An EHR Incentive Crosswalk: Additional Incentives Beyond Meaningful Use

West Texas Health Information Technology Regional Extension Center - Making Electronic Health Records a Reality -

An EHR Incentive Crosswalk: Additional Incentives Beyond

Meaningful Use

Sharon Rose, RN MAM BSOE HIT Pro-CPRegional Coordinator, Lubbock

Bruce Edmunds, MEd Director of Regional Coordinators

West Texas Health Information Exchange Regional Extension CenterJune 6, 2013


Objectives• Explain the requirements and goals of Meaningful

Use Stage 2 objectives• List the changes beginning in 2013 for Meaningful

Use Stage 1 objectives• Discuss recommendations on how to encourage

patient and family engagement• Identify what needs to be done now to prepare for

Stage 2• Discovery what the REC can do for you beyond

Meaningful Use


Meaningful Use Stage 2 Summary• Final Rule Released, August, 2012• Stage 2 begins in 2014• Most of the Stage 1 Menu Set Objectives have

been moved to Stage 2 Core Set Objectives• Most of the thresholds have been increased• Inclusion of patient portals and electronic access

to health information


Stage 2 Goals• Increase health information exchange between

providers to:– Improve coordination of care– Reduce medical errors– Eliminate duplication of tests and screening

• Increase patient engagement by:– Providing access and means to view, download,

transmit their health information– Sending preventative and follow-up reminders– Providing opportunities for electronic

communication with the provider


Changes to Stage 1 for 2013• Optional alternate measure added for CPOE• Exclusion added for Electronic Prescribing• Optional changes for Blood Pressure age limit• Optional new exclusions for EPs• Electronic exchange of key clinical information not required in Stage 1• No longer a separate objective for reporting CQM• Public Health Reporting

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1ChangesTipsheet.pdf




Stage 2 Requirements

http://www.cms.gov/EHRIncentivePrograms/

Eligible Professionals15 core objectives

5 of 10 menu objectives20 total objectives

Eligible Hospitals & CAHs

14 core objectives5 of 10 menu objectives

19 total objectives

Eligible Professional17 core objectives

3 of 6 menu objectives20 total objectives

Eligible Hospitals & CAHs

16 core objectives3 of 6 menu objectives

19 total objectives


More of The Same: Same Objective, New Expectations

Stage 1 Stage 2CPOE * 30% Now 60% + Lab 30% & Radiology 30%

E-Prescribing 40% 50%

Demographics * 50% 80%

Vital Signs * 50% , age 2 + 80%, BP optional under age 3

Smoking * 50% 80%

Clinical Decision Support *

1 5 relate to CQMs plus drug-drug and drug-allergy interaction checks

Visit Summaries 50% within 3 days 50% within 1 day


Security Risk Analysis

• Conduct or review SRA of CEHRT– Address encryption/security of data stored in CEHRT– Implement updates as necessary at least once prior to end of

reporting period– Correct identified security deficiencies as part of risk

management process• Parameters of SRA are defined 45 CFR 164.308(a)(1) created by

the HIPAA Security rule• http://www.hhs.gov/ocr/privacy/hipaa/administrative/ securityrule/

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.htmlALL Stage 2 EHR Meaningful Use Specification Sheets for Eligible Professionals

http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/



http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html



Security

• Texas HIPAA (HB300) also known as “HIPAA on STEROIDS!”• Went into effect 9/1/2012; 21 pages• Dramatically Impacts ALL Texans• Requires PHI training customized to each

employees role within 60 days of hire and at least every 2 years

• Audits from Federal and State agencies

www.capitol.state.tx.us/tlodocs/82R/billtext/pdf/HB00300F.pdf


Menu to CoreLabs * Incorporate lab results for more than 55%

Patient List * Generate patient list by specific condition

Preventive Reminders Use EHR to identify and provide reminders for preventive/follow-up care for more than 20% of patients with 2 or more office visits in the last 2 years

Patient Access * Provide online access to health information for more than 50% with more than 5% actually accessing

Patient Education * Use EHR to identify and provide education resources for more than 10%

Medication Reconciliation *

Medication reconciliation at more than 50% of transitions of care

Summary of Care * Summary of care document for 50% of transitions of care; referrals with 10% sent electronically; one sent to a recipient with a different EHR vendor or CMS test EHR

Immunizations * Successful ongoing transmission of immunization data


Menu to CoreLab Results to Public Health Agencies

Capability to submit electronic data on reportable (as required by state or local law) lab results to public health agencies with ongoing successful submissions

Syndromic Surveillance

Capability to submit electronic syndromic surveillance data to public health agencies with ongoing successful submission


New Core ObjectivesPatient Electronic Access to Records (EP only)

Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP. Provide online access to health information for more than 50% with more than 5% actually accessing

Secure Messaging (EP only)

More than 5% of patients sence secure messages to their EP

Patient Electronic Access to Records (EH only)

Provide patients the ability to view online, download and transmit their health information within 36 hours after discharge from the hospital

eMAR (EH only) More than 10% of medication orders created during the EHR reporting period for which all doses are tracked using eMAR


New & Updated Menu Objectives For Eligible Providers

Imaging Results More than 20% of imaging results are accessible through Certified EHR Technology

Family History Record family history for more than 20 %

Syndromic Surveillance Successful ongoing transmission of syndromic surveillance data

Cancer Successful ongoing transmission of cancer case information

Specialized Registry Successful ongoing transmission of data to a specialized registry

Progress Notes Enter an electronic progress note for more than 30% of unique patients


New & Updated Menu Objectives For Eligible Hospitals

Advance Directives More than 50% of all unique patients 65 years old or older admitted

Progress Note Enter an electronic progress note for more than 30%

Imaging Results More than 20% of imaging results are accessible through Certified EHR Technology

Family History Record family history for more than 20 %

E-Rx More than 10% of hospital discharge medication orders for permissible prescriptions transmitted electronically

Structured Electronic Lab Results to Ambulatory Providers

Hospital labs send structured electronic clinical lab results to the ordering provider for more than 20% of electronic lab orders received


Going Elsewhere

• Or made easier…Drug-drug & drug-allergy interaction checks

No longer a separate measure; incorporated into CDS

Problem List No longer a separate measure; incorporated into Summary of Care Document

Medication List No longer a separate measure; incorporated into Summary of Care Document

Medication Allergy List No longer a separate measure; incorporated into Summary of Care Document

Capacity to Exchange Key Clinical Information

Eliminated for Stage 1 in 2013; no longer a measure for Stage 2; Replaced with the “View, Download, and Transmit” measure

Timely Electronic Patient Access to Health Information

Eliminated as separate measure; part of View, Download, Transmit


Clinical Quality Measures 2014 for EPs

• No longer a core objective• Required to report to demonstrate meaningful use• Submit CQM data electronically• Potential list of 64 CQMs from 6 National Quality

Strategy domains• Submit 9 CQMs from at least 3 domains• Aligning Quality Measures and reporting among

programs– HIQRP– PQRS– CHIPRA– ACO

http://www.himss.org/policy/d/20120829_HIMSS_Stage2_MU_FinalRule_ExecSummary.pdf




Clinical Quality Measures 2014 for EHs

• No longer a core objective• Required to report to demonstrate meaningful use• Submit CQM data electronically• Potential list of 29 CQMs from 6 National Quality

Strategy domains• Submit 16 CQMs from at least 3 domains• Aligning Quality Measures and reporting

electronically





CQM Reporting for 2014Optional Reporting Period in 2014*

Eligible ProfessionalsCalendar year quarter:

January 1 – March 31April 1 – June 30July 1 – September 30October 1 – December 31

Eligible Hospitals & CAHsFiscal year quarter:October 1 – December 31January 1 – March 31April 1 – June 30July 1 – September 30


Benefits• Decreased medical record keeping costs• Fewer repeated tests• Decrease in medical errors• Increase patient safety• Increase quality of care• Incentive payments for doing the “right

thing”



Complications• Installing/upgrading systems to meet 2014

EHR certification standards• More workflow adjustments• No longer have full control over qualifying

for measures


Patient and Family Engagement• Get patients and their family – More involved in their Healthcare– Better informed and more active in monitoring their care

• Secure Messaging – Improve patient following treatment plans– Follow up with questions regarding treatment plan or

questions forgotten during visit– Increase patient satisfaction– Allows for pressure free setting which may increase comfort

of communication especially with sensitive issues


What This Means to Your Practice• Clinical Summaries

3 Days in 1 Day inStage 1 Stage 2

• Patient EducationFrom Menu To Core

• Data AccessView, Download, Transmit

• Secure Electronic MessagingSecure and protected transmission of informationbetween patients and their providers


Secure Messaging Benefits to Provider

• Reduce time spent answering phone calls and getting connected with Chatty Cathy

• Documents communication in patient record automatically

• Increases patient satisfaction• Ability to send auto-reply for routine issues• More appropriate and relevant questions• Improved quality outcomes


Stage 2 To Do List

Communicate with your EHR vendor

When will they be ready for Stage 2?What costs are involved?Is additional training needed and available?What support and documentation will the vendor provide to demonstrate compliance with Stage 2 security requirements?

Patient portal is key *Collect patient e-mail addresses along with demographics

Set up patient portalPush clinical summaries and patient education to patient portal

Promote portal to patients


More Stage 2 To Do List

Lab – Think ‘In and Out’ Orders in (Labs will cover the cost of the interface)Results out (Labs will cover the cost of the interface)If not interfaced with labs – work on in 2013

Radiology/ Imaging Orders in (HIE will have image library access capability)Communicate with radiology about interface availabilityTransitions of Care How does your EHR recognize a transition of care for reporting?

Clinical Decision Support Review PQRS measures relevant to your practiceActivate CDS to align (i.e. Obesity Incentive)


CQM Crosswalk Quality Programs• ACO – Pioneer• ACO - Medicare Shared Savings Program• ACO - Advanced Payment• CPC (Comprehensive Patient Care)• Million Hearts• NCQA PCMH• BCBS PCMH• State-based Health or Medical Home initiative• Other Medical Home initiatives• Supporting specialists with Health IT / Meaningful Use adoption• CMS 90/10• Payer Incentives: Pay for Performance or Outcomes-Based• Transitions of Care initiatives• Triple Aim Innovation Program (better health care, better health, and reduced costs) • DSRIP• HEDIS • Medicare Obesity Incentive• PQRS


CMS Obesity Funding• CMS supports Intensive Behavioral Therapy (IBT) for

obesity consistent with framework developed by the the U.S. Preventive Services Task Force (USPSTF) - an independent group of national experts – that work to improve the health of Americans by making evidence-based recommendations about clinical preventive services.

• CMS has determined there is adequate evidence to conclude that IBT is reasonable and necessary for the prevention or early detection of illness or disability and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B.


CMS Obesity Funding• IBT for obesity consists of:– Screening for obesity in adults using

measurement of Body Mass Index (BMI); *CDS– Dietary (nutritional) assessment; and – Intensive behavioral counseling and behavioral

therapy to promote sustained weight loss through high intensive interventions on diet and exercise.

• Intensive behavioral intervention for obesity should be consistent with the 5-A framework highlighted by the USPSTF outlined on the next slide.


CMS Obesity Funding IBT 5A Framework

1. Assess behavioral health risk and factors affecting choice of behavior change goals;

2. Advise provide clear, specific, personalized behavior change advice including information about personal health harms and benefits;

3. Agree collaboratively on appropriate treatment goals and methods based on the patient’s interest and willingness to change;

4. Assist patient using behavioral change techniques, aid the patient in achieving agreed-upon goals by acquiring the skills, confidence and social/environmental support for behavior change, supplemented with adjunctive medical treatments; and

5. Arrange scheduled follow-up contacts to provide support, plan adjustments and referrals for more specialized treatments.


CMS Obesity Funding How Does it Work?

• For Medicare beneficiaries who are competent and alert at the time that counseling is provided and whose counseling is furnished by a qualified primary care physician or other primary care practitioner and in a primary care setting; CMS provides reimbursement for:– One face-to-face visit every week for the first month;– One face-to-face visit every other week for months 2

through 6; and– One face-to-face visit every three months for months 7

through 12, if the beneficiary meets a 3kg weight loss within the first six month.

• A timeline for office visits is outlined on the next slide.


CMS Obesity Funding Timeline

Example:If you have 100 patients that are Obese then you get 20 paid visits a year which equals 2000 total visits x Medicare reimbursement rate of approximately $25 = $50,000 in additional revenue per year


CMS Obesity Funding Sites Do you qualify?

• CMS covers IBT for obesity provided in primary care settings:– Independent Clinics– Outpatient Hospitals– Physician Offices– State or Local Public Health Clinics

• CMS defines a primary care setting as one that provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients and practicing in the context of family and community.


CMS Obesity Funding Providers • Primary care physicians include:– 01 – General Practitioner– 08 – Family Practice– 11 – Internal Medicine– 16 – Obstetrics/Gynecology– 38 – Geriatric Medicine– 37 - Pediatric Medicine

• Other primary care practitioners include:– 50 – Nurse Practitioner– 89 – Certified Clinical Nurse Specialist– 97 – Physician Assistant


CMS Obesity Funding Sites Excluded

• Sites excluded from CMS obesity funding include:– Emergency Departments– Inpatient Hospital Settings– Ambulatory Surgical Centers– Independent Diagnostic Testing Facilities– Skilled Nursing Facilities– Inpatient Rehabilitation Facilities– Hospice


CMS Obesity Funding Billing• CMS Obesity Funding is effective for claims with service on or

after November 29, 2011. • Patient progress, including the six month patient assessment,

must be documented in the physician office records.• Compensation works out to be about $25 per visit for what is

supposed to be a 15 minute average.• Medicare coinsurance and Part B deductible are waived for

these services.• Obesity counseling is not separately payable with another

encounter/visit on the same day.• Claims must be submitted with HCPCS code G0447 and must

contain an ICD-9-CM diagnosis code indicating BMI ≥ 30 V85.30 – V85.39 or V85.41 – V85.45.


WTxHITREC Services Snapshot• MU Stage 1 and Stage 2

• Assessment• Meaningful Use Gap Analysis• Documentation• Registration • Attestation• Post Attestation analysis

• EHR Implementation Assistance • Security and Risk Assessment tools and guidance • Clinical Workflow Analysis • Post Attestation Checklist and Audit Documentation

• Assistance in avoiding penalties• Pay for performance metrics Education • Introduction to Additional Incentive and Certification Opportunities• CMS and TMHP direct line of contact to resolve issues• Vendor Issue assistance


References and Resources• http://

www.himss.org/policy/d/20120829_HIMSS_Stage2_MU_FinalRule_ExecSummary.pdf

• http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html

• http://www.cms.gov/EHRIncentivePrograms/

• https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1ChangesTipsheet.pdf

• www.capitol.state.tx.us/tlodocs/82R/billtext/pdf/HB00300F.pdf













http://www.capitol.state.tx.us/tlodocs/82R/billtext/pdf/HB00300F.pdf


CQM Resources• CLINICAL QUALITY MEASURES FOR 2014 CMS EHR INCENTIVE PROGRAMS FOR

ELIGIBLE PROFESSIONALShttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EP_MeasuresTable_Posting_CQMs.pdf• 2014 Clinical Quality Measures (CQMs) Pediatric Recommended Core Measures

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_PrediatricRecommended_CoreSetTable.pdf• 2014 Clinical Quality Measures (CQMs) Adult Recommended Core Measures

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_AdultRecommend_CoreSetTable.pdf• CLINICAL QUALITY MEASURES FINALIZED FOR ELIGIBLE HOSPITALS AND CRITICAL

ACCESS HOSPITALS BEGINNING WITH FY 2014http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_EH_FinalRule.pdf• 2014 Clinical Quality Measures (CQMS) & eCQM Resources

(for web pages and publications links) http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/CQM_ResourceTable_2012_10.pdf

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EP_MeasuresTable_Posting_CQMs.pdf



http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_PrediatricRecommended_CoreSetTable.pdf

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_PrediatricRecommended_CoreSetTable.pdf

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_AdultRecommend_CoreSetTable.pdf

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_AdultRecommend_CoreSetTable.pdf

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_EH_FinalRule.pdf

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_EH_FinalRule.pdf

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/CQM_ResourceTable_2012_10.pdf

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/CQM_ResourceTable_2012_10.pdf


Questions?


Contact Us

West Texas Health Information TechnologyRegional Extension Center (WTxHITREC)

4430 South Loop 289, Suite 300806-743-7960Carson Scott

www.wtxhitrec.org

http://www.wtxhitrec.org/

An EHR Incentive Crosswalk: Additional Incentives Beyond Meaningful Use

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