Massachusetts Medicaid EHR Incentive Payment Program

Massachusetts Medicaid EHR Incentive Payment Program

Agenda Vision & Goals High-level overview where we are going Medicare vs. Medicaid EHR Incentive Programs Performance and Progress Eligibility Overview Meaningful Use Overview HIT Success Stories 2

Program Overview Medicaid VISION GOAL To improve the quality and coordination of care by connecting providers to patient information instantly through the use of certified EHR technology (CEHRT) To promote the adoption and meaningful use of interoperable CEHRT to Eligible Professionals (EPs) and Eligible Hospitals (EHs) across the Commonwealth 3

Where are we going? Data Capturing and Sharing Advance Clinical Processes Improved Outcomes Additional Stages TBD Interoperable EHR Stage 1 MU Stage 2 MU Stage 3 MU Adopt Implement MU Upgrade 4

Medicare vs. Medicaid EHR Incentive Payment Program Medicare EHR Incentive Payment Program Managed by CMS Incentive payments for eligible hospitals are based on a number of factors, beginning with a $2 million base payment Payment reductions begin in 2015 for providers who are eligible but choose not to participate In the first year and all remaining years, providers have MU objectives and associated measures they must meet to get incentive payments EPs can receive a maximum incentive amount of $44,000* (over 5 successive years of program participation) *NOTE: As of 2013, payment amount annually reduced Medicaid EHR Incentive Payment Program State manages its own program Incentive payments for eligible hospitals are based on a number of factors, beginning with a $2 million base payment No Medicaid payment reductions if providers choose not to participate In the first year, providers can receive an incentive payment for adopting, implementing or upgrading a certified EHR. In all remaining years, providers must meet the same MU objectives and associated measures as Medicare EPs can receive a maximum incentive amount of $63,750 (over 6 years of program participation) 5

How Much Can a Medicaid Eligible Professional Receive in Incentives? NOTE: Pediatricians that meet the 20% Medicaid patient volume threshold may receive up to $42,500 over a six year period: $14,167 in the first year of participation and up to $5,667 in subsequent years. Pediatricians that meet the 30% Medicaid patient volume threshold may receive the full incentive amount. 6

Incentive Program Performance and Progress

Performance: Registration Metrics REGISTRATIONS BY PROVIDER TYPE FROM 10/03/2011 to 06/7/2013 8

Performance: Payment Metrics TOTAL INCENTIVE AMOUNT DISTRIBUTED AS OF 06/7/2013 9

Performance: Payment Metrics PAYMENTS by PAYEE TYPE FROM 10/03/2011 to 06/7/2013 3,000 49.9 Million 2,500 2,000 1,500 20.4 Million 23.6 Million 2,591 1,000 500 1,127 1,344 1.6 Million 92 72 Million 80 0 CHC/FQHC Group Individual Hospital Physician's Organization Hospitals 10

Eligibility Requirements CEHRT Provider Type Threshold

Eligible Professionals: Requirements 1. Y/N ONC CEHRT (CHPL) Acquire system from ONC Certified Health IT Product List 2. Y/N ELIGIBLE PROVIDER TYPES Physicians: MD / DO Certified Midwives Nurse Practitioners Residents Dentists Limited License Dentists 3. Y/N No more than 90% of services furnished in hospital setting: POS 21: Inpatient POS 23: Emergency Room or Provider contributed funds to acquisition, implementation, and maintenance of CEHRT hardware and interfaces to meet Meaningful Use *NEW* 4. Y/N Demonstrate at least 30% (20% Pediatricians) paid Medicaid/Medicaid 1115 Waiver encounters in 90 period from previous CY or 12-month period leading up to attestation or Demonstrate at least 30% (20% Pediatricians) were Medicaid/Medicaid 1115 Waiver enrollees in 90 period from previous CY or 12-month period leading up to attestation *NEW* Effective 2013 and beyond: Providers can include zero-paid and denied claims. 12

Meaningful Use Core Menu CQMs

Key Healthcare Policy Domains Patient and Family Engagement Patient Safety Care Coordination Population and Public Health Efficient Use of Healthcare Resources Clinical Process/ Effectiveness 14

Focus of Stage 1 Meaningful Use Criteria STAGE 1 STAGE 2 STAGE 3 Electronically capturing health information in a structured format and using that information to track key clinical conditions Establishing the functionalities of certified EHR technology that will allow for continuous quality improvement and easy information exchange Communicating information for care coordination purposes (whether that information is structured or unstructured, but in a structured format whenever feasible) Implementing clinical decision support tools to facilitate disease and medication management Beginning to use CEHRTs to engage patients, their families, and report clinical quality measures and public health information 15

2013 Stage 1 Meaningful Use Stage

Meaningful Use: General Requirements 50% of an EP s encounters must occur at the location or location(s) that utilize CEHRT At least 80% of unique patients must have their data in a CEHRT during the chosen 90-day reporting period EXAMPLE: Dr. Jones Practices at 1 Location Practice Location: 180 Lyman St. 90-Day Reporting Period (Current CY): 6/1/12 8/31/12 CEHRT 100% encounters occur at 180 Lyman St. 80 unique patients 70 in CEHRT 70/80 x 100 = 87% Provider meets Meaningful Use general requirements 17

Stage 1 Requirements Highlights Stage 1 Changes required in 2013 and onward: Generate and transmit permissible prescriptions electronically Capability to exchange key clinical information among providers of care and patient authorized entities electronically: will no longer be a required core measure. Actual exchange will be required in Stage 2 starting in 2014. Public Health Objectives: additional except where prohibited to the objective regulation language for the three public health measures Optional in 2013 only: Record and track changes in vital signs Addition of alternative age limitations, includes blood pressure for patients ages three and over only and height and weight for all ages. Additional alternative exclusion Sees no patients 3 years or older is excluded from recording blood pressure Optional in 2013 and remains optional: Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines: addition of alternative measure. More than 30 percent of medication orders are recorded using CPOE. 18

Stage 2 Requirements Highlights 2014 Certification Requirements All EHR systems must be certified to the Office of National Coordinators (ONC) 2014 certification requirements Core & Menu Measure Requirements EPs must meet 17 Core objectives and 3 of 6 Menu measures Clinical Quality Measures (CQMs) Electronic submissions of Clinical Quality Measures regardless of what stage of Meaningful Use EPs are in (beginning 2014 and beyond) EPs must report on 9 out of 64 CQMs selected from at least 3 of the key health care policy domains MassHealth is currently evaluating the process and system to electronically capture CQMs Meaningful Use Reporting Period For 2014 only, all EPs attesting to meaningful use will use a 90-day EHR reporting period Health Information Exchange Connect and electronically transmit data (ex: transmit summary of care record) 19

Mass HIway Hub for Health Information Exchange The Mass HIway enables the secure electronic exchange of health information among diverse participants in the Commonwealth: Payer Pharmacy Labs Health System Public Health Hospital Small Practice The Benefits of HIE Improve & streamline care coordination Fewer medical errors/improved patient safety Reduce duplication Supports achieving Meaningful Use Reduce costs throughout the care delivery system Ease & improve public health reporting & analytics Foundation for Accountable Care Organizations & value-based healthcare models Mass HIway Last Mile Program 1.855.MA-HIWAY (1.855.624.4929) Option 1 MassHiway@mehi.masstech.org mehi.masstech.org/what-we-do/mass-hiway 20

Health IT Success Story Example Benefits of Achieving Meaningful Use (MU) small practice In this small practice, achieving MU required physicians and staff members to work outside of their comfort zones, but resulted in new policies and procedures that improved healthcare quality. While the financial/time resources required were demanding on this small practice, the benefits are tangible. By implementing an HER and achieving MU, Dr. Smith's practice is now using technology to help improve patient care such as: E-prescribing Automated recall processes for preventative services and chronic disease follow-up Patient registries (e.g., diabetes and coronary artery registries) Dr. Smith's practice has seen improved safety and reduced healthcare costs, as well as improved population health. For example, Dr. Smith notes that "being alerted when my patients' BMI falls out of range prompts me to do something about it and has resulted in more frequent discussions with my patients on the importance of weight management." Achieving MU also fostered a relationship between Dr. Smith's practice and the Immunization Registry. Without the MU incentive payments, it was unlikely that the practice would have gone to the trouble of implementing a system that was able to participate in a statewide immunization registry. Adopting new technology and achieving meaningful use improved our workflows, helped us refine our policies and procedures, and, best of all, improved patient care -Dr. Smith 21

Health IT Success Story Example Lessons Learned: Obstetrics & Gynecology Practice Dr. Jones at this Obstetrics & Gynecology practice offers the following lessons learned for other practices considering health IT adoption: Use a reliable, local IT company or administrator to install and maintain your hardware and software Develop simple and complete patient demographic and medical information forms that match the software for easy entry Make sure your leadership team is ready and able to undertake a complex and stressful long term project Prepare financially and establish reserve funds to account for a temporary drop in productivity and increase in payroll and overtime pay Schedule short, daily meetings to work through small but important implementation details Create deadlines for complete implementation of key components of the program Don t underestimate the amount of time that will need to be dedicated to training Don t let implementation stall out continue to press on to maximize the functionality of the implementation Focus on two or three issues to tackle every week. Do not try to fix every problem simultaneously Be patient, ask for assistance when needed, and don t give up! The System has paid for itself several times over in practice efficiency and cost savings Dr. Jones 22

Contact Us Contact Us Massachusetts Medicaid EHR Incentive Payment Program: P: 1-855-MassEHR (1-855-627-7347) E: massehr@masstech.org F: 508-898-3211 23