2 Final Rule for EPs. Meaningful Use Stage 2. October 18, 2012

Transcription

1 Meaningful Use Stage 2 Final Rule for EPs October 18, 2012 Ivy Baer ibaer@aamc.org Mary Wheatley mwheatley@aamc.org Meaningful Use Stage 2 CMS final rule was released in the Federal Register on September 4 at 04/pdf/ pdf ONC s standards rule is in the same FR, at 04/pdf/ pdf Next opportunity for comment on MU? HIT Policy Committee Stage 3 Proposals November 2012? 2 1

2 Agenda for Today s Call 1. Meaningful Use Payment Update 2. Timing Issues 3. MU Stage 1 Changes 4. MU Stage 2 Themes 5. MU Stage 2 Measures 6. MU Stage 2 Clinical Quality Measures 7. Penalties 8. Appeals, Audits & Medicaid Issues 3 MU Payment Update 4 2

3 Where are we so far in MU world? (as of Aug. 31, 2012) EPs paid to date: Medicare: 74,317 EPs Medicaid: 55,012 EPs Hospitals paid to date: 3,905 hospitals Total $$ paid to date: $7,119,946,974 5 Timing Issues 6 3

4 Publication & Effective Dates Rule published September 4, 2012 Most provisions effective November 5, 2012 Some provisions effective September 4: A few changes to definition of meaningful user Changes to criteria for submission of info to immunization registries, lab results to public health agencies, & syndromic surveillance data Incentive payments for EPs in HPSA Changes or clarifications to Subpart D Days If 2014 is 2 nd year Stage 1 or 1 st year Stage 2: For Medicare-pick a quarter (Jan-March, April- June, July-Sept, Oct-Dec) For Medicaid-continuous 90 days or 3 months (state option) 4

5 Stages of Meaningful Use By Payment Year First Payment Year for Payment Year EP/Hospital Stage 1 Stage 1 Stage 1 Stage 2 Stage 2 Stage 3 Stage Stage 1 Stage 1 Stage 2 Stage 2 Stage 3 Stage Stage 1 Stage 1 Stage 2 Stage 2 Stage Stage 1 Stage 1 Stage 2 Stage Stage 1 Stage 1 Stage Stage 1 Stage Stage 1 9 Meaningful Use Reporting Periods? General Rule: First payment year: any continuous 90-day period Subsequent payment years: full calendar year NEW Exception for 2014 ONLY: Existing meaningful users only need to report during a 3-month quarter Jan. 1, 2014 Mar. 31, 2014 Apr. 1, 2014 June 30, 2014 July 1, 2014 Sept. 30, 2014 Oct. 1, 2014 Dec. 31,

6 Changes to MU Stage 1 11 Changes to MU Stage 1 in THIS Rule One change is required for 2013: Public health measure submission except where prohibited (i.e. even en if not required) Most changes are required for 2014 See full chart of Stage 1 changes at 77 Fed. Reg

7 Selected Stage 1 changes Starting 2013: CPOE alternative measure 30% med orders during reporting period recorded using CPOE Starting 2014: Can split exclusion for vital sign objectives Starting 2014: meeting exclusion for a menu set objective won t reduce # of menu objectives EP must meet. EXCEPT: if meet exclusion for 5 or more menu set objectives must meet all remaining non-excluded menu set objectives Hospital-Based EPs EPs who can show they fund the acquisition, implementation, and maintenance of CEHRT can be determined to be non-hospital based 7

8 MU Stage 2 Themes 15 Stage 1 Stage 2 IN GENERAL. There is created. EPs 15 core 5 of 10 menu 20 total objectives EPs 17 core 3 of 6 menu (was 5) 20 total objectives Hospitals/CAHs 14 core 15 of 10 menu 19 total objectives Hospitals/CAHs 16 core 3 of 6 menu (was 2 of 4) 18 total objectives 16 8

9 Stage 2 Reporting core objectives meet or qualify for exclusion 2. 3 of 6 menu objectives 3. Reporting on 9 CQMs MU Stage 2 Themes Increasing thresholds Measures dependent on actions by others than EP/hospital E.g., Number of patients accessing online record Menu items from Stage 1 became core in Stage 2 More emphasis on exchange Denominator change (hospitals) Quality Reporting Alignment with other programs No longer technically a measure Penalties determined based on payment year well in advance of penalty year 18 9

10 MU Stage 2 Measures 19 Multiple Locations Core: can sum numerators/denominators across locations with CEHRTs Menu: If different objectives implemented in different locations attest to 3 objectives that represent greatest # patient encounters 20 10

11 Stage 2 Patient Denominators Unless measure is for unique patients seen, EPs can limit denominator to patients whose records are maintained using CEHRT Other denominators Number of orders (med, lab, rad) Office visits Transitions of care/referrals If EP receiving referral: include first encounters with new patient and encounters with existing pts where summary of care record is provided to the receiving provider If EP initiates/refers: count only transitions/referrals he/she ordered (not those that are patient-initiated) 11

12 Objectives with No Exclusions Core: Record demographics: preferred language, sex, race, ethnicity, DOB Generate lists of specific patients by specific conditions Protect electronic health info through implementation of appropriate technical capabilities Menu: Record electronic notes in patient records Must meet IT functionality + CQMs CMS finalized Stage 2 requirements Earliest required = 2014 EPs must meet: All 17 core measures 3 of 6 menu measures 9 clinical quality measures/3 domains Note: Chart of finalized Objectives & Measures is at 77 Fed. Reg ; Chart of finalized CQMs for EPs is at 77 Fed. Reg

13 Core Objectives 1. CPOE 2. erx 3. Demographics* 4. Vital signs 5. Smoking status 6. Clinical decision support 7. Clinical lab results into CEHRT as structured data 8. Lists of pts by specific conditions* 9. Pt reminders 10. Pts to view online, download, transmit health info 11.Clinical summaries 12. Pt-specific education resources 13. Med reconciliation 14. Summary care record for transition of care 15. Immunization registries 16. Protect electronic health info* 17. Communicate with pts thru secure e-messaging *No exclusions Menu Objectives (3 of 6) 1. Imaging results and other accompanying info available through CEHRT 2. Record pt family health history as structured data 3. Capability to submit e-syndromic surveillance data to public health agencies 4. Capability to identify and report cancer cases to public health central cancer registry 5. Capability to identify and report specific cases to specialized registry 6. Record e-notes in patient records* *No exclusion available 13

14 Batch Attestation Batch attestation available for core and menu objectives only by 1/1/14 for groups of 2 or more EPs Group can be different than CQM group 50% or more of o/p encounters must be at locations where CEHRT available Must include information on all outpatient encounters (except in i/p and EDs) where CEHRT is available, even is location is NOT part of EP s Medicare EHR Incentive Group 27 MU Clinical Quality Measures (CQMs) Finalized for Eligible Professionals Starting

15 Finalized CQM Changes Through 2013 Report 3 core/alternate core + 3 measures Attest to results or EHR-PQRS pilot submission 29 Changes in 2014 Criteria for CQM same for all stages 3 options for reporting, including group reporting Electronic submission beyond first year EHR has to be certified for the measures submitted Six Quality Domains Aligns with National Quality Strategy Patient and Family Engagement Patient Safety Care Coordination Population and Public Health Efficient Use of Healthcare Resources Clinical Process/Effectiveness 15

16 2014 CQM - 3 Options for EPs 1) 9 measures/ 3 domains 2) PQRS-EHR Group Reporting At least one measure in at least 3 domains 64 measures Core measures encouraged not required Follows rules for PQRS-EHR submission Credit for individual PQRS and EHR program ACOs and GPRO Option only available for Medicare EHR Incentive Must use CEHRT 31 Recommended Core Measures - Adult Domain NQF # Recommended Measures Patient/Family Engagement TBD Functional status assessment for complex chronic conditions Patient Safety 0022 Use of High-Risk Medications in the Elderly 0419 Documentation of Current Medications in the Medical Record Care Coordination TBD Closing the Referral Loop: Receipt of Specialist Report Population and Public Health Efficient Use of Resources Clin. Process/ Effectiveness 0028 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 0418 Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan 0421 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up 0052 Use of Imaging Studies for Low Back Pain 0018 Controlling High Blood Pressure 32 16

17 Recommended Core Measures - Peds Domains NQF # Measures Population and Public Health Efficient Use of Resources Clin. Process/ Effectiveness 0024 Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents 0033 Chlamydia Screening for Women 0418 Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan 0002 Appropriate Testing for Children with Pharyngitis 0069 Appropriate Treatment for Children with Upper Respiratory Infection (URI) 0036 Use of Appropriate Medications for Asthma 0038 Childhood Immunization Status 0108 ADHD: Follow-Up Care for Children Prescribed Attention- Deficit/Hyperactivity Disorder (ADHD) Medication TBD Children who Have Dental Decay or Cavities 33 Group CQM Reporting Who can report group CQM? PQRS GPRO participants p that use CEHRT (excludes claims, registry) Pioneer and MSSP ACOs Covers all EPs, including first year of attesting CAVEAT: Does not cover EP that is trying to avoid penalty by reporting by Oct 1 of the year prior to penalty. Does not cover Medicaid EPs 34 17

18 CQM/PQRS/Value Modifier Reporting Period Individual CQM Reporting (3 core/alt core plus 3 measures) PQRS- EHR Pilot PQRS GPRO using CEHRT* ACOs using CEHRT Contributes to 2013 Incentives Medicare EHR Incentive Yes Yes No No Medicaid EHR Incentive Yes No No No PQRS Incentive No Yes Yes Yes Avoids 2015 Penalties Medicare EHR Incentive Yes Yes No No PQRS No Yes Yes Yes Value Modifier (for groups)** No No Yes N/A 35 * Excluding claims and registry group reporting ** As proposed in 2013 PFS Proposed Rule CQM/PQRS/Value Modifier Reporting Period (Changes from 2013 Underlined) Individual CQM Reporting (9 measures/ 3 domains) PQRS- EHR Pilot PQRS GPRO using CEHRT* ACOs using CEHRT Contributes to 2014 Incentives Medicare EHR Incentive Yes Yes YES YES Medicaid EHR Incentive Yes No No No PQRS Incentive No Yes Yes Yes Avoids 2016 Penalties Medicare EHR Incentive Yes Yes YES YES PQRS No Yes Yes Yes Value Modifier (for groups)** No No Yes N/A 36 * Excluding claims and registry group reporting ** As proposed in 2013 PFS Proposed Rule 18

19 PENALTIES Penalty Exceptions: If first year of MU is 2014-must attest by 10/1/14 EPs in areas without sufficient internet access* New EPs for first 2 years of practice Extreme circumstances* EPs with primary specialty of anesthesia, rad, & path will be deemed to qualify for exception, but law limits to 5 years EPs practicing in multiple locations w/o control over whether CEHRT is available for 50% or more of outpatient encounters* * Applications for exemptions due by July 1,

20 Medicaid Meaningful Users... Avoid Medicare penalty (but remember, A/I/U Meaningful Use) 39 To avoid penalties, do what by when? To Avoid Penalties in FY: 2015 Existing Meaningful User: MU for All of FY 2013 Attest by February 28, 2014 New Meaningful User: MU for 90 days Attest by Oct 1, Existing Meaningful User: MU for CY 2014 (quarter) Attest by February 28, Existing Meaningful User: MU for 90 days Attest by Oct 1,

21 Appeals, Audits, & Medicaid Issues 41 Appeals Process Proposed rule: discussed variety of appeals categories and requirements Final rule: does not address comments; removes administrative appeals from regulatory process After review of the public comments and the appeals files as of the writing of this rule, we believe the administrative review process is primarily procedural and does not need to be specified in regulations. Will issue procedural guidance and post at

22 Medicaid Audits & Appeals CMS finalized option for states to turn Medicaid audit and appeals function over to CMS (for hospitals, not EPs) 43 Stage 3 Rulemaking early 2014 All Stage 2 menu set to become Stage 3 core set Implementation starting

23 Responses to Questions 1. Are certified medical assistants considered licensed healthcare professionals for using CPOE? Credentialed medical assistants can use CPOE if they are credentialed from outside the employing organization (p ) 2. For Medicaid volume calculation, will Stage 2 changes apply ppy retroactively to EPs currently in Stage 1? Changes in Medicaid volume apply only to 2013 and subsequent years (p ) Questions 3. If EP registers for Medicare/Medicaid and is unable to attest due to reasons outside their control but does not qualify for a hardship exemption, is the EP subject to a penalty? YES 4. Any movement toward alignment of Medicare and Medicaid EP requirements? 5. What happens if an organization hires an established provider subject to the penalty based on working at a different organization? Penalty is not based on employment. It remains with the provider for the entire calendar year