Meaningful Use Overview for HIM Professionals Pat Gowan & JoAnne Hawkins Last Updated: June 11,...
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Meaningful Use Overview for HIM Professionals Pat Gowan & JoAnne Hawkins Last Updated: June 11, 2012
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Transcript of Meaningful Use Overview for HIM Professionals Pat Gowan & JoAnne Hawkins Last Updated: June 11,...
Meaningful Use Overview
for HIM ProfessionalsPat Gowan & JoAnne
HawkinsLast Updated: June 11, 2012
Today’s Objectives
• Understand the Centers for Medicare and Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Program
• Understand and differentiate the Meaningful Use Performance Measures and Meaningful Use Clinical Quality Measures
• Review the current Meaningful Use performance Measures as they pertain to HIM Professionals
Medicare and Medicaid EHR Incentive Program Overview
The American Recovery and Reinvestment Act of 2009 provides incentive payments for Medicare and Medicaid Eligible Hospitals and Eligible Professionals that are meaningful users of certified EHR technology. The EHR incentive programs are part of the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009 which amended the Social Security Act.
Indian Health Service (IHS), Tribal and Urban Indian health programs (I/T/U) eligible hospitals and eligible professionals can receive EHR incentive payments if they meet requirements of the Medicare and/or Medicaid EHR incentive programs starting in 2011. For, Medicare they need to demonstrate meaningful use of certified EHR. For Medicaid, they need to adopt, implement and upgrade to a certified EHR in their first participation year.**Eligible hospitals and eligible professionals must take steps to receive payments.
The IHS Resource and Patient Management System (RPMS) successfully passed all tests required for certification as a complete EHR for ambulatory and inpatient use, based on criteria established by the Office of the National Coordinator for Health Information Technology. I/T/Us that do not use RPMS EHR must ensure that their EHR is certified separately.
MEANINGFUL USE
Meaningful Use: What is Meaningful Use?
• Meaningful Use is using certified EHR technology to:
• Improve quality, safety, efficiency, and reduce health disparities
• Engage patients and families in their health care
• Improve care coordination• Improve population and public health• All the while maintaining privacy and security
Meaningful Use: Stages of Meaningful Use
• 3 stages of Meaningful Use• Requirements will increase over time…more work
lies ahead
Stage 12011-2012
Stage 22013-2014
Stage 32015+
MEDICAREEHR Incentive Program
MEDICAIDEHR Incentive Program
Implemented by the Federal Government and started January 3, 2011
Voluntary for States to implement - Most are expected to start by late summer 2011
Must initiate participation by 2014Must participate by 2012 to receive the maximum incentive paymentProgram ends in 2016
Must initiate participation by 2016Must participate by 2016 to receive the maximum incentive payment Program ends in 2021
Must demonstrate MU in Year 1 over a consecutive 90-day report period
A/I/U option for Year 1
No patient volume requirement Must meet patient volume thresholds
Medicare payment reductions begin in 2015 for EH/EPs who do not demonstrate MU of certified EHR technology
No Medicaid payment reductions
Meaningful Use: Definition of A/I/U
• Adopt: Acquire, purchase, or secure access to certified EHR technology
• Implement: Install or commence utilization of certified EHR technology capable or meeting MU requirements
• Upgrade: Expand the available functionality of certified EHR technology capable of meeting MU requirements at the practice site, including staffing, maintenance, and training or upgrade from existing EHR technology to certified EHR technology per the ONC EHR certification criteria
EHR CERTIFICATION
Name Space
Package or Application Version Patch Release Date
AG Patient Registration 7.1 9 12/3/10APCL Export 3.0 27 11/10/10APSP Pharmacy MOD-ePrescribing (eRx) 7.0 1010 4/29/11BGP Clinical Reporting System (CRS) 11.0 3 6/22/11
BJMD C32 1.0 1 6/24/11BJPC PCC Mgmt Reporting 2.0 6 6/2/11BMC Referred Care Information System
(RCIS)4.0 7 5/12/11
BQI iCare 2.1 3/11/11BRN Release of Information (ROI) 2.0 3 4/13/11BYIM Immunization Exchange Message 2.0 01 2/24/11BGO Electronic Health Record (EHR) 1.1 8 06/10/11LR Lab 5.2 1027 or 372 or 334 12/07/10
PXRM EHR Reminders 1.5 1007 4/13/10BPHR Personal Health Record (PHR) 1.0 6/22/11
Central Ensemble 2009.1.6 921.0.10414 2011GuardianEdge/ Symantec 8.0 3/31/11IPSEC (Windows) 2010VanDyke (AIX) 2010WinHasher 1.6 2011Universal Client or HIE Viewer The URL to access the application is http://ditdev4.d1.na.ihs.gov:9090/DocViewer
1.0 4/27/11
EHR Certification: EHR Certification Number*
• Inpatient Certification #: 30000002ELL6EAI
• Ambulatory Certification #: 30000002EJKDEAI
*The number will be entered during CMS registration and attestation
ELIGIBLE PROFESSIONALS & HOSPITALS
Eligible Professionals: Medicare & Medicaid Comparison
Medicare-only Eligible Professionals
Could be eligible for both Medicare &
Medicaid incentives
Medicaid-only Eligible Professionals
Professionals may be eligible for both Medicare & Medicaid, but can only
participate in one program at a time
Hospitals only eligible for Medicare incentive
Could be eligible for both Medicare & Medicaid (most
hospitals)
Hospitals only eligible for Medicaid incentive
Eligible Hospitals: Medicare & Medicaid Comparison
Eligible Professional: Incentive Program Timeline
CY 2012
01/01/12 First day of calendar & EHR reporting year
09/30/12LAST day to establish clean-date for the Medicare Incentive
Program
10/01/12LAST day to begin 90-day reporting period for the
Medicare Incentive Program
12/31/12 Last day of calendar & EHR reporting year
02/28/13LAST day to register & LAST day to attest
Eligible Hospital: Incentive Program Timeline
FY 2012
10/01/11 First day of calendar & EHR reporting year
06/30/12 LAST day to establish clean-date for the Medicare Incentive Program
07/01/12 LAST day to begin 90-day reporting period for the Medicare Incentive Program
09/30/12 Last day of fiscal year & EHR reporting year
11/30/12 LAST day to register & LAST day to attest
MEDICAID FORELIGIBLE
PROFESSIONALS & HOSPITALS
Eligible Professionals & Medicaid: Patient Volume Threshold
Eligible Professional (EP)
If EP does not practice predominantly at
FQHC/RHC: Minimum Medicaid patient
volume thresholds
If EP does practice predominantly at
FQHC/RHC*: Minimum needy individual patient volume thresholds
Physicians 30% 30%
- Pediatricians 20% 30%
Dentists 30% 30%
Certified Nurse-Midwives
30% 30%
NPs 30% 30%
PAs practicing at an FQHC/RHC that is led by a PA
N/A 30%
* All Tribal clinics are deemed FQHC/RHC for the CMS incentive program
Eligible Hospital: Medicaid Patient Volume Requirement
Eligible Hospitals Minimum Medicaid patient volume threshold
Acute care hospitals, including Critical Access Hospitals
10%
Medicare does not have a patient volume threshold
INCENTIVES
Eligible Professionals: Summary of Medicare & Medicaid Incentives
MEDICARE MEDICAID
Incentives Start
CY 2011 CY 2011
IncentivesEnd
CY 2016(max. 5 years, must start
by 2014)
2021(max. 6 years, must start
by 2016)
Incentive Amount
•Up to $44,000 total per provider
•Based on % Medicare claims
•Additional 10% bonus for EP’s in HPSAs
•Up to $63,750 total per provider
Reimbursement Reduced
CY 2015 No penalties
Eligible Professionals: Medicare Incentive Payment Example
Amount of Payment Each Year of Participation
Calendar Year EP Receives a Payment
CY 2011 CY 2012 CY 2013 CY2014CY 2015 and later
CY 2011 $18,000
CY 2012 $12,000 $18,000
CY 2013 $8,000 $12,000 $15,000
CY 2014 $4,000 $8,000 $12,000 $12,000
CY 2015 $2,000 $4,000 $8,000 $8,000 $0
CY 2016 $2,000 $4,000 $4,000 $0
TOTAL $44,000 $44,000 $39,000 $24,000 $0
Eligible Professionals: Medicaid Incentive Payment Example
Amount of Payment Each Year if Continues Meeting Requirements
1st Calendar Year EP Receives a Payment
CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016
CY 2011 $21,250
CY 2012 $8,500 $21,250
CY 2013 $8,500 $8,500 $21,250
CY 2014 $8,500 $8,500 $8,500 $21,250
CY 2015 $8,500 $8,500 $8,500 $8,500 $21,250
CY 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250
CY 2017 $8,500 $8,500 $8,500 $8,500 $8,500
CY 2018 $8,500 $8,500 $8,500 $8,500
CY 2019 $8,500 $8,500 $8,500
CY 2020 $8,500 $8,500
CY 2021 $8,500
TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750
Eligible Hospital: Medicare & Medicaid Incentive Summary
MEDICARE MEDICAID
Incentives Start
FY 2011 FY 2011
IncentivesEnd
FY 2016(max. 4 years, must start
by 2015)
2021(max. 6 years, must start
by 2016)
Incentive Amount
•Varies, depending on % Medicare inpatient bed days
•CAHs based on EHR costs & % Medicare inpatient bed days
•Varies, depending on % Medicaid inpatient bed days
Reimbursement Reduced
FY 2015 No penalties
PERFORMANCE MEASURES
Eligible Professionals: Meaningful Use Requirements
STAGE 1: Meaningful Use Requirements
• 20 total Performance Measures• 15 core performance measures*• 5 performance measures out of 10 from menu set*
• 6 total Clinical Quality Measures• 3 core or alternate core• 3 out of 38 from menu set
* Most measures require achievement of a performance target
Eligible Hospital: Meaningful Use Requirements
STAGE 1: Meaningful Use Requirements
• 19 total Performance Measures• 14 core performance measures*• 5 performance measures out of 10 from menu set*
• 15 total Clinical Quality Measures
* Most measures require achievement of a performance target
EP EH Target Measure
1. X >50%: Clinical Summaries
2. X >20%: Patient Reminders
3. X >50%: Transition of Care Summary
4. X >10%: Patient Electronic Access
5. X Yes/No Patient Lists
6. X X >50%: Electronic Copy of Health Information
7. X X >50%: Record demographics
8. X X >80%: Maintain Problem List
9. X X >80%: Active Medication List
10. X X >80%: Medication Allergy List
Performance Measures
EP EH Target Measure
11. X X >50%: Record Smoking Status
12. X X Yes/No: Clinical Quality Measures
13. X X Yes/No: Electronic Exchange of Clinical Information
14. X X Yes/No: Protect Electronic Health Information
15. X X >40%: Clinical Lab Test Results
16. X >50%: Electronic Copy of Discharge Instructions (upon request)
17. X >50%: Advance Directives
18. X X Yes/No: *Immunization Registries Data Submission
19. X X Yes/No: *Syndromic Surveillance Data Submission
20. X Yes/No: *Reportable Lab Results to Public Health Agencies
Performance Measures
MEANINGFUL USE REPORTS
Demonstrating Meaningful UseEligibility
Patient Volume Report
3rd Party Billing
Calculates:* EP Medicaid patient
volume rates* group practice rates in lieu
of calculating the rate for each individual EP
* EH Medicaid patient volume rates
Performance Measures Report
PCC
Calculates Performance Measures for EPs and EHs
1 out of 15 core Performance Measures: Submit CQMs to CMS
EPs: 15 coreEHs: 14 core
EPs & EHs: 5 out of 10 menu
No delay in data capture caused by data entry / coding
Stage 1 Meaningful Use Reports
Clinical Quality Measures Report
Clinical Reporting
Calculates Clinical Quality Measures for EPs and EHs
No targets for Stage 1
EPs: 6 total CQMs3 core or alternate core
3 out of 38 from menu setEHs: 15 total CQMs
Affects of Data Entry / Coding
Medicaid: Patient Volume Report - Coding must be up to date so that a claim can be generated and paid
Medicare : Allowable Charges
Clinical Quality Measures Report - If coding isn’t up to date, CQM report results may be low
Meaningful Use Reports Reference Sheet
MU Report Report Name
Relative path Keys Required Package Name space
Version Patch Release Date Links to related documents
EP Patient VolumePVP CORE>ABM>RPTP>
MURP>MUPVABMDZ MU PV SETUP
Third Party Billing
ABM 2.6 8 11/15/2011 http://www.ihs.gov/RPMS/PackageDocs/abm/abm_0260.07o.pdf
Clean Date ReportMUCD CORE > APC >
MANR > MUR PCC * BJPC 2 6 6/2/2011 http://www.ihs.gov/mean
ingfuluse/pdf/MUPerformanceMeasuresLogic.pdfEP MU Performance
MeasuresMU1P CORE > APC >
MANR > MURn/a PCC * BJPC 2 6 6/2/2011 http://www.ihs.gov/mean
ingfuluse/pdf/MUPerformanceMeasuresLogic.pdf
EP MU CQM Report
EP CORE>GPRA>CI11>RPT>MUP
BGPZMENU (required), BGPZ PATIENT LISTS (optional), BGPZ SITE PARAMETERS (optional), BGPZ TAXONOMY EDIT (optional), BGPZAREA (optional)
Clinical Reporting System
BGP 11.1 1 11/23/2011 http://www.ihs.gov/meaningfuluse/pdf/CRSMUCQMReportsSimpleLogicDocument.pdf
EH Patient VolumePVH CORE>ABM>RPTP>
MURP>MUPVABMDZ MU PV SETUP
Third Party Billing
ABM 2.6 8 11/15/2011 http://www.ihs.gov/RPMS/PackageDocs/abm/abm_0260.07o.pdf
Clean Date ReportMUCD CORE > APC >
MANR > MUR PCC * BJPC 2 6 6/2/2011 http://www.ihs.gov/mean
ingfuluse/pdf/MUPerformanceMeasuresLogic.pdf
InPatient Bed DaysFEIR CORE>ABM>RPTP>
MURP Third Party
BillingABM 2.6 8 11/15/2011 http://www.ihs.gov/RPM
S/PackageDocs/abm/abm_026u.pdf
EH MU Performance Measures
MU1H CORE > APC > MANR > MUR
n/a PCC * BJPC 2 6 6/2/2011 http://www.ihs.gov/meaningfuluse/pdf/MUPerformanceMeasuresLogic.pdf
EH MU CQM Report
CORE>GPRA>CI11>RPT>MUP
BGPZMENU (required), BGPZ PATIENT LISTS (optional), BGPZ SITE PARAMETERS (optional), BGPZ TAXONOMY EDIT (optional), BGPZAREA (optional)
Clinical Reporting System
BGP 11.1 1 11/23/2011 http://www.ihs.gov/meaningfuluse/pdf/CRSMUCQMReportsSimpleLogicDocument.pdf
* The Performance Measure report relies on a number of packages to collect the necessary data to run the report. Please refer to the EHR for Meaningful Use: Resource and Training Reference Tool for Eligible Professionals or Eligible Hospitals for which packages are needed for each measure.
http://www.ihs.gov/meaningfuluse/pdf/EHRforMeaningfulUseforEPsScavengerHunt.pdf
http://www.ihs.gov/meaningfuluse/pdf/EHRforMeaningfulUseforEHsCAHsScavengerHunt.pdf
MU Reports: EP & EH Performance Reports
MU Reports: Clinical Quality Measure Report
WHAT DOES HIM REALLY NEED TO KNOW
• Differences/commonalities between:
-CORE SET and MENU SETS
-PERFORMANCE MEASURES and CLINICAL QUALITY MEASURES
-MEASURES FOR EH/CAH versus EP
• Reports that demonstrate reaching meaningful use
• Measures that require attestation only
• Effects of accurate and timely completion of coding queue on MU
• Effects of inpatient coding and clinical documentation on reaching CQM
• Effects of PCC errors on MU
• Effects of complete and comprehensive patient registration on MU
STAGE 2
Stage 2 – Proposed Rule
• Proposed delay of Stage 2 until 2014• Proposed new Performance Measures• Proposed increase in targets for some
measures• Proposed moving menu set to core• Proposed new Patient Volume
methodology• Proposed changes to Stage 1
Proposed Stage 2 Delay
2011 2012 2013 2014 2015 2016
Stage1MU 90 Days
Stage 1MU 365 Days
Stage 1MU 365 Days
Stage 2MU 365 Days
Stage TBDMU 365 Days
Stage1MU 90 Days
Stage 1MU 365 Days
Stage 2MU 365 Days
Stage TBDMU 365 Days
Stage TBDMU 365 Days
Stage1MU 90 Days
Stage 1MU 365 Days
Stage TBDMU 365 Days
Stage TBDMU 365 Days
Stage1MU 90 Days
Stage TBDMU 365 Days
Stage TBDMU 365 Days
Eligible Professionals: Meaningful Use Requirements
STAGE 1:
20 total Performance Measures
• 15 core performance measures*• 5 performance measures out of
10 from menu set*
• 6 total Clinical Quality Measures• 3 core or alternate core• 3 out of 38 from menu set
* Most measures require achievement of a performance target
STAGE 2 (Proposed Rule)
20 total Performance Measures
• 17 core performance measures*
• 3 of 5 menu set measures
12 Total Clinical Quality Measures
* Most measures require achievement of a performance target
Eligible Hospitals: Meaningful Use Requirements
STAGE 1: Meaningful Use Requirements
19 total Performance Measures
• 14 core performance measures*
• 5 performance measures out of 10 from menu set*
15 total Clinical Quality Measures
* Most measures require achievement of a performance target
STAGE 2 (Proposed Rule)
18 total Performance Measures
• 16 core performance measures*
• 2 of 4 menu set measures
24 Total Clinical Quality Measures
* Most measures require achievement of a performance target
Stage 1 Core vs. Stage 2 NPRM
EP EH Target Stage 1 Core Measure EP EH Target Stage 2 NPRM Core Measure
X X >30% CPOE for Medication Orders X X >60%CPOE for Medication, Laboratory,
and Radiology Orders
X X Yes/No Drug Interaction Checks Incorporated into CDS
X X >80% Maintain Problem List Incorporated into summary of care
for transition of care
X >40% E-Prescribing X >65% E-Prescribing
X X >80% Active Medication List Incorporated into summary of care
for transition of care
X X >80% Medication Allergy List Incorporated into summary of care
for transition of care
X X >50%: Record demographics X X >80% Record demographics
X X >50% Record Vital Signs X X >80% Record Vital Signs
X X >50% Record Smoking Status X X >80% Record Smoking Status
X X Yes/No Clinical Quality Measures
CQM’s are included in the definition for demonstrating MU.
They are no longer included in the objectives. Reporting on CQM’s
will still be required.
Stage 1 Core vs. Stage 2 NPRM
EP EH Target Stage 1 Core Measure EP EH Target Stage 2 NPRM Core Measure
X X Yes/No Clinical Decision Support Rule X X Yes/NoClinical Decision Support Rule
(Implement 5)
X X >50%Electronic Copy of Health
Information
Replaced objective with View, download and transmit
X >50% Clinical Summaries X >50% Clinical Summaries
X >50%Electronic Copy of Discharge
Instructions
Replaced objective with View, download and transmit
X X Yes/NoElectronic Exchange of Clinical
Information
Objective removed. Electronic Exchange included in Transition of
Care Summary.
X X Yes/NoProtect Electronic Health
InformationX X Yes/No
Protect Electronic Health Information
New X >10% Secure Messaging
New X >10% E-MAR
New X X>50%>10%
Timely online access to health info Patients view, download, transmit
Stage 1 Menu moved to Stage 2 Core (NPRM)
EP EH Target Stage 1 Menu Set Measure EP EH TargetStage 2 NPRM Menu moved to Core Set
X >20% Patient Reminders X >10% Patient Reminders
X 10% Patient Electronic Access X >50%>10%
Provided info online accessPatients that view, download,
transmit
X X >10%Patient Specific Education
ResourcesX X >10%
Patient Specific Education Resources
X X >50% Medication Reconciliation X X >65% Medication Reconciliation
X X >50% Transition of Care Summary X X>65%>10%
Transition of Care SummaryTransitions to outside organization
with different CEHR
X X Yes/No*Immunization Registries Data
SubmissionX X Yes/No
*Immunization Registries Data Submission
X X Yes/No*Syndromic Surveillance Data
Submission
Menu
X
Core
XYes/No
*Syndromic Surveillance Data Submission
X Yes/No*Reportable Lab Results to
Public Health Agencies X Yes/No
*Reportable Lab Results to Public Health Agencies
Stage 2 NPRM Menu Set
EP EH Target Stage 1 Menu Set Measure EP EH TargetStage 2 NPRM Menu Set
Measure
X X Yes/No Drug-Formulary Checks Incorporated objective into
eRx
X >50% Advance Directives X >50% Advance Directives
New X X >40% Imaging Results
New X X >20% Patient Family History
New X >10% eRx discharge
New X Yes/No*Report Cancer Cases to
State Cancer registry
New X Yes/No *Specialized Registry
Area Area MU Contact Email Phone Number
Aberdeen CAPT Scott Anderson [email protected] (605) 335-2504
Alaska
Richard HallKimi GosneyErika Wolter Karen Sidell
[email protected] [email protected]
[email protected]@anthc.org
(907) 729-2622(907) 729-2642(907) 729-3907(907) 729-2624
Albuquerque Jacque Candelaria [email protected] (505) 946-9311
Bemidji Jason Douglas Bevin Moon
[email protected]@ihs.gov
(218) 444-0550 (505) 377-7888
Billings CAPT James Sabatinos [email protected] (406) 247-7125
California Marilyn FreemanSteve Viramontes
[email protected]@ihs.gov
(916) 930-3981 x.362 (916) 930-3981 x.359
Nashville Robin Bartlett [email protected] (615) 467-1577
Navajo CDR Michael BelgardeDonna Nicholls
[email protected]@ihs.gov
(928) 871-1416(505) 205-9177
Oklahoma Amy Rubin [email protected] (405) 951-3732
Phoenix CAPT Lee SternKeith Longie, CIORick Bowman
[email protected]@[email protected]
(602) 364-5287(602) 364-5080(520) 254-2211
Portland Donnie Lee, MDAngela Boechler
[email protected]@ihs.gov
(503) 326-2017(971) 221-8057
Tucson Scott Hamstra, MD Rick Bowman
[email protected]@ihs.gov
(520) 295-2532(520) 254-2211
Regional Extension CenterREC REC Contact Email Areas
NIHB Tom Kauley [email protected]; (505) 977-6053 All
ANTHC Richard HallKimi GosneyErika WolterKaren Sidell
[email protected]; (907) [email protected]; (907) [email protected]; (907) 729-3907 [email protected]; (907) 729-2624
Alaska
CRIHB Tim CampbellRosario Arreola ProAmerita Hamlet
[email protected]; (707)[email protected]; (916)929-9761 [email protected]; (916)929-9761 x.1323
California
NPAIHB Katie Johnson [email protected]; (503) 416-3272 Portland
USET Vicki FrenchJames Chavez
[email protected] (615)[email protected] (505) 977-1754
AberdeenAlbuquerqueBemidjiBillingsNashvilleNavajoOklahomaPhoenixTucson
IHS Meaningful Use: Contact Information
• Chris Lamer, Meaningful Use Project Lead, IHS [email protected]; (615) 669-2747
• Luther Alexander, MU Project Manager, DNC [email protected]; (301) 443-8114
• JoAnne Hawkins, MU Healthcare Policy Analyst, [email protected]; (505) 767-6600 x1525
• Cecelia Rosales, MU Requirements Manager, DNC [email protected]; (505) 767-6600 x1230
Questions?Discussion Time
Sign up for the MU Listserv!http://www.ihs.gov/listserver/index.cfm?module=signUpForm&list_id=168
More questions, contact us at:[email protected]
