checks. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. Send reminders to patients per patient preference for preventive/follow-up care. The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice. Incorporate clinical lab test results into EHR as structured data. Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP. Use certified EHR technology to identify patientspecific education resources and provide those resources to the patient if appropriate. The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral. Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice. 15

16 Clinical Quality Metrics NQF Measure Number/ PQRI Implementation Number Clinical Quality Measure (Core Set) NQF 0013 Hypertension: Blood pressure measurement NQF 0028 NQF 0421 PQRI 128 Preventive Care and Screening Measure Pair: a) Tobacco Use Assessment b) Tobacco Cessation Intervention Adult Weight Screening and Follow-up 16

17 Clinical Quality Metrics Alternate Core Set NQF Measure Number/ PQRI Implementation Number NQF 0024 NQF0041 PQRI 110 Clinical Quality Measure (Alternate Core Set) Weight Assessment and Counseling for Children and Adolescents Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or Older NQF 0038 Childhood Immunization Status 17

18 Examples from the 38 Menu Set Clinical Quality Measures HbA1C> 9 LDL < 100 BP < 140/90 ACE or ARB in HF Beta-blocker in hx of CAD or MI Patients >50 yrs old w/ influenza vaccine Patients > 65 yrs old w/ pneumovax vaccine Breast CA screening Colorectal CA screening Antiplatelet therapy in CAD Beta-blocker in HF +LVSD Anti-depression medication in new episode of depression Others. 07/10 SOURCE: HIT Policy Committee; HCI HIT team analysis 1 8

19 A Detailed Example from the Menu Set Clinical Summaries Objective Provide clinical summaries for patients for each office visit. Clinical summaries provided to patients for more than 50 percent of all office visits within 3 business days. Measure Exclusion NUMERATOR: Number of patients in the denominator who are provided a clinical summary of their visit within three business days. DENOMINATOR: Number of unique patients seen by the EP for an office visit during the EHR reporting period. Any EP who has no office visits during the EHR reporting period.

20 What is a Clinical Summary? Clinical Summary An after-visit summary that provides a patient with relevant and actionable information and instructions containing: the patient name and providers contact information date and location of visit An updated medication list and vitals reason(s) for visit procedures and other instructions based on clinical discussions that took place during the office visit updates to a problem list immunizations or medications administered during visit summary of topics covered/considered during visit time and location of next appointment/testing if scheduled or a recommended appointment time if not scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders test/laboratory results (if received before 24 hours after visit) symptoms.

21 Office Visit Office Visit Office visits include separate, billable encounters that result from evaluation and management services provided to the patient and include: (1) Concurrent care or transfer of care visits, (2) (2) Consultant visits (3) Prolonged Physician Service without Direct (Face-To- Face) Patient Contact (tele-health) A consultant visit occurs when a provider is asked to render an expert opinion/service for a specific condition or problem by a referring provider.

22 How to Achieve the Measure The clinical summary can be provided through a PHR (Patient Health Record), patient portal on the web site, secure , electronic media such as CD or USB fob, or printed copy. If the EP chooses an electronic media, they would be required to provide the patient a paper copy upon request. When a patient visit lasts several days and the patient is seen by multiple EPs, a single clinical summary at the end of the visit can be used to meet the meaningful use objective for provide clinical summaries for patients after each office visit.

23 Additional Information The provider is permitted, but not required, to limit the measure of this objective to those patients whose records are maintained using certified EHR technology. i.e. this is a measure of all patients in the EHR, not all patients The provision of the clinical summary is limited to the information contained within certified EHR technology. If an EP believes that substantial harm may arise from the disclosure of particular information, an EP may choose to withhold that particular information from the clinical summary. Providers should not charge patients a fee to provide this information.

24 General Takeaways for This Objective Providing a Clinical Summary is a MANDATORY Objective It is in the Core Set This one is measurement based Numerator: Number of patients in the denominator who are provided a clinical summary of their visit within three business days. Denominator: Number of unique patients seen by the EP for an office visit during the EHR reporting period. It is based on the patients in your EHR You can use all patients, but the EHR is going to calculate this by what it has in there, so don t create extra work for yourself and calculate something handed to you For this and other percentage based calculations, adjust your workflow and aim for 100% usage Providing clinical summaries to 100% of your patients is something an EHR is designed to do, 50% should be easy

25 The REC Simplifies Meaningful Use for You Snow Meaningful Use of Snow We make EHR Adoption and Meaningful Use easy to understand and simpler to achieve!

26 Regional Extension Centers Are Not New Agricultural Extension Center were Created by Congress nearly a century ago to address agricultural issues and increase farm productivity Accelerated the adoption of new technology for farmers who thought they were too busy to change Developed practical applications of researched knowledge (sharing of best practices) Gave demonstrations of improved practices/ technologies in agriculture (growth of cooperative extensions) 26

27 It Takes Time to Change Like those farmers in the 1910 s, health providers are very busy and have few resources and change is always hard Average day: hour days See patients per day Documentation, claims, & payer follow-up Field telephone messages a day Review and sign off on test results Process Rx renewal requests Receive over 50 s, faxes or paper mail BUT, only the face-to-face time with patients is reimbursed.

28 Regional Extension Centers: Who Do We Serve A Priority Primary Care Provider (MD, DO, NP, PA, CNMW) practicing in typical primary care specialties including OB-GYN and Pediatrics; and Practice size is 10 provides (with prescriptive privileges) or fewer - or - Practice is a federally-qualified health center, rural health clinic, public hospital, critical access hospital or primarily serves medically underserved populations You are eligible for the program even if you already have an EHR. The REC will assist you with postimplementation services to get your practice ready for Medicare and Medicaid incentive programs

29 Regional Extension Centers of New York New York has two Regional Extension Centers: NYeC Regional Extension Center Serves providers in NY state outside NYC NYC REACH Serves providers within the 5 Boroughs of NYC

30 NYeC Regional Extension Center Service Models Full Service One-time fee of $750 per provider Consultant services from vendor selection to MU attainment Approximately $5000 of consulting time per provider Meaningful Use Service FREE Installed Based Program through June 2011 for small office, primary care practices Consultant services provided at low to no cost to an eligible provider already using an EHR Limited free spaces are available for this program Approximately $3500 of consulting time per provider Eligible Providers can start the sign-up process today!

31 HIT Adoption Raises Many Concerns For a practice trying to adopt an electronic records system alone it s SCARY out there Which system to choose? What about my old records? How will I train my staff? Who will handle the IT issues? What about patient privacy? HOW much $? Do I qualify for federal incentives?

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33 Meaningful Use is a Process: FOLLOW THE BLUE LINE AND WE LL GET YOU THERE

34 Every Journey Begins with the First Step

35 Start Your Journey: Join the Regional Extension Center With the REC We provide thousands of $$$s in top-quality subsidized services for a small fee We help train you & your staff We help you decide which EHR system works for you We negotiate with vendors We help you understand Meaningful Use We help you get the incentives Without the REC Try to find and hire technical staff you may not need after you transition to your EHR You hire expensive consultants to advise you You select a system from 300 Certified EHRs You negotiate vendor contracts You train yourself to be a meaningful use expert How will you get the $$$ from the feds? Page 35

36 Step One: Assess & Plan With the REC We analyze your practice and determine how it can benefit from an EHR and determine the best path to successful adoption for you We ll help you assess and plan and good planning = good execution Without the REC You attempt to evaluate the needs of your own practice while you re busy running your practice You educate yourself about what EHR services are out there so you can decide what you might or might not want Page 36

37 Click to edit Master title style Step Two: Select an EHR With the REC Each system has its pros and cons we ll help you find the right one for you We selected a preferred list of vendors who meet our criteria however, you do not have to choose from this list We ll negotiate purchase agreements and services on your behalf We ve negotiated 20-30% discounts with our preferred vendors savings in the thousands of $$$s per provider We ve also selected many qualified Meaningful Use Partners and receive training on their technology Without the REC You decide on which EHR is best for you among 300 Meaningful Use certified EHR Make sure the EHR you re looking at will qualify with the feds so you get your incentive $$$ You compare features and pricing so you don t get taken Page 37

38 Step Three: Design Infrastructure With the REC We ll evaluate your current infrastructure and physical workflow to help you choose an IT infrastructure solution that fits your practice and EHR Tablets, laptops or desktops Wireless, wired or mixed network Printers, scanners, signature pads Without the REC You determine the hardware that you believe will work for you and your practice NYeC REC partnered with IT companies pre-selected to assist small practices with the design, procurement, and installation of networks, computer hardware and software You locate and contract with IT Vendors to help you design, procure and deploy hardware and infrastructure Page 38

39 Step Three: Design Infrastructure Full State Coverage Upstate Western NY: Lower Hudson Valley/White Plans Long Island Page 39

40 Step Four: Purchase With the REC We ll evaluate the vendor if you choose from our preferred list, we ll negotiate the contract on your behalf We ensure that all our preferred vendors meet their responsibilities on behalf of our participants Without the REC You negotiate the best deal you can with the information you have You hope you got a good deal and that the vendor will live up to its commitments We ll help you set up contracts for IT support We ll help you decide what payment method is right for you Lease Buy Software as a Service Page 40

41 Step Four: Purchase NYeC has contracted with two commercial banks to enable faster, easier financing if you need it They understand this market, the products and the implementation process Less time explaining your loan needs Easier credit check Faster turnaround on quotations Competitive interest rates One stop shop software, hardware and services financing available Competitive low fixed rates, including deferred payment programs All our other preferred vendors have been pre-qualified by the banks for fast transactions Page 41

42 Step Five: Prepare for Launch With the REC This is a crucial step Without the REC You get this wrong, and you may be way off track We deliver guided workflow redesign that sets the stage for successful transformation redesign makes or break the success of adoption We ll train you & your staff so launch day has few surprises you ll be ready You try to redesign the workflow of your practice and become an expert at what your EHR will do before you know what it can really do Achieving Meaningful Use on your own will likely be a lot more challenging Page 42

43 Step Five: Prepare for Launch A recent study found that over 90 percent of all physicians who adopt an EHR are glad they did it The benefits are real and are more prevalent for providers who implement a Fully-Functional System vs a Basic System Better technology makes it easier to attract and retain provider talent Patients equate technology adoption with quality and start making care decisions differently when new, replacement technology emerges Patient communication is greatly improved if the technology is used to its fullest Rates of Positive Survey Responses on the Effect of Adoption of Electronic-Health-Records Systems (New England Journal of Medicine)

44 Step Five: Prepare for Launch We ll Make Sure Your EHR Adoption is Thorough! Measure to measure, full system implementations were always more satisfied than basic

45 Step Six: Implement With the REC This is your BIG DAY. We ve made sure you are ready for this GO-LIVE! We re there with you we ll help you troubleshoot any issues that arise right away. Without the REC Oh boy, this is a really Big Day. If something goes wrong, you have to stop everything and figure out a solution. You re already busy running your practice. Page 45

46 Step Seven: Use Click to edit Master title style With the REC We did it. You re digital! We re helping you work out some kinks and make sure you implement the right solutions to any problems that arise, but it s all starting to make sense Together, we ve made your office workflow more efficient and you are enjoying the benefits of your EHR Without the REC You did it. You re digital! You re working through the kinks in the system. Sometimes it is quicker to work around them because you haven t had time to figure out the right solution You have to address any issues that arise on your own. You re so busy Page 46

47 Step Eight: Achieve Meaningful Use With the REC The REC is the federally-designated Meaningful Use expert for New York and we are here to share our knowledge with you. We ll walk you through what your practice needs to do We ll help you measure your readiness so you re prepared for your 90-day Meaningful Use attestation period Without the REC The federal definition is over 800 pages long! You try to measure whether you re ready for attestation You organize yourself for your first 90-day Meaningful Use attestation period Page 47

48 Final Destination: Receive Federal Incentives With the REC Without the REC Hopefully this: But, could be: Page 48

49 Every Journey Begins with a First Step

50 Start Your Journey with Us Now! Time is Running Out Federal incentives and support won t last forever: Must reach Meaningful Use by 2012 to be eligible for the full Medicare incentive Must reach Meaningful Use by 2016 to be eligible for the full Medicaid incentive REC has 3000 slots left to fill 2000 of the original 5107 are already taken We are averaging 400 sign-ups per month Visit the NYeC table to learn how to join today! 50

51 Contact Information Paul L Wilder New York ehealth Collaborative (646) pwilder@nyehealth.org