Meaningful Use Stage 2

Transcription

1 Meaningful Use Stage 2 Shannon Vogel Director, Health Information Technology

2 Electronic Health Record Boost ARRA passed on Feb. 13, Health Information Technology for Economic and Clinical Health (HITECH) Act has HIT provisions. Significant physician incentives!

3 Year of eligibility Medicare Physician Incentives Total Paid 2011 $18,000 $12,000 $8,000 $4,000 $2,000 - $44, $18,000 $12,000 $8,000 $4,000 $2,000 $44, $15,000 $12,000 $8,000 $4,000 $39, $12,000 $8,000 $4,000 $24, Last year to begin is Last payment year is *Health professional shortage area (HPSA) physicians eligible for additional 10 percent

4 Medicare Incentives Incentives based on the individual, not the practice Payments based on 75 percent of Medicare allowable charges Year 1 Year 2 Year 3 Year 4 Year 5 $24,000 $16,000 $10,667 $5,334 $2,667 X 75% X 75% X 75% X 75% X 75% =$18,000 =$12,000 =$8,000 =$4,000 =$2,000

5 Medicaid Incentives Eligible physicians with at least 30-percent Medicaid volume could receive up to $63,750 over a six-year period. Adopting, implementing, and upgrading an EHR Meaningfully operating and maintaining an EHR Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 $21,250 $8,500 $8,500 $8,500 $8,500 $8,500 Total possible Medicaid incentive is $63,750. Medicaid incentives available through 2021 Full incentive available if you wait until 2016 to begin

6 Medicaid Incentives Eligible pediatricians with at least 20-percent Medicaid volume could receive up to $42,500 over a six-year period. Adopting, implementing, and upgrading an EHR Meaningfully operating and maintaining an EHR Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 $14,167 $5,667 $5,667 $5,667 $5,667 $5,665 Total possible Medicaid incentive is $42,500. Medicaid incentives available through 2021 Full incentive available if you wait until 2016 to begin

7 Stages of Meaningful Use Stage I Data capture and sharing Stage II Advanced clinical processes Stage III Improved outcomes (no rules yet)

8 Requirements by Payment Year First Year Payment Year Stage I Stage I Stage 1 Stage 2 Stage 2 Stage Stage I Stage I Stage 2 Stage 2 Stage Stage I Stage 1 Stage 2 Stage 2 90-days meaningful use allowed in Stage I Stage 1 Stage Stage 1 Stage 1

9 EHR Upgrade Starting in 2014, ALL practices must use the 2014 edition of their certified EHR, regardless of meaningful use stage. Check the Certified Health IT Product List (CHPL): edition Ambulatory Click on product to see CQM list

10 EHR Upgrade Because of the EHR upgrade, the 2014 reporting period is reduced to three months. The reporting periods for those beyond year one* must choose reporting periods by quarter. Jan.1 to March 31 April 1 to June 30 July 1 to Sept. 30 Oct. 1 to Dec. 31 * Year one still gets any 90-day reporting period.

11 Program Participation Texas EPs Medicare EHR Program (as of Aug. 2014) 29,292 participants $1.1 billion Medicaid EHR program (as of Aug. 2014) 11,187 participants $6.8 million

12 Stages 1 & 2 Meaningful Use

13 Meaningful Use Exclusions Stage 1: Exclusions allowed for 13 of the 24 criteria Stage 2: Exclusions allowed for 19 of the 23 criteria Stage2_MeaningfulUseSpecSheet_TableContents_EPs.pdf Bookmark these sites!

14 Physicians must meet all 17 core objectives:

15 Core objectives (Cont d)

16 Choose 3 of 6 Menu Objectives Must choose three menu criteria where exclusions are not applicable.

17 What s so difficult? There is a delicate balance between how much physicians are pushed and industry readiness. Criteria are primary-care focused. Not all specialties find value in all requirements.

18 Core 1: CPOE Use computerized physician order entry (CPOE) for more than 60 percent of medication, 30 percent of laboratory, and 30 percent of radiology orders. Exclusion: Any eligible provider (EP) who writes few than 100 medication, 100 radiology, or 100 laboratory orders.

19 Core 2: e-prescribing Generate, compare with at least one drug formulary, and transmit more than 50 percent of all permissible prescriptions. Exclusion: 1) any EP who writers few than 100 permissible prescriptions during the EHR reporting period. 2) Does not have a pharmacy within their organization or 10-mile radius accepting e- prescriptions.

20 Core 3: Demographics Record demographics as structured data for more than 80 percent of all unique patients seen by the EP. No exclusion Must record the following: Preferred language Sex Race Ethnicity Date of birth

21 Core 4: Vital Signs Record blood pressure (over age 3), height, and weight as structured data for more than 80 percent of all unique patients seen by the EP. Exclusion 1: No patients 3 years or older excluded from BP Exclusion 2: Believes all vital signs of height, weight, and BP have no clinical relevance. Exclusion 3: Believes height and weight are relevant, but BP is not, is excluded from recording BP. Exclusion 4: Believes BP is relevant, but not height and weight are excluded from recording height/weight.

22 Core 5: Smoking Status Record smoking status of unique patients 13 and older. Just status smoking cessation counseling is for PQRS. Exclusion if no patients 13 or older.

23 Core 6: Clinical Decision Support Measure 1: Implement five clinical decision support interventions related to four or more clinical quality measures related to scope of practice. Measure 2: Enable drug-drug and drug-allergy interactions for entire reporting period. Exclusion: Writes few than 100 medication orders during reporting period. Consult with vendor to determine clinical decision support rules capable within your EHR.

24 Core 7: Patient Electronic Access Measure 1: More than 50% of all unique patients are provided timely (within 4 business days) online access to their health information. Measure 2: More than 5% of all unique patients (or their representative) must view, download, or transmit to a 3 rd part their health information. Exclusion: Conducts 50% or more of visits in a county that does not have 50% or more of its housing with 3Mbps broadband.

25 Core 8: Clinical Summaries Clinical summaries provided to patient or authorized representatives within one business day for more than 50% of all office visits. Exclusion: No office visit during the reporting period. Can be provided through PHR, portal, secure , USB, CD, or even printed copy. Cannot charge patients for this access.

26 Patient Electronic Access More than 50% of all unique patients are provided timely (within 4 business days) online access to their health information. Gather addresses!! More than 5% of all unique patients (or their representative) must view, download, or transmit to a 3 rd part their health information. An electronic secure message was sent to the physician through the EHR or patient portal by more than 5% of unique patients seen during the EHR reporting period.

27 Core 8: Clinical Summaries Clinical summaries provided to patient or authorized representatives within one business day for more than 50% of all office visits. Exclusion: No office visit during the reporting period. Can be provided through PHR, portal, secure , USB, CD, or even printed copy. Cannot charge patients for this access.

28 Patient Access and Clinical Summary Patient Access/4 business days Patient name Physician s name/office contact Current and past problem list Procedures Visit Summary/1 business day Patient name Physician s name/office contact Date, location, and reason for office visit Current problem list Procedures during visit Current medication list and history Current medication list Medication allergies and history Laboratory test results Vital signs (height, weight, BP, BMI, growth charts) Current medication allergies Laboratory test results Vital signs during visit (height, weight, BP, BMI, growth charts)

29 Patient Access and Clinical Summary Patient Access/4 business days Smoking status Demographic information (sex, race, ethnicity, date of birth, preferred language) Care plan (goals and instructions) Known care team members (such as PCP of record) Visit Summary/1 business day Smoking status Demographic information (sex, race, ethnicity, date of birth, preferred language) Care plan (goals and instructions) Immunizations during visit Diagnostic tests pending Clinical instructions Future appointments Referrals to other providers Future scheduled tests Recommended patient decision aids

30 Core 9: Protect Patient Information Conduct a security risk analysis (SRA) SRA must occur during the reporting period. ONC did create a SRA tool to use in your practice:

31 Core 10: Clinical Lab Test Results More than 55% of all clinical lab tests results are incorporated into the EHR as structured data. Only for lab tests reported in positive/negative or numeric format. Exclusion: No lab tests or ordered or results are not in positive/negative or numeric format.

32 Core 11: Patient lists Generate at least one report listing patients with a specific condition. Be sure to retain the report in the event of an audit. Run a different report each EHR reporting period.

33 Core 12: Preventative Care More than 10% of all unique patients who have had 2 or more office visits within the 24 months before the reporting period were sent a reminder, per patient preference. Exclusion: No office visits in the 24 months before the EHR reporting period. Must be a reminder for care the patient was not already scheduled to receive.

34 Core 13: Patient-specific education Patient-specific education resources identified by the EHR are provided for more than 10% of unique patients. Exclusion: No office visits during EHR reporting period. Education resources do not have to be stored in your EHR. Must use EHR for suggested resources based on patient information in the EHR. You make final determination to its relevancy. Information can be provided in printed format, through portal, or PHR.

35 Core 14: Medication Reconciliation Perform medication reconciliation for more than 50 percent of patients transitioned to your care. Exclusion: You were not the recipient of any transitions of care during the reporting period.

36 Core 15: Summary of Care Measure 1: Must provide a patient summary of care record when you transition your patient to another care provider for more than 50% of all transitions. Measure 2: Submit the summary of care record via health information exchange (HIE) for 10% of all transitions and referrals. Measure 3: Conducts one or more successful exchange of a summary of care document or conducts one or more successful tests with CMS. Exclusion: Excluded from all three measures if referring a patient less than 100 times during reporting period.

37 Health Information Exchange (HIE) Exchanges are in various stages throughout Texas. Texas received $28 million from the Office of the National Coordinator for HIT to work. Texas Health Services Authority (THSA) overseeing grant dissemination for regional HIEs in Texas. Details about Texas HIEs available at October 2012 issue of Texas Medicine article Vital Connections provides detailed information.

38 HIEs in Texas

39 Core 16: Immunization Registries Successful ongoing submission of electronic immunization data from EHR to immunization registry (ImmTrac in Texas). Exclusion 1: Do not administer immunizations Exclusion 2: No immunization registry in the state. ImmTrac website:

40 Core 17: Secure Messaging An electronic secure message was sent to the physician through the EHR or patient portal by more than 5% of unique patients seen during the EHR reporting period. Exclusion: No office visits or conducts 50% or more of visits in a county that does not have 50% or more of its housing with 3Mbps broadband.

41 Menu 1: Syndromic Surveillance Successful ongoing submission of syndromic surveillance data from EHR to a public health agency for reporting period. Exclusion 1: Not in a category that collects ambulatory syndromic surveillance data on patients. Exclusion 2: Operates in a jurisdiction where agency cannot receive the data electronically. Exclusion 3: Operates in a jurisdiction where agency does not provide information timely on how to receive data. Exclusion 4: Operates in a jurisdiction where agency cannot accept EHR technology standards.

42 Menu 2: Electronic Notes Record electronic notes in patient record for more than 30% of all unique patients. No exclusion. Text of the notes must be text searchable.

43 Menu 3: Imaging results More than 10% of all tests whose result is one or more images ordered during reporting period. Exclusion: orders less than 100 tests whose result is an image during the reporting period.

44 Menu 4: Family Health History More than 20% of all unique patients have structured data entry for one or more first-degree relatives. Exclusion: No office visits Acceptable to record unknown as structured data if patient is asked and does not know family history.

45 Menu 5: Report Cancer Cases Must attest to ongoing submission of cancer case information from EHR to central cancer registry. Exclusion 1: Does not diagnose or treat cancer Exclusion 2: In jurisdiction with no cancer registry Exclusion 3: Agency does not provide submission information in a timely manner Exclusion 4: Agency cannot receive information at beginning of reporting period Texas cancer registry:

46 Menu 6: Report Specific Cases Successful ongoing submission of specific case information from EHR to specialized registry. Exclusions: similar to previous registry exclusions.

47 Clinical Quality Measures CQMs are no longer a core objective, but all physicians are required to report on CQMs to demonstrate meaningful use. CQMs are integrated with PQRS reporting. PQRS requires full-year reporting, which does not align with EHR 2014 reporting. Single submission of PQRS and EHR for 2014 payment year would have to take place between Jan. 1 and Feb. 28, Must submit electronically to CMS (EXCEPT for year one MU physicians)

48 Clinical Quality Measures Must select CQMs from at least three of the six National Quality Strategy domains: Patient and family engagement (PFE) Patient safety (PS) Care coordination (CC) Population and public health (PPH) Efficient use of health care resources (HCR) Clinical processes/effectiveness (CPE)

49 Clinical Quality Measures Must report on nine of 64 CQMs Adult recommended core set: Controlling high blood pressure Use of imaging studies for low back pain Preventive care and screening: Body mass index screening Use of high-risk medications in the elderly Preventive care and screening: Screening for clinical depression Closing the referral loop: Receipt of specialist report Preventive care and screening: Tobacco use screening and cessation Documentation of current medications in the medical record Functional status assessment for complex chronic conditions

50 Clinical Quality Measures Submission to CMS: Check to see which CQMs your EHR vendor is able to e-submit: Whoever submits to CMS must register with IACS. If practice submits register with IACS If vendor submits practice does not need to register with IACS Check the Certified Health IT Product List (CHPL): Click on product to see CQM list

51 Medicare Physician Penalties Penalties Percentage % % 2017 and beyond 3 % The U.S. Department of Health and Human Services may decrease payments 1 percent per year to a maximum of 5 percent if 75 percent of office-based physicians do not have meaningful use by 2018.

52 EHR Penalty Prevention Must take action each year to prevent the penalty for next payment year. Too late to prevent penalty in 2015 (2 exceptions) If claiming exemptions, must be claimed by July 1 each year. Exemptions include: Infrastructure New physician Unforeseen circumstances/closing practice Patient interaction

53 EHR Penalty Prevention Exemption portal reopened for these exceptions: Unable to implement 2014 certified technology Unable to attest by Oct. 1 using flexibility options. Must submit by Nov. 30, 2014 to prevent 2015 penalty. Application found here: Guidance/Legislation/EHRIncentivePrograms/PaymentA dj_hardship.html

54 EHR Flex Options CMS provided some relief to practices if their EHR vendor did not come through with 2014 technology upgrades. This may include using an earlier software version to attest, and may allow for an earlier stage. Only applies to practices that could not get 2014 software from the vendor in time to attest. Details here:

55 Audits/Document

56 Meaningful Use Audits CMS is conducting audits. Some are random. Some are based on complex algorithms. Participants should document everything! Keep all documentation for six years.

57 Attestation Requirements Once physicians meet meaningful use, attestation is required for every year of program participation. Separate attestation page for each meaningful use measure Direct technical questions about the registration and attestation pages to the EHR Information Center: (888) Mon-Fri; 7:30 am to 6:30 pm (CT)

58 Texas Regional Extension Centers North Texas 1,498 physicians DFW Hospital Council (469) ( CentrEast 1,000 physicians Texas A&M HSC (979) Gulf Coast 2,928 physicians UT HSC Houston (713) West Texas 1,022 physicians Texas Tech HSC (806)

59 EHR Adoption Rates Texas We currently use an EHR., 68% EHR Status We do not plan to implement an EHR., 20% We want to or plan to implement an EHR., 12%

60 Use of Scribes 20 percent of practices now use scribes for data entry. Practice Use of Scribes Hired new staff, 19% Both, 33% Retrained existing staff, 47%

61 EHR Program Websites Medicare: Medicaid:

62 E-Prescribing Controlled Substances (EPCS) Physicians are now permitted through DEA (2010) and Texas DPS (2014) rules to electronically transmit controlled substance prescriptions. Prescriptions requiring a DEA number are considered controlled substances. These include: All schedule II Many III Some IV Some V

63 EPCS Check with EHR vendor for EPCS module. Can also check Surescripts website:

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65 EPCS It is important for the erx network to know the vendor is certified and has flipped the switch to prevent blocking the prescription. Surescripts largest network. There are a handful of other private networks through vendors.

66 EPCS Software vendor will handle DEA-required certification. There is an identity-proofing process. EPCS software requires 2-factor authentication. Must be: Something you know (PIN) Something you are (biometrics, such as thumb print) Something you have (FOB frequency operated button, app, magnetic strip)

67 EPCS Check with local pharmacies to see if they are accepting EPCS. Not all of them are. Chain pharmacies will most likely be early adopters.

68 EPCS Issues Pharmacy software may vary in capability to hold prescriptions for issuance at later date. Pharmacy may not be able to forward prescription if Schedule II prescription is not in stock.

69 TMA Resources EHRs Resource EHR Implementation Guide (105 pages) EHR Readiness Assessment EHR Comparison Tool EHR Price Guides Solo physician Two-physician 10-physician EHR Buyer Beware: Issues to Consider When Contracting with EHR Vendors HIT homepage Access TMA Members Only TMA Members Only TMA HIT Helpline Call: (800)

70 TMA Resources EHR Incentives Resource Federal stimulus information EHR incentive timelines Program comparisons Meaningful use information Access Medicare EHR Incentive Guide Step-by-step registration instructions Medicaid EHR Incentive Guide Step-by-step registration instructions REC Resource Center REC locator tool Service and eligibility information TMA HIT Helpline Call: (800)

71 Questions? CONTACT INFORMATION Shannon Vogel Director, Health Information Technology 401 W. 15th St. Austin, Texas (800) , ext