Teasing Some Meaning Out of Meaningful Use

Transcription

1 Teasing Some Meaning Out of Meaningful Use An Overview Colorado Bar Association, Health Law Section December 15, 2010 Steve Nash, Partner Melodi (Mel) Mosley Gates Agenda Incentives for Healthcare Providers The EHR Adoption Challenge Timeline What is Meaningful Use? Companion Rulemakings ONC: Certified EHR Technology Certification Program CMS: Meaningful Use Requirements Stage 1: Requirements, Objectives & Clinical Quality Measures Stages 2 & 3: Guidance Challenges for Healthcare Providers Resources

2 Incentives for Healthcare Providers HITECH Act Provides Both Medicare & Medicaid Programs Eligible Providers (EPs) May Choose One, But Not Both Medicare Eligible Providers May Earn Up to $44K in Up to $48,400 for Health Provider Shortage Areas No Incentives If First Eligible Year is After 2014 Penalties for Non-Adoption Begin in 2015 Lose 1% of Fee Schedule Payments, Escalating to 3% by 2017 Significant Hardship Exception Annual Review, No More than 5 Years Total Additional Incentives for Hospitals (Based on Hospital Type) Incentives for Healthcare Providers (cont..) Medicaid EPs May Participate When State Offers the Program Can Receive Up To $63,750 in Incentives Must Participate by 2016 to Receive Maximum Before 2015, EPs May Switch Between Programs Once After First Payment Initiated Both Programs Require MEANINGFUL USE of CERTIFIED EHR TECHNOLOGY

3 The EHR Adoption Challenge According to Surveys by the National Center for Health Statistics, Barely Half of Physicians Report Using Any EMR/EHR system (not solely for billing) in their Office-Based Practices CDC National Center for Health Statistics, Electronic Medical Record/Electronic Health Record Systems of Office-based Physicians: United States, 2009 and Preliminary 2010 State Estimates, 12/8/2010 The EHR Adoption Challenge (cont..) Another Recent Study* Found That 85% of Physicians Contacted Were Aware of EHR Incentives, But 35% of Physicians Contacted Were Unaware They Face Penalties for Non-Adoption And of Those Unaware of Penalties, 65% Said It Would Not Cause Them to Implement an EHR System. Further, Incentives Are Likely to be Taxable.** Thus, at Least 23% of Those Studied Not On Board with EHR Adoption! *Physicians Reciprocal Insurers (PRI), News Release on Study, 9/22/2010 ** CMS EHR Meaningful Use Bonus Money Subject to Federal Taxes, American Academy of Family Physicians News NOW, 10/20/2010

4 Timeline Penalties Begin Incentives Begin Medicare & Medicaid EHR Incentive Program, Meaningful Use, Stage 1 Requirements Summary, CMS, 8/24/ What Is Meaningful Use? Four Key Elements 2 Under HITECH, an eligible professional (EP) is 1 treated as a meaningful EHR user, if: The EP is using certified EHR technology in a meaningful manner, including e-prescribing; The EP s certified EHR technology provides electronic health information exchange (e.g., to promote care coordination); and The EP submits measures using certified EHR technology on clinical quality measures as specified by the HHS Sec y. 4

5 Companion Rulemakings One MUST Use (1) Certified EHR Technology to Satisfy (2) Meaningful Use Requirements (1) Office of the National Coordinator for Health Information Technology (ONC) Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for EHR Technology 45 CFR 170 [July 2010] (2) Centers for Medicare & Medicaid Services (CMS) Medicare and Medicaid Programs; EHR Incentive Program 42 CFR 412, 413, 422 et al. [July 2010] ONC: Certified EHR Technology Defines Standards & Processes for Certification Content Exchange Standards Technology Standards General Criteria Functional Capabilities Security Measures Audit Logging Ambulatory Setting Criteria Inpatient Setting Criteria Complete EHRs Developed to Meet ALL Certification Criteria EHR Modules Satisfy at Least One, But Not All Certification Criteria

6 ONC: Certification Program Temporary Certification Program For HIT 45 CFR 170.4xx [June 2010] ONC Authorized Testing & Certification Bodies (ONC-ATCBs) Independent Organizations Provide Testing & Certification Per ONC Rules First Three ONC-ATCBs Approved Sept CCHIT, Drummond Group, InfoGard Labs Two Additional ONC-ATCBs Just Approved, December 10th ICSA Labs, SLI Global Solutions (Denver-Based) ONC Maintained Certified HIT Products List (CHPL) Identifies Certified Products & Combinations, as Reported by ONC-ATCBs and Verified by ONC Products Must Appear on the CHPL to Obtain the CMS-Required Reporting Number for Meaningful Use Attestation First Entries Posted Oct Now More Than 125 Entries ONC: Certification Program (cont..) Common Scenarios Using a Combo of EHR Modules? Each Must be Tested & Certified Using Individual Modules of a Complete EHR? Modules Must Be Certified Separately No Derivation from Complete EHR Certification, But May Issue Simultaneously Using Provider-Developed Technology? Must Seek Certification Includes Other IT Infrastructure, e.g., Document Management, Data Warehouse Rules are Still Evolving ONC FAQs Issued 9/21/2010 Rule Updated to Certain Withdraw Public Health Surveillance Standards, Adopted in Error, 10/13/2010 Nat l Institute of Standards & Technologies (NIST) Testing Procedures Version 1.1 Published 9/24/2010, Use Required by 10/24/2010 Final Certification Program Rule Sent to OMB, Early December 2010

7 CMS: Meaningful Use Requirements Two Main Elements Objectives Clinical Quality Measures (CQM) We want to pay particular attention to smaller practices and hospitals We want to raise the tides but not sink the boats. Requirements build Over Three Stages Stage /2012 (Available NOW) Stage (Estimate) Stage (Estimate) Paul Tang, Chairman of the Meaningful Use Workgroup, speaking to Government Health IT, 9/23/2010. CMS: Stage 1 Requirements EPs Must Complete 20 Objectives 15 Core + 5 Chosen from Menu of 10 6 Clinical Quality Measures (CQM) 3 Core/Alternate Core + 3 from Alternate Set of 38 Hospitals Must Complete 19 Objectives 14 Core + 5 Chosen from Menu of Clinical Quality Measures (CQM) Recent Clarification from ONC Demonstration versus Implementation Must implement all objectives, may choose those used for demonstration. 42 CFR 495

8 CMS: Stage 1 Requirements (cont.) Specific Measures Defined For Each Objective/CQM Exclusions N/A to a Practice Do Not Count in Requirements (e.g., Dentists don t immunize, Chiropractors do not e-prescribe) 80% of Patients Must Have Records In Certified EHR Technology for Some Objectives/Measures Rules Are Still Evolving October 2010: CMS about to Publish Rules Update to Clarify Stage 1 Requirements December 2010: CMS to Issue Notice to Correct Technical Errors in Rule CMS FAQ Website Provides Clarifications (e.g., hospital patient types, Observed Services versus All ED Visits ) Nat l Coordinator for HIT, David Blumenthal has publicly pointed to relief here for specialists 42 CFR 495 Progress Surveys HIMSS Analytics Quarterly Hospital Survey Shows Steady Progress* Survey Questions Are Evolving with the Rules College for Health Information Management Executives Survey Shows Significant Confidence Drop as 2010 Progresses** CIO Confidence for April 1, 2011 Incentive Qualification August % Expected to Qualify November % Expect to Qualify * HIMSS Analytics: Hospitals Ready to Meet Some Components of Meaningful Use, 11/15/2010 ** College of Healthcare Information Management Executives, Member MU Readiness Survey, 12/2010

9 CMS: Stage 1 Core Objectives 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 Implement one clinical decision support rule and the ability to track compliance with the rule Report clinical quality measures to CMS or the States Record demographics: preferred language, gender, race, ethnicity, date of birth, and date and preliminary cause of death in the event of mortality in the eligible hospital or CAH Maintain up-to-date problem list of current and active diagnoses Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies, discharge summary, procedures), upon request Capability to exchange key clinical information (ex: problem list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically Maintain active medication list Maintain active medication allergy list Protect electronic health information created or maintained by certified EHR technology through the implementation of appropriate technical capabilities EPs Only: Provide clinical summaries for each office visit HIPAA Security Rule Tie-In Record and chart vital signs: height, weight, blood pressure, calculate and display BMI, plot and display growth charts for children 2-20 years, including BMI Record smoking status for patients 13 years old or older EPs Only: Generate and transmit permissible prescriptions electronically (erx) Hospitals Only: Provide patients with an electronic copy of their discharge instructions at time of discharge, upon request 45 CFR 495 Medicare & Medicaid EHR Incentive Program, Meaningful Use, Stage 1 Requirements Summary, CMS, 8/24/2010 CMS: Stage 1 Menu Set Objectives Implement drug-formulary checks Incorporate clinical lab-test results into certified EHR technology as structured data Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient, if appropriate The EP, eligible hospital or CAH 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, eligible hospital or CAH who receives a patient from another setting of care or provider of care or refers their patient to another provider of care should provide a summary of care record for each transition of care or referral Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice EPs Only: Send reminders to patients per patient preference for preventive/follow-up care EPs Only: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within 4 business days of the information being available to the EP Hospitals Only: Capability to submit electronic data on reportable (as required by state or local law) lab results to public health agencies and actual submission in accordance with applicable law and practice Hospitals Only: Record advance directives for patients 65 years old or older 45 CFR 495 Medicare & Medicaid EHR Incentive Program, Meaningful Use, Stage 1 Requirements Summary, CMS, 8/24/2010

10 CMS: Stage 1 CQMs for EPs Core Hypertension: Blood Pressure Measurement Preventive Care and Screening Measure Pair: a) Tobacco Use Assessment, b) Tobacco Cessation Intervention Adult Weight Screening and Follow-up Alternate Core Weight Assessment and Counseling for Children and Adolescents Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or Older Childhood Immunization Status Alternate Set Diabetes: Hemoglobin A1c Poor Control Diabetes: Low Density Lipoprotein (LDL) Management and Control Diabetes: Blood Pressure Management Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) Pneumonia Vaccination Status for Older Adults Breast Cancer Screening Colorectal Cancer Screening Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)effective Continuation Phase Treatment Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care Asthma Pharmacologic Therapy Asthma Assessment Appropriate Testing for Children with Pharyngitis Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies Diabetes: Eye Exam Diabetes: Urine Screening Diabetes: Foot Exam Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL- Cholesterol Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation Ischemic Vascular Disease (IVD): Blood Pressure Management Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) Prenatal Care: Anti-D Immune Globulin Controlling High Blood Pressure Cervical Cancer Screening Chlamydia Screening for Women Use of Appropriate Medications for Asthma Low Back Pain: Use of Imaging Studies Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control Diabetes: Hemoglobin A1c Control (<8.0%) 45 CFR 495 Medicare & Medicaid EHR Incentive Program, Meaningful Use, Stage 1 Requirements Summary, CMS, 8/24/2010 CMS: Stage 1 CQMs for Hospitals Emergency Department Throughput admitted patients Median time from ED arrival to ED departure for admitted patients Emergency Department Throughput admitted patients Admission decision time to ED departure time for admitted patients Ischemic stroke Discharge on anti-thrombotics Ischemic stroke Anticoagulation for A-fib/flutter Ischemic stroke Thrombolytic therapy for patients arriving within 2 hours of symptom onset Ischemic or hemorrhagic stroke Antithrombotic therapy by day 2 Ischemic stroke Discharge on statins Ischemic or hemorrhagic stroke Stroke education Ischemic or hemorrhagic stroke Rehabilitation assessment VTE prophylaxis within 24 hours of arrival Intensive Care Unit VTE prophylaxis Anticoagulation overlap therapy Platelet monitoring on unfractionated heparin VTE discharge instructions Incidence of potentially preventable VTE 45 CFR 495 Medicare & Medicaid EHR Incentive Program, Meaningful Use, Stage 1 Requirements Summary, CMS, 8/24/2010

11 CMS: Stages 2 & 3: Guidance Stage 2: Backfilling Approach Intermediate Step Between Stage 1 and Stage 3 More Rigorous Expectations for Health Information Exchange Stage 1 Optional Objectives Likely To Be Required Stage 3: Ultimate Goal for Meaningful Use Continue to Promote Quality, Safety, and Efficiency Improvements Robust, Patient-Centered Health Information Exchange Challenges for Healthcare Providers Aggressive Adoption Timelines EPs Must Change Supporting Processes & Procedures Training, Compliance Reporting EHR Technology is EVOLVING Vendor Selection Features/Capabilities (specialists?!) ONC: Healthcare Providers May Seek Certification of a Particular System Version on Their Own Certification Costs (Approx. $19,500-$34,300/Complete EHR) Disclosure of 3 rd Party Software Components Caution Required When Customizing or Reconfiguring Certified Systems Early Adopter Impacts Current/Legacy EHR Systems Must Be Certified or Upgraded to Qualify Key Adoption Challenge It s Not Just About the Technology!

12 Resources Centers for Medicare & Medicaid Services (CMS) Official Website for EHR Incentive Programs Office of the National Coordinator for Health information Technology (ONC) General Information on Meaningful Use Certified HIT Products List (CHPL) Colorado s State-Designated Entity for HIE & Regional Extension Center (REC) Colorado Regional Health Information Organization (CORHIO)