Thank You to Our Sponsors! CMS EHR Incentive Requirements. CMS EHR Incentive Programs. CMS EHR Incentive Programs. Steps to Get Started 3/15/2012

Transcription

1 Thank You to Our Sponsors! AOA EHR Preparedness Program EHR Incentive Programs and Meaningful Use Update Jay W. Henry, O.D., M.S. Philip J. Gross, O.D. CMS EHR Incentive Programs Provide incentive payments for certain health care providers (Optometrists included) to use EHR technology in ways that can have a positive impact and enhance patient care Specific requirements must be met to qualify for an incentive payment CMS EHR Incentive Requirements To receive an EHR incentive payment Providers must show that they are meaningfully using their ONC Certified EHR by meeting thresholds for specific meaningful use objectives These meaningful use objectives have been established by CMS and they define what all providers must do to receive an incentive payment CMS EHR Incentive Programs Meaningful use and the incentive programs are designed to: Move data out of individual providers offices Help physicians actively and securely exchange patient data Reward physicians and hospitals for adopting certified, comprehensive, connected EHRs Steps to Get Started Select a certified EHR software Determine which EHR incentive program you are eligible for Medicare / Medicaid Register Achieve meaningful use Attest 1

2 Select a Certified EHR Software Certified EHR Software To get an incentive payment you must use an EHR that is certified specifically for the EHR Incentive Programs EHR software is certified by version number Verify your EHR is certified by visiting the ONC CHPL website at: Certified Health IT Product Website Certification of EHRs ONC has developed two levels of certification: Modular EHR certification: According to the ONC (Office of the National Coordinator) ; EHR Modules are those technologies that are certified to at least one of the certification criteria as defined in the Standards and Certification Criteria Final Rule Complete EHR certification: According to the ONC (Office of the National Coordinator) ; Complete EHRs are those technologies that are certified to ALL of the certification criteria as defined in the Standards and Certification Criteria Final Rule Complete EHR Certification Modular EHR Certification Notice how all required boxes are marked as completed Notice how only some of the required boxes are marked as completed 2

3 Why Certified EHRs? Steps to Get Started Certification provides: Assurance to you that the EHR system offers the necessary technological capability, functionality, and security to help you meet the meaningful use criteria Allows you to have confidence that the EHR products and systems are secure, can maintain data confidentially, and can work with other systems to share information Select a certified EHR software Determine which EHR incentive program you are eligible for: Medicare or Medicaid Register Achieve meaningful use Attest EHR Incentive Programs for Physicians Two programs are available Choose only one Medicare - Non-Hospital based Medicare Medicaid - At least 30% Medicaid Patient Encounter Volume This includes Medicaid managed care programs: MCOs, prepaid inpatient health plans (PIHPs), or prepaid ambulatory health plans (PAHPs) EHR Incentive Programs for Physicians Government wants to encourage quick movement to EHRs Largest payments early in program Under Medicare Incentive payments began in 2011 Penalties begin in 2015 Carrot and then the Stick! Under Medicaid Incentive payments began in 2010 Medicare EHR Incentive Program Medicare EHR Incentive Program Can earn up to $44,000 over 5 years per NPI Incentives based on the Individual, not the practice The payment is per individual NPI not an entity If Multiple ODs in your office each can participate Based on submitted allowable Medicare charges 75% of allowable charges up to a maximum annual cap Health provider shortage area may get 10% bonus Does not include Medicare Advantage Payments 3

4 Example of Year 1 Calculation Medicare EHR Incentive Program $18,000 is year one maximum incentive payment Medicare Allowable charges $24,000 for a year 75% of $24,000 = $18,000 First Year You Participate: 2011 $18, $12,000 $18, and Later In other words, you need to bill $24,000 in allowable charges in the first year to receive the year one maximum incentive for Medicare If you only billed out $10,000 then you would get 75% of 10K = $ $8,000 $12,000 $15, $4,000 $8,000 $12,000 $12, $2,000 $4,000 $8,000 $8,000 $ $2,000 $4,000 $4,000 $0 TOTAL $44,000 $44,000 $39,000 $24,000 $0 EHR Incentive Program Stages Incentive program consists of 3 stages Each stage will have different requirements to demonstrate meaningful use We are currently in Stage 1. Everything discussed today will be Stage 1 requirements Stage 1 = Capture data and share Stage 2 = Expand exchange of information and advanced clinical processes Stage 3 = Improved outcomes - Focus on CDS for high priority conditions, patient self management, and access to comprehensive data HITECH Medicare Program - Stages First Payment Year Payment Year Stage 1 $18K Stage 1 $12K Stage 1 $18K Stage 2 $8K Stage 1 $12K Stage 1 $15K Stage 2 $4K Stage 2 $8K Stage 2 $12K Stage 1 $12K Stage 3 $2K Stage 3 $4K Stage 3 $8K Stage 3 $8K Stage 3 $0K Stage 3 $2K Stage 3 $4K Stage 3 $4K 2015 Penalty Penalty Maximum Incentive $44K $44K $39K $24K Medicare EHR Incentive Program In order to participate in the Medicare EHR Incentives you MUST be billing Medicare! In order to receive Medicare reimbursements your Medicare enrollment information must be listed in PECOS by July 6th, 2010 Therefore, you must be listed in PECOS to participate in the EHR Incentive programs What is PECOS? Provider Enrollment, Chain and Ownership System (PECOS) PECOS is a database of physicians who have enrolled or re-enrolled in Medicare If you have enrolled in Medicare or updated your enrollment since November 2003 you should already be listed in PECOS You can verify your listing in PECOS at: OrderingReferringReport.pdf If you are not listed in PECOS you must enroll or reenroll in Medicare using either paper (855 form) or online via PECOS You must be listed in PECOS to participate in the CMS EHR incentive programs 4

5 Medicare EHR Incentive Program FAQs Can I skip a year? In order to receive the maximum incentive payment you need to participate for 5 consecutive years If you skip a year you will forfeit your payment for that year of the program Will there be penalties if I choose not to be a meaningful user? If you do not meet meaningful use requirements starting in 2015 providers will be subject to a Medicare payment reduction starting at 1% per year These reductions may go as high as 5% per year in future years after 2015 Medicare EHR Incentive Program FAQs What is a reporting period? A reporting period is the time period for which EPs must report their meaningful use Year 1 = Any continuous 90 days All subsequent years = Full calendar year 365 Days Jan Feb March April May June July Aug Sept Oct Nov Dec Medicare EHR Incentive Program FAQs Do EPs have to register only once or every year for the incentive program? You are only required to register once. If any basic information changes you need to update your information on the registration site When will CMS begin to pay incentives to EPs? Payment began in May 2011 as a lump sums about 4-8 weeks after an EP successfully attests. Payments will be held for EPs until the EP meets the $24,000 threshold in allowed charges or until March of the following year to allow for all pending claims to be processed Medicare EHR Incentive Program FAQs Are payments from the EHR incentive program subject to federal income tax? The payments will be treated like any other income Do the meaningful use objectives apply to all patients or only Medicare patients? You must include ALL patients when meeting meaningful use objectives Medicare EHR Incentive Program FAQs What is the maximum incentive payment under Medicare? The total maximum incentive amount you can receive under the Medicare EHR program is $44,000 over five consecutive years of participation You only receive the maximum incentive amount by starting in 2011 or 2012 If you don t start by 2014 you are not eligible to receive any incentive money under the Medicare Program Medicare EHR Incentive Program Questions? 5

6 Medicaid EHR Incentive Program Medicaid EHR Incentive Program Can earn up to $63,750 over 6 (not necessarily consecutive) years Must have a Medicaid patient volume of 30% Patient volume is calculated for any continuous 90 day period in the preceding calendar year Includes Medicaid managed care programs: MCOs, prepaid inpatient health plans (PIHPs), and prepaid ambulatory health plans (PAHPs) SCHIP does not count toward 30% Medicaid encounter (defined by each state) but typically means Medicaid paid for all or part of service Medicaid EHR Incentive Program Your State must consider O.D. s as physicians and be able to bill for medical services Currently Optometrists are eligible for the Medicaid incentive program in a few states Incentive payments began in 2010 (your state must be ready) Year 1 - EPs can qualify by adopting, implementing, or upgrading to certified EHR technology Unlike Medicare which requires meaningful use in year 1 Year 2 EPs start Meaningful Use 90 day reporting period Incentive is a flat fee intended to cover the net average allowable costs of purchasing, implementing and maintaining an EHR Medicaid EHR Incentive Program By statute, payments will be capped at: Year 1: $21,250 Year 2: $8,500 Year 3: $8,500 Year 4: $8,500 Year 5: $8,500 Year 6: $8,500 You can get total of $63,750 over 6 years Year Medicaid EHR Incentive Program Adopt 2011 Adopt 2012 Adopt 2013 Adopt 2014 Adopt 2015 Adopt $21, $8,500 $21, $8,500 $8,500 $21, $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $8, $8,500 $8,500 $8,500 $8, $8,500 $8,500 $8, $8,500 $8,500 0 $8,500 0 Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750 0 Adopt Medicaid EHR Incentive Program FAQs Do I register with CMS or my state for the Medicaid EHR incentive program You must first register with CMS and then you will need to register with your state Who will validate my 30% Medicaid patient volume? Each state will have a registration process in which it will ask for patient volume numbers of Medicaid and all other encounters during a 90 day period from the preceding calendar year. These numbers will be used to validate your Medicaid patient volume of 30% Do I attest on the CMS website or with my state You will attest on your states website for Medicaid 6

7 Comparison of Medicare and Medicaid EHR Incentive Programs Medicare Program Must meet meaningful use objectives in the first year and all years after Maximum incentive payment is $44,000 for 5 consecutive years of participation Run by CMS Medicaid Program In the first year EPs may qualify by adopting, implementing, or upgrading a certified EHR In the remaining years must meet meaningful use objectives Maximum incentive payment $63,750 for 6 years of participation Does not have to be consecutive years Run by each state Steps to Get Started Select a certified EHR software Determine which EHR incentive program you are eligible for Medicare / Medicaid Register Achieve meaningful use Attest EHR Incentive Program Registration You can register online at: EHR Incentive Program Registration Registering does not mean that you have to participate You can cancel your registration at any time You can change your registration Register early in the year you are going to attest Registering helps you become aware of issues that could interfere with or delay your participation Registration User Guides Before you begin your registration view the online user guides located at: Medicare nloads/ehrmedicareep_registrationuserguide.pdf Medicaid nloads/ehrmedicaidep_registrationuserguide.pdf EHR Incentive Program Registration Items Needed: Must have an NPI and be listed in PECOS NPPES (national plan & provider enumeration system) user ID and password system utilizes this for login EHR certification information (certification number if known not required at this stage but will be for attestation) Individual SSN, Individual NPI, Business Taxpayer Identification Number, group payee NPI, business address, and phone number 7

8 Registration Process: Login National Plan and Provider Enumeration System (NPPES) If you have a NPPES login you are ready If you DO NOT have a NPPES login go to : Registration Process: Login Registration Process Registration Process: Start 8

9 Registration Process: Choose a Program Software Certification Number Software Certification Number Software Certification Number Software Certification Number Software Certification Number 9

10 Registration Process: Payment goes to? Registration Process: Submission Registration Process: Submission Registration Process: Completed Registration Process: Status Registration Process: Medicaid CMS will notify your state once you have successfully completed your Medicaid registration on the CMS website You will need to follow up with your state to complete any further registration they require at the state level 10

11 CMS Incentive Programs Timeline So is Anyone Registering? More than 176,049 eligible professionals, eligible hospitals, and critical access hospitals are actively registered in the Medicare and Medicaid EHR Incentive Programs as of December 2011 So, are EPs getting any money? More than $1.3 Billion in Medicare EHR Incentive Program payments have been made as of December 31 st, 2011 More than $1.1 Billion in Medicaid EHR Incentive Program payments have been made as of December 31 st, 2011 Total amount paid under Medicare and Medicaid as of December 31 st, 2011 $2,533,689,145 11

12 Incentive Payments by Specialty Incentive Payments by Specialty 1. Family Practice Internal Medicine Cardiology Podiatry OB/GYN Gastroenterology Orthopedic Surgery Urology Optometry General Surgery EHR Incentive Payments to OD s Successful Attestations by Specialty 614 optometrists getting the bonus before the end of 2011 If they got the payment by the end of the year they would each have gotten the full $18k year one incentive payment Which totals $11,052,000 Attestations by Specialty 1. Family Practice Internal Medicine Cardiology Podiatry OB/GY Gastroenterology Optometry Orthopedic Surgery 1149 Family Practice Internal Medicine 1238 = $22 Million for Optometry Steps to Get Started Select a certified EHR software Determine which EHR incentive program you are eligible for Medicare / Medicaid Register Achieve meaningful use Attest Meaningful Use 12

13 Meaningful Use Meaningful Use Term created under HHS Objectives to explain what you and your certified EHR will need to do to qualify for EHR incentive payment To qualify for an incentive payment you must meet the Stage 1 Meaningful Use requirements established by CMS There are three main components of meaningful use The use of a certified EHR in a meaningful manner (e.g.: e-prescribing) The use of certified EHR technology for electronic exchange of health information to improve quality of health care The use of certified EHR technology to submit clinical quality and other measures Meaningful Use: Reporting Period Reporting period is the time period for which EPs must report their meaningful use Year 1 of EP s participation Reporting period is any continuous 90 day period during the calendar year All subsequent years Reporting period is a full calendar year Meaningful Use Goals of Meaningful Use Improve quality of health care Improve safety, efficiency and reduce health disparities Engage patients and families in their care Improve Care Coordination Improve population and public health Ensure adequate privacy and security protections for personal health information Meaningful Use 15 Core Objectives Everyone must meet and report on all 15 core objectives Some have exclusions which could exempt you from having to complete that objective (If you exempt from an objective you get credit as if you did it) 10 Menu Objectives Everyone must meet and report on 5 out of the 10 available menu objectives You get to choose the 5 Some have exclusions which could exempt you from having to complete that objective Stage 1 Meaningful Use Evaluating the 15 core objectives What are the exact requirements of the objective What percentage of the time does the objective need to be completed to achieve credit How will my office and software allow me to complete this objective Are there any exclusions to the objective that apply to Optometry or my office How does it look in an EHR 13

14 15 Core Objectives Meaningful Use Summary 15 Core Objectives 1. Record patient demographics 2. Record and chart changes in vital signs 3. Maintain an up to date problem list of current and active diagnoses 4. Maintain active medication list 5. Maintain active medication allergy list 6. Record smoking status for patients 13 years or older 7. E-Prescribing (erx) 8. Computerized provider order entry (CPOE) 9. Drug-drug and drug-allergy checks 10. Implement clinical decision support 11. Report ambulatory clinical quality measures to CMS / States 12. Provide Clinical summaries for patients for each office visit 13. Provide patients with an electronic copy of their health information, upon request 14. Capability to exchange key clinical information 15. Protect electronic health information Record demographics More than 50% of all unique patients seen by the EP have demographics recorded. Preferred language Gender Race Ethnicity Date of Birth There is no exclusion for this objective. Record demographics DOB and Gender typically already collected Preferred language, race, and ethnicity The three new ones that software must track Consider adding these three to welcome / history forms Preferred language Ask what is your preferred language and let patient select or write in Ethnicity (federal definition) Hispanic or Latino Not Hispanic or Latino Race (Federal definition, one or more that apply) American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White 14

15 Record and chart changes in vital signs For more than 50% of all unique patients age 2 and over seen by the EP, height, weight and blood pressure are recorded as structured data. BMI should be calculated and displayed Plot and display growth and BMI charts for 2-20 years. You can be excluded from this objective if: You don t see any patients 2 years or older You don t believe all 3 of these vital signs are relevant to your scope of practice. Record and chart changes in vital signs Height/weight/BMI: Can add height and weight to patient questionnaire Consider scanning driver license into EHR and obtain height and weight information from it Suggest starting with patient attestation for height and weight but move to actually measuring it The BMI is a function of the software Blood pressure: We should be doing this on all patients Height-to-Age Chart 15

16 Maintain an up-to-date list of current and active diagnosis (problem list) 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. There is no exclusion for this objective. Maintain an up-to-date list of current and active diagnosis (problem list) We typically already record problems or diagnosis This item will be software generated and we may simply have to enter each diagnosis as a separate line item in the record Should be easily completed with certified software Maintain active medication list Maintain active medication list More than 80% of all unique patients seen by the EP have at least one medication recorded or an indication that the patient is not currently prescribed any medication recorded. There is no exclusion for this objective. We should be checking all patients medication list at each visit This really should not be an issue except we now need to indicate a negative if no prescribed medications exist In other words, we have to make sure that the record shows no prescribed medications 16

17 Maintain active medication allergy list More than 80% of all unique patients seen by the EP have at least one medication allergy recorded or an indication that the patient has no known medication allergies recorded. There is no exclusion for this objective. Maintain active medication allergy list We should all be currently checking all patients allergy status at each visit We now need to indicate a negative if no medication allergies exist In other words, we have to make sure that the record shows no active medication allergies This really should be easy to comply 17

18 Record smoking status for patients 13 years or older More than 50% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data. You can be excluded from this objective if you do not see any patients who are age 13 years or older. Record smoking status for patients 13 years or older Consider adding questions to the patient registration form to get the information on status Have this information recorded during history taking This must be recorded in the EHR as structured data and it will be tracked by the EHR for compliance This should be easy to comply 18

19 E-Prescribing (erx) E-Prescribing (erx) More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology. You can be excluded from meeting this objective if you write fewer than 100 prescriptions during the reporting period. Compliance thoughts: All certified software will likely have integrated eprescribing You must sign up and utilize E-Prescribing This is entirely software generated EHR will have to track all Rx s which are been prescribed and be able to report which have been prescribed electronically Hopefully, all Rx s will be generated by erx! Computerized provider order entry More than 30% of all unique patients seen by the EP with at least one medication in their medication list have at least one medication order entered using CPOE. You can be excluded from meeting this objective if you write fewer than 100 prescriptions during the reporting period. 19

20 Computerized provider order entry This is easily covered with integrated eprescribing systems Remember, more than 40% of all permissible prescriptions written by the EP need to be transmitted electronically using certified EHR technology Even if you are not e-prescribing every single medical Rx you can meet CPOE (need 30% time) As long as you enter the Rx electronically into your EHR software you would meet CPOE for that Rx Drug-drug and drug-allergy checks EP has enabled the functionality to automatically check for drug-drug or drugallergy interactions for the entire EHR reporting period. There is no exclusion for this objective. Drug-drug and drug-allergy checks If we are using a certified EHR with eprescribing, this should occur as part of the ordering of the medications Be sure this feature is turned on and active for you entire reporting period Stresses why eprescribing is so important 20

21 Implement clinical decision support Implement clinical decision support Implement one clinical decision support rule that will trigger alerts for providers when they have patients with certain diagnosis or conditions. There is no exclusion for this objective. These are rules designed to help us meet the standard of care in terms of testing and follow up care Examples: If a patient has an active medication of Plaquenil listed, has a macular visual field, color vision testing, and a SD OCT been ordered When an IOP is above a specific level, a warning of possible glaucoma is triggered If a diagnosis of glaucoma is entered, is the patient scheduled or have they had a VF or a scanning laser within the last 6-12months Certified software will have at least one pre-programmed into the EHR. Some EHRs will allow you to create your own Report ambulatory clinical quality measures to CMS Successfully report to CMS ambulatory clinical quality measures selected by CMS in the manner specified by CMS. You will need to report on 3 core (or alternate core if core measures don t apply) as well as 3 other measures from a list There is no exclusion for this objective. Report ambulatory clinical quality measures to CMS Every EP must report on clinical quality measures Your certified EHR will track and produce a report with your clinical quality measures data (numerators and denominators). You will utilize this report when you complete your attestation There are no thresholds or percentages that you must meet. You just need to report the data exactly as it is contained in your EHR report 21

22 Report ambulatory clinical quality measures to CMS You must report on: 3 Core measures (If you don t collect data on one or more of the 3 core measures, you can use a measure from the alternate core list as a replacement) AND 3 measures that are relevant to Optometry from an additional Menu list of 38 items Report ambulatory clinical quality measures to CMS The 3 core clinical quality measures are: Core Clinical Quality Measure Hypertension: Blood Pressure Measurement Preventive Care and Screening Measure Pair: a. Tobacco Use Assessment b. Tobacco Cessation Intervention National Quality Forum (NQF) and / or PQRS Measure Number NQF 0013 NQF 0028 Adult Weight Screening and Follow-up NQF 0421 PQRS 128 Report ambulatory clinical quality measures to CMS The 3 alternate core clinical quality measures Alternate are: Core Clinical Quality Measure Weight Assessment and Counseling for Children and Adolescents Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old National Quality Forum (NQF) and / or PQRS Measure Number NQF 0024 NQF 0041 PQRS 110 Childhood Immunization Status NQF Report ambulatory clinical quality measures to CMS Additional Clinical Quality Measures You must pick 3 from the list of 38. Optometry relevant shown belowadditional Clinical Quality Measures Primary Open Angle Glaucoma: 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 National Quality Forum (NQF) and / or PQRS Measure Number PQRS 12 PQRS 18 PQRS 19 Diabetes: Eye exam PQRS 117 Report ambulatory clinical quality measures to CMS Your certified EHR does the work! It will track and calculate the measures as you enter patient data You must report these numbers when you attest If you have a zero in the denominator on one or more of the core clinical quality measures replace it with one (or more) measures from the alternate list Choose 3 measures from the additional list that are relevant to Optometry to report on Remember there are no minimum values that you must obtain you just report the numbers from your certified EHR Report ambulatory clinical quality measures to CMS Need help understanding CQMs?? CQM webpage ualitymeasures.asp#topofpage User guide Guide_to_CQMS.pdf You tube video 22

23 Provide clinical summaries for patients for each office visit Clinical summaries must be provided to patients within 3 business days of visit for more than 50% of all office visits. You may be excluded if you have no office visits. Provide clinical summaries for patients for each office visit At completion of the exam, the EHR would take the key elements from the electronic record and create a summary of the findings which can be given to the patient The clinical summary can be provided through a personal health record, patient portal on the web site, secure , electronic media such as CD or USB fob, or printed copy. If the EP chooses an electronic media, they would be required to provide the patient a paper copy upon request 23

24 Provide clinical summaries for patients for each office visit Summaries should include items such as: updated medication list, vital signs, reason for visit, problem list, medications / immunizations, lab tests ordered / results, and follow up appointments An EP may choose to withhold particular information if they believe substantial harm may arise from disclosure Providers should not charge a fee Provide patients with an electronic copy of their health information More than 50% of all patients who request an electronic copy of their health information are provided the electronic copy within 3 business days. You may be excluded if none of your patients requests an electronic copy of their health information. Provide patients with an electronic copy of their health information When a patient makes a request, EPs must provide the patient with all of the health information they have available electronically within 3 business days At a minimum includes: diagnostic test results, problem list, medication lists, medication allergies Certified software will generate this report The media could be any electronic form such as patient portal, PHR, CD, USB fob, etc. EPs are expected to make reasonable accommodations for patient preference Per HIPAA rules, you may charge a fee for this service 24

25 Capability to exchange key clinical information Perform at least one test of EHRs ability to electronically exchange key clinical information. There is no exclusion for this objective. Capability to exchange key clinical information The test of electronic exchange of key clinical information must involve the transfer of information to another provider of care with a different certified EHR system than your own The use of test information about a fictional patient that would be identical in form to what would be sent about an actual patient would satisfy this objective This test must be done at least once prior to the end of the EHR reporting period Every payment year requires its own, unique test If multiple EPs are using the same certified EHR technology in a shared physical setting, testing would only have to occur once for a given certified EHR technology An unsuccessful test is considered valid for meeting the measure of this objective Protect electronic health information Protect electronic health information Conduct or review a security risk analysis and implement security updates as needed and correct identified security deficiencies as part of the process. There is no exclusion for this objective. This is similar to the current HIPAA security rules You must conduct or review a security risk analysis and implement updates as necessary Should be done once prior to end of reporting period Security update would be required if any deficiencies were identified during your risk analysis Your software vendor should be able to provide you with tools to complete the risk analysis 25

26 10 Menu Objectives Harder Easier Meaningful Use Summary 10 Menu Objectives 1. Submit electronic data to immunization registries 2. Submit electronic syndromic surveillance data to public health agencies 3. Drug formulary checks 4. Patient specific education resources 5. Generate lists of patients by specific conditions 6. Summary of care record for transitions of care 7. Send reminders to patients for preventive / followup care 8. Medication reconciliation 9. Electronic access to health information for patients 10. Incorporate clinical lab-test results Meaningful Use - 10 Menu Objectives You have to report on 5 of the 10 menu objectives At least one of the 5 you report on must be a Public Health Objective Public Health Objectives: 1. Submit electronic data to immunization registries 2. Submit electronic syndromic surveillance data to public health agencies Submit electronic data to immunization registries Perform at least one test of certified EHRs capacity to submit electronic data to immunization registries and follow up submission if the test is successful. You are excluded from meeting this objective if: You don t administer immunizations There s no immunization registry to which you can send information Submit electronic data to immunization registries Remember the exclusion: If an EP does not perform immunizations during the reporting period, or if no immunization registry is capable of receiving the information, the EP would be excluded Certainly Optometrists can take this exclusion All certified EHRs will have the ability to transmit the data Must have an immunization registry able to accept the data An unsuccessful test to submit electronic data to immunization registries or immunization information systems will be considered valid and would satisfy this objective 26

27 Submit electronic syndromic surveillance data to public health agencies Perform at least one test of certified EHRs capability to provide electronic syndromic surveillance data to public health agencies and follow up submission if the test is successful. You are excluded from meeting this objective if: You don t collect any reportable syndromic data There s no registry to which you can send information Submit electronic syndromic surveillance data to public health agencies Remember the exclusion: If an EP does not collect any reportable syndromic information or if no public health agency is capable of receiving the information the EP would be excluded Certainly Optometrists can take this exclusion All certified EHRs will have the ability to transmit the data Must have a public health agency that is able to accept the data An unsuccessful test to submit electronic syndromic surveillance data to public health agencies will be considered valid and would satisfy this objective Public Health Objectives In most cases we will be able to take the exclusion for both of these Remember when you attest you will still need to select one of them and when asked if you qualify for an exemption from it select yes You will then need to attest on four other menu objectives Drug formulary checks Drug formulary checks EP has enabled functionality for drug formulary checks and has access to at least one internal or external formulary for the entire reporting period. There is no exclusion for this objective if you choose it as one of your menu items. This is a function of your certified EHR software e-prescribing system Be sure the functionality is turned on and active for your entire reporting period This is an easy menu objective to achieve 27

28 Patient specific education resources Patient specific education resources More than 10% of all unique patients seen by the EP are provided patient specific education resources. There is no exclusion for this objective if you choose it as one of your menu items. Certified EHRs have the ability to identify patient specific educational resources based on the problem list, medication list, or lab test results The EHR technology should be used to suggest the patient educational resources The resources do not have to be stored within or generated by the EHR This is an easy menu objective to achieve! 28

29 Generate lists of patients by specific conditions Generate at least one report listing patients of the EP with a specific condition. There is no exclusion for this objective if you choose it as one of your menu items. Generate lists of patients by specific conditions All certified EHRs can generate a list of patients based on certain conditions The objective does not dictate the reports which must be generated An EP can determine which reports are most useful to their care efforts This is an easy menu objective to achieve! 29

30 Summary of care record for transitions of care EP who refers or transitions their patient to another provider or setting provides a summary of care record more than 50% of the time. You can be excluded from meeting this objective if you don t refer or transfer any patients to another setting during the reporting period. Summary of care record for transitions of care You must provide a summary of care record to the provider you are referring the patient to You could use the clinical summary or your electronic copy An electronic or paper copy of the summary care record can be sent Directly to the next provider Provided to the patient to deliver to the next provider This is an easy menu objective to achieve! Send reminders to patients for preventive / follow up care More than 20% of all patients 65 years or older or 5 years or younger were sent the appropriate reminder during the reporting period. You can be excluded from this objective if you have no patients 65 years or older or 5 years old or younger. 30

31 Send reminders to patients for preventive / follow up care This is fairly easy to do in all certified EHR software There is no specific requirements for the reminders You have the discretion to determine the frequency, means of transmission and form of the reminder limited only by the requirements of HIPAA This is an easy menu objective to achieve! Medication reconciliation EP performs medication reconciliation (including name, dosage, frequency, and route) more than 50% of transitions of care in which the patient is transitioned into care of the EP. You can be excluded from this objective if you do not see any patients after they received care from another provider. Medication reconciliation Medication reconciliation is the process of identifying the most accurate list of all medications the patient is taking by comparing the medical record to an external list of medications obtained from a patient, hospital or other provider While on the surface this seems easy, you must remember that true medication reconciliation is defined to include: Medication name, dosage, frequency, and route This is obtainable but may be more difficult to achieve 31

32 Electronic access to health information for patients At least 10% of all unique patients seen by the EP are provided timely (within 4 business days of being updated in the EHR) electronic access to their health information. You must provide access but you are not responsible for utilization. You can be excluded from this objective if you do not order or create any of the following: Lab results Problem list Medication list Medication allergy list Electronic access to health information for patients Online electronic access through either a patient portal or personal health record (PHR) will satisfy this objective The minimal information to be included is: Lab test results, problem list, medication list, and medication allergy list You may withhold information from the electronic copy in accordance with HIPAA The focus of this objective is on the availability of access and the timeliness of data, not utilization by patients You are not responsible for ensuring that 10% of your patients request access or have the means to access, only that 10% of all unique patients could access the information if they desired This is very achievable, but may require additional cost. If your software makes this easy to use and inexpensive then it may be a menu objective that you select 32

33 Incorporate clinical lab-test results More than 40% of all clinical lab test results ordered by the EP during the reporting period (whose results are in a +/- or numerical format) are incorporated in the EHR as structured data. You can be excluded from this objective if you did not order any lab tests during the reporting period or if none of the lab tests ordered have results in a positive / negative or numerical format. Incorporate clinical lab-test results This applies to lab results ordered by the you during the reporting period whose results are either positive/negative or numerical format Typically blood, urine, path reports Many of us could take the exemption for not ordering any lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period This may be a more difficult objective for many of us because we don t order a lot of labs and you and your software will have to communicate with labs to transfer the information back and forth 33

34 Meaningful Use Summary 15 Core Objectives 1. Record patient demographics 2. Record and chart changes in vital signs 3. Maintain an up to date problem list of current and active diagnoses 4. Maintain active medication list 5. Maintain active medication allergy list 6. Record smoking status for patients 13 years or older 7. E-Prescribing (erx) 8. Computerized provider order entry (CPOE) 9. Drug-drug and drug-allergy checks 10. Implement clinical decision support 11. Report ambulatory clinical quality measures to CMS / States 12. Provide Clinical summaries for patients for each office visit 13. Provide patients with an electronic copy of their health information, upon request 14. Capability to exchange key clinical information 15. Protect electronic health information Harder Easier Meaningful Use Summary 10 Menu Objectives 1. Submit electronic data to immunization registries 2. Submit electronic syndromic surveillance data to public health agencies 3. Drug formulary checks 4. Patient specific education resources 5. Generate lists of patients by specific conditions 6. Summary of care record for transitions of care 7. Send reminders to patients for preventive / followup care 8. Medication reconciliation 9. Electronic access to health information for patients 10. Incorporate clinical lab-test results Steps to Get Started Select a certified EHR software Determine which EHR incentive program you are eligible for Medicare / Medicaid Register Achieve meaningful use Attest Attestation Process Attestation Attestation is a legal statement that you have met the requirements of the EHR incentive program EPs will report numerator, denominator, and exclusion results (if applicable) for the meaningful use objectives and attest that they have successfully met the requirements of the program via an internet based system Once EPs have completed a successful online submission through the Attestation System, they qualify for a Medicare EHR incentive payment The Attestation System for the Medicare EHR Incentive Program opened on April 18, Attestation During the attestation process you will be required to enter the information from a report that your certified EHR system has created You will be required to report on: 15 core objectives 5 menu objectives (one public health) 3 core or alternate core clinical quality measures 3 additional clinical quality measures 34

35 Attestation To begin the attestation process under the Medicare EHR incentive program you will go to the same site you registered for the EHR incentive program which is: Attestation Process To begin the attestation process under the Medicaid EHR incentive program you will go to your states website 35

36 Attestation Process Attestation Process Attestation Process Attestation Process Attestation Process Attestation Process 36

37 Attestation Process Attestation Process Attestation Process Attestation Process Attestation Process 37

38 Attestation Help Review the attestation user guide at: /Downloads/Ep_Attestation_User_Guide.pdf Attestation Help Watch the video tutorial on attestation at: Want To Practice Before You Attest? Want To Practice Before You Attest? /Downloads/EP_Attestation_Worksheet.pdf Where To Go For Help EHR incentive program help: For questions, contact the EHR information center: (TTY ) 7:30am-6:30pm CST M-F (except federal holidays) 38

39 ICD-10-CM Will You Be Ready? International Classification Of Disease Tenth Edition Clinical Modification (CM) ICD-10 ICD-10 is used world-wide All major countries use ICD-10 except the US and Italy Published by the World Health Organization (WHO) ICD-10-CM Characteristics Exceeds ICD-9-CM in the number of concepts Greater number of codes available ICD-9: approximately 13,600 ICD-10: approximately 69,000 Codes report not only the disease but its current clinical manifestation implementation date ICD-10-CM Codes (October 1, 2013) An ICD-10 code: Is three to seven digits long. Begins with an alphabetic character. Has a numeral as the second digit. Includes alpha or numeric digits as the third through seventh characters. Has high levels of differentiation of right vs. left vs. bilateral ICD-10-CM H00: Hordeolum: H00.021: Hordeolum internum right upper eyelid H00.022: Hordeolum internum right lower eyelid H00.023: Hordeolum internum right eye, unspecified eyelid H00.024: Hordeolum internum left upper eyelid H00.025: Hordeolum internum left lower eyelid H00.026: Hordeolum internum left eye, unspecified eyelid H00.029: Hordeolum internum unspecified eye, unspecified eyelid 39

40 Interesting ICD-10-CM Codes Burn due to water-skis on fire, initial encounter ICD-10 code = V9107XA Struck by turtle, initial encounter ICD-10 code = W5922XA Walked into lamp post, initial encounter ICD-10 code = W2202XA ICD-10 Realities Electronic Health Records will be key Inquire if your software has/plans to update to ICD-10 Clinical documentation in EHR EHR can suggest ICD-10 Correct codes based on: Condition Eye Level of disease / condition Questions? Philip J. Gross, O.D. Jay W. Henry, O.D., M.S. 40