Meaningful Use 2015 and beyond Presented by: Anna Mrvelj EMR Training Specialist 1
Agenda A look at the CMS Website Finding your EMR version Certification Number Proposed Rule by the Centers for Medicare and Medicaid Services on 4/15/2015 How the proposed rule will affect Stage One Meaningful Use in 2015 through 2017 Clinical Quality Measure Reporting MicroMD s 2015 Clinical Quality Measure Calculation Manual 2
CMS Website 3
CMS Website 4
CMS Website 5
CMS Website 6
Certification Number Each EMR version has a unique certification number that can be found on our website www. micromd.com 7
ACRONYMS As any professional working in or with healthcare knows, you can literally speak in acronyms if you try. Here s an overview of the abbreviations that are specific to the CMS EHR Incentive Programs: EP Eligible Professional. Providers who are eligible to secure incentives from one of the EHR incentive programs. MU Meaningful Use. The requirement to meaningfully use certified EHR technology according to CMS and ONC requirements. CQM Clinical Quality Measures. One of the sets of data that needs to be recorded and tracked for a provider to attest to achieving MU. A/I/U Adoption, Implementation, Upgrade. First year Medicaid providers participating in a program have the option to secure their first payment year of incentives by simply proving adoption, implementation or upgrade to certified EMR technology. Then in the second payment year they would need to actually demonstrate MU and report and attest to that. This is specific to the Medicaid program. CMS Centers for Medicare and Medicaid Services. Entity responsible for the incentive program and establishing the hospital and provider requirements, including MU and clinical quality measure requirements. ONC Office of the National Coordinator. Entity that establishes the EMR certification and testing requirements. The ONC and CMS typically work together to create their final rules. CEHRT Certified EHR Technology. The certification term for medical software. Going forward all software should have a 2014 edition, or beyond, certification. NQS National Quality Strategy PHA Public Health Agencies 8
Proposed Rule On April 15, 2015 CMS Issued a new proposal rule for the Medicare and Medicaid EHR Incentive Programs. The rule is open for public comment until June 15, 2015 at 5:00PM. 9
Proposed Rule The following is a summary of how the proposed rule will affect Stage One Meaningful Use in 2015. This is based on our interpretation of the rule. We strongly encourage you to read the proposal in its entirety and to follow and make comments prior to the June 15 th deadline. 10
Proposed Rule Summary This proposed rule would change the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program EHR reporting period in 2015 to a 90-day period aligned with the calendar year, and also would align the EHR reporting period in 2016 with the calendar year. In addition, this proposed rule would modify the patient action measures in the Stage 2 objectives related to patient engagement. Finally, it would streamline the program by removing reporting requirements on measures which have become redundant, duplicative, or topped out through advancements in EHR function and provider performance for Stage 1 and Stage 2 of the Medicare and Medicaid EHR Incentive Programs. 11
A look at Stage One Meaningful Use in 2015 with proposed rule To qualify for Stage 1, a provider must meet: 9 core objectives 1 public health objective (2 measure options) In the Stage 3 proposed rule, the method and approach for identifying the objectives and measures retained for Stage 3 of meaningful use in 2017 was discussed. Objectives and measures which are now redundant, duplicative, or topped out; would no longer be required for the successful demonstration of meaningful use for Stage 3. In this proposed rule, the same method is used to identify objectives and measures from Stages 1 and 2 of meaningful. These changes would remove the menu and core structure of Stages 1 and 2 and reduce the overall number of objectives to which a provider must attest. 12
A look at Stage One Meaningful Use in 2015 with proposed rule OBJECTIVES OBJECTIVE MEASURE IN 2014 STAGE ONE MEASURE WITH PROPOSED RULE FOLLOWING STAGE TWO CRITERIA 1 Use computerized provider order entry (CPOE) for medication orders More than 30% of patients with one medication in list have at least one medication entered through CPOE (EMR medications module) 1. More than 60% of medication orders 2. 30% of laboratory orders 3. 30% of radiology orders created by the EP during the EHR reporting period are recorded using CPOE. Alternate Measure: More than 30% of medication orders created by the EP during the reporting period are recorded using CPOE (EMR prescription module) Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period. Exclusion: Any EP who writes fewer than 100 prescriptions during the reporting period. Any EP who writes fewer than 100 lab orders during the reporting period. Any EP who writes fewer than 100 radiology orders during the EHR reporting period. ALTERNATE EXCLUSION IN 2015 ONLY: PROVIDER MAY CLAIM AN EXCLUSION FOR MEASURE 2 AND 3 (LABORATORY AND RADIOLOGY ORDERS) OF THE STAGE 2 CPOE OBJECTIVE. 2 y/n Drug/Drug and Drug/Allergy Interaction Checking NULL Functionality enabled for the entire reporting period, drug drug and drug allergy. NO LONGER REPORTABLE. INCLUDED IN STAGE 2 USE CLINICAL DECISION SUPPORT RULE (Core10 in Stage 1 Core 6inStage2 2014) 3 Up to date Problem List of Current and Active Diagnoses NULL 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. NO LONGER REPORTABLE. INCLUDED IN STAGE 2 GENERATE AND TRANSMIT RX ELECTRONICALLY (Core 4 in Stage1 Core 2 in Stage 2 2014) 13
A look at Stage One Meaningful Use in 2015 with proposed rule 4 Generate and Transmit Rx Electronically ( 2 IN STAGE 2 2014) More than 40% of permissible prescriptions transmitted electronically. Exclusions: 1. Any EP who writes fewer than 100 prescriptions during the EHR reporting period. 2. Any EP who does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EPs practice location at the start of his/her reporting period. More than 50% of all permissible prescriptions, written by the EP are queried for a drug formulary and transmitted electronically using CEHRT. Combined with Up to date Problem List in 2014. Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period, OR any EP who does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of his/her EHR reporting period. IN 2015 ONLY MORE THAN 40% OF PERMISSABLE PRESCRIPTIONS TRANSMITTED ELECTRONICALLY. 5 Maintain Active Medication List NULL More than 80% of all unique patients seen by the EP have at least one entry (or an indication that patients is not currently prescribed any medication) COMBINED WITH MEASURE 15 IN STAGE 2 2014 6 Maintain Active Medication Allergy List NULL More than 80% of all unique patients seen by the EP have at least one entry (or an indication that the patient has no known medication allergies) COMBINED WITH MEASURE 15 IN STAGE 2 2014 14
A look at Stage One Meaningful Use in 2015 with proposed rule 7 Record Patient Demographics NULL More than 50% of all unique patients seen by the EP have demographics recorded as structured data. MEET CRITERIA AS EITHER REDUNDANT, DUPLICATIVE, OR TOPPED OUT WITH NEW PARTICIPANTS 8 Record Vitals and Chart Changes in Vital Signs NULL More than 50% of all unique patients seen by the EP have height, weight,(all ages) and BP (age 3 and over only) recorded as structured data. MEET CRITERIA AS EITHER REDUNDANT, DUPLICATIVE, OR TOPPED OUT WITH NEW PARTICIPANTS Exclusions Any EP who: 1. Sees no patients 3 years or older is excluded from recording BP. 2. Believes all 3 vital signs of height, weight, and BP have no relevance to the scope of their practice will be excluded from recording them. 3. Believes the height and weight are relevant to the scope of their practice but the BP is not will be excluded from recording the BP. 4. Believes the BP is relevant to the scope of their practice but the height and weight are not will be excluded from recording the height and weight. 15
A look at Stage One Meaningful Use in 2015 with proposed rule 9 Smoking Status recorded NULL More than 50% of patients 13 years and older seen by the EP have a smoking status recorded. MEET CRITERIA AS EITHER REDUNDANT, DUPLICATIVE, OR TOPPED OUT WITH NEW PARTICIPANTS 10 y/n 11 Implement One Clinical Decision Support Rule and Ability to Track Compliance ( 6 IN STAGE 2 2014) Provide Patients with Electronic Access to Health Information ( 7 IN STAGE 2 2014) Successful implementation of Rule More than 50% of patients within 4 days of an EHR update Exclusion: Any EP that neither orders nor creates any of the information listed at 45 CFR 170.304(g) during the EHR reporting period. Successful implementation of five Clinical Decision Support Rules and functionality enabled for the entire reporting period for drug drug and drug allergy interaction checks IN 2015 ONLY SUCCESSFUL IMPLEMENTATION OF ONE RULE a: More than 50% of all unique patients seen by the EP during the EHR reporting period are provided timely (within 4 business days after the information is available to the EP) online access to their health information b: One unique patient seen by the EP during the EHR reporting period (or their authorized representatives) will view, download, or transmit to a third party their health information. Exclusions: Provider who neither orders or creates any of the information listed for inclusion as part of both measures OR If a provider conducts 50% or more of his/her encounters in a county that does not have 50% or more of its housing units with 3 Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period. IN 2015 ONLY AN EXCLUSION CAN BE TAKEN FOR PART B. 16
A look at Stage One Meaningful Use in 2015 with proposed rule 12 Provide Patient with Clinical Summary at Each Visit NULL More than 50% of patients within 3 business days Exclusion: Any EP who has no office visits during the EHR reporting period. MEET CRITERIA AS EITHER REDUNDANT, DUPLICATIVE, OR TOPPED OUT WITH NEW PARTICIPANTS 13 y/n Implement systems to protect patient privacy and security in the EHR ( 9 STAGE 2 2014) Conduct security risk analysis, implement updates, and correct deficiencies. Protect electronic health information created or maintained by CEHRT through implementation of appropriate technical capabilities 17
A look at Stage One Meaningful Use in 2015 with proposed rule Menu Set THOSE NOT NULL WILL NOW BE ITEMS WITH EXCLUSIONS IN 2015 MENU 1 MENU 2 Objective MEASURE IN 2014 STAGE ONE MEASURE WITH PROPOSED RULE FOLLOWING STAGE TWO CRITERIA Submit Electronic PUBLIC HEALTH REPORTING OBJECTIVES WITH MULTIPLE Immunization Data OPTIONS. MUST SHOW ACTIVE ENGAGEMENT BY ONE OF to Registry Public THE FOLLOWING: Health Measure COMPLETED REGISTRATION TO SUBMIT DATA WITHIN *Required to select one Public Health measure Submit Electronic Syndromic Data to Public Health Agencies Public Health Measure *Required to select one Public Health measure At least one test of data submission and follow up submission, with continuation of regular reporting if test submission is successful. Exception: An EP who administers no immunizations during the EHR reporting period or where no immunization registry has the capacity to receive the information electronically. At least one test of data submission and follow up submission, with continuation of regular reporting if test submission is successful. Exception: An EP who does not collect any reportable syndromic information on their patients during the EHR reporting period or does not submit such information to any public health agency that has the capacity to receive the information electronically. 60 DAYS AFTER START OF REPORTING PERIOD TESTING AND VALIDATION STAGE PRODUCTION STAGE EPs would be required to choose from Measures 1 through 5 (below) and would be required to successfully attest to any combination of two measures: 1) IMMUNIZATION REGISTRY 2) SYNDROMIC SURVEILLANCE REPORTING 3) CASE REPORTING 4) PUBLIC HEALTH REPORTING 5) CLINICAL DATA REPORT REGISTRY 18
A look at Stage One Meaningful Use in 2015 with proposed rule MENU 3 y/n MENU 4 Drug Formulary Checks NULL Include Lab Test Results in EHR NULL System implemented and can access at least one internal or external formulary for the entire reporting period More than 40% of +/ or numerical format results Exclusion:: Any EP who orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period COMBINED WITH STAGE 1 4 / STAGE 2 2 2014 MEET CRITERIA AS EITHER REDUNDANT, DUPLICATIVE, OR TOPPED OUT WITH NEW PARTICIPANTS 19
A look at Stage One Meaningful Use in 2015 with proposed rule MENU 5 y/n MENU 6 MENU 7 Create Lists of Patients by Condition to use in Quality Improvement, Reduction in Disparities NULL Send Reminders to Patients for Preventive and Follow Up Care NULL Use the EHR to Identify Patient Specific Educational Resources and Provide to Patient ( 13 STAGE 2 2014) Successful generation of one listing during EHR reporting period More than 20% of patients are sent reminders OR for patients 65 yrs+ OR for patients 5 yrs or less Exclusion: Any EP who has no patients 65 years old or older or 5 years old or younger with records maintained using certified EHR technology. More than 10% of patients seen by the EP during the reporting period are provided patient specific education MEET CRITERIA AS EITHER REDUNDANT, DUPLICATIVE, OR TOPPED OUT WITH NEW PARTICIPANTS MEET CRITERIA AS EITHER REDUNDANT, DUPLICATIVE, OR TOPPED OUT WITH NEW PARTICIPANTS Provide patient specific education resources identified by CEHRT for more than 10% of all unique patients with office visits seen by the EP during the EHR reporting period. Exclusion: Any EP who has no office visits during the EHR reporting period. EXCLUSION FOR 2015 ONLY IF PROVIDER DID NOT INTEND TO SELECT THIS MENU ITEM TO REPORT ON. 20
A look at Stage One Meaningful Use in 2015 with proposed rule MENU 8 Medication Reconciliation Between Care Settings ( 14 STAGE 2 2014) EP to perform medication reconciliation for more than 50% of transitions of care IN when the patient is transitioned into the care of the EP. Exclusion: Any EP who does not receive any transitions of care. Perform medication reconciliation for more than 50% of patients transitioned to the care of the Eligible Provider. Exclusion: Any EP who was not the recipient of any transitions of care during the EHR reporting period. EXCLUSION FOR 2015 ONLY IF PROVIDER DID NOT INTEND TO SELECT THIS MENU ITEM TO REPORT ON. MENU 9 NEW Provide Summary of Care for Patients Referred ( 15b STAGE 2 2014) Secure Electronic Messaging ( 17 STAGE 2 2014) EP who transitions or refers their patients to another setting of care or provider of care provides a summary of care for more than 50% of transitions of care or referrals. Exclusion: Any EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period During the EHR reporting period, the capability for patients to send and receive a secure electronic message with the provider was fully enabled. MODIFIED TO ONLY REQUIRE SECOND MEASURE IN STAGE 2 Core 15b: The EP who transitions or refers their patients to another setting of care or provider or care provides a summary of care for more than 10% of such transitions or referrals electronically utilizing CEHRT to a recipient, with one of those being successfully transmitted to a different EHR or to a CMS designated test EHR. Exclusion: Any provider who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period. EXCLUSION FOR 2015 ONLY SINCE NO EQUIVALENT MEASURE IN STAGE 1. Exclusion: Any EP who has no office 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 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period. EXCLUSION FOR 2015 ONLY SINCE NO EQUIVALENT MEASURE IN STAGE 1. 21
A look at Stage One Meaningful Use in 2015 with proposed rule Reporting on Clinical Quality Measures: Beginning in 2014, the reporting of CQMs changed for all providers. All EPs will report using the new 2014 criteria regardless of whether they are participating in Stage 1 or Stage 2. In 2014 and beyond, EPs will report on 9 CQMs from a list of 64 There is also a new requirement that the quality measures selected must cover at least 3 of the 6 available National Quality Strategy (NQS) domains, which represent the Department of Health and Human Services NQS priorities for health care quality improvement. The 6 NQS domains are: 1. Patient and Family Engagement 2. Patient Safety 3. Care Coordination 4. Population/Public Health 5. Efficient Use of Healthcare Resources 6. Clinical Process/Effectiveness 22
A look at Stage One Meaningful Use in 2015 with proposed rule For an EHR reporting period in 2015, and for providers demonstrating meaningful use for the first time in 2016, the proposed rule is that providers may Attest to any continuous 90-day period of CQM data during the calendar year through the Medicare EHR Incentive Program registration and attestation site; or Electronically report CQM data using the established methods for electronic reporting. For 2016 and subsequent years, providers beyond their first year of meaningful use may attest to one full calendar year of CQM data or they may electronically report their CQM data using the established methods for electronic reporting. 23
Reporting CQM S In the proposed rule for meaningful use in 2015 through 2017, CMS is proposing to maintain the existing requirements established in earlier rulemaking for the reporting of CQMs. The options for CQM submission for providers in the Medicare EHR Incentive Program are as follows: EP Options for Medicare EHR Incentive Program Participation (single program participation) Option 1: Attest to CQMs through the EHR Registration & Attestation System. Option 2: Electronically report CQMs through Physician Quality Reporting System (PQRS) Portal. 24
Reporting CQM S EP Options for Electronic Reporting for Multiple Programs (for example: EHR Incentive Program plus PQRS participation) Option 1: Report individual eligible professionals' CQMs through PQRS Portal. Option 2: Report group's CQMs through PQRS Portal. Note that under option 2, this may include an EP reporting using the group reporting option, either electronically using QRDA, or via the GPRO Web Interface through Pioneer ACO participation. 25
2015 Clinical Quality Measure Calculations Manual This helpful reference manual can be found by going to the lounge at www.micromd.com http://www.micromd.net/documentation/meaningful%20 Use/Clinical%20Quality%20Measure%20Calculations %202015%20MicroMD%2010.0-1.pdf 26
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CMS Website For specific details regarding the incentive programs, such as registration, attestation processes, MU requirements and EMR certification, visit the CMS EHR Incentive Program website: http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/in dex.html?redirect=/ehrincentiveprograms/ 28
Federal Registry For information on the proposed rule initiated 4/10/15 Modifications to Meaningful Use in 2015 through 2017: https://www.federalregister.gov/articles/2015/04/ 15/2015-08514/medicare-and-medicaidprograms-electronic-health-record-incentiveprogram-modifications-to 29
THANK YOU FOR YOUR KIND ATTENTION! 30