Michigan Medicaid EHR Incentive Program. Ryan Koolen - MDCH

Transcription

1 Michigan Medicaid EHR Incentive Program Ryan Koolen - MDCH

2 Topic Overview 1)Program Basics 2)Participation with the program 3)Program Progress 4)Helpful Information 5)Questions

3 Program Basics Introduction & Background American Recovery and Reinvestment Act of 2009 (ARRA): - Law directed about 150 billion in new funds to the healthcare industry - 87 Million towards Medicaid Billion towards health Information technology - 10 Billion towards the National Institute for health Million to support preventative and wellness activities - Authorized Incentive Payments for certain providers participating with either Medicaid or Medicare.

4 Program Basics Introduction & Background MDCH Data Hub is SOM Infrastructure EHR Incentive Program is the Foundation

5 Program Basics Introduction & Background - Participation in either Medicare or Medicaid Program: - Programs provide financial incentives for the demonstration of Meaningful Use of Certified EHR Technology. - Meeting Certain measurements thresholds ranging from recording patient information as structured data to - Exchanging summary care reports.

6 Program Basics Introduction & Background Run by CMS Medicare EHR Incentive Program Medicaid EHR Incentive Program Run by Your State Medicaid Agency Maximum incentive amount is $44,000 Maximum incentive amount is $63,750 Payments over 5 consecutive years Payment adjustments will begin in 2015 for providers who are eligible but decide not to participate Providers must demonstrate meaningful use every year to receive incentive payments. Payments over 6 years, does not have to be consecutive No payment adjustments for providers who are only eligible for the Medicaid program Year 1 providers can receive an incentive payment for either AIU or MU. Providers must demonstrate meaningful use in the remaining years to receive incentive payments.

7 Program Basics Introduction & Background Stages of Meaningful Use EPs- Calendar year EHs- Fiscal Year Stage Data Capture and Sharing Stage Advance clinical processes Stage Improved Outcomes

8 Program Basics Introduction & Background Stage 1 Data Capture and Sharing Begins in 2011 Stage 2 Advance Clinical Processes Begins in 2014 Stage 3 Improved Outcomes Begins in 2017 Eligible Professionals 13 Core Measures 5/9 Menu Measures Total of 18 Objectives Report on Clinical Quality Measures (CQMs) Eligible Professionals 17 Core Measures 3/6 Menu Measures Total of (20) Objectives Report on Clinical Quality Measures (CQMs) 9/64 To be determined

9 Program Basics Introduction & Background Centers for Medicare & Medicaid Services (CMS) GOALS: 1) Better clinical outcomes 2) Improved population health outcomes 3) Increase transparency and efficiency 4) Empowered individuals 5) Reducing paperwork and improving efficiencies. 6) Facilitating electronic information sharing across providers, payers, and state lines. 7) Enable data sharing using state Health Information Exchanges (HIEs) and National Health Information Networks (NHIN)

10 Provider Registers at CMS Provider is invited by the State to complete registration Provider registers and attests at the State Level State makes Eligibility Determinations Registration is sent to CMS for duplicate check verification Payment is issued and notification is sent to CMS

11 What Eligible Professional can participate with the Medicaid EHR Incentive Program: 1) Physicians 1) Medical Doctor (M.D.) 2) Doctor of Osteopathy (D.O) 2) Dentists (D.D.S. or D.M.D.) 3) Optometrists (D.O.) 4) Nurse Practitioners (NP) 5) Certified Nurse-Midwives (CNM) 6) Physician Assistants (PA) practicing in a PA-Led FQHC or RHC 7) Pediatricians (M.D. or D.O. with certification)

12 Eligibility Criteria: 1) Non-hospital based 2) Eligible Medicaid patient volume 1) Pediatrician (20% Medicaid Volume) 2) Non-pediatrician (30% Medicaid Volume) 3) EPs may not participate in both Medicare & Medicaid 4) There is no longer the ability to switch between Medicare and Medicaid Programs 5) EPs must use certified EHR technology that meets or surpass minimum government requirements for security, privacy, and interoperability

13 Registering for the Medicaid EHR Incentive Program: Federal Registration 1) All EPs MUST have a National Provider Identifier (NPI) 2) An EP must first register with the CMS registration and attestation system (RAS) 1) Individual (type 1) National Provider Identifier (NPI) 2) Payee Tax Identification Number (if reassigning you benefits) 3) Payee National Provider Identifier (NPI) (if reassigning your benefits) 4) Demographic information 5) CMS EHR certification number (not required but strongly recommended) 3) Finally an EP will receive a letter inviting them to complete the registration process in the Community Health Automated Medical Processing System (CHAMPS) 1) There is a 90 day window.

14 Registering for the Medicaid EHR Incentive Program: State Registration 1) Items already submitted to CMS RAS 2) EP 90-day eligibility reporting period 3) Provider Type 4) Encounter Types 1) Hospital 2) Group Proxy 3) Encounters in an FQHC/RHC 4) Medicaid Managed care encounters 5) Any out of state encounters 5) EHR stage information (adopt, implement, upgrade, or meaningful use) 6) CMS EHR Certification ID 7) Contact (if not provided during Federal Level registration)

15 Adoption, Implementation, Upgrading (AIU) and Meaningful Use (MU) 1) AIU- refers to an EP either: 1) Acquiring certified EHR technology (Adoption), e.g., purchasing 2) Using EHR (Implementation), e.g., staff training or data entry 3) Expanding EHR use (Upgrading), e.g., upgrading to a Certified program 2) MU- refers to an EP: 1) Meeting certain program objectives meant to: 1) Improve quality and safety 2) Engage patients and families 3) Improve care coordination, population, and public health 4) Maintain privacy and security of patient health information

16 Reporting Periods Eligibility Reporting Period Continuous 90-day reporting period during which an EP demonstrates that s/he has maintained adequate Medicaid eligible Patient Volume. Meaningful Use (MU) Reporting Period Continuous period during which the EP demonstrates meeting the MU objectives. *Note Program years don t have to be consecutive; EPs can skip years however Medicare payment adjustments for failing to meet MU still apply. Stage 1 Data Capture and Sharing Begins in 2011 Stage 2 Advance Clinical Processes Begins in 2014 Stage 3 Improved Outcomes Begins in Core Measures 5/9 Menu Measures Report on Clinical Quality Measures (CQMs) 17 Core Measures 3/6 Menu Measures Report on Clinical Quality Measures (CQMs) 9/64 To be determined

17 EPs have the option to begin the program in AIU or MU Generally once an EP begins MU, they are in a stage for 2 years START 2014 START MU Option Applicable Stage With Flex Payment Year Program Year Eligibility Reporting Period MU Reporting Period MU Option Applicable Stage With Flex Payment Year Program Year Eligibility Reporting Period MU Reporting Period AIU N/A N/A days n/a MU STAGE 1 YEAR 1 STAGE 1 YEAR days 90 days MU STAGE 1 YEAR 1 N/A days 90 days MU STAGE 1 YEAR 2 N/A days full year MU STAGE 1 YEAR 2 N/A days full year MU STAGE 2 YEAR 1 N/A days full year MU STAGE 2 YEAR 1 N/A days full year MU STAGE 2 YEAR 2 N/A days full year MU STAGE 2 YEAR 2 N/A days full year MU STAGE 3 YEAR 1 N/A days full year MU STAGE 3 YEAR 1 N/A days full year MU STAGE 3 YEAR 2 N/A days full year

18 EPs have the option to begin the program in AIU or MU Generally once an EP begins MU, they are in a stage for 2 years START 2015 START MU Option Applicable Stage Flex Rule Payment Year Program Year Eligibility Reporting Period MU Reporting Period MU Option Applicable Stage Flex Rule Payment Year Program Year Eligibility Reporting Period MU Reporting Period AIU N/A N/A days n/a MU STAGE 1 YEAR 1 N/A days 90 days MU STAGE 1 YEAR 1 N/A days 90 days MU STAGE 1 YEAR 2 N/A days full year MU STAGE 1 YEAR 2 N/A days full year MU STAGE 2 YEAR 1 N/A days full year MU STAGE 2 YEAR 1 N/A days full year MU STAGE 2 YEAR 2 N/A days full year MU STAGE 2 YEAR 2 N/A days full year MU STAGE 3 YEAR 1 N/A days full year MU STAGE 3 YEAR 1 N/A days full year MU STAGE 3 YEAR 2 N/A days full year

19 1) Medicare Payment Adjustments Mandated as part of ARRA. 1) Affects an EP who can participate in either the Medicare or Medicaid EHR Incentive Program UNLESS they are Meaningful Users or were granted a Hardship 2) Eligible Professionals 1) Payment adjustment begin January 1, 2015 and is applied to the Medicare physician fee schedule (PFS) 2) Payment adjustment amount is tied to the year they didn t demonstrate MU 3) Hardship Exceptions 1) An EP may qualify if they are unable to meet MU prior to the Medicare payment adjustment deadline.* *Further information available at

20 Medicare Payment Adjustment: 1. Payment adjustment amount is tied to the year they didn t demonstrate MU. 2. Depending on the total number of EPs who are MU ers under the EHR Incentive Programs after 2018, the maximum payment adjustment can reach as high as 5%. Payment Adjustment year % Adjustment 99% 98% 97% 96% 95% 95% 90 day EHR MU Reporting Period 2013 Full Year EHR MU Reporting Period 2014*

21 Meaningful Use Stage & Payment 1st year AIU $21, TBD TBD TBD TBD 2012 AIU $21, TBD TBD TBD TBD 2013 AIU $21, TBD TBD TBD AIU or MU1 $21, AIU or MU1 $21, AIU or MU1 $21, TBD TBD TBD 3 3

22 Core & Menu Objectives

23 Core Objectives Measures related to medications and allergies. Measures related to Vitals, smoking and electronic records

24 Menu Objectives Labs and patient centered measures Public Health measures

25 Public Health - MCIR Michigan Care Improvement Registry MCIR is an immunization registry that compiles complete immunization histories for children and adults in Michigan Accessed by over 6000 immunizing facilities Total vaccination records over 106 million

26 Public Health - MCIR Public Health Reporting HIE (QOs, VQOs or substate HIEs) State-wide Shared Services MDCH Data Hub

27 Public Health - MSSS Michigan Syndromic Surveillance System A real-time surveillance system that tracks the chief presenting complaints from healthcare providers allowing public health officials and providers to monitor trends and investigate unusual increases in symptom presentations. System sends alerts to Michigan public health officials 95 active facilities submitting syndromic data 2013, 4.5 million registrations averaging 12,343/day

28 Clinical Quality Measures CQM Changes in 2014 Provider Prior to and Beyond* EPs Complete 6 out of 44 3 Core or 3 Alternate core 3 Additional CQMs *Regardless of the stage of MU, all providers will complete this number of CQMs in 2014 Complete 9 out of 64 Choose at least 1 measure from 3 of 6 NQS domains

29 Clinical Quality Measures

30 Clinical Quality Measures

31 Clinical Quality Measures

32 Clinical Quality Measures

33 Grand Total ($) $245,028,545 Program Progress Payments Medicaid EHR Incentive Payments as of EP EH AIU Stage 1 Year 1 N/A N/A Stage 1 Year 2 N/A N/A N/A N/A 38 3 Stage 2 Year 1 N/A N/A N/A 18 N/A N/A N/A 0 Total ($) $100,083,375 $144,945,170 Unique # Total #

34 Helpful Information

35 Helpful Information

36 Helpful Information

37 Helpful Information

38 Helpful Information

39 Helpful Information

40 Comments? Questions? Ryan Koolen - MDCH 400 S. Pine St P.O. Box Lansing, MI koolenr@michigan.gov

41 HIE in Michigan HIE noun : The organization(s) formed to provide services that assist in the exchange of health information. HIE verb : The transmission of healthcarerelated data among facilities, health information organizations (HIO) and government agencies according to National standards. Ultimately HIE allows doctors, nurses, pharmacists, other health care providers and patients to appropriately access and securely share a patient s vital medical information electronically.

42 What Does HIE (verb) Do? Benefits Avoiding repeat diagnostic tests Enables a clinician to add or remove a differential diagnosis in a timely fashion Prevent future or fill known and unknown knowledge deficits Optimal choice of tests and therapy More rapid response to a contraindication or any necessary refinements to a given therapy Care coordination: helps ensure that the next clinician involved in the patient s care will see the relevant information about the patient! Adapted from Hripcsak et al. (2007) Copyright Michigan Health Information Network Shared Services 42

43 Statewide Coordination Duplication of effort, waste, & expense (N x N-1 connections) Shared Services (N connections) Patients & Families Physicians Public Health Patients & Families Physicians Public Health Lab tests & XRAYs Specialty Providers Lab tests & XRAYs Specialty Providers Hospitals & Clinics Medications Insurance Companies Hospitals & Clinics Medications Health Plans Copyright 2014 Michigan Health Information Network 43

44 Network of Networks: Federal Health Plan QOs (more coming) Immunizations MSSS Consumer QOs (more coming) HIE QOs (Qualified sub-state HIEs) State-wide Shared Services Mi Syndromic Surveillance System MDCH Data Hub Data Warehouse Mi Disease Surveillance System State LABS Medicaid Doctors & Community Providers Virtual QOs Pharmacies (more coming) Single point of entry/exit for state Copyright 2014 Michigan Health Information Network 44

45 Clear Chain of Trust Covered Entity Qualified Sub-state HIE Business or VQO Associate Business Associate Covered Entity Qualified Sub-state HIE Business or VQO Associate Covered Entity Copyright Michigan Health Information Network Shared Services 45