CMS Final Rules: Meaningful Use Criteria

VITL Webinar August 5, 2010Tonya H. Howard, MSN, FNP-C

VITL Clinical Consultant

Today’s Objectives• Covering rules only for Eligible Professionals

(EP’s)• Brief overview of the Final Rules Meaningful

Use Criteria • Look specifically at the Clinical Quality

Measures reporting requirements• Recommended next steps

What Was Changed?

• Changes based on 2000+ Comments

• Fewer requirements (20 vs. 25 for EP’s)

• Percentages required for meeting compliance lowered

• More clarity for some of the rules

Stage I Meaningful Use Objectives and

Measures

Overview• 15 Objectives in the Core Set• Reporting on 3 Core and 3 Selected Clinical

Quality Measures • 10 “Menu” Objectives—select 5 to “defer”• State may add up to 4 additional public health

objectives to list of core objectives • “Structured Data”—in a data field with limited

or controlled entry possibilities; reportable, exchange-able; NOT free text or narrative

Health Outcomes Priority: Improve quality, safety, efficiency, reduce health disparities

1. CPOE (Computerized Physician Order Entry) for medication orders (>30%)

2.Implement drug-drug and drug-allergy interaction checks (Function enabled? Yes or No)

3.ePrescribing (>40%)

4.Record demographics (including Language, Race, Ethnicity) (50%)

Health Outcomes Priority: Improve quality, safety, efficiency, reduce health disparities

5. Up-to-date problem list of current and active diagnoses (>80%)

6. Maintain active medication list (>80%)

7.Maintain active medication allergy list (>80%)

8.Record and chart changes in vital signs: (>50%)– Height, Weight, BP– BMI for Adults– Plot and Display BMI for Children

Health Outcomes Priority: Improve quality, safety, efficiency, reduce health disparities

9. Record smoking status for patients 13 and older (>50%)

10. Implement one clinical decision support rule with ability to track compliance with that rule (Implented? Yes or No)

11. Report ambulatory clinical quality measures to CMS or the States (Provide numerator, denominator, and exclusions in 2011 2012 electronic submission)

Health Outcomes Priority: Engage Patients and Families in their Health Care

• 12. Provide patients with an electronic copy of their health information within 3 days(e.g., CD, Flash Drive, Web Portal, etc. (>50%)– Diagnostic test results– Problem List– Med List– Med Allergies

• 13. Clinical summaries for pts for each office visit within 3 days(>50%)

Health Outcomes Priority: Improve care coordination

14. Capability to exchange key clinical information among providers and patient authorized entities electronically (one test of capacity of EHR to exchange information)

Health Outcomes Priority: Ensure adequate privacy and security protections for PHI

15. Privacy and Security Risk Analysis (address risks)

Menu Set of Stage 1 Objectives: Choose 5 to eliminate

1. Drug-formulary checks

2. Lab results as structured data

3. Generate lists of patients by condition

4. Send reminders per patient preference for preventive/follow-up care

5. Patient access to health information within 4 days

Menu Set of Stage 1 Objectives: Continued

6. Electronic patient education/Resources

7. Medication reconciliation

8. Provide summary of care record

9. Submit data to immunization registries*

10. Submit syndromic surveillance data to* public health

Clinical Quality Measures Reporting**If you do not have patients for whom one or more of these measures applies, the measure(s) may be substituted for an Alternate Core Measure (e.g., Pediatrics)

**If you do not have patients for whom one or more of these measures applies, the measure(s) may be substituted for an Alternate Core Measure (e.g., Pediatrics)

3 Core Measures**o Hypertension: BP recorded

o Tobacco Use Assessment and Cessation Intervention

o Adult Weight Screening and Follow-up

Clinical Quality Measures Reporting

3 Alternate Core Measureso Weight Assessment and

Counseling for Children and Adolescents

o Influenza Immunization for Patients > 50 y/o

o Childhood Immunization Status

Clinical Quality Measures Reporting

3 Selected Measures from a list of 38 (vs. 90 in the preliminary rules—no longer divided by specialty)

CQM: Additional Set for EP’s1. Diabetes: Hemoglobin A1C poor

control2. Diabetes: LDL Management and

Control3. Diabetes: BP Management4. Heart Failure: Ace/ARB Rx for LVSD5. CAD: Beta Blocker for prior MI6. Pneumonia Vaccination for Older

Adults7. Breast CA screening8. Colorectal Cancer screening9. CAD: Oral Antiplatelet Rx10. Heart Failure: Beta Blocker for

LVSD11. Anti-depressant medication mgmt

12. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation

13. Diabetic Retinopathy: Documentation of presence or absence of Macular Edema and Level of Severity of Retinopathy

14.Diabetic Retinopathy: Communication with Managing Physician

15.Asthma Pharmacologic Therapy16.Asthma Assessment17.Appropriate testing for children

with pharyngitis18.Oncology Breast Cancer: Hormonal

Tx for Estrogen/Progesterone Receptor Positive CA

CQM: Additional Set for EP’s (Cont’d)

19. Oncology Colon Cancer: Chemo for Stage III CA patients

20. Prostate CA: Avoid overuse of Bone Scan for Staging Low Risk pts

21. Smoking and Tobacco Use Cessation, Medical Assistance

22. Diabetes: Eye Exam23. Diabetes: Urine screening24. Diabetes: Foot Exam25. CAD: Statin Rx for lowering LDL26. Heart Failure: Warfarin for A-Fib27. IVD: BP Management28. IVD: Use of ASA/Antiplatelet

29. Initiate ETOH/Drug Abuse Tx30. Prenatal Care: Screening for HIV31. Prenatal Care: Anti-D Immunoglob32. Controlling High BP33. Cervical Cancer Screening34. Chlamydia Screening for Women35. Use of Appropriate Meds for

Asthma36. Low Back Pain: Use of Imaging

Studies37. IVD: Complete Lipid Panel and LDL

Control38. Diabetes: HBA1C Control (<8.0%)

10 Menu Set Objectives

15 Core Objectives

44Clinical Quality

Measures

PQRI/NQFMeasures

Stage 1: Reporting RequirementsStage 1: Reporting Requirements

8/5/2010 VITL 19

CMS/State

15 measures

5 measures

3 core

3 additional

or 3 alternate

1 must be public health

measure

State can move 4 from menu to core

HypertensionTobacco useAdult weight

Alternate: Children WeightFlu Immunization > 50 yrs

Children Immunization

Meaningful Use Assessment Tool

Will be available on the VITL website in the next few days