Overview of the EHR Incentive Program

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1 Overview of the EHR Incentive Program presented by Meaningful Use Stages 1 & 2 1

2 P Automated coding P Chief-complaint-driven P AnticiPlate Technology P Point-and-Click Functionality P erx through Surescripts P Follow-up Functionality P ExitCare Instruction Sheets P Credit Card Preauthorization P Rapid charting P Prepackaged medication dispensing P Viztek (radiology software) integration Startup Success provided by NMN Consultants 100+ Urgent Care Startup Clients We help clients stay on target and on time, leaving no uncompleted task significant to the clinic opening 22+ Years in Urgent Care with Ownership Experience Our team of experienced leaders does nothing but urgent care, having worked directly in the industry Nationally Recognized Leadership NMN Consultants industry leaders bring expertise in urgent care startups, software solutions, billing, and contract and credentialing All Pieces Tried & Tested Standard startup consulting includes market analysis, site selection, business license, business plan, and more Patrice Pash, BSN, RN Senior Consultant, NMN Consultants Our team of experienced leaders is dedicated to giving you the tools for startup success. (888) Meaningful Use Stages 1 & 2

3 Meaningful Use Stages 1 & 2 Presented by Practice Velocity, LLC As a part of the American Recovery and Reinvestment Act of 2009 (ARRA), the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed by Congress and signed into law by President Obama in This long-awaited legislation is intended to improve the quality, efficiency, and safety of the nation s healthcare system by incentivizing qualifying physicians and hospitals who embrace information technology. These incentives, which are being offered to qualifying physicians who adopt certified electronic health records, come in the form of two payment programs available through Medicare and Medicaid. The purpose of these incentives is a part of a broader effort to reform the U.S. healthcare system through the acceleration of the usage of health information technology (HIT) and electronic health records (EHR). The goal is for the meaningful use of EHR technology, which must meet the certification standards defined by the Office of the National Coordinator for Health Information Technology (ONC), to result in healthcare that is patient-centered, evidence-based, prevention-oriented, efficient, and equitable. Overview of the Medicare EHR Incentive Program The Medicare EHR Incentive Program began in 2011, and EHR incentive payments under Medicare will continue through Depending on the first year they participate, eligible professionals (EP) can participate for up to five continuous years throughout the duration of the program, and can receive up to $44,000 over five years. Additional incentives are available to eligible professionals who provide services in a Health Professional Shortage Area (HPSA). The last year to begin participation in the Medicare EHR Incentive Program is Qualifying EPs are eligible to receive up to 75 percent of their Medicare allowable charges, subject to maximum payments, with incentive payments ending after The reporting period for the first year is any 90 continuous days during the calendar year. The reporting period for all subsequent years is the entire calendar year, except for 2014 during which EPs can retain the 90-day reporting period. After 2015, Medicare EPs who do not successfully demonstrate meaningful use will receive a 1 percent payment reduction in their Medicare allowed charges. This reduction will increase by 1 percent each year and is projected to cap at 5 percent, with the penalty potentially becoming permanent based on the discretion of the Secretary of Health and Human Services. Medicare eligible professional (EP) Doctor of medicine or osteopathy Doctor of dental surgery or dental medicine Doctor of podiatric medicine Doctor of optometry Chiropractor The HITECH Act includes an exception for the payment reduction in order to assist EPs who may experience significant hardship by complying with the requirements for being a meaningful EHR user, such as a rural EP without sufficient Internet access. These exemptions will be determined by the Secretary on a case-by-case basis and will be subject to annual renewal. However, no EP will be granted an exemption for more than 5 years. Table 1: Medicare EHR Incentive Program Payment Schedule for Eligible Professionals Payment amount for 2011 will be If qualified to receive first payment in 2011 $18, $12,000 $18, $8,000 $12,000 $15, $4,000 $8,000 $12,000 $12, $2,000 $4,000 $8,000 $8, $2,000 $4,000 $4,000 Total payment $44,000 $44,000 $39,000 $24,000 Meaningful Use Stages 1 & 2 3

4 Medicaid eligible professional (EP) Physician Nurse practitioner Certified nurse-midwife Dentist Physician assistant who furnishes services in a Federally Qualified Health Center or (FQHC) Rural Health Clinic (RHC) Overview of Medicaid EHR Incentive Program Eligible professionals can receive up to $63,750 as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in their first year of participation and demonstrate meaningful use for up to six remaining years. It s important to note this distinction from the Medicare program, as Medicaid program participants are not necessarily required to prove meaningful use in their first participation year. It is possible for Medicare program participants to qualify within their first participation year by adopting, implementing, or upgrading of/to certified EHR technology and demonstrating meaningful use in subsequent participation years. The Medicaid program is voluntarily offered by individual states and territories. As of May 2013, the EHR Incentive Program is offered with open registration for all states except Hawaii. The District of Columbia opened July There are no payment adjustments under the Medicaid EHR Incentive Program. EPs who meet the requirements of both the Medicare and Medicaid programs may participate in only one program and must designate the program in which they would like to participate. After a payment is made, EPs can change their program selection only once before In order to prevent duplicate payments, hospital-based eligible professionals, which are defined as EPs who furnish 90 percent or more of their allowed services in a hospital inpatient setting or hospital emergency department, are not eligible for either incentive program. As of March 2013, more than 259,000 health care providers received payment for participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. As of March 2013, more than $8.2 billion in Medicare EHR Incentive Program payments have been made, and more than $5.2 billion in Medicaid EHR Incentive Program payments have been made. Certified Technology In order to receive certification, EHR technology must meet the standards of technology capability, functionality, and security that assist purchasers and users in meeting the meaningful use criteria set by the Centers for Medicare and Medicaid Services (CMS), a crucial component of the incentive program. CMS worked closely with ONC to ensure the certification standards for EHR technology are coordinated with the definition of meaningful use of certified EHR technology. Table 2: Medicaid EHR Incentive Program Payment Schedule for Eligible Professionals Payment amount for 2011 will be If qualified to receive first payment in 2011 $21, $21, $21, $21, $21, $21, Total payment $63,750 $63,750 $63,750 $63,750 $63,750 $63,750 4 Meaningful Use Stages 1 & 2

5 Meaningful Use It s not enough to simply adopt and implement EHR technology; eligible professionals must use the technology in a meaningful way in order to achieve the health and efficiency goals outlined in the HITECH Act. The main components of meaningful use involve the use of certified EHR technology for the electronic exchange of health information to improve the quality of healthcare and to submit clinical qualities and other measures. EPs, however, will not just reap financial benefits from complying with the meaningful use regulations. They will also experience benefits such as reduction in errors; availability of records and data; reminders and alerts; clinical decision support; and e-prescribing/refill automation. Criteria for Meaningful Use In the Medicare and Medicaid Programs and Electronic Health Record Incentive Program Final Rule, CMS acknowledges the final regulations for meaningful use are ambitious given the current state of technology and standards of care. However, the expectation is that the delivery of healthcare will evolve through the implementation of the incentive programs. The criteria for meaningful use outlined in the Final Rule is based on what technology is currently available coupled with provider practice experience, with a more robust definition to be determined in the future based on anticipated developments in technology. To allow for this continued evolvement of meaningful use criteria, CMS will implement the criteria outlined in the Final Rule in three stages. Stage 1 (2011, 2012, 2013) sets the baseline for electronic data capture and information sharing, while Stage 2 (2014) and Stage 3 (2016) will continue to expand on this baseline. As the expectations for health information exchange become more inclusive in Stages 2 and 3, the end result is to bring to fruition the goal that information follows the patient. Table 3: Important Incentive Program Dates Jan. 1, 2013 Reporting year begins for eligible professionals 90 days for first year of participation. Entire year for subsequent years of participation. Some Stage 1 changes take effect, others are optional. Feb. 28, 2013 Last day for eligible professionals to register and attest to receive an Incentive Payment for calendar year (CY) Sept. 30, 2013 Last day of the federal fiscal year. Oct. 3, 2013 Last day for eligible professionals to begin their 90-day reporting period for CY 2013 for the Medicare EHR Incentive Program. Dec. 31, 2013 Reporting year ends for eligible professionals. Jan. 1, 2014 Reporting period begins for eligible professionals for CY days for ALL participants. Stage 2 begins for eligible professionals. Eligible professionals attest for a three-month reporting period, regardless of when they began participation in the Medicare EHR Incentive Program. Last year eligible professionals can begin the Medicare EHR Incentive Program. Feb. 28, 2014 Last day for eligible professionals to register and attest to receive an Incentive Payment for CY 2013 for the Medicare EHR Incentive Program. Sept. 30, 2014 Last day of the federal fiscal year. Oct. 3, 2014 Last day for eligible professionals to begin 90-day reporting period for CY 2014 for the Medicare EHR Incentive Program. Last year eligible professionals can begin the Medicare EHR Incentive Program. Dec. 31, 2014 Reporting year ends for eligible professionals. Meaningful Use Stages 1 & 2 5

6 Goals for Stage 1 1. Electronically capturing health information in a standardized format 2. Using that information to track key clinical conditions 3. Communicating that information for care coordination processes 4. Initiating the reporting of clinical quality measures and public health information 5. Using information to engage patients and their families in their care Stage 1 The main focus in stage 1 is establishing the functionalities of certified EHR technology that set the stage for continuous quality improvement and ease of information exchange. Under Stage 1, EPs must meet 14 required core objectives and 5 menu objectives from a list of 10. Each objective is aligned with a measure for how healthcare professionals will be expected to report on their usage of EHR technology, as well as any exclusions that take into account healthcare professionals with practice limitations that hinder their participation in the program. Previously in the Stage 1 meaningful use regulations, CMS had established a time line that required providers to progress to Stage 2 criteria after two program years under the Stage 1 criteria. This original time line would have required Medicare providers who first demonstrated meaningful use in 2011 to meet the Stage 2 criteria in However, CMS delayed the onset of Stage 2 criteria. The earliest the Stage 2 criteria will be effective is in calendar year 2014 for EPs. Table 4 below illustrates the progression of meaningful use stages from when a Medicare provider begins participation in the program. In the first year of participation of Stage 1, providers must demonstrate meaningful use for a 90-day EHR reporting period; in subsequent years, providers will demonstrate meaningful use for a full calendar year EHR reporting period except in 2014, described below. Providers who participate in the Medicaid EHR Incentive Programs are not required to demonstrate meaningful use in consecutive years as described by the table below, but their progression through the stages of meaningful use would follow the same overall structure of two years meeting the criteria of each stage, with the first year of meaningful use participation consisting of a 90-day EHR reporting period. As of January 1, 2013, some changes to the Stage 1 meaningful use objectives, measures, and exclusions for eligible professionals have taken effect. Other Stage 1 changes will not take effect until 2014 and are optional in Table 4: Stages of Meaningful Use Criteria by Payment Year Stage of Meaningful Use First Payment Year Stage 1 Stage 1 Stage 1 Stage 2 Stage 2 Stage 3 Stage 3 TBD TBD TBD TBD 2012 Stage 1 Stage 1 Stage 2 Stage 2 Stage 3 Stage 3 TBD TBD TBD TBD 2013 Stage 1 Stage 1 Stage 2 Stage 2 Stage 3 Stage 3 TBD TBD TBD 2014 Stage 1 Stage 1 Stage 2 Stage 2 Stage 3 Stage 3 TBD TBD 2015 Stage 1 Stage 1 Stage 2 Stage 2 Stage 3 Stage 3 TBD 2016 Stage 1 Stage 1 Stage 2 Stage 2 Stage 3 Stage Stage 1 Stage 1 Stage 2 Stage 2 Stage 3 For 2014 Only All providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a three-month EHR reporting period. For Medicare providers, this three-month reporting period is fixed to the quarter of the calendar year in order to align with existing CMS quality measurement programs, such as the Physician Quality Reporting System (PQRS) and Hospital Inpatient Quality Reporting (IQR). For Medicaid providers only eligible to receive Medicaid EHR incentives, the three-month reporting period is not fixed, where providers do not have the same alignment needs. CMS is permitting this one-time, three-month reporting period in 2014 only so that all providers who must upgrade to 2014 Certified EHR Technology will have adequate time to implement new Certified EHR systems. 6 Meaningful Use Stages 1 & 2

7 Stage 2 CMS published the Final Rule in September 2012 that specifies the Stage 2 criteria that EPs must meet in order to continue to participate in the Medicare and Medicaid EHR Incentive Programs. All providers must achieve meaningful use under the Stage 1 criteria before moving to Stage 2. The earliest the Stage 2 criteria will be effective is in fiscal year Stage 2 retains the core and menu structure for meaningful use objectives. Although some objectives have been combined or eliminated, most of the Stage 1 objectives are now core objectives under the Stage 2 criteria. For many of these Stage 2 objectives, the threshold that providers must meet for the objective has been raised as CMS expects providers in Stage 2 to demonstrate meaningful use for an even larger portion of their patient populations. To demonstrate meaningful use under Stage 2 criteria, EPs must meet 17 core objectives and 3 menu objectives that they select from a total list of 6, or a total of 20 objectives. Though most of the new objectives introduced for Stage 2 are menu objectives, EPs have a new core objective they must achieve. CMS believes this objective will have a positive impact on patient care and safety and are therefore requiring all providers to meet the objectives in Stage 2. Goals for Stage 2 1. More rigorous health information exchange (HIE) 2. Increased requirements for e-prescribing and incorporating lab results 3. Electronic transmission of patient care summaries across multiple settings 4. More patient-controlled data New Stage 2 Core Objective for EPs: Use secure electronic messaging to communicate with patients on relevant health information Stage 2 also replaces the previous Stage 1 objectives to provide electronic copies of health information or discharge instructions and provide timely access to health information with objectives that allow patients to access their health information online. Stage 2 Patient Access Objective for EPs: Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP The Stage 2 criteria place an emphasis on health information exchange between providers to improve care coordination for patients. One of the core objectives for EPs requires providers who transition or refer a patient to another setting of care to provide a summary of care record for more than 50 percent of those transitions of care and referrals. Additionally, there are new requirements for the electronic exchange of summary of care documents: For more than 10 percent of transitions and referrals, EPs that transition or refer their patient to another setting of care or provider of care must provide a summary of care record electronically. The EP that transitions or refers their patient to another setting of care or provider of care must either a) conduct one or more successful electronic exchanges of a summary of care record with a recipient using technology that was designed by a different EHR developer than the sender s, or b) conduct one or more successful tests with the CMS-designated test EHR during the EHR reporting period. Stage 3 The Health IT Policy Committee (HITPC) released the preliminary recommendations for Meaningful Use Stage 3 requirements, slated to go into effect in The proposed rule will focus on sustainability of the program through improvements in quality, safety, and efficiency that improve health outcomes. Preliminary recommendations for Stage 3 would retire some measures, increase thresholds for others and add new requirements to achieve meaningful use. Some key Stage 3 changes are: Smoking status would be tracked by a CQM. Implementing 15 clinical decision support intervention requirements. Requiring clinical summaries be sent to patients within one business day during 50 percent of eligible encounters. Directing practices to use EHRs to query research systems for clinical trials. New certification criteria would identify patient eligibility for relevant trials. Requiring the identification of education resources in five non-english languages; 80 percent of materials written in at least one of those languages be made available to patients. Goals for Stage 3 1. Improving quality, safety, and efficiency, leading to improved health outcomes 2. Decision support for national high-priority conditions 3. Patient access to selfmanagement tools 4. Access to comprehensive patient data through patient-centered HIE 5. Improving population health Meaningful Use Stages 1 & 2 7

8 Stage 1 Core Set Objectives Objectives Measures Exclusions 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. 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). More than 30% of all unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE. Optional Alternate: More than 30% of medication orders created by the EP during the EHR reporting period are recorded using CPOE. The EP has enabled this functionality for the entire EHR reporting period. More than 80% of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data. More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology. Any EP who writes fewer than 100 prescriptions during the EHR reporting period. 1.) Any EP who writes fewer than 100 prescriptions during the EHR reporting period; 2.) Any EP who does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP s practice location at the start of his/her EHR reporting period. Maintain active medication list. Maintain active medication allergy list. Record all of the following demographics: preferred language, gender, race, ethnicity, date of birth. 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. Record smoking status for patients 13 years old or older. Report ambulatory clinical quality measures to CMS or, in the case of Medicaid EPs, the states. Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule. More than 80% of all unique patients seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data. More than 80% of all unique patients seen by the EP have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data. More than 50% of all unique patients seen by the EP have demographics recorded as structured data. For more than 50% of all unique patients ages 2 and older seen by the EP, height, weight, and blood pressure are recorded as structured data. New Measure (Optional 2013; Required 2014 and beyond): For more than 50% of all unique patients seen by the EP during the EHR reporting period have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data. More than 50% of all unique patients ages 13 or older seen by the EP have smoking status recorded as structured data. Successfully report to CMS ambulatory clinical quality measures selected by CMS in the manner specified by CMS. Implement one clinical decision support rule. Any EP who either sees no patients 2 years or older or who believes that all three vital signs of height, weight, and blood pressure of their patients have no relevance to their scope of practice. Any EP who either sees no patients 2 years or older, or who believes that all three vital signs of height, weight, and blood pressure of their patients have no relevance to their scope of practice. New Exclusion (Optional 2013; Replaces exclusion above in 2014): Any EP who 1.) Sees no patients 3 years or older is excluded from recording blood pressure; 2.) Believes that all three vital signs of height, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them; 3.) Believes that height and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure; or 4.) Believes that blood pressure is relevant to their scope of practice, but height and weight are not, is excluded from recording height and weight. Any EP who sees no patients 13 years or older. No exclusions. Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, medication allergies) upon request. More than 50% of all patients who request an electronic copy of their health information are provided it within 3 business days. Any EP who has no requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period. Provide clinical summaries for patients for each office visit. Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. Clinical summaries provided to patients for more than 50% of all office visits within 3 business days. Conduct or review a security risk analysis in accordance with the requirements under 45 CFR (a) (1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process. Any EP who has no office visits during the EHR reporting period. 8 Meaningful Use Stages 1 & 2

9 Stage 1 Menu Set Objectives Objectives Measures Exclusions Implement drug formulary checks. Incorporate clinical lab test results into EHR as structured data. 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. Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within four business days of the information being available to the EP. Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. 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. 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 data to immunization registries or immunization information systems and actual submission according to applicable law and practice. Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice. The EP has enabled this functionality and has access to at least one internal or external formulary for the entire EHR reporting period. More than 40% of all clinical lab test results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data. Generate at least one report listing patients of the EP with a specific condition. More than 20% of all patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period. At least 10% of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP s discretion to withhold certain information. More than 10% of all unique patients seen by the EP are provided patient-specific education resources. The EP performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP. The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals. Performed at least one test of certified EHR technology s capacity to submit electronic data to immunization registries and follow-up submission if the test is successful (unless none of the immunization registries to which the EP submits such information has the capacity to receive the information electronically), except where prohibited. Performed at least one test of certified EHR technology s capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP submits such information has the capacity to receive the information electronically), except where prohibited. Any EP who writes fewer than 100 prescriptions during the EHR reporting period. An EP who orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period. An EP who has no patients 65 years old or older or 5 years old or younger with records maintained using certified EHR technology. Any EP that neither orders nor creates lab tests or information that would be contained in the problem list, medication list, medication allergy list (or other information as listed at 45 CFR (g)) during the EHR reporting period. An EP who was not the recipient of any transitions of care during the EHR reporting period. An EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period. An EP who administers no immunizations during the EHR reporting period, where no immunization registry has the capacity to receive the information electronically, or where it is prohibited. An EP who does not collect any reportable syndromic information on their patients during the EHR reporting period, does not submit such information to any public health agency that has the capacity to receive the information electronically, or if it is prohibited. Changes to Stage 1 in 2013 REQUIRED for all providers in 2013 Public Health Reporting Objectives Change: Clarification that providers must perform at least one test of their certified EHR technology s capability to send data to public health agencies, except where prohibited Timing/Compliance: Required in 2013 and beyond for all Stage 1 public health objectives What It Means: The intent of this modification is to encourage all EPs to submit public health data, even when not required by State/local law. Therefore, if providers are authorized to submit the data, they should do so even if it is not required by either law or practice. REMOVED for all providers in 2013 Electronic Exchange of Key Clinical Information Change: Removal of electronic exchange of key clinical information objective for Stage 1 Timing/Compliance: Removed in 2013 and beyond What It Means: Providers will no longer have to meet or attest to this objective for the EHR Incentive Programs. Meaningful Use Stages 1 & 2 9

10 Stage 2 Core Set Objectives, Table 1 of 2 Objectives Measures Exclusions Use computerized provider order entry (CPOE) for medication, laboratory, and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines. Generate and transmit permissible prescriptions electronically (erx). Record the following demographics: preferred language, sex, race, ethnicity, date of birth. More than 60% of medication, 30% of laboratory, and 30% of radiology orders created by the EP during the EHR reporting period are recorded using CPOE. More than 50% of all permissible prescriptions, or all prescriptions, written by the EP are queried for a drug formulary and transmitted electronically using CEHRT. More than 80% of all unique patients seen by the EP have demographics recorded as structured data. Any EP who writes fewer than 100 medication, radiology, or laboratory orders during the EHR reporting period. Any EP who: (1) Writes fewer than 100 permissible prescriptions during the EHR reporting period; (2) Does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP s practice location at the start of his/her EHR reporting period. Record and chart changes in the following vital signs: height/length and weight (no age limit); blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI. More than 80% of all unique patients seen by the EP have blood pressure (for patients age 3 and over only) and/or height and weight (for all ages) recorded as structured data. Any EP who: (1) Sees no patients 3 years or older is excluded from recording blood pressure; (2) Believes that all 3 vital signs of height/length, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them; (3) Believes that height/length and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure; (4) Believes that blood pressure is relevant to their scope of practice, but height/ length and weight are not, is excluded from recording height/length and weight. Record smoking status for patients 13 years old or older. Use clinical decision support to improve performance on high-priority health conditions. More than 80% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data. Measure 1: Implement five clinical decision support interventions related to four or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. Absent four clinical quality measures related to an EP s scope of practice or patient population, the clinical decision support interventions must be related to high-priority health conditions. Measure 2: The EP has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period. Any EP that neither sees nor admits any patients 13 years old or older. For the second measure, any EP who writes fewer than 100 medication orders during the EHR reporting period. Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP. Measure 1: More than 50% of all unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within four business days after the information is available to the EP) online access to their health information. Measure 2: More than 5% of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information. Any EP who: (1) Neither orders nor creates any of the information listed for inclusion as part of both measures, except for Patient name and Provider s name and office contact information, may exclude both measures; (2) Conducts 50% or more of his/her patient encounters in a county that does not have 50% or more of its housing units with 3Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period may exclude only the second measure. Provide clinical summaries for patients for each office visit. Protect electronic health information created or maintained by the certified EHR technology (CEHRT) through the implementation of appropriate technical capabilities. Incorporate clinical lab-test results into Certified EHR Technology (CEHRT) as structured data. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. Clinical summaries provided to patients or patientauthorized representatives within one business day for more than 50% of office visits. Conduct or review a security risk analysis in accordance with the requirements under 45 CFR (a) (1), including addressing the encryption/security of data stored in CEHRT in accordance with requirements under 45 CFR (a)(2)(iv) and 45 CFR (d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the provider s risk management process for EPs. More than 55% of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in Certified EHR Technology as structured data. Generate at least one report listing patients of the EP with a specific condition. Any EP who has no office visits during the EHR reporting period. Any EP who orders no lab tests where results are either in a positive/negative affirmation or numeric format during the EHR reporting period. 10 Meaningful Use Stages 1 & 2

11 Stage 2 Core Set Objectives, Table 2 of 2 Objectives Measures Exclusions Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference. Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient. More than 10% of all unique patients who have had two or more office visits with the EP within the 24 months before the beginning of the EHR reporting period were sent a reminder, per patient preference when available. Patient-specific education resources identified by Certified EHR Technology are provided to patients for more than 10% of all unique patients with office visits seen by the EP during the EHR reporting period. Any EP who has had no office visits in the 24 months before the EHR reporting period. Any EP who has no office visits during the EHR reporting period. 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. 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 data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice. The EP who performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP. EPs must satisfy both of the following measures in order to meet the objective: Measure 1: The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals; Measure 2: The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 10% of such transitions and referrals either (a) electronically transmitted using CEHRT to a recipient or (b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the NwHIN; Measure 3: An EP must satisfy one of the following criteria: (a) Conducts one or more successful electronic exchanges of a summary of care document, as part of which is counted in measure 2 (for EPs the measure at 495.6(j)(14)(ii)(B) with a recipient who has EHR technology that was developed designed by a different EHR technology developer than the sender s EHR technology certified to 45 CFR (b)(2). (b) Conducts one or more successful tests with the CMS designated test EHR during the EHR reporting period. Successful ongoing submission of electronic immunization data from CEHRT to an immunization registry or immunization information system for the entire EHR reporting period. Any EP who was not the recipient of any transitions of care during the EHR reporting period. Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period is excluded from all three measures. Any EP that meets one or more of the following criteria may be excluded from this objective: (1) the EP does not administer any of the immunizations to any of the populations for which data is collected by their jurisdiction s immunization registry or immunization information system during the EHR reporting period; (2) the EP operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required for CEHRT at the start of their EHR reporting period; (3) the EP operates in a jurisdiction where no immunization registry or immunization information system provides information timely on capability to receive immunization data; or (4) the EP operates in a jurisdiction for which no immunization registry or immunization information system that is capable of accepting the specific standards required by CEHRT at the start of their EHR reporting period can enroll additional EPs. Use secure electronic messaging to communicate with patients on relevant health information. A secure message was sent using the electronic messaging function of CEHRT by more than 5% of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period. Any EP who has no office visits during the EHR reporting period, or any EP who conducts 50% or more of his or her patient encounters in a county that does not have 50% or more of its housing units with 3Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period. Meaningful Use Stages 1 & 2 11

12 Stage 2 Menu Set Objectives Objectives Measures Exclusions Capability to submit electronic syndromic surveillance data to public health agencies except where prohibited, and in accordance with applicable law and practice. Record electronic notes in patient records. Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT. Record patient family health history as structured data. Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice. Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice. Successful ongoing submission of electronic syndromic surveillance data from CEHRT to a public health agency for the entire EHR reporting period. Enter at least one electronic progress note created, edited and signed by an EP for more than 30 percent of unique patients with at least one office visit during the EHR Measure reporting period. The text of the electronic note must be text searchable and may contain drawings and other content More than 10% of all tests whose result is one or more images ordered by the EP during the EHR reporting period are accessible through CEHRT. More than 20% of all unique patients seen by the EP during the EHR reporting period have a structured data entry for one or more first-degree relatives. Successful ongoing submission of cancer case information from CEHRT to a public health central cancer registry for the entire EHR reporting period. Successful ongoing submission of specific case information from CEHRT to a specialized registry for the entire EHR reporting period. Any EP that meets one or more of the following criteria may be excluded from this objective: (1) the EP is not in a category of providers that collect ambulatory syndromic surveillance information on their patients during the EHR reporting period; (2) the EP operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data in the specific standards required by CEHRT at the start of their EHR reporting period; (3) the EP operates in a jurisdiction where no public health agency provides information timely on capability to receive syndromic surveillance data; or (4) the EP operates in a jurisdiction for which no public health agency that is capable of accepting the specific standards required by CEHRT at the start of their EHR reporting period can enroll additional EPs. Any EP who orders less than 100 tests whose result is an image during the EHR reporting period; or any EP who has no access to electronic imaging results at the start of the EHR reporting period. Any EP who has no office visits during the EHR reporting period. Any EP that meets at least 1 of the following criteria may be excluded from this objective: (1) The EP does not diagnose or directly treat cancer; (2) The EP operates in a jurisdiction for which no public health agency is capable of receiving electronic cancer case information in the specific standards required for CEHRT at the beginning of their EHR reporting period; (3) The EP operates in a jurisdiction where no PHA provides information timely on capability to receive electronic cancer case information; or (4) The EP operates in a jurisdiction for which no public health agency that is capable of receiving electronic cancer case information in the specific standards required for CEHRT at the beginning of their EHR reporting period can enroll additional EPs. Any EP that meets at least 1 of the following criteria may be excluded from this objective: (1) The EP does not diagnose or directly treat any disease associated with a specialized registry sponsored by a national specialty society for which the EP is eligible, or the public health agencies in their jurisdiction; (2) The EP operates in a jurisdiction for which no specialized registry sponsored by a public health agency or by a national specialty society for which the EP is eligible is capable of receiving electronic specific case information in the specific standards required by CEHRT at the beginning of their EHR reporting period; (3) The EP operates in a jurisdiction where no public health agency or national specialty society for which the EP is eligible provides information timely on capability to receive information into their specialized registries; or (4) The EP operates in a jurisdiction for which no specialized registry sponsored by a public health agency or by a national specialty society for which the EP is eligible that is capable of receiving electronic specific case information in the specific standards required by CEHRT at the beginning of their EHR reporting period can enroll additional EPs. Educational Resources CMS has a number of resources to help you participate in the programs. Audio recordings, written transcripts, and presentation materials from provider training sessions are available online. Visit then click on Regulations and Guidance > EHR Incentive Programs > Educational Resources 12 Meaningful Use Stages 1 & 2

13 Clinical Quality Measures In addition to the core and menu set objectives that prove meaningful use of EHR technology, healthcare professionals must also attest to clinical quality measures (CQMs) that provide a qualitative look at their technology usage. CMS defines CQMs as measures of processes; experience, and/or outcomes of patient care; observations; or treatment that relates to one or more quality aims for healthcare, such as effective, safe, efficient, patient-centered, equitable, and timely care. Currently, in Stage 1 of meaningful use CQMs are required as a core meaningful use objective. EPs must submit data from certified EHR Technology CQMs in order to receive an incentive payment. In Stage 2, CQMs are no longer a core meaningful use objective; however, EPs are still required to submit CQMs in order to successfully participate in the program. There are two sets of recommended CQMs, one set of nine CQMs for adults and one set of nine CQMs for children. Selected CQMs must cover at least three of the National Quality Strategy s (NQS) domains. The priorities are Patient and Family Engagement, Patient Safety, Care Coordination, Population/Public Health, Efficient Use of Healthcare Resources, and Clinical Process/Effectiveness. There are 44 clinical quality measures for eligible professionals 3 core, 3 alternate core, and 38 additional CQMs. The core measures for EPs include blood pressure measurement; tobacco use assessment and cessation intervention; and adult weight screening and follow-up. More detailed information on the CQMs is available in the Final Rule or is downloadable from the CMS website CQM for 2013: EPs will continue to report from the 44 measures finalized for Stage 1 in the same schema laid out for Stage 1 3 core/alternate core 3 additional measures for EPs CQM Updates Although reporting CQMs is no longer a core objective of the EHR Incentive Program and listed as one of the meaningful use objectives, all providers are required to report on CQMs in order to demonstrate meaningful use. Clinical quality reporting is now tied to year, rather than stage. Regardless of the stage of meaningful use, all providers are subject to the expanded measure set in 2014 and beyond. CQM for 2014: Beginning in 2014, all providers, regardless of whether they are in Stage 1 or Stage 2, will be required to report on the 2014 CQMs finalized in the Stage 2 rule. How to Prove Meaningful Use In 2013, there are two reporting methods available for reporting the Stage 1 measures: Attestation ( Physician Quality Reporting System EHR Incentive Program Pilot for EPs Beginning in 2014, all Medicare-eligible providers beyond their first year of demonstrating meaningful use must electronically report their CQM data to CMS. (Medicaid EPs that are eligible only for the Medicaid EHR Incentive Program will electronically report their CQM data to their state.) EPs can electronically report CQMs either individually or as a group using the following: Physician Quality Reporting System (PQRS) Electronic submission of samples of patient-level data. EPs can also report as group using the PQRS GPRO tool. EPs beyond the first year of demonstrating meaningful use who electronically report using this option will meet both their EHR Incentive Program and PQRS reporting requirements. CMS Portal Electronic submission of aggregate-level data. Medicare Payment Adjustments Medicare payment adjustments are required by statute to take effect in The rule finalized a process in which payment adjustment will be determined by an EHR reporting period prior to the payment adjustment year Any Medicare EP that demonstrates meaningful use in 2013 will avoid payment adjustment in Also, a Medicare EP that first demonstrates meaningful use in 2014 will avoid the penalty if they successfully register and attest to meaningful use by October 1, Meaningful use attestations to State Medicaid Agencies by EPs who are eligible for either Medicare or Medicaid but opted for Medicaid, will be accepted to avoid the Medicare penalty. However, Medicaid EHR incentive payments for adopt, implement, or upgrade will not be considered having met meaningful use for those same providers (there is no payment adjustment for Medicaid payments to eligible professionals). Meaningful Use Stages 1 & 2 13

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