6/26/2013. Continuing Medical Education Disclaimer

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1 Meaningful Use Stage 2: Understanding the Requirements and Changes June 26, :30 1:30 p.m., EDT Marnivia Spencer, CCME EHR Consultant 2013 The Carolinas Center for Medical Excellence All Rights Reserved Continuing Medical Education Disclaimer This is to certify that Marnivia Spencer has disclosed no relevant financial relationships to this presentation. Meaningful Use Stage 2 - Understanding the Requirements and Changes June 26, :30 1:30 p.m., EDT Marnivia Spencer, CCME EHR Consultant 2013 The Carolinas Center for Medical Excellence All Rights Reserved 1

2 Meaningful Use Stage 2 SAVE THE DATE!! Jan. 1, 2014 Stage 2 The Details CMS: Legislation/EHRIncentivePrograms/Downloads/Stage2 _Toolkit_EHR_0313.pdf Federal Register: Meaningful Use Stage 2 New Focus Stage 2 Advanced Clinical Processes Patient engagement Care Coordination Clinical Decision Support Increased HIE 2

3 Meaningful Use Stage 2 Final Rule Medicaid Changes Menu Objective Exclusion Hardship Exceptions Meaningful Use Changes: Hospital- based EP, Menu Objective Exclusion Payment Adjustments Stage 1 Changes Stage 2 Objectives Medicare EP Timeline Final Rule Stage 2 CQMs MU Stage 2 Eligible Professionals Medicare OD DPM DC Medicare & Medicaid MD DO DDS/DMD Medicaid NP PA* CNM OD** *PAs working in a FQHC that are PA led **South Carolina Stage 2 Changes Menu Objective Exclusions Certified EHR Technology Batch Reporting Objectives and CQM Reporting Attest HIT MU Measures Submit CQMs to PQRS or CMS portal 3

4 Stage 2 Objectives Stage 2 Stage 1 17 Core 15 Core 3/6 Menu 5/10 Menu MU Stage 2 Objectives The Facts Most of the Stage 1 Menu objectives are now Stage 2 Core objectives Combined Stage 1 objectives Increased thresholds Reporting CQMs is no longer an objective (but still required) New Menu Objectives Stage 2 Menu Objective Exclusions No longer count towards meeting the number of menu objectives Menu Objective Exclusions Menu Objectives 4

5 Core 1 CPOE Added CPOE for labs and radiology Increased Medication Threshold >60% Medications >30% Labs >30% Radiology Certified Medical Assistants are considered eligible for CPOE entry. Exclusion: EP writes <100 medication, radiation or lab orders Core 2 e-prescribing Threshold increase >50% Prescriptions compared to drug formulary Additional Exclusion Does not have a pharmacy within their organization and there isn t a pharmacy within 10 miles that excepts electronic prescriptions at the start of the EHR reporting period. Core 3 Demographics >80% of all unique patients Gender changed to Sex Exclusion: None 5

6 Core 4 Vital Signs >80% all unique patients BP and HT/WT split Age limitations changed Exclusion: Exclude practice irrelevant data HT/WT BP HT/WT/BP Core 5 Smoking Status >80% of all unique patients Exclusion: Doesn t see patients >13 years old Core 6 Clinical Decision Support Two-part measure (combines two Stage 1 measures) 1. Clinical decision support 2. Implementing d/d and d/a checks Increased from 1 to 5. Related to 4 CQMs. Drug/drug and drug/allergy interaction checks do not count towards meeting requirements Exclusion (second measure): <100 medication orders 6

7 Core 7 Patient Electronic Access Two-part measure (replaces two Stage 1 objectives) 1. >50% patients the ability to access health information online within 4 business days 2. >5% patients view, download, third party transmission Exclusion: Both Measures: Required information not ordered/created Second Measure: At least 50% encounters in county where at least 1/2 houses do not have adequate internet facilities Core 8 Clinical Summary >50% of patients/representatives One business day Exclusion: No office visits Core 9 Protect Electronic Health Info Conduct or review the required security risk analyses Address data encryption Implement security updates The parameters defined by the HIPPA Security Rule Exclusion: None 7

8 Core 10 Clinical Lab Test Results > 55% lab results Positive/negative Numeric Exclusion: No lab tests in a positive/negative or numeric format Core 11 Patient Lists Previous Menu objective No measure changes One report Reports used previously cannot be used Exclusion: None Core 12 Preventative Care >10% of all unique patients >2 office visits Last 24 months before start reporting period Clinically relevant information stored in CEHRT Exclusion: No office visits within the 24 months prior to the EHR reporting period 8

9 Core 13 Patient Specific Education >10% of all unique patients Education material must be identified or suggested by the CEHRT Exclusion: No office visits Core 14 Medication Reconciliation >50% of patients transitioned to the EP No threshold increase Previous menu objective Exclusion: No transitions of care Core 15 Summary of Care Three part measure: 1. >50% of transitions of care/referrals 2. >10% sent electronically 3. Either a or b: a. at least one sent to a recipient with a different EHR vendor b. successfully testing with CMS test EHR Must be received by the provider to who the sending provider is referring or transferring the patient Exclusion (all three measures): Transfers care to another setting or refers a patient to another provider <100 times during the EHR reporting period. 9

10 Core 16 Immunization Registries Data Submission Previous Menu Measure Successful ongoing transmission Exclusions: The EP doesn t administer data being collected by their area s registry EP works in an area where the registry isn t capable of excepting the required CEHRT standards EP works in an area where the registry has not made known their capability to except the required CEHRT standards All approved registries are no longer accepting new EPs. Core 17 Secure Electronic Messaging New >5% of patients seen sent a secure message using the CEHRT The EP does not have to respond Exclusions: No office visits At least 50% encounters in county where at least 1/2 houses do not have adequate internet facilities Stage 2 Menu Objectives EPs must select 3 out of the 6: Menu Objective 1. Syndromic Surveillance* 5. *NewCancer Menu Objective Successful ongoing transmission of cancer case *Stage 1 menu item Measure Successful ongoing transmission of syndromic surveillance data 2. Progress notes Enter an electronic progress note in the patient s record for more than 30% of unique patients 3. Imaging Results More than 10% of imaging results are accessible through Certified EHR Technology 4. Family History Record family health history for more than 20% 6. Specialized Registry information Successful ongoing transmission of data to a specialized registry (other than cancer) 10

11 MU Stage 2 Objective Reporting Periods 2014* Medicare 3 month calendar quarter (Jan 1 March 31, April 1- June 30, July 1-Sept 30, and Oct 1 Dec 31) Medicaid Any 90-day period (not tied to monthly quarters) 2015 and beyond Full calendar year *EPs in their second year and beyond. First year MU EPs any continuous 90 day period. Clinical Quality Measures (CQMs) Stage 2 CQMs The Facts* Removed as Core objective, but a MU requirement 9 out of 64 CQMs Select CQMs from 3 out of 6 NQS domains Recommended Core Individual or Group reporting Report using 2014 electronic CEHRT technology Align reporting programs *Medicare EPs 11

12 CQM Measures Based on conditions and measures that: Contribute to morbidity and mortality Represent national public health priorities Common to health disparities Disproportionately drive healthcare costs Measure quality of care in new dimensions Allow more patient/caregiver engagement CQM Domains Select CQMs from 3 out of 6 NQS domains Patient and Family Engagement Patient Safety Care Coordination Population and Public Health Efficient Use of Healthcare Resources Clinical Processes/Effectiveness CQM Measures Recommended Core 9 Adult Population 9 Pediatric Population NQF 0018 (Controlling High Blood Pressure) 12

13 CQMs Core Adult Recommended Controlling High Blood Pressure Use of High-Risk Medications in the Elderly Tobacco Use: Screening and Cessation Intervention Low Back Pain Clinical Depression Documentation of Current Medications Body Mass Index (BMI) Screening and Follow-Up Closing the referral loop Assessment for complex chronic conditions CQMs Adult Recommended Downloads/2014_CQM_AdultRecommend_CoreSetTable.pdf CQMs Core Pediatric Recommended Pharyngitis Testing Weight Assessment and Counseling for Nutrition and Physical Activity Chlamydia Screening Asthma Medications Upper Respiratory Infection (URI) ADHD Clinical Depression and Follow-Up Plan Dental decay or cavities Immunization 13

14 CQMs Pediatric Recommended Downloads/2014_CQM_PrediatricRecommended_CoreSetTable.pdf CQM Measures Reporting Time Period Reporting Period Electronic Submission 2014 (Optional Medicare Reporting Period) 3 month calendar year quarter (or 1 full year) Identical to 3-month MU objectives reporting period 2 months after the end of the reporting period Full Calendar Year 2 months after the end of the reporting period (Jan. 1 Feb 28) Medicaid CQM Reporting CQM data submitted to State State determines Submission method Process Timeline 14

15 CQMs Reporting Options* Data Level Payer Level Submission Type Reporting Schema INDIVIDUAL EPS Option 1 Aggregate All Payer Electronic Submit 9 CQMs (includes adult and pediatric recommended core CQMs), coveringat least 3 NQS domains Option 2 Patient Medicare Only GROUP REPORTING EPsin an ACO Patient Medicare Only Electronic Electronic Satisfy requirements of PQRS reporting options using CEHRT Satisfy requirementsof Medicare Shared Savings Program of Pioneer ACOs using CEHRT EPs satisfactorily reporting viapqrs group reporting options Patient Medicare Only Electronic Satisfy requirements of PQRS group reporting options using CEHRT *Beyond first year of Meaningful Use participation Payment Adjustments Play or Pay! Start Year Medicare Participation Years Incentive (up to) Start Year Medicaid Participation Years Incentive (up to) $44, $63, $44, $63, $39, $63, $24, $63, Incentive Payments Penalties Begin $ $63, $63,750 Note: Penalties apply to Medicare eligible providers 15

16 Payment Adjustments The Facts Medicare eligible EPs who are not CEHRT meaningful users Attest to MU under either the Medicare or Medicaid EHR Incentive Program Begin January 1, 2015 Applied to the physician fee schedule (PFS) Avoid penalties: Begin 90-day reporting period by July 1, 2014 Attest by October 1, 2014 Based on prior years reporting periods Payment Adjustments The Facts Must demonstrate every year to avoid payment adjustments 1% per year Cumulative for each year that EP is not a meaningful user Maximum 5% adjustment AIU MU Medicaid No adjustments Medicaid eligible only EP EP Payment Adjustment Percentages CY 2018 and beyond <75% of EPs are Meaningful Users EP is not subject to the payment adjustment for e-rx in 2014 EP is subject to the payment adjustment for e-rx in % 98% 97% 96% 95% 95% 98% 98% 97% 96% 95% 95% CY 2018 and beyond >75% of EPs are Meaningful Users EP is not subject to the payment adjustment for e-rx in 2014 EP is subject to the payment adjustment for e-rx in % 98% 97% 97% 97% 97% 98% 98% 97% 97% 97% 97% 16

17 EHR Reporting Period Reporting period length depends upon the first year of participation 2011 or 2012: EP demonstrated MU Adjustment Year Based on Full Yr Reporting * : First year to demonstrate MU Adjustment Year Based on 90 day Reporting 2013 Based on Full Year Reporting 2014* : First year to demonstrate MU Adjustment Year Based on 90 day Reporting * Based on Full Year Reporting * Optional 3 month/90-day reporting period Hardship Exceptions Granted under specific conditions Demonstrate to CMS significant barriers Infrastructure New EPs Unforeseen circumstances Lack of face/face, telemedicine, or follow-up with patients Lack of control over the availability of Certified EHR Technology of more than 50% of patient encounters. Resources EHRIncentivePrograms/Stage_2.html EHRIncentivePrograms/EducationalMaterials.html EHRIncentivePrograms/ClinicalQualityMeasures.html 17

18 Thank you for joining us today! Marnivia Spencer, CCME EHR Consultant Upcoming Webinars CME Available! LUNCH & LEARN WEBINAR Back to Basics with EHR Adoption: Implementation July 17th 12:30 1:00 p.m., EDT LUNCH & LEARN WEBINAR Back to Basics with EHR Adoption: Post Live August 14th 12:30 1:00 p.m., EDT 18