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MEANINGFUL USE UPDATE
Dental Management Coalition
Poco Diablo, Sedona, AZ
July 28, 2013
Maggie Maule, DMD, MBA
Huong Le, DDS,MA, FACD
EHR AND MEANINGFUL USE INCENTIVE
PROGRAM OVERVIEW
The American Recovery and Reinvestment Act of 2009
authorizes CMS to provide incentive payments to eligible
professionals (EPs) and hospitals who adopt, implement,
upgrade or demonstrate meaningful use of certified electronic
health record (EHR) technology.
Providers have to meet specific requirements in order to
receive incentive payments: Meaningful Use Objectives
HISTORY OF EHR INITIATIVE IN 2004
President Bush began the EHR Initiative April 2004 , emphasizing “ innovations in electronic health records and the secure exchange of medical information will help transform healthcare in America.”
Bush appointed the head of National Health Information Infrastructure within DHHS (Dr Tommy Thompson) that will speed up the adoption of technology
HL7 EHR was adopted
10-year plan, $50M in 2004 in grants to local and regional organizations to create system to share healthcare information; $100 M for demonstration projects to test effectiveness of HIT and best practices and also create incentives and opportunities for providers to use the EMR technology
WHAT IS ELECTRONIC HEALTH RECORD?
EHR
ELECTRONIC MEDICAL/DENTAL RECORD
(EMR/EDR)
An electronic record of health-related information on an individual within one health care organization, such as a Health Center
A computerized record of a patient's clinical, demographic, and administrative data
Real-time data access and evaluation in medical / dental care
Provides the mechanism for longitudinal data storage and access
A motivation for health care providers to implement this technology derives from the need for medical outcome studies, more efficient care, speedier communication among providers and management of health plans
EHR=EMR+EDR
Provides a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting
Includes information such as patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports
Automates and streamlines the clinician's workflow
Has the ability to generate a complete record of a clinical patient encounter - as well as supporting other care-related activities directly or indirectly via interface - including evidence-based decision support, quality management, and outcomes reporting
Conforms to nationally recognized interoperability standards that can be created, managed, and consulted by authorized clinicians and staff, across more than one health care organization
INTEROPERABILITY
EHR Flow Chart
BENEFITS OF AN INTEGRATED EDR/EHR
Informed clinical practice
Reduction in errors, increased availability of records
and data, reminders and alerts, e-prescribing/refill
automation
Interconnection of clinicians
Personalized care
Improvements in population health
ARE WE READY TO PULL THE PLUG ON PAPER
CHART AND READY TO BE PLUGGED INTO EHR?
Do we have a choice? Not just any EHR.
Certification required
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
CMS definition
GOALS OF USING CERTIFIED EHR PRODUCT
TO ACHIEVE MEANINGFUL USE
GOALS OF MEANINGFUL USE
Adoption
Meaningful
Use
Exchange
Improved Individual
and Population
Health Outcomes
Increased
Transparency and
efficiency
Improved ability to
study and improve
care delivery
• Regional Extension Centers
• Medicaid EHR Program 1st year
incentive
• Workforce Training
• Medicare and Medicaid EHR
Incentive Programs
• State Grants for Health Information
Exchange
• Medicaid Administrative Funding for HIE
• Standards and Certification Framework
• Privacy and Security Framework
Health IT Practice Research
A CONCEPTUAL APPROACH TO MEANINGFUL
USE
Data Capture and Sharing
Advanced clinical Processes
Improved Outcomes
ACHIEVING MEANINGFUL USE
1. Use of certified EHR in a meaningful manner (e.g., e-prescribing)
2. Use of certified EHR technology for electronic exchange of health information to improve quality of health care
3. Use of certified EHR technology to submit clinical quality measures(CQM) and other such measures selected by the Secretary
WHO IS ELIGIBLE FOR MEANINGFUL USE
INCENTIVE PAYMENTS?
ELIGIBILITY: PRACTICES PREDOMINANTLY & NEEDY
INDIVIDUALS
EP is also eligible when practicing predominantly in FQHC/RHC providing care to needy individuals
Practicing predominantly is when FQHC/RHC is the clinical location for over 50% of total encounters over a period of 6 months in the most recent calendar year
Needy individuals (specified in statute) include:
Medicaid or CHIP enrollees;
Patients furnished uncompensated care by the provider; or
Furnished services at either no cost or on a sliding scale
ELIGIBILITY FOR INCENTIVE PAYMENTS
CMS original rule is the providers have to demonstrate that they have adopted, implemented or upgraded certified EHR technology, for the first year of payment, and that they are meaningful users of certified EHR technology for the 90-day EHR reporting period.
The above ruling was changed. At this time, you do not need to have a certified EHR in order to register for the Medicaid EHR Incentive Program (AIU).
As an alternatively accepting AIU attestations from Medicaid providers, not meaningful use, as this is the minimum necessary for a Year 1 incentive payment.
IN NOVEMBER 2011, ONC MADE ANNOUCEMENT THAT AIU IS NOT REQUIRED FOR FIRST ATTESTATION TO RECEIVE FIRST PAYMENTS.
NNOHA’s HIT White Paper
VERSION 2.0, AUGUST 2012
Helps oral health providers select and EDR/EHR and
participate in Meaningful Use (MU) incentive programs
through an EDR/EHR Selection Tool
Provides review of MU and requirements applicable to
oral health providers
Identifies 6 Clinical Quality Measures (CQMs) that
would be more applicable to Health Center oral health
programs than current CQMs included in MU incentive
programs
HIT White Paper Version 2.0
Interviews four vendors to determine:
interoperability between EDR and EHR
ability to meet MU objectives
capability of reporting NNOHA’s proposed CQMs for
oral health
HIT White Paper Version 2.0 (cont.)
Four vendors included in process:
QSI/NextGen: QSI EDR and NextGen EHR.
Open Dental/eClinicalWorks: Open Dental EDR and
eClinicalWorks EHR. Please note eClinicalWorks is a
separate corporation.
Henry Schein/Vitera (formerly Sage): Dentrix Enterprise and
Sage Intergy EHR. Please note Vitera is a separate
corporation and has a HL7 interface to Dentrix Enterprise.
Mediadent/SuccessEHS: Mediadent EDR and Success EHS
EHR.
EDR/EHR Selection Tool: Vendors
Step Description of Steps
1 Eligible Professional Assessment
2 Vendor Background Information - Request For Information (RFI)
3 Review of Meaningful Use Core & Menu Set Objectives
4 Review of Meaningful Use Clinical Quality Measures (CQMs)
5 Vendor Response to Meaningful Use Certification and Reporting
Measures
6 Vendor Response to NNOHA's Proposed Clinical Quality Measures
(CQMs) for Oral Health
7 Vendor Response to EDR-EHR Practice-Specific Requirements
8 Vendor Response to Qualitative Requirements
9 Vendor Response to Vendor Solution Cost
10 Vendor Selection Criteria and Summary Ratings
EDR/EHR Selection Tool: The Process
Clinical Care management
Treatment planning requirements
Dental specific charting (tooth and perio)
Dental Lab case tracking
Productivity Measurement
Admin functions (form letters, alerts, appt tracking,
short list, billing, fee schedules, statements)
Technical requirements
Integration ability
Dental imaging
JC standards
Vendor Questions beyond MU
RECOMMENDATIONS
FOR HEALTH CENTER DENTAL PROGRAMS
Before embarking on Meaningful Use, Health Centers should consider the following strategic roadmap questions:
What are the implications of participating in Meaningful Use?
Are the dentists eligible for Meaningful Use incentives?
What external organizations can assist in the early planning, implementation and achievement of Meaningful Use of EDR/EHR systems?
What features and capabilities should be included beyond suggested requirements?
What is the Center’s capital and operating budget for an EDR/EHR solution?
What EDR/EHR selection process and deployment model should be used?
WHAT TO REPORT TO RECEIVE PAYMENTS
Core Objectives: mandatory
Menu Objectives
Clinical Quality measures
REQUIREMENTS FOR MU REPORTING
MEANINGFUL USE CALCULATIONS
Denominator (bottom) is describes the eligible cases for a measure or the eligible patient population. This includes all patients seen or admitted during the EHR reporting period. The denominator is all patients regardless of whether their records are kept using certified EHR technology.
Numerator (top) describes the specific clinical action required by the measure for performance. This includes actions or subsets of patients seen or admitted during the EHR reporting period or actions taken on behalf of those patients, whose records are kept using certified EHR technology
Reporting rate (dividing the numerator by the denominator) identifies the percentage of a defined patient population that was reported for the measure
Exclusions: some patients may be excluded from the denominator based on medical, patient or system exclusions allowed by the measure.
PAYMENT SCHEDULE
Medicaid: Payments began in 2011, as determined by each state and continue to pay on a diminishing scale over six years, through 2021.
Stage I Year 1: Under the Medicaid EHR Incentive Program, incentives can also be paid for the adoption, implementation, or upgrade of certified EHR technology which can qualify your practice for the first year.
Stage I Year 2: meaningful use must be maintained for 90 days and for year 3, the eligible providers must be meaningfully using their certified EHR technology for the entire 12 month period (calendar year for EPs, federal fiscal year for hospitals) (stage II).
STAGES OF PAYMENTS
PAYMENTS: EP ADOPTION TIMELINE
2011 2012 2013 2014 2015 2016
2011 $21,250
2012 $8,500 $21,250
2013 $8,500 $8,500 $21,250
2014 $8,500 $8,500 $8,500 $21,250
2015 $8,500 $8,500 $8,500 $8,500 $21,250
2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250
2017 $8,500 $8,500 $8,500 $8,500 $8,500
2018 $8,500 $8,500 $8,500 $8,500
2019 $8,500 $8,500 $8,500
2020 $8,500 $8,500
2021 $8,500
TOT
AL
$63,750 $63,750 $63,750 $63,750 $63,750 $63,750
STAGES OF PAYMENTS
Providers who were early demonstrators of
meaningful use (2011) will meet three consecutive
years of meaningful use under the Stage 1 criteria
before advancing to the Stage 2 criteria in 2014.
All other providers would meet 2 years of
meaningful use under the Stage 1 criteria before
advancing to the Stage 2 criteria in their 3rd year.
In the first year of participation after AIU, providers
must demonstrate meaningful use.
STAGE I PAYMENTS (CONT’D)
The following states have had the highest Medicare and Medicaid provider payments since the program began: 1. Texas 2. Florida 3. California 4. Pennsylvania 5. New York
COMBINED MEDICARE AND MEDICAID
PAYMENTS JAN 2011-APRIL 2012
CMS MU REGISTRATION AND PAYMENTS MAY
2013
PROVIDER TYPE MAY 2013
PAYMENT SUMMARY AS OF MAY 2013
STAGE I PAYMENTS FROM DECEMBER 2012 TO
FEBRUARY 2013
DECEMBER 2012
More than 350,000 eligible health care professionals and more than 4,200 hospitals have registered for the program.
Over 106,000 EPs have received Medicare payments and over 69,000 have received Medicaid payments since it began in January 2011.
9,404 Dentists registered as of December 2012
4,912 Dentists have been paid under Medicare and Medicaid
FEBRUARY 2013
More than 384,294 eligible health care professionals and more than 4299 hospitals have registered for the program.
Over 264,292 EPs have received Medicare payments and over 120,002
have received Medicaid payments since it began in January 2011.
319 dentists have received Medicare payments and
10,577 dentists received Medicaid payments
IMPORTANT DATES TO REMEMBER
FOR ATTESTATION FOR MU
October 3, 2012: Medicare EP. Last date to start the 90-day reporting period to earn an $18,000 EHR incentive payment for 2012, and to be eligible for the maximum total of $44,000. (The potential total drops to $39,000 in 2013.) Physicians do not have to be registered by this date—they can register at any time before they attest.
January 1, 2013: First day of the 365-day, 2013 reporting period for any provider who earned first incentive payment in 2011 or 2012.
February 28, 2013: Last date to register and to attest for the 2012 EHR incentive. Note: The entire reporting period has to have occurred within 2012.
October 1, 2013: For eligible providers (EPs) whose first EHR payment year will be 2013, last day to start the 90-day reporting period and earn a $8,500.
2013: EPs who successfully demonstrate meaningful use in 2013 will not be subject to the 2015 payment adjustment.
October 1, 2014: For EPs whose first incentive year is 2014, this is the last date to submit a successful meaningful use attestation and avoid the 2015 payment adjustment.
Source: Health Security Solutions
STATE FLEXIBILITY TO REVISE MU
States can seek CMS prior approval to require 4 MU objectives be core for their Medicaid providers
Generate lists of patients by specific conditions for quality improvement, reduction of disparities, research, or outreach (can specify particular conditions)
Reporting to immunization registries, reportable lab results, and syndromic surveillance (can specify for their providers how to test the data submission and to which specific destination)
PAYMENT METHODOLOGY
How will the EHR incentive payments actually be
distributed to the eligible professionals?
They are distributed and taxed as income to the
Tax ID number that the eligible providers uses
when they register at the CMS registration system
for both Medicare and Medicaid’s EHR Incentive
Programs, which went live on January 3, 2011.
Taxable income unless signing over to health
centers.
WHAT TO REPORT TO RECEIVE PAYMENTS
Quality measures:
Core Objectives: mandatory
Menu Objectives: optional
REQUIREMENTS FOR MU REPORTING
MEANINGFUL USE CALCULATIONS
Denominator is describes the eligible cases for a measure or the eligible patient population. This includes all patients seen or admitted during the EHR reporting period. The denominator is all patients regardless of whether their records are kept using certified EHR technology.
Numerator describes the specific clinical action required by the measure for performance. This includes actions or subsets of patients seen or admitted during the EHR reporting period or actions taken on behalf of those patients, whose records are kept using certified EHR technology
Reporting rate (dividing the numerator by the denominator) identifies the percentage of a defined patient population that was reported for the measure
Exclusions: some patients may be excluded from the denominator based on medical, patient or system exclusions allowed by the measure.
STAGE I COMPONENTS
STAGE I-AIU/UPGRADE
MEDICAID – Only for first participation year
Adopt/have purchase agreement
Implement –– Acquire and Install, Commence Utilization of EHR Eg: Staff training, data entry of patient demographic information into EHR
Upgrade – Expand Upgrade to certified EHR technology or added new functionality to meet the definition
of certified EHR technology
Must be certified EHR technology capable of meeting meaningful use
Meaningful use (MU) Successive participation year; and
Some dually-eligible hospitals in year 1
Medicaid Providers’ AIU/MU does not have to be over six consecutive years
No EHR reporting period
STAGE I REQUIREMENTS CONTINUED
Stage 1 Objectives and Measures Reporting
Eligible Professionals must complete: 15 core
objectives
5 objectives out of 10 from menu set
6 total Clinical Quality Measures (3 core or
alternate core, and 3 out of 38 from additional
set)
STAGE I (CONT)
Some MU objectives not applicable to every provider’s clinical practice, thus they would not have any eligible patients or actions for the measure denominator. Exclusions do not count against the 5 deferred measures
In these cases, the eligible professional, eligible hospital or CAH would be excluded from having to meet that measure
Examples: Dentists who do not perform immunizations; Chiropractors do not e-prescribe
15 CORE OBJECTIVES Objective Measure Exclusion Dentist
Routine
Record patient demographics (sex,
race, ethnicity, date of birth, preferred
language)
More than 50% of patients’ demographic
data recorded as structured data
None Yes
Record vital signs and chart changes
(height, weight, blood pressure, body-
mass index, growth charts for
children)
More than 50% of patients 2 years of age
or older have height, weight, and blood
pressure recorded as structured data
An EP who either sees no
patients 2 years or older, or
who believes that all three
vital signs of height, weight,
and blood pressure of their
patients have no relevance
to their scope of practice
Yes: Blood
pressure
No: Other
vitals
Maintain up-to-date problem list of
current and active diagnoses
More than 80% of patients have at least
one entry recorded as structured data
None Yes
Maintain active medication list More than 80% of patients have at least
one entry recorded as structured data
None Yes
Maintain active medication allergy list More than 80% of patients have at least
one entry recorded as structured data
None Yes
Record smoking status for patients 13
years of age or older
More than 50% of patients 13 years of age
or older have smoking status recorded as
structured data
An EP who sees no
patients 13 years or older
Potential
Provide patients with clinical
summaries for each office visit
Clinical summaries provided to patients for
more than 50% of all office visits within 3
business days
An EP who has no office
visits during the EHR
reporting period
Potential
On request, provide patients with an
electronic copy of their health
information (including diagnostic test
results, problem list, medication lists,
medication allergies)
More than 50% of requesting patients
receive electronic copy within 3 business
days
An EP that has no requests
from patients or their
agents for an electronic
copy of patient health
information during the EHR
reporting period
Potential
15 CORE OBJECTIVES… CONTINUED Objective Measure Exclusion Dentist Routine
Generate and transmit permissible
prescriptions electronically
More than 40% are transmitted electronically
using certified EHR technology
An EP who writes fewer
than 100 prescriptions
during the EHR reporting
period
Potential
Computer provider order entry
(CPOE) for medication orders
More than 30% of patients with at least one
medication in their medication list have at
least one medication ordered through CPOE
An EP who writes fewer
than 100 prescriptions
during the EHR reporting
period
Potential
Implement drug-drug and drug-allergy
interaction checks
Functionality is enabled for these checks for
the entire reporting period
None Yes
Implement capability to electronically
exchange key clinical information
among providers and patient-
authorized entities
Perform at least one test of EHR’s capacity
to electronically exchange information
None Yes
Implement one clinical decision
support rule and ability to track
compliance with this rule
One clinical decision support rule
implemented
None Yes
Implement systems to protect privacy
and security of patient data in the
EHR
Conduct or review a security risk analysis,
implement security updates as necessary,
and correct identified security deficiencies
None Yes
Report clinical quality measures
(CQMs) to CMS or states
For 2011, provide aggregate numerator and
denominator through attestation; for 2012,
electronically submit measures. Note:
NNOHA has proposed additional CQMs for
consideration that are relevant to oral health.
None
Potential
SELECT 5 OUT OF 10 MENU OBJECTIVE Objective Measure Exclusion Dentist
Routine
Implement drug formulary checks Drug formulary check system is
implemented and has access to at
least one internal or external drug
formulary for the entire reporting period
None Yes
Incorporate clinical laboratory test
results into EHRs as structured data
More than 40% of clinical laboratory
test results whose results are in
positive/negative or numerical format
are incorporated into EHRs as
structured data
An EP who orders no lab tests
whose results are either in a
positive/negative or numeric format
during the EHR reporting period
Potential
Generate lists of patients by specific
conditions to use for quality
improvement, reduction of
disparities, research, or outreach
Generate at least one listing of patients
with a specific condition
None Yes
Use EHR technology to identify
patient-specific education resources
and provide those to the patient as
appropriate
More than 10% of patients are provided
patient-specific education resources
None Yes
Perform medication reconciliation
between care settings
Medication reconciliation is performed
for more than 50% of transitions of care
An EP who was not the recipient of
any transitions of care during the
EHR reporting period
Potential
Provide summary of care record for
patients referred or transitioned to
another provider or setting
Summary of care record is provided for
more than 50% of patient transitions or
referrals
An EP who neither transfers a
patient to another setting nor refers
a patient to another provider during
the EHR reporting period
Potential
SELECT 5 OUT OF 10 MENU
OBJECTIVES CONTINUED Objective Measure Exclusion Dentist
Routine
Send reminders to patients (per
patient preference) for preventive
and follow-up care
More than 20% of patients 65 years of
age or older or 5 years of age or
younger are sent appropriate
reminders
An EP who has no patients 65 years
old or older or 5 years old or
younger with records maintained
using certified EHR technology
Potential
Provide patients with timely
electronic access to their health
information (including laboratory
results, problem list, medication
lists, medication allergies)
More than 10% of patients are
provided electronic access to
information within 4 days of its being
updated in the EHR
An EP that neither orders nor
creates any of the information listed
at 45 CFR 170.304(g) during the
EHR reporting period
Potential
*PH* Submit electronic immunization
data to immunization registries or
immunization information systems
Perform at least one test of data
submission and follow-up submission
(where registries can accept electronic
submissions)
An EP who administers no
immunizations during the EHR
reporting period or where no
immunization registry has the
capacity to receive the information
electronically
No
*PH* Submit electronic syndromic
surveillance data to public health
agencies
Perform at least one test of data
submission and follow-up submission
(where public health agencies can
accept electronic data)
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
Potential
Proposed Top Three Alternate Core Set Measures for
Dentists (substitute when any of the
current CQMs do not apply)
Dentist Routine
Annual Oral Health Visit
Yes
Topical Fluoride or Fluoride Varnish Treatment Yes
Periodontal Disease Assessment Yes
Proposed Other Alternate Core Set Measures for Dentists Dentist Routine
Dental Sealant Yes
Oral Cancer Risk Assessment & Counseling Yes
Completed Comprehensive Treatments Plan Yes
NNOHA’S PROPOSED CQMS
STAGE 2 COMPONENTS
2. STAGE II MENU OBJECTIVES (OPTIONAL)
Access imaging results through EHR (more than 10%)
Record patient family health histories (more than 20%)
Record electronic notes (more than 30%)
Submit electronic syndromic surveillance data to public health registries (ongoing submissions)
Identify and report cancer cases to a public health registry (ongoing submissions)
Identify and report non-cancer cases to a specialized registry (ongoing submissions)
APPROVED STAGE II CQM: ORAL HEALTH
Measure 1: Children who have dental decay or cavities
Description: Percentage of children ages 0-20, who have had
tooth decay or cavities during the measurement period.
Measure 2: Primary Caries Prevention Intervention as Offered by
Primary Care Providers, including Dentists
Description: Percentage of children, age 0-20 years, who received
a fluoride varnish application during the measurement period.
3. CERTIFIED EHR REQUIRED
To meet meaningful use, providers must attest to the use of
EHR technology that is certified by the Office of the National
Coordinator Authorized Testing and Certification Body (ONC-
ATCB)
A list of the latest certified technology can be found on the ONC
website
http://onc-chpl.force.com/ehrcert
ANOTHER REQUIREMENT: CERTIFIED EHR
HOW TO REPORT
EXAMPLES
Measure Information and Measure Values
1. Objective: Use computerized provider order entry (CPOE) for medication orders directly entered by a licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines
Measure: More than 30 percent of all unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period would be excluded from this requirement
Does this exclusion apply to you?
Numerator: The number of patients in the denominator that have at least one medication order entered using CPOE
Denominator: Number of unique patients with at least one medication in their medication list seen by the EP during the EHR reporting period
2. Objective: Implement drug-drug and drug-allergy interaction checks
Measure: The EP has enabled this functionality for the entire EHR reporting period Note: This measure only requires a yes/no answer
Numerator: N/A
Denominator: N/A
OTHER REQUIREMENTS: CLINICAL QUALITY MEASURES (CQM)
AND PAYOR MIX
There are also Clinical Quality Measures that must be met such as BP measurements
Medicaid: There is no minimum billing amount required for Medicaid. To qualify for the incentive program, 30% of your encounters within any 90-day consecutive period from the prior calendar year must be Medicaid patients (20% if you are a pediatrician). The exception is for EPs who have more than 50% of their encounters at an FQHC or RHC, who then can meet the patient volume requirement with 30% needy individuals (Medicaid, CHIP, sliding fee scale and uncompensated care).
STAGE I YEAR 1-2
The final rule from the Centers for Medicare and Medicaid (CMS) Services state that eligible providers must use certified EHR technology product for at least 90-days in the payment year and for a full twelve months in subsequent years.
Eligible providers will register at the CMS website.
Medicare providers will continue on the same website to attest that they have meaningful used certified EHR technology.
Medicaid providers will complete their attestations with the State Medicaid agencies.
EP WORKING AT MULTIPLE SITES
An Eligible Professional who works at multiple locations, but does not have certified EHR technology available at all of them would:
Have to have 50% of their total patient encounters at
locations where certified EHR technology is available
Would base all meaningful use measures only on encounters that occurred at locations where certified EHR technology is available
STAGE I REPORTING CHANGES
Reporting periods for meaningful use will be three months long regardless of what stage an eligible professional is following ( Rob Anthony, a health specialist with the CMS Office of E-Health Standards and Services)
Also beginning in 2014, a physician group can submit a meaningful use attestation for all of its eligible professionals in one file, saving the practice from entering each individual’s information separately.
FROM THE CMS FINAL RULE
Dentists must report on 6 clinical measures; 3 core measures and 3 additional
measures . ***Please refer to NNOHA Guide to the Future or CMS website
If any of the core measures have a 0 as the denominator because it is not within the
dentists’ scope of practice to capture that information then (s)he must choose from
the alternates list. If the alternates don’t apply he/she must verify that the
alternates are not applicable to his/her scope of practice. **It is possible that the
EP because of his/her specialty will not report on 3 of the core/alternate measures.
If a dentist cannot find three measures within the menu set of 38 quality measures
on which to report because it falls outside of his/her scope of practice, dentist has
the option of sending a statement attesting to that fact. **It is possible that the
dentist will not report on 3 menu clinical measures.
STAGE I CHALLENGES
The most commonly deferred menu objective, at 84% had trouble providing a summary of care to patients at transitions to other physicians or hospitals.
Next, 80% had trouble using the EHR to send reminders to specific groups of patients about preventive care.
68% of doctors deferred on syndromic surveillance — sending information to public health agencies.
And 66% deferred on being able to give patients electronic access to their records.
The least-deferred items involved tasks that did not require outside transfers of information: checking drug formularies (15% deferral rate) and generating patient lists (25%).
FROM STAGE I TO STAGE II
Stage I: 70% of physicians who achieved stage 1
requested an exclusion to the requirement that
practices needed to provide, to 50% of patients
who requested them, an electronic copy of their
records within three days, according to CMS data.
They qualified for exemptions because no patients
asked for the records
Stage II: require at least 5% of patients to
download their records — with few exceptions.
FROM STAGE I TO STAGE II
Stages 1 and 2 each require meeting 20 total objectives, but stage 2 makes mandatory some EHR measures that are optional for stage 1, such as whether the electronic systems can incorporate clinical laboratory test results.
Other measures stay the same but have higher thresholds, such as a requirement that EHRs send more than 50% of applicable prescriptions electronically, up from more than 40%.
The number of required core set measures goes up to 17 in stage 2 from 15 in stage 1.
Physicians also must choose and comply with three out of six additional “menu” set measures, as well as report at least nine clinical quality measures.
STAGE II
Begins 2014
About 251,000 physicians and other eligible professionals already have received more than $2.6 billion in payments for the first stage of the Centers for Medicare & Medicaid Services’ electronic health records incentive program.
Collecting for stage 2 will rely on two things: getting patients to look at their paperless records and exchanging data with others.
STAGE II
The biggest hurdles with all of the electronic initiatives is interoperability
To meet stage 2 requirements by 2014, practices over the next year will need to focus on getting vendors to perform necessary upgrades, improving patient engagement, and getting other organizations to adopt systems capable of receiving and sending data to and from their EHR systems
STAGE II
In addition to meeting the core and menu objectives, eligible professionals, eligible hospitals and CAHs are also required to report clinical quality measures.
Eligible professionals must report on 6 total clinical quality measures: 3 required core measures (or 3 alternate core measures) and 3 additional measures (selected from a set of 38 clinical quality measures).
Eligible hospitals and CAHs must report on all 15 of their clinical quality measures.
STAGE II MANDATES
Physicians who earned EHR bonuses in 2011 and 2012 would be required to meet stage 2 requirements starting in 2014.
Doctors who start achieving meaningful use in 2013 or later would report under stage 1 rules for two years before moving onto stage 2, regardless of whether they incur any noncompliance penalties for being late adopters
Please note, however, that you would not meet these Stage 2 requirements until you have met the Stage 1 requirements of the EHR Incentive Programs for a 90-day period in your first year of participation and a full year in your second year of participation.
STAGE I VS. STAGE II
STAGE I
15 core objectives
5 objectives out of 10 from menu set
6 total Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from additional set)
Complete set for Stage II can be found on www.cms.gov
STAGE II 2014 and beyond
17 core objectives
3 of 6 menu objectives
9 out of 64 CQMs
3 of the 6 key health care policy domains
1. Patient and Family Engagement
2. Patient Safety
3. Care Coordination
4. Population and Public Health
5. Efficient Use of Healthcare Resources
6. Clinical Processes/Effectiveness
STAGE II MU CORE SET
o Use computerized physician order entry (>60% medication, 30% lab and 30% radiology
orders)
o Prescribe permissible drugs electronically (>50%)
o Record patient demographics (>80%)
o Record and chart changes in vital signs (>80%)
o Record smoking status (>80%)
o Use clinical decision support (at least five interventions)
o Incorporate clinical lab results into EHR (more than 55%)
o Generate lists of patients by specific conditions (at least one list)
o Identify patients who need reminders for preventive or follow-up care (>10%)
o Provide at least half of patients with access to health information (>5% use access)
o Provide clinical summaries for patients within one business day (>50%)
o Identify patient-specific education resources (>10%)
o Communicate with patients on relevant health information (>5%)
o Perform medication reconciliation during care transitions (>50%)
o Send summaries of care during referrals (more than 50%)
o Submit electronic data to immunization registries (ongoing submissions during
reporting period)
o Protect EHR information
STAGE II BEGINS 2014
Stage two of the program will begin in 2014. No providers will be required to follow the Stage 2 requirements outlined today before 2014.
Outline the certification criteria for the certification of EHR technology, so eligible professionals and hospitals may be assured that the systems they use will work, help them meaningfully use health information technology, and qualify for incentive payments.
Modify the certification program to cut red tape and make the certification process more efficient.
Allow current “2011 Edition Certified EHR Technology” to be used through 2013. Providers have the option of using 2014 certification in 2013 but they MUST use the 2014 certification starting in 2014.
The CMS final rule also provides a flexible reporting period for 2014 to give providers sufficient time to adopt or upgrade to the latest EHR technology certified for 2014
DENTAL PROVIDERS: HOW
ARE WE AFFECTED?
DENTAL PROVIDERS
Medicaid
Voluntary for States to implement (may not be an option in every State)
No Medicaid payment reductions
A/I/U option for 1st participation year
Maximum incentive is $63,750 for EPs
States can adopt certain additional requirements for MU
Last year a provider may initiate program is 2016; Last year to register is 2016
5 types of EPs, acute care hospitals (including CAHs) and children’s hospitals
FROM THE CMS FINAL RULE
Dentists must report on 6 clinical measures; 3 core measures and 3 additional measures . ***Please refer to NNOHA Guide to the Future or CMS website
If any of the core measures have a 0 as the denominator because it is not within the dentists’ scope of practice to capture that information then (s)he must choose from the alternates list. If the alternates don’t apply he/she must verify that the alternates are not applicable to his/her scope of practice. **It is possible that the EP because of his/her specialty will not report on 3 of the core/alternate measures.
If a dentist cannot find three measures within the menu set of 38 quality measures on which to report because it falls outside of his/her scope of practice, dentist has the option of sending a statement attesting to that fact. **It is possible that the dentist will not report on 3 menu clinical measures.
STAGE 2 CQM: ORAL HEALTH
Measure 1: Children who have dental decay or cavities
Description: Percentage of children ages 0-20, who have had
tooth decay or cavities during the measurement period.
Measure 2: Primary Caries Prevention Intervention as Offered by
Primary Care Providers, including Dentists
Description: Percentage of children, age 0-20 years, who received
a fluoride varnish application during the measurement period.
ACCEPTED ORAL HEALTH MEASURES
I. Oral Evaluation
Measure Concept: Children who received a comprehensive or periodic oral evaluation
Aligned Administrative Measure: Percentage of enrolled children who accessed [dental/ oral health] care (received at least one service) who received a comprehensive or periodic oral evaluation within the reporting year.
II. Prevention: Fluoride or sealants
Measure Concept: Children who received topical fluoride or sealants
Aligned Administrative Measure: Percentage of enrolled children at elevated risk who accessed [dental/ oral health] care (received at least one service) who received topical fluoride or sealants within the reporting year.
ADDITIONAL ORAL HEALTH MEASURES BEING
PROPOSED
III. Prevention: Sealants for 6 – 9 years-To be tested
Measure Concept: Children aged 6-9 years who receive sealants in the first molar
Aligned Administrative Measure: Percentage of enrolled children aged 6-9 years at elevated risk who accessed [dental/ oral health] care (received at least one service) who received a sealant in the first molar within the reporting year.
IV. Prevention: Sealants for 10 – 14 years
Measure Concept: Children aged 10-14 years who receive sealants in the second molar
Aligned Administrative Measure: Percentage of enrolled children at elevated risk aged 10-14 years who accessed [dental/ oral] health care (received at least one service) who received a sealant in the second molar within the reporting year
ADDITIONAL ORAL HEALTH MEASURES BEING
PROPOSED
V. Prevention: Topical Fluoride –Already tested
Measure Concept: Children who receive topical fluoride
Aligned Administrative Measure: Percentage of enrolled children at elevated risk who accessed [dental/ oral] health care (received at least one service) who received topical fluoride within the reporting year.
VI.Care Continuity-Ready to be tested
Measure Concept: Children who received a comprehensive or periodic oral evaluation in two consecutive years
Aligned Administrative Measure: Percentage of enrolled children who accessed [dental/ oral health] services (received at least one service) who received a comprehensive or periodic oral evaluation in the year prior to the measurement, who also received a comprehensive or periodic oral evaluation within the reporting year.
VII. Dental caries-Already Tested
Measure Concept: Children who have new caries or untreated caries
Aligned administrative measure: NA.
STAGE III
Public comment period opened in January 2013
Mystery as only a handful of proposed measures
AMA is asking to delay
No date has been set
Likely to follow the same format with a divide core
(mandatory) and menu (optional) requirements,
with continuation of stage I and II and some new
ones
RECAP: THREE STAGES
Stage 1: The basic functionalities electronic health records must include such as capturing data electronically and providing patients with electronic copies of health information.
Stage 2: (Will begin in 2014) Increases health information exchange between providers and promotes patient engagement by giving patients secure online access to their health information.
Stage 3: (Rule will be released in 2014) Will continue to expand meaningful use objectives to improve health care outcomes.
RECAP: (CONT’D)
Stage 2 of the program will begin in 2014. No providers will
be required to follow the Stage 2 requirements outlined
today before 2014.
Outline the certification criteria for the certification of EHR
technology, so eligible professionals and hospitals may be
assured that the systems they use will work, help them
meaningfully use health information technology, and qualify
for incentive payments.
Modify the certification program to cut red tape and make
the certification process more efficient.
RECAP: (CONT’D)
Allow current “2011 Edition Certified EHR
Technology” to be used through 2013. Providers
have the option of using 2014 certification in 2013
but they MUST use the 2014 certification starting
in 2014.
The CMS final rule also provides a flexible reporting
period for 2014 to give providers sufficient time to
adopt or upgrade to the latest EHR technology
certified for 2014
ADDITIONAL RESOURCES
Get information, tip sheets and more at CMS’ official website for the EHR incentive programs:
http://www.cms.gov/EHRIncentivePrograms
Follow the latest information about the EHR Incentive Programs on Twitter at http://www.Twitter.com/CMSGov
Learn about certification and certified EHRs, as well as other ONC programs designed to support providers as they make the transition
http://healthit.hhs.gov
www.nnoha.org
QUESTIONS?
THANK YOU!