& Patient Centered Medical Home Mara Robertson, Director Health Information Technology Programs Jane Jumbelick, Director Clinical Quality Improvement February 25, 2011 Connecting Communities Who Care 1
Agenda: Meaningful Use & Patient Centered Medical Home I. Meaningful Use (MU) 1. Program Eligibility 2. Program Goals 3. Incentive Payment / Payment Years 4. Reassignment of Incentive Payments 5. Eligible Professionals 6. Thresholds / Patient Volume 7. Registration / Attestation 8. CHPL (Certified HIT Product Listing) II. Patient Centered Medical Home (PCMH) 2
Program Eligibility Medicaid Incentive Program Medicare Incentive Program 3
Goals 1 2 3 4 5 Improve Quality, Safety, and Efficiency Engage Patients and Families Improve Care Coordination Improve Population and Public Health Ensure Privacy and Security Protections 4
Medicare-only Eligible Professionals Medicaid-only Eligible Professionals 5
Medicare Eligible Professionals 6
An eligible professional for the TennCare/Medicaid incentive program must not be hospital-based and be one of the following provider types: Physician Dentist Certified Nurse-Midwife Nurse Practitioner Physician Assistant practicing in an FQHC or RHC led by a physician assistant In addition, to be eligible for the TennCare/Medicaid incentive, 30% of the eligible professional s patient encounters must be TennCare/Medicaid (20%, if the eligible professional is a pediatrician) or the eligible professional must practice predominantly in a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) and have a minimum of 30% patient encounters attributable to needy individuals. 7
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sample language for reassignment clause 9
EPs may use a clinic or group practice s patient volume as a proxy for their own under three conditions: The clinic or group practice s patient volume is appropriate as a patient volume methodology calculation for the EP (for example, if an EP only sees Medicare, commercial, or self-pay patients, this is not an appropriate calculation); There is an auditable data source to support the clinic s patient volume determination; and So long as the practice and EPs decide to use one methodology in each year (in other words, clinics could not have some of the EPs using their individual patient volume for patients seen at the clinic, while others use the clinic-level data). The clinic or practice must use the entire practice's patient volume and may not limit it in any way. EPs may attest to patient volume under the individual calculation or the group/clinic proxy in any participation year. Furthermore, if the EP works in both the clinic and outside the clinic (or with and outside a group practice), the clinic/practice level determination includes only those encounters associated with the clinic/practice. 10
If Clinic A uses the clinic s patient volume as a proxy for all EPs practicing in Clinic A, this would not preclude the part-time EP from using the patient volume associated with Clinic B and claiming the incentive for the work performed in Clinic B. In other words, such an EP would not be required to use the patient volume of Clinic A simply because Clinic A chose to invoke the option to use the proxy patient volume. However, such an EP s Clinic A patient encounters are still counted in Clinic A s overall patient volume calculation. In addition, the EP could not use his or her patient encounters from Clinic A in calculating his or her individual patient volume. 11
CLINIC A (with a fictional EP and provider type) o EP #1 (physician): individually had 40% Medicaid encounters (80/200) o EP #2 (nurse practitioner): individually had 50% Medicaid encounters (50/100) o Practitioner at the clinic, but not an EP (registered nurse): individually had 75% Medicaid encounters (150/200) o Practitioner at the clinic, but not an EP (pharmacist): individually had 80% Medicaid encounters (80/100) o EP #3 (physician): individually had 10% Medicaid encounters (30/300) o EP #4 (dentist): individually had 5% Medicaid encounters (5/100) o EP #5 (dentist): individually had 10% Medicaid encounters (20/200) Totals: 1,200 encounters in the selected 90-day period for Clinic A 415 encounters attributable to Medicaid 35% of the clinic s volume This means that 5 of the 7 professionals would meet the Medicaid patient volume under the rules of the EHR Incentive Program. Two of the professionals are not eligible for the program on their own, but their clinical encounters at Clinic A should be included. 12
Adopt / Implement / Update (A/I/U) verses Meaningful Use Demonstration 13
Adopt, implement, or upgrade certified EHR technology (Year One) In order to receive a first year payment in 2011 through the TennCare /Medicaid EHR Provider Incentive Program, EPs & EHs must demonstrate that they have adopted, implemented, and/or upgraded certified EHR technology. Information on certification and certified EHR technology can be found at the Office of the National Coordinator for Health IT website (http://healthit.hhs.gov) or through the Bureau s EHR Provider Incentive page - http://www.tn.gov/tenncare/pipregistration.html Meet meaningful use criteria (Years 2-6) In subsequent payment years in the TennCare/Medicaid incentive program, EPs & EHs must prove they are using the EHR system in a meaningful way by meeting federally-designated meaningful use criteria Stage 1 Rules have been promulgated by CMS - Capture data electronically in a structured format - Implement decision support tools - Engage patients in their care - Public Health and Quality Reporting Stages 2 & 3 Rules to be promulgated by CMS at a later date - Enhanced focus on health information exchange (HIE) - Demonstrated improvements in quality of care and patient access 14
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Provider receives this message when there are problems with the registration. E.g., no match in PECOS, on the Death Master File, etc. 24
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Plan to attend TPCA / TNCare Webinar: Medicaid Incentive Program Registration Attestation 32
Patient Centered Medical Home Consider for Dialogue: 1. Is your Center considering NCQA PCMH recognition in 2011? 2. What resources (information, TA, etc.) are needed for PCMH? 3. Are you working with one of the MCO s to prepare for PCMH? 33