MDeverywhere, Inc. Presents 2014 CMS EHR Incentive Program Requirements: What Providers Need To Know Presented by: Kristen Heffernan Director Product Management & Marketing, Henry Schein MicroMD
Agenda Acronyms Agenda CMS EHR Incentive Program Overview Stage 1 Overview Final Rule Stage 2 Overview Final Rule Stage 2 Changes to Medicaid Eligibility Final Rule Stage 2 Changes to Stage 1 Stage 2 Objectives + CQMs Final Rule Stage 2 Payment Adjustments + Exceptions Preparation to participate Our Commitment and Q&A
Let s start with the acronym dance EP = Eligible Professional (Providers eligible to secure CMS EHR Incentive Program reimbursement) MU = Meaningful Use of EMR CQMs = Clinical Quality Measures (One of the sets of data to be recorded and tracked to achieve Medicare program Meaningful Use) A/I/U = Adoption, Implementation or Upgrade of EMR (Medicaid) CMS = Centers for Medicare/Medicaid (Est. provider requirements) ONC = Office of the National Coordinator (Est. EMR requirements) SC&C = Standards & Certification Criteria (Est. criteria for new 2014 Edition EHR certification) ONC-ATCB = Approved Testing and Certification Body for EMR (Tests and certifies Stage 1 EMRs eligible for helping EPs secure reimbursement through 2013) CEHRT = Certified EHR Technology
Agenda Acronyms Agenda AUDIENCE POLL CMS EHR Incentive Program Overview Stage 1 Overview Final Rule Stage 2 Overview Final Rule Stage 2 Changes to Medicaid Eligibility Final Rule Stage 2 Changes to Stage 1 Stage 2 Objectives + CQMs Final Rule Stage 2 Payment Adjustments + Exceptions Preparation to participate Our Commitment and Q&A
CMS EHR Incentive Program Overview American Recovery and Reinvestment Act (ARRA) of 2009 Healthcare IT portion ARRA Referred to as HITECH Act Billions in incentive $ to providers and other resources to assist providers in achieving HITECH Act goals HITECH Act goals Improve quality, safety and efficiency of care while reducing disparities Engage patients and families in care Promote public and population health Improve care coordination Promote the privacy and security of health information EMR can help providers achieve these goals
Timeline for Stages of MU EPs starting an incentive program in 2014 and beyond will complete 2 years of MU in Stage 1 before progressing to Stage 2 requirements Source: CMS EHR Incentive ProgramStage 2 Toolkit: http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_Toolkit_EHR_0313.pdf
Medicare Payment Schedule Note: Health Professional Shortage Area professionals will receive 10% additional bonus Source: Medicare Electronic Health Record Incentive Payments for Eligible Professionals: http://www.cms.gov/regulationsand-guidance/legislation/ehrincentiveprograms/downloads/mln_medicareehrprogram_tipsheet_ep.pdf
Medicaid Payment Schedule CMS EHR Incentive Program: Medicaid Payment Schedule
Agenda Acronyms Agenda CMS EHR Incentive Program Overview Stage 1 Overview Final Rule Stage 2 Overview Final Rule Stage 2 Changes to Medicaid Eligibility Final Rule Stage 2 Changes to Stage 1 Stage 2 Objectives + CQMs Final Rule Stage 2 Payment Adjustments + Exceptions Preparation to participate Our Commitment and Q&A
Stage 1 MU: Overview Focuses on electronic capture and use of health info: Track key clinical conditions Communicate info for care coordination Report clinical quality measures and public health info EPs must meet 20 objectives total 15 Core objectives (Mandatory) 5 Menu Set objectives selected from a list of 10 (Mandatory)
Agenda Acronyms Agenda CMS EHR Incentive Program Overview Stage 1 Overview Final Rule Stage 2 Overview Final Rule Stage 2 Changes to Medicaid Eligibility Final Rule Stage 2 Changes to Stage 1 Stage 2 Objectives + CQMs Final Rule Stage 2 Payment Adjustments + Exceptions Preparation to participate Our Commitment and Q&A
Final Rule Stage 2 Overview Officially delayed Stage 2 until 2014 Establishes new MU requirements and payment year by stage New 2014 EMR technology requirements New EMR certification: 2014 Edition Certification Changes to Medicaid provider eligibility Medicare payment adjustments + exceptions Changes to 2014 Stage 1 MU Some objectives unchanged Some thresholds raised Some objectives eliminated/combined CQMs: Requirement, # + electronic reporting Stage 2 MU requirements outlined Build on Stage 1 Change in # of objectives New objectives
Stage 2 MU: Overview Focuses on: Exchange + access to health information Expansion of MU requirements Move beyond data collection to care improvement Broad way to reform healthcare quality, efficiency safety Providers meeting at least 2 years of Stage 1 MU start Stage 2 in 2014 Must meet 20 objectives total 17 Core objectives (Mandatory) 3 Menu Set objectives selected from a list of 6 and patient
Agenda Acronyms Agenda CMS EHR Incentive Program Overview Stage 1 Overview Final Rule Stage 2 Overview Final Rule Stage 2 Changes to Medicaid Eligibility Final Rule Stage 2 Changes to Stage 1 Stage 2 Objectives + CQMs Final Rule Stage 2 Payment Adjustments + Exceptions Preparation to participate Our Commitment and Q&A
Final Rule Stage 2: Changes to Medicaid Eligibility Expansion Medicaid patient volume calculations changed to boost eligibility Anyone enrolled in a Medicaid program (Stage 1 only allowed patients to be counted if Medicaid had paid a claim) Zero-pay claims applicable Medicaid expansion encounters CHIP encounters for Patients in both Title 19 and 21 (Expanded from only Title 19) No longer limited to 90 day period in last calendar year; will be able to run patient volume calculation across 90 day period within 12 month period prior to EP attestation
Agenda Acronyms Agenda CMS EHR Incentive Program Overview Stage 1 Overview Final Rule Stage 2 Overview Final Rule Stage 2 Changes to Medicaid Eligibility Final Rule Stage 2 Changes to Stage 1 Stage 2 Objectives + CQMs Final Rule Stage 2 Payment Adjustments + Exceptions Preparation to participate Our Commitment and Q&A
Final Rule Stage 2: Changes to Stage 1 MU Optional: Addition of optional measure for reporting CPOE Can do originally stated way: More than 30% of unique patients with at least 1 medication in medication list have at least one medication order entered with CPOE Or use new Alternative Measure: More than 30% of medication orders are recorded using CPOE Required: Record and chart changes in vital signs Blood pressure: More than 50% of unique patients over age of 3 (Was those over age 2) Height + weight: More than 50% for ALL patients (Unless don t apply to EP) Required: Changes to timely access of health info to more than 50% of patients have ability to view online, download or transmit health info within 4 business days (Used to be simply provide electronic copy upon request)
Final Rule Stage 2: Changes to Stage 1 MU 2014: Capability to submit syndromic surveillance data to public health: Added wording except where prohibited 2014: New exclusion for erx measure: Any EP without a pharmacy in their organization or that does not have pharmacy within 10 miles that accepts erx 2014: Electronic exchange of clinical information not required 2014: CQMs no longer a separate objective but EPs will need to report them Through PQRS Or submit to CMS test EHR (TBD) 2014: Menu Objective Exclusions changes Must meet 5 of the 10 objectives If excluded from 1, doesn t exempt provider from selecting a replacement If excluded from 6, must do 4, regardless of whether a Core or Alternative Core Menu objective
Agenda Acronyms Agenda AUDIENCE POLL CMS EHR Incentive Program Overview Stage 1 Overview Final Rule Stage 2 Overview Final Rule Stage 2 Changes to Medicaid Eligibility Final Rule Stage 2 Changes to Stage 1 Stage 2 Objectives + CQMs Final Rule Stage 2 Payment Adjustments + Exceptions Preparation to participate Our Commitment and Q&A
Stage 2 MU: Unchanged Objectives Generate at least 1 list of patients by specific conditions to use for Quality improvement Reduction in disparities Research Outreach Provide patient-specific education from EHR to more than 10% of unique patients with office visits Perform medication reconciliation for more than 50% of patients transitioned to care of EP
Stage 2 MU: Measurement Thresholds Raised/Redefined Use CPOE for orders Medications: 60% (Stage 1 was Medications: 30%) Lab: 30% Radiology: 30% Generate + transmit permissible prescriptions electronically (erx) more than 50% (Up from 40%) Record demographics for 80% of unique patients (Up from 50%) Record and chart changes in vital signs Blood pressure: More than 80% of unique patients over age of 3 (Was 50% of those over 2) Height + weight: More than 80% for ALL patients (Unless don t apply to EP) Calculate + display BMI Plot + display growth charts for patients age 0-20, including BMI
Stage 2 MU: Measurement Thresholds Raised/Redefined Record smoking status for more than 80% of unique patients age 13+ (Up from 50%) Use clinical decision support to improve high-priority health conditions Implement 5 clinical decision support rules related to 4 CQMs (Up from 1) Enable drug-drug and drug-allergy interaction checks (Status quo) Provide patients with ability to view online, download and transmit health info within 4 business days (Used to be providing info in 3 business days) 50% unique patients receive online access to health info 5% of those patients must view, download or transmit health info to a 3rd party Provide clinical summaries to patients within 1 business day for 50% of visits (Time shortened to 1 day)
Stage 2 MU: Measurement Thresholds Raised/Redefined Protect EHR health information by implementation of appropriate technical capabilities Conduct security risk analysis to ensure encryption/security of data Implement corrections for deficiencies (i.e. Implement HIPAA-compliant ebackup solution) Incorporate 55% of positive/negative or numerical lab test results into EHR (Up from 40%) Use EHR to ID + remind patients for preventative/follow up care for 10% of patients with 2 or more office visits in last 2 years) Provide Summary of Care for 50% of transitions of care or referrals 10% electronically submitted from EHR (1 of those to be successfully submitted to a different EHR or to CMS-designated test EHR) Successful ongoing submission of electronic syndromic surveillance data to public health agency (No longer just 1 test of submission)
Stage 2 MU: Combined Objectives Part of Stage 2 Clinical Decision Support Measure: Implement drug-drug + drug-allergy interaction checks Part of Stage 2 Summary of Care Document at transitions of care + referrals Maintain up-to-date problem list + active diagnosis Maintain active medication list Maintain active allergy list Part of erx Measure: Implement drug formulary checks
Stage 2 MU: Eliminated Objectives CQMs no longer a Core Objective, but still need to be reported for MU attestation Capability to exchange key clinical info (i.e. Problem + Medication lists) Provide patients with timely electronic access to health info
Stage 2 MU: New Core Objectives Use secure electronic messaging to communicate with patients on relevant health information (5% of unique patients) Provide patients the ability to view online, download and transmit health information For 50% of patients 5% seen by provider to utilize Provide Summary of Care document for transitions of care + referrals (50% of the time/10% to be electronic) Conduct at least 1 successful electronic exchange of Summary of Care record with a recipient: Using a different EHR Or with CMS EHR test system (TBD)
Stage 2 MU: New Menu Objectives Record electronic progress notes in patient records Ability to access imaging through EHR Record patient family history for 20% of unique patients ID + report cancer cases to State cancer registry ID + report specific cases to specialized registry (Other than a cancer registry)
Stage 2 MU: CQM Changes Providers in Payment Year 2 + beyond will need to report on CQMs electronically in Stage 2 Medicare: During one of the CMS-established 3 month quarterly periods; report on CQMs for same period as MU reporting/submit as PQRS data or through CMS system (TBD) Medicaid: Can report on any 90 day period/submit to State Submit 9 CQMs from a list of 64; 3 need to be from the 6 National Quality Strategy domains: Patient + family engagement Patient Safety Care coordination Population + public health Efficient use of healthcare resources Clinical processes/effectiveness New CQM info: http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/2014_ClinicalQualityMeasures.html
Stage 2: MU Core Objectives Attest to 17 objectives: Mandatory CORE OBJECTIVE 1 Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders MEASURE More than 60% of medication, 30% of laboratory, and 30% of radiology orders created by the EP during the EHR reporting period are recorded using CPOE 2 Generate and transmit permissible prescriptions electronically (erx) 3 Record demographic information: Preferred language, gender, race, ethnicity, DOB 4 Record and chart changes in vital signs: Height, weight, blood pressure (age 3 and over), calculate and display BMI, plot and display growth charts for patients 0-20 years, including BMI 5 Record smoking status for patients 13 years old or older More than 50% of all permissible prescriptions written by the EP are compared to at least one drug formulary and transmitted electronically using Certified EHR Technology More than 80% of all unique patients seen by the EP have demographics recorded as structured data More than 80% of all unique patients seen by the EP have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data More than 80% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data 6 Use clinical decision support to improve performance on high-priority health conditions 1. Implement 5 clinical decision support interventions related to 4 or more clinical quality measures, if applicable, at a relevant point in patient care for the entire EHR reporting period. 2. The EP, eligible hospital, or CAH has enabled the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period
Stage 2: MU Core Objectives Attest to 17 objectives: Mandatory CORE OBJECTIVE 7 Provide patients the ability to view online, download and transmit their health information 8 Provide clinical summaries for patients for each office visit 9 Protect electronic health information created or maintained by the Certified EHR Technology 10 Incorporate clinical lab-test results into Certified EHR Technology 11 Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach MEASURE 1. More than 50% of all unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within 4 business days after the information is available to the EP) online access to their health information 2. More than 5% of all unique patients seen by the EP during the EHR reporting period (or their authorized Clinical summaries provided to patients within one business day for more than 50% of office visits Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308 (a)(1), including addressing the encryption/security of data at rest and implement security updates as necessary and correct identified security deficiencies as part of its risk management process More than 55% of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in Certified EHR Technology as structured data Generate at least one report listing patients of the EP with a specific condition
Stage 2: MU Core Objectives Attest to 17 objectives: Mandatory CORE OBJECTIVE 12 Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care MEASURE Use EHR to identify and provide reminders for preventive/follow-up care for more than 10% of patients with two or more office visits in the last 2 years 13 Use certified EHR technology to identify patient-specific education resources Patient-specific education resources identified by CEHRT are provided to patients for more than 10% of all unique patients with office visits seen by the EP during the EHR reporting period 14 Perform medication reconciliation The EP performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP
Stage 2: MU Core Objectives Attest to 17 objectives: Mandatory CORE OBJECTIVE 15 Provide summary of care record for each transition of care or referral MEASURE 1. The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals 2. The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record either a) electronically transmitted to a recipient using CEHRT or b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or is validated through an ONC-established governance mechanism to facilitate exchange for 10% of transitions and referrals 3. The EP who transitions or refers their patient to another setting of care or provider of care must either a) conduct one or more successful electronic exchanges of a summary of care record with a recipient using technology that was designed by a different EHR developer than the sender's, or b) conduct one or more successful tests with the CMS-designated test EHR during the EHR reporting period
Stage 2: MU Core Objectives Attest to 17 objectives: Mandatory CORE OBJECTIVE 16 Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission except where prohibited and in accordance with applicable law and practice 17 Use secure electronic messaging to communicate with patients on relevant health information MEASURE Successful ongoing submission of electronic immunization data from Certified EHR Technology to an immunization registry or immunization information system for the entire EHR reporting period A secure message was sent using the electronic messaging function of Certified EHR Technology by more than 5% of unique patients seen during the EHR reporting period
Stage 2: MU Menu Set Objectives Attest to 3 of 6 MENU SET OBJECTIVE MEASURE 1 Submit electronic syndromic surveillance data to public health agencies Successful ongoing submission of electronic syndromic surveillance data from Certified EHR Technology to a public health agency for the entire EHR reporting period edited and signed by an EP for more than 30% of unique 2 Record electronic notes in patient records Enter at least one electronic progress note created, patients 3 Imaging results accessible through CEHRT More than 10% of all scans and tests whose result is an image ordered by the EP for patients seen during the EHR reporting period are incorporated into or accessible through Certified EHR Technology 4 Record patient family health history More than 20% of all unique patients seen by the EP during the EHR reporting period have a structured data entry for one or more first-degree relatives or an indication that family health history has been reviewed 5 Identify and report cancer cases to a State cancer registry 6 Identify and report specific cases to a specialized registry (other than a cancer registry) Successful ongoing submission of cancer case information from Certified EHR Technology to a cancer registry for the entire EHR reporting period Successful ongoing submission of specific case information from Certified EHR Technology to a specialized registry for the entire EHR reporting period
Agenda Acronyms Agenda CMS EHR Incentive Program Overview Stage 1 Overview Final Rule Stage 2 Overview Final Rule Stage 2 Changes to Medicaid Eligibility Final Rule Stage 2 Changes to Stage 1 Stage 2 Objectives + CQMs Final Rule Stage 2 Payment Adjustments + Exceptions Preparation to participate Our Commitment and Q&A
Final Rule Stage 2: Payment Adjustments + Exceptions Medicare EPs who are not meaningful users will be subject to a 1% payment adjustment beginning on January 1, 2015, 2% in 2016, etc. 2011/2012 EPs who first demonstrated meaningful use in 2011 or 2012 must demonstrate meaningful use for a full year in 2013 to avoid payment adjustments in 2015. 2013 EPs who first demonstrate meaningful use in 2013 must demonstrate meaningful use for a 90-day reporting period in 2013 to avoid payment adjustments in 2015. 2014 EPs who first demonstrate meaningful use in 2014 must demonstrate meaningful use for a 90-day reporting period in 2014 to avoid payment adjustments in 2015. Start in 2014: Must meet MU in 2014/Attest no later than October 1 Attestation must be in a quarter within the first 9 months; start no later than July 1; attest no later than October 1 For EPs participating in Medicaid EHR incentive, but also accept Medicare, A/I/U in 2013 or 2014 does no exempt EPs from 2015 payment adjustments Medicaid only EPs can continue to start with A/I/U for their 1st payment year; not subject to Medicare payment adjustments
Final Rule Stage 2: Payment Adjustments + Exceptions Exception granted if CMS determines EP demonstrated circumstances post a significant barrier to achieving MU New EPs: 2 year exemption Unforeseen circumstances: Natural disaster Other specialist/provider types: Lack face-to-face or telemedicine interaction with patients Lack of follow-up need with patients Lack of control over availability of EHR technology at practice location (Practice at multiple locations without EHR) Exception must be applied for (Process TBD) Pathologists, Radiologists + Anesthesiologists automatically meet No need to apply for exemption As long as PECOS code matches determined exempt specialties
Agenda Acronyms Agenda CMS EHR Incentive Program Overview Stage 1 Overview Final Rule Stage 2 Overview Final Rule Stage 2 Changes to Medicaid Eligibility Final Rule Stage 2 Changes to Stage 1 Stage 2 Objectives + CQMs Final Rule Stage 2 Payment Adjustments + Exceptions Preparation to participate Our Commitment and Q&A
Providers are ready. Not all EHR systems are. Roughly one physician in eight has an electronic health record (EHR) system capable of supporting most requirements for Stage 2 of the "meaningful use" program Only 13% of office-based physicians reported an intention to participate in the EHR incentive program and had a system meeting 14 of the 17 Stage 2 core objectives, according to a report released this week from the CDC's National Center for Health Statistics (NCHS) In 2011, over 1,500 EHRs had Complete certification Currently, only 110 EHRs have Complete certification Sources: CMS CHPL Website + Use and Characteristics of Electronic Health Record Systems Among Officebased Physician Practices: United States, 2001 2013: http://www.cdc.gov/nchs/data/databriefs/db143.htm
Preparing for 2014 CMS EHR Incentives 2014 is the last year to start the Medicare incentive program Upgrade existing EMR to 2014 Edition CEHRT Train: EHR for selected Objectives + CQMs 2014: Complete 3 months MU within calendar quarter Same quarter during which PQRS will be reported Attest by February 28, 2015 Purchase current EHR with 2014 Edition CEHRT Plan + execute implementation project Train: EHR for selected Objectives + CQMs 2014: Complete 3 months MU within calendar quarter Same quarter during which PQRS will be reported Attest by February 28, 2015 2015: Complete 365 days MU
Agenda Acronyms Agenda AUDIENCE POLL CMS EHR Incentive Program Overview Stage 1 Overview Final Rule Stage 2 Overview Final Rule Stage 2 Changes to Medicaid Eligibility Final Rule Stage 2 Changes to Stage 1 Stage 2 Objectives + CQMs Final Rule Stage 2 Payment Adjustments + Exceptions Preparation to participate Our Commitment and Q&A
About MicroMD: PM + EMR for Administrative, Financial and Clinical Automation Ease of use + configurable: Simple yet powerful Integrated + interoperable: PM + EMR + eservices + Surescripts CIN + patient portal + HIE + registries, add on administrative and clinical tools Economical: Powerful functionality at an affordable price Flexible access + purchase options: Cloud, host your own data, All In plans and lease options Experience: 30+ years of medical software experience Longevity: Medical software division of Henry Schein, Inc. Established national client base 15,000+ physicians 3,000+ healthcare organizations 42+ specialties use MicroMD Rankings: Among top products by KLAS + Black Book Certification: 2014 Edition Complete Ambulatory CEHRT to assist providers in securing EHR incentives in 2014 CLIENT TESTIMONIAL Since using MicroMD PM + EMR, our collection rate is over 95 percent and our funds are usually collected within 7 days, so it s increased our collections close to 20 percent. Our revenue stream at least 15 to 20 percent. David Hicks, DO West Coast Family Medical Care, Clearwater, FL Family Practice, 1 Provider
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About MDeverywhere For information about MDeverywhere RCM, EMR & Credentialing services contact: Phone: 631-232-4260 Option 4 Email: questions@mdeverywhere.com Visit us at: www.mdeverywhere.com MDeverywhere offers a leading revenue cycle management (RCM) and electronic medical record (EMR) solution including credentialing services for physicians. Our unique RCM solution includes purpose-built, cloud-based practice management software, coding rules engines, contract monitoring tools and full-scope claims management and back-office services. A fully integrated, user friendly, Meaningful Use Stage 2 For information on Henry Schein MicroMD PM & EMR software contact: certified EMR ensures our clients will be fully compliant with regulations. Our single source solution is More proven incentive to streamline information workflow, decrease visit: denials micromd.com/emr/incentive and increase revenue. MicroMD Video: www.micromd.com E-mail: kkristen.heffernan@henryschein.com As an NCQA Certified CVO we assist clients in taking control of their credentialing processes through delegation. We were founded in 1995 and currently serve over 7,000 physicians nationwide. Our clients include solo practices, group practices, large faculty practices, and hospitals in over 40 different specialties. THANK YOU FOR ATTENDING