Meaningful Use (MU): Determining your Stage and Timeline Shannon Means, MPA Healthcare Performance Professional SCAN Health Plan
Agenda What Stage are you in? September 2014 Flexibility Rule Changes Stage 1 2014 Criteria Stage 2 MU overview Overcoming barriers and preparing now Q&A 2
Determining your Meaningful Use Timeline 1st year of MU 2011 2012 2013 2014 2015 2016 2017 2011 AIU (Adopt/Implement/ Upgrade) Stage 1 Year 1 Stage 1 Year 2 Stage 2 Year 3 Stage 2 Year 4 Stage 2 Year 5 TBD 2012 AIU (Adopt/Implement/ Upgrade) Stage 1 Year 1 Stage 1 Year 2 Stage 2 Year 3 Stage 2 Year 4 Stage 2 Year 5 2013 AIU (Adopt/Implement/ Upgrade) Stage 1 Year 1 Stage 1 Year 2 Stage 2 Year 3 Stage 2 Year 4 2014 AIU or Stage 1 Year 1 (numerators & denominators if you bill Medicare Part B) Stage 1 Year 1 Stage 1 Year 2 Stage 2 Year 3 2015 AIU or Stage 1 Year 1 Stage 1 Year 1 if you did AIU or Stage 1 Year 2 if you did AIU (if you bill Medicare Part B it Stage 1 Year 2 if you did not do or is recommended you do not do AIU to avoid the payment adjustment) AIU Stage 2 Year 3 if you did not do AIU 2016 AIU or Stage 1 Year 1 (if you bill Medicare Part B it is recommended you do not do AIU to avoid the payment adjustment) *N/D stands for the avestawon of numerators and denominators. For example, for Smoking Status a reading of 88/100 indicates that 88 individuals 13 years and older had a smoking assessment recorded out of the 100 individuals 13 and over seen in the reporwng period. 88 is the numerator and 100 is the denominator. The performance rate would be 88%. Stage 1 Year 1 if you did AIU or Stage 1 Year 2 if you did not do AIU 2017 AIU or Stage 1 Year 1 (if you bill Medicare Part B it is recommended you do not do AIU to avoid the payment adjustment) 3
Avoiding the Medicare Part B FFS Payment Adjustment Payment adjustments are only applicable to Medicare Part B FFS Reimbursements An Eligible Provider (EP) must have been a Meaningful User by October 1, 2014 to avoid payment adjustments unless you were able to submit a hardship exempwon applicawon AIU does NOT COUNT as being a Meaningful User Providers must meet Meaningful Use for consecuwve years in order to avoid payment adjustments (1% per year) Hardship ExempWons can be granted for providers who apply and indicate they were not able to meet Meaningful Use due to Vendor Delays Maximum payment adjustment is 5% 4
2014 Flexibility Rule Changes The rule grants flexibility to providers who are unable to fully implement 2014 EdiKon CEHRT for an EHR reporwng period in 2014 due to delays in 2014 CEHRT availability. For 2014 only, providers may use EHRs that have been: cerwfied under the 2011 EdiWon a combinawon of the 2011 and 2014 EdiWons or the 2014 EdiWon In 2015 you MUST be on a 2014 CEHRT To avest for AIU in 2014 you MUST be on a 2014 CEHRT 5
Flexibility Flow Chart 6
Flexibility Rule Summary Stage 1 Providers: If you were unable to fully implement your 2014 CEHRT to meet MU due to vendor delays you can select a reporwng period where you were either all or parwally on the 2011 CEHRT to meet Stage 1 MU 2013 Criteria Stage 2 Providers: If you were unable to fully implement your 2014 CEHRT to meet MU due to vendor delays you can select a reporwng period where you were: Only on a 2011 CEHRT to meet MU Stage 1 2013 Criteria On a combinawon of 2011 and 2014 CEHRT to meet MU Stage 1 on either 2013 or 2014 Criteria On the 2014 CEHRT only to meet MU Stage 1 2014 Criteria If you were able to fully implement your 2014 CEHRT then you MUST avest to Stage 2 Measures using a 2014 CEHRT * If a provider who is scheduled to start Stage 2 in 2014 uses the Flex rule to report on Stage 1 Measures, CMS will s@ll count 2014 as the provider s first year of Stage 2. Therefore, in 2015 it will be the providers second year of Stage 2. 7
Stage 1 2014 Criteria Menu measures cannot be met by exclusion. Public health measures must be reported. Providers must report on 9 Clinical Quality Measures covering 3 NaWonal Quality Strategy Domains CQMs must be submived electronically for Medicare- Eligible Providers (EPs): Applies to EPs beyond their first year Two choices: PQRS or CMS Portal for Meaningful Use (MU) 8
Stage 1 2014 Criteria (cont d) Medi- Cal won t accept electronic CQM submission Must have a 2014 MU- cerwfied system Regardless of stage in 2014, all providers report for 90 days Medicare: calendar quarter Medicaid: any 90- day period Must have a pawent portal Providers who have reported on Stage 1 Measures (numerators & denominators) for either 2 or 3 years must meet Stage 2 criteria 9
Stage 2 *CAHs = CriWcal access hospitals 10
Stage 1 vs Stage 2 Measures 11
Stage 1 vs Stage 2 (cont d) 12
Stage 1 vs Stage 2 (cont d) 13
Clinical Quality Measures (CQMs) and their SigniLicance Increases quality of care for your pawents Promotes care coordinawon and sharing of best pracwces between providers Decreases medicawon errors Promotes appropriate use of diagnoswcs, images and screenings Mechanism to track performance, meet pracwce goals, and measure success of implemented intervenwons 14
2014 Clinical Quality Measures- Stages 1 & 2 All providers must select 9 CQMs from at least 3 of the 6 Health and Human Services NaWonal Quality Strategy (NQS) domains: PaWent and family engagement (4 Measures) PaWent safety (6 Measures) Care coordinawon (1 Measure) PopulaWon and public health (9 Measures) Efficient use of healthcare resources (4 Measures) Clinical processes/effecwveness (40 Measures) 15
Measures Selection Nine measures need to cover at least three domains. Do not need even split across three domains. Example: Seven Clinical Process, one PaWent Safety, and one Care CoordinaWon Do measures coincide with quality improvement (QI) goals? Is your pracwce s pawent demographic relevant to any of the CQMs? Do the measures align with other QI iniwawves? 16
Measures Selection (cont d) Check which CQMs your EHR is cerwfied to report. 1. Visit the Office of the NaWonal Coordinator s CerWfied Health IT Product List hvp://oncchpl.force.com/ehrcert/ehrproductsearch 2. Select 2014 ediwon 3. Search your EHR version 4. This list will show you all of the measures and which ones your EHR is cerwfied to report on. Not all EHRs are cer@fied to report on all 64 CQMs. Select CQMs your EHR is cer@fied to report on. 17
2014 CQM Reporting Period EPs aveswng to their first year of MU can select any 90- day period in 2014. EPs aveswng to Medicare must select a calendar quarter for their MU avestawon period. Medicare EPs must submit electronic CQMs (ecqms). EPs have the opwon of using their corresponding calendar quarter for their ecqms or the enwre calendar year. 18
2014 CQM Reporting Period (cont d) EPs aveswng to Medi- Cal select any 90- day period in 2014 to avest for MU. In 2014, Medi- Cal will not accept electronic submission of CQMs. CQMs are to be submived via avestawon in the SLR, as in previous years. 19
Rural Health MU Barriers Monetary PaWent portal 2014- cerwfied EHR Interfaces (labs, registries, etc.) PaWent engagement PaWents using the pawent portal Health InformaWon Exchange Electronic TransiWon of Care Summaries (Stage 2) EHR vendors releasing 2014 ediwon Broadband access ImplemenWng and training of new measures 20
Overcoming Barriers: 2014 Editions What is the cost for the upgrade? Does your vendor have a 2014- cerwfied version? Currently, this is not an exhauswve list. Many outpawent EHRs are currently not 2014- cerwfied. hvp://www.healthit.gov/buzz- blog/meaningful- use/cerwfied- ehr- health- it- products- list- available/ Training on upgraded version? Workflow redesign to capture new measures? In 2015 you must be on a 2014 CEHRT, if you are using the Flex Rule for 2014, work on your upgrade now to be ready for 2015. 21
Overcoming Barriers: Patient Engagement PaWent portal does not have to be through your EHR, but it does have to meet certain requirements and be modularly cerwfied. Explore different opwons to find a best fit and if it can interface with your EHR. Explore using a Health InformaWon OrganizaWon (HIO). Discuss with your pawents (encourage login, viewing) and confirm access with message to the provider. 22
Overcoming Barriers: Health Information Exchange Inquire with your vendor how with their system you can electronically send transiwon of care summaries Is it built within the system (ie, ecw P2P)? Will you need to join a Health InformaWon OrganizaWon (HIO)? Do you have a Direct address? Direct email is a secure, encrypted email which ensures that messages can only be accessed by the intended recipient. In Stage 2, 10% of all transiwon of care summaries need to be provided electronically (electronic fax does not count) 23
Overcoming Barriers: Broadband Access You may be eligible for an exclusion Objective Use secure electronic messaging to communicate with patients on relevant health information. Measure A secure message was sent using the electronic messaging function of CHERT by more than 5 percent of unique patients (or their authorized representatives) seen by the EP during the EHR period. Exclusion Any EP who has no oflice visits during the EHR reporting period, or any EP who conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 3Mbps broadband availability according to the latest information available from the FCC on the Lirst day of the EHR reporting period. 24
WorkLlow and Planning Workflow Assess exiswng workflow ( as- is ) and create Stage 2 workflows ( to- be ). Plan for coordinawon of interfaces and pawent portal. Project management planning Create Stage 2 implementawon schedule to cover upgrades, training, workflow redesign, monitoring of Stage 2 achievement, and avestawon. Assign a staff person responsible for monitoring Stage 2 progress and updates. Pull monthly reports and inform providers of their successes Complete regular gap analysis to track progress and keep all staff involved on the progress and gaps that need to be remediated. 25
Resources! Stage 2 Toolkit: hvp://www.cms.gov/regulawons- and- Guidance/LegislaWon/ EHRIncenWvePrograms/Downloads/Stage2_Toolkit_EHR_0313.pdf CerKfied HIT Product List: hvp://oncchpl.force.com/ehrcert?q=chpl ecqms Table (EPs): hvp://www.cms.gov/regulawons- and- Guidance/LegislaWon/ EHRIncenWvePrograms/Downloads/2014_EP_MeasuresTable_June2013.pdf Adult Recommended CQMs (EPs): hvp://www.cms.gov/regulawons- and- Guidance/LegislaWon/ EHRIncenWvePrograms/Downloads/ 2014_CQM_AdultRecommend_CoreSetTable.pdf PaKent Engagement Fact Sheet hvp://www.healthit.gov/sites/default/files/ key_considerawons_for_health_informawon_organizawons_vdt.pdf Payment Adjustments and Hardship ExcepKons hvp://www.cms.gov/regulawons- and- Guidance/LegislaWon/ EHRIncenWvePrograms/Downloads/ PaymentAdj_HardshipExcepTipSheesorEP.pdf Stage 2 Measures, Sample Workflows and Best PracKces hvp://www.healthit.gov/providers- professionals/step- 5- achieve- meaningful- use- stage- 2 26
Thank you! Shannon Means, MPA smeans@scanhealthplan.com 916.670.0844 27