The now tips, the how tools, and the must timing for your MU path in 2014.

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1 Meaningful Use in Window of Opportunity The now tips, the how tools, and the must timing for your MU path in Inside you will find: CLICK ON TITLES TO NAVIGATE MU 2014 updates; Must know changes! MU 2014 support; Do it right, from the start! Choose the right EHR the right way The Must Do! MU list for 2014 Success stories, links, and our popular Ten Tips for MU Success in 2014

2 CLICK ON TITLES TO NAVIGATE year.?table of Contents Introduction Don t miss your MU window! Is your window of Chapter 1 MU 2014 Updates opportunity closing? Chapter 2 MU 2014 What Chapter 3 MU 2014 How This new ebook will show you Chapter 4 MU Success Stories how to start Meaningful Use Chapter 5 MU 2014 Tool Box Ten Tips! (MU) in or keep going with it... before the window closes. Learn the important MU Stage 1 and MU Stage 2 changes for this

3 Introduction Don t miss your MU window in 2014! Your MU window of opportunity is still open. But it s starting to close. Especially if you re planning to participate in the Medicare MU program. The tools and support you use in 2014 to make the changes you need to achieve MU Stage 1, and now Stage 2, should more than ever enable you to adapt and thrive in this year of MU expansion, continued ICD-10 transition, HIPAA regulation, and PQRS compliance. The CMS EHR Incentive Programs help offset costs to acquire or upgrade to the certified EHR technology you need to achieve better workflows, patient outcomes, and financial results in today s reform-driven healthcare economy.

4 What are the MU Stages? HITECH envisioned a three-stage process for Meaningful Use. Each stage has a goal and its own final rule a set of objectives developed by the Department of Health and Human Services (HHS) and published in the Federal Register. Who is this program for? Medicare Eligible Professionals (EPs) Doctor of medicine or osteopathy Doctor of dental surgery or dental medicine Doctor of podiatry Doctor of optometry MU Stages Began in 2011 STAGE 1 Capture data in coded format Began in 2014 STAGE 2 Expand exchange of information in the most structured format possible Begins in 2017 STAGE 3 Focus on clinical decision support for high-priority conditions, patient selfmanagement, and access to comprehensive data Chiropractor Medicaid Eligible Professionals (EPs) Physicians (primarily doctors of medicine and doctors of osteopathy) Nurse practitioner Certified nurse/midwife Dentist Physician Assistant (PA) who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant. Eligible Hospitals (EHs) Critical Access Hospitals (CAHs) Learn more about eligibility here

5 Chapter 1. MU 2014 Updates The must-know updates for MU in and beyond Delays and Extensions Along the way, there have been some changes to the MU timeline. First, as part of the Stage 2 final rule, announced in September 2012, and then in December Here s what you must know about these changes.

6 MU Changes 2014 You will meet either Stage 1 or Stage 2 MU depending upon the year of your first MU reporting period:* - Stage 2 if you started in 2011 or Stage 1 if you started in 2013 or plan to start in 2014 You still must attest to 90 days of MU in 2014: - If you have previously attested to MU, your 2014 MU reporting period must align with a calendar quarter (e.g., January-March, April-June, etc.) - You may choose any 90 days if 2014 is your first year of MU under Medicare, or if you are participating in the Medicaid MU program Penalties begin in 2015 if you have not done the following: - Completed your 90 days by the end of calendar year 2014 (Continuing meaningful users) - Attested by October 1, 2014 (First time meaningful users) STAGE 2 Stage 3 MU has been delayed until 2017: With an additional year of Stage 2 in 2016 for providers who started Stage 2 in 2014 Did you know? EPs participate in MU in calendar years while EHs and CAHs participate according to the federal fiscal year. * Good News: In 2014, regardless of your MU Stage you only report and attest for 90 days. STAGE 1 STAGE 3

7 Chapter 2. MU 2014 What MU The must-dos for MU in 2014 Whether you are switching to a new EHR or implementing for the first time, you ll need to go live in time to meet MU in To achieve MU, you ll need to successfully meet an entire set of Core objectives and also select from a of set Menu objectives Core and Menu objectives are designed to measure your use of certified electronic health record technology (CEHRT) for things such as e-prescribing, clinical decision support, and reporting clinical quality measures (CQMs) to CMS

8 Stage 1 and Stage 2 MU Objectives in 2014 and Beyond Clinical Quality Measures (CQMs) in 2014 and Beyond STAGE 1 STAGE AND BEYOND Eligible Professionals 13 core objectives 5 of 9 menu objectives 18 total objectives Eligible Professionals 17 core objectives 3 of 6 menu objectives 20 total objectives Eligible Professionals 9 out of 64 - At least 3 in 6 NQS domains Eligible Hospitals & CAHs 14 core objectives 5 of 10 menu objectives 19 total objectives Eligible Hospitals & CAHs 16 core objectives 3 of 6 menu objectives 19 total objectives Eligible Hospitals & CAHs 16 out of 29 - At least 3 in 6 NQS domains Meaningful Use Stage 2 is live right now! And the final rule for Stage 2 includes some changes to Stage 1. Keep going with your MU program and note these points: Most objectives have numerator/denominator measures Some are basic Yes/No responses All are reported through the CMS MU Incentive Program attestation website or through your state s Medicaid agency You ll also need to choose from a new list of clinical quality measures (CQMs) to report to CMS Beginning in 2014, you have two options for reporting CQMs: Option 1: Report manually (as in prior years) as part of your MU attestation using the EHR Registration & Attestation System Option 2: Report electronically to CMS using the Physician Quality Reporting System (PQRS) Portal National Quality Strategy (NQS) domains 1. Patient and Family Engagement 2. Patient Safety 3. Care Coordination 4. Population/Public Health 5. Efficient Use of Healthcare Resources 6. Clinical Process/Effectiveness NQS domains represent the Department of Health and Human Services (HHS) NQS priorities for a coordinated national health care quality improvement platform.

9 But what s in it for me? Centers for Medicare and Medicaid Services (CMS) created two separate EHR Incentive Programs. Providers must choose one. The Medicare EHR Incentive Program is run by CMS. Under the Medicare incentive program providers can receive up to $44,000 over five years that s big bucks (a little less if you re starting MU Stage 1 for the first time this year). The Medicaid EHR Incentive Program is administered by each state. If you qualify for the Medicaid incentives you can receive up to $63,750 over six years that s bigger bucks.

10 Chapter 3. MU 2014 How The how to for MU success in 2014 Earning MU incentive revenue, and leveraging improved workflows to improve care and reduce costs, requires collaboration and partnership. Partner with an EHR vendor that demonstrates, on several fronts, that their integrated suite of solutions is ready for MU Stage 2 and the transition to ICD-10.

11 Choose carefully. Picking the right EHR for your specialty and your individual practice is important. Finding the vendor that meets your most important needs is a lot like finding the right builder for your home. You check references, assess capabilities, and verify licenses or certifications before making a commitment. Selecting and implementing an EHR is a big commitment. Lofty expectations, broken promises, sub-standard products, lack of training, and lack of vendor resources are the main reasons some EHR vendor relationships just don t work out. Making sure your vendor is a good fit, a good partner, and in it for the long haul is a critical success factor. And, by the way partnership is a two-way street. You ll need to commit time, effort, and resources, as well.

12 Chapter 4. MU Success Stories Now You re Talking! You re probably feeling a little overwhelmed. Don t worry you aren t alone. Every provider who has achieved and attested for Meaningful Use has been where you are right now. But there s hope! Read on to see how providers just like you have successfully achieved Meaningful Use.

13 and client success stories Achieving Meaningful Use as a gateway to Collaborative Care NextGen provided the pathway to move us from PCMH to MU and now on to ACO, while ensuring continuity between the inpatient and outpatient experience. Kimberly Haspert, COO New Pueblo Medicine In 2014, MU Stage 2 success requires making progress on key healthcare reform drivers like patient engagement, collaborative care and care transition, direct exchange of PHI, CPOE for orders, and using clinical decision support to improve patient safety and treatment outcomes. Achieving Meaningful Use and Getting Paid It s a real team effort with a greater purpose, though the incentive is nice, too. I gave my staff a bonus for all the hard work and I bought myself a new EKG! and more MU Success! See how these practices did it New Jersey Health System Puts Docs On Path To Meaningful Use Center for Family Medicine Earns Maximum MU Incentive Dr. Steven Davis HealthCare Partners

14 Chapter 5. MU Toolbox Essential links and information to help you on the path to MU. CMS EHR Incentives Homepage Certified Health IT Product List (CHPL) NextGen Healthcare Updated MU FAQ Every practice needs the tools and tips to help guide them on the path to Meaningful Use. EHR Incentive Program Registration and Attestation MU Stage 1 Objectives MU Stage 2 Objectives CMS Educational Resources for EHR

15 MU Toolbox 10 Tips for Meaningful Use Choose a vendor for your specialty and practice that addresses more than just MU and being ICD-10 ready; is their ONC 2014 Edition certified solution also SNOMED-ready? Ensure vendor is stable, established, and proven, with a solid strategy for the future 1 Register today! Register early, don t wait get this administrative task 3 Build a Meaningful Use SWAT Team out of the way Build a cross-functional, dedicated MU team, consisting You don t need to have an EHR or EHR certification of physicians, other clinicians, administrative, and number to register technical stakeholders Go here: Include an in-house MU subject matter expert, or consider a consultant 2 Select the right certified product for your medical specialty and manner of practice 2014 is a mandatory software upgrade year for all EHR users to 4 Become MU smart! Take advantage of learning opportunities Partner with your vendor; do they provide learning opportunities? an ONC 2014 Edition certified system or module. Partner with Visit Medicare and Medicaid Incentive Program websites a top-five vendor offering proven ONC 2014 Edition certified Attend local, regional, national, or virtual training solutions, training, and support, including extensive MU Stage 2 and ICD-10 transition assistance and information More than 50 percent of attestation made using top five vendors Consider workflow and clinical content for your specialty

16 5 Build an MU action plan 8 Implement a Patient Portal Create a plan that s understood and supported by providers, Stage 1 and Stage 2 required, starting in 2014 executives, administrators, and staff; get early buy-in from all Integrate with EHR and practice management system physicians and staff Must be an ONC 2014 Edition certified solution Create and maintain a formal training schedule Include a friendly but highly visible in-office (and Internet) Include practice time prior to go-live patient portal micro marketing presence with patients Select a go-live period where patient volumes are less to encourage sign-in and use 6 Have an MU ramp-up period 9 Deploy interfaces early Implement and use your EHR for several weeks Lab results must be entered or imported as structured data, a (prior to 90-day reporting) core requirement in Stage 2 Focus on proper use of your EHR (not MU) but Must choose Immunization or Syndromic reporting in Stage 1 you ll find you re doing both just by using your EHR! Immunization reporting is a core requirement in Stage 2 Syndromic, cancer, and specialty registries are Menu 7 Choose your Clinical Quality Measures (CQMs) wisely options in Stage 2. Interfaces to support exchange of health information (Stage 2 includes tougher interoperability requirements) Pick the CQMs most relevant and helpful to your practice MU Stage 2 requires nine out of 64 measures Three of six domains based on NQS six priorities: 10 Perform GAP analysis, THEN ATTEST! 1) Patient and Family Engagement; 2) Patient Safety; Identify missing thresholds and corrective steps 3) Care Coordination; 4) Population and Public Health; Perform attestation once you hit thresholds 5) Efficient Use of Healthcare Resources; Document your results, protect against audit 6) Clinical Process/Effectiveness

17 Core and Menu Objectives MU Stage MU Stage 2 went live this January and carries higher thresholds (than Stage 1) for demonstrating MU and introduces some new core and menu objectives. Changes to Stage 1 also took effect in January. A new Stage 1 Core Objective, that replaces earlier patient engagement objectives (Core and Menu), requires you to provide a way for patients to view online, download, and transmit their own health data [ you ll find this in Stage 2 as well, but with an additional measure for patient participation]. CMS also eliminated a Stage 1 interoperability requirement and dropped a core objective concerning Clinical Quality Measures (CQMs). You still have to report CQMs but there s no core objective stating so, leaving 13 out of the original 15 Stage 1 core measures. U STAGES Core 1. Use CPOE for medication orders 2. Implement drug-drug and drug-allergy interaction checks 3. Maintain a problem list 4. Use erx 5. Maintain a medication list 6. Maintain a medication allergy list 7. Record demographics 8. Record vitals 9. Implement clinical decision support 10. Provide patients ability to view online, download, and transmit their health information 11. Record smoking status 12. Provide patients with clinical summaries 13. Protect health information Menu 1. Implement drug formulary checks 2. Incorporate lab test results 3. Generate a list of patients by condition 4. Send patient reminders 5. Identify patient education 6. Perform medication reconciliation 7. Provide a summary of care record 8. Submit data to an immunization registry 9. Submit syndromic surveillance data to a public health agency

18 Core and Menu Objectives MU Stage Core 1. Use CPOE for medication, laboratory and radiology orders 2. Use erx 3. Record demographics 4. Record vitals 5. Record smoking status 6. Implement clinical decision support 7. Provide patients ability to view online, download, and transmit their health information 8. Provide patients with clinical summaries 9. Protect health information in the EHR 10. Incorporate lab test results 11. Generate a list of patients by condition 12. Send patient reminders 13. Identify patient education 14. Perform medication reconciliation 15. Provide a summary of care record 16. Submit data to an immunization registry 17. Use secure electronic messaging As of January 2014, more than 22,000 providers have already successfully attested for approximately $550 million in MU incentives using certified solutions from NextGen Healthcare* * Based on ONC Medicare attestation data by vendor and an estimate of NextGen Healthcare Medicaid attestations as a percentage of overall Medicaid attestations as reported by CMS Menu 1. Submit syndromic surveillance data to a public health agency 2. Record electronic notes 3. Access imaging results 4. Record family health history 5. Identify and report cancer cases 6. Identify and report specific cases to a specialized registry [non-cancer]

19 Take the next step. Contact us at Or visit nextgen.com MU Bonus Tip! Think Big Picture Embrace the journey Health reform is driving automation and change Pay for Performance replacing Fee-for-Service Keep things in perspective; keep things positive Prepare for change and change NextGen Healthcare Information Systems, LLC 795 Horsham Road, Horsham, PA Copyright 2014 NextGen Healthcare Information Systems, LLC All rights reserved. NextGen is a registered trademark of QSI Management, LLC, an affiliate of NextGen Healthcare Information Systems, LLC. All other names and marks are the property of their respective owners. EDU6-4/14

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