Meaningful Use for Eligible Providers

Session One:

ARRA Meaningful Use Overview

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Session Agenda1. Understand the background of the Meaningful Use

Regulation2. Provide a basic definition of Meaningful Use3. Understand the different certifications that are available

and how they each relate to the Meaningful Use Regulation and the roles of different organizations in process

4. Define “eligible provider” for Meaningful Use:a. Medicareb. Medicaid

5. Understand financial incentives available and future fee schedule changes for physician practices not using EHR:a. Medicareb. Medicaid

6. Know the next steps for yourself as an “Eligible Provider”

Suggestions from our Meaningful Use Eligible Provider Pilot Team

“During the journey upon which you are embarking to embrace the meaningful use requirements, it is vital to understand the eventual goal will be to meet all of these requirements 100% of the time.Meaningful use will result in better care for our patients, but the documentation of this care is not easy to attribute to an individual provider, make it a team effort.”

“CareTracker, like many EHR applications, includes a patient record. This record may cross multiple providers in a single company; the record may contain both billing and clinical components; and it may be used by different providers and clinical users. In order to ensure your practice meets the thresholds put forth in this regulation you, as the leader in your practice, need to ensure that that all users in your practice understand not only their responsibilities, but also how their role can impact measurements across the entire practice.”

“Get everyone involved; put together a team and make these trainings mandatory for all providers and clinical users to ensure success!”

(Paraphrased from several of the providers assisting with this project)

BackgroundAmerican Recovery and Reinvestment Act of 2009 signed by

President Obama on February 17, 2009

New law provides many opportunities to the Department of Health and Human Services, its partner agencies and the States to improve health care through health information technology (Title XIII, Division A and Title IV, Division B)This includes the promotion of the “meaningful use” of electronic

health records through incentives

Copy of the Meaningful Use Final Rule can be found at: http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf

An overview of the incentive programs and useful downloads can be located at:http://www.cms.gov/EHRIncentiveProgramsMedicare recently published a “friendly” tool that also explains

each requirement and it is located at:http://www.cms.gov/EHRIncentivePrograms/Downloads/EP-MU-TOC-Core-and-MenuSet-Objectives.pdf

Basic Requirements for Meaningful Use Use a certified EHR technology in a meaningful manner The certified EHR technology is connected in a manner that

provides for the electronic exchange of health information to improve the quality of care

Physicians using certified EHR technology submit information on clinical quality measures and other selected measures

Specifically for Ambulatory Physician Offices the Final Rule outlines 15 Core Requirements (must meet all) and 10 Menu Set Requirements (choose 5 of 10 to meet) for which the eligible provider must provide documentation or attestation for meaningful use

How to meet each of these requirements will be detailed in three additional CareTracker Recorded Training Sessions:• Session Two: Core Requirements• Session Three: Menu Set Requirements• Session Four: KPI Reports and MU Dashboard

The Core Requirements – Final Regulation

Report ambulatory clinical quality measures to CMS or states (For 2011, provide aggregate numerator, denominator, and exclusions through attestation, 2012 submit electronically).C 15

Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities (conduct or review a security risk analysis in accordance with the requirements and implement security updates as necessary) C 14

Implement one clinical decision support rule relevant to specialty or high clinical priority along with and ability to track compliance for that rule.C 13

Implement capability to electronically exchange key clinical information among providers and patient authorized entities (Perform at least one test of EHR’s capacity to exchange information) C 12

Implement drug-drug and drug-allergy interaction checks (functionality is enabled for these checks for the entire reporting period)C 11

Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines. (30 percent for patients with at least one medication ordered through CPOE)C 10

Generate and transmit permissible prescriptions electronically — eRx (40 percent requirement, does not apply to hospitals)C 9

Provide patients with electronic copy of their health information (problems, medication, medication allergies, diagnostic test results) upon request (50 percent of patients must receive electronic copy within three days).C 8

Provide patient with clinical summary for patients for each office visit within 3 business days (more than 50 percent for all office visits).C 7

Record smoking status for patients 13 years old or older as structured data (50 percent requirement).C 6

Maintain active medication allergy list with at least one entry or indication of "no known medication allergies" as structured data (80 percent requirement).C 5

Maintain active medication list with at least one entry or indication of "no currently prescribed medications" as structured data (80 percent requirement).C 4

Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT (80 percent of all unique patients admitted have at least one entry or an indication of “no problems are known” recorded as structured data).C 3

Record and chart changes in vital signs (BP, height, weight, & display BMI); additionally, plot and display growth charts for children age 2 to 20 including BMI (50 percent requirement).C 2

Record demographics as structured data for preferred language, race, ethnicity, date of birth, and gender (50 percent requirement).C 1

CORE REQUIREMENTS (must meet all of these)CT #

ARRA EHR MEANINGFUL USE STAGE 1 REQUIREMENTS

The Menu Set Requirements – Final Regulation

Information About Certification Health Information Technology (HIT): Tasked to and developed an initial

Set of Standards, Implementation Specifications, and Certification Criteria for EHR Technology interim final rule (45 CFR Part 170) was published on January 13, 2010; a final rule was published July 20, 2010.

National Institute of Standards and Technology (NIST) has been appointed by the Office of the National Coordinator for Health Information Technology to develop the standards, implementation specifications, and certification criteria for EHR technology. The testing standards were published on August 13, 2010.

Certification Commission for Health Information Technology (CCHIT) was founded in 2004 and established the first comprehensive process to test and certify EHR technology, and in September CCHIT was named as one of three certifying bodies for ARRA Meaningful Use. The other certifiers are Drummond Group and InfoGard.

CCHIT Comprehensive certification currently exists for 2006, 2007, 2008 and 2011.

Ingenix CareTracker Version 7 is CCHIT Certified 2011 for Ambulatory EHR.

CareTracker is also ONC-ATCB Certified 2011/2012 (Meaningful Use).

Who is an “Eligible Provider” for Medicare? Medicare Eligible Professional qualifications: Eligible Professionals include: doctor of medicine or

osteopathy, doctor of dental surgery or medicine, doctor of podiatric medicine, doctor of optometry, chiropractor

Eligible Professionals shall be a credentialed with Medicare and:Receiving fee for service reimbursements for

services - or -Have an employment or contractual relationship with

a qualifying Medicare Advantage organization

Who is an “Eligible Provider” for Medicaid?Eligible Professional qualifications:Eligible Professionals include: physicians, dentists, certified

nurse-midwives, nurse practitioners, physicians assistants (*cannot be hospital based unless practicing predominantly in an Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC))Eligible Professionals shall have a minimum of 30% of all

patient encounters attributable to Medicaid over any continuous 90-day period (*includes those practicing predominantly in an FQHC or RHC)Eligible Professionals who are Pediatricians shall have a

minimum of 20% of all patient encounters attributable to Medicaid over any continuous 90-day period (*Pediatricians meeting the 20% minimum will be subject to a 1/3 reduction in incentives for that payment year)

Who is an “Eligible Provider” for Medicaid?

http://www.cms.gov/MLNProducts/downloads/EHRIP_Eligible_Professionals_Tip_Sheet.pdf

Flow Chart to Eligibility for EHR IncentiveAccess this URL to download a tool from CMS: http://www.cms.gov/EHRIncentivePrograms/downloads/eligibility_flow_chart.pdf

The Incentives for Eligible Professionals Incentives to be distributed through Medicare Fee for

Service, Medicare Advantage, and Medicaid programs Eligible providers (EPs) may only receive incentives

through one program EPs will be allowed to make single “one time” switch

between programs during the incentive program timeframe (Medicare 2011 – 2014; Medicaid 2011 - 2016) If an EP acts on this “one time” switch he/she would

continue in the next program at whichever payment year they would have attained had they chosen not to switch

Subject to a maximum financial incentive cap of $63,750

The Incentives - Medicare Payment year #1: demonstration of “Meaningful Use” during any

continuous 90-day period within the year will qualify for the full annual incentive maximum

Payment year #2 - 4: demonstration of “Meaningful Use” must be as of January 1st to receive credit for the entire reporting year with no prorating

Payments will be made as soon as Eligible Professionals ascertain “Meaningful Use” and will be in the form of a lump sum

Medicare Eligible Professionals participating are entitled to an incentive payment amount, subject to an annual limit, equal to 75% of the Secretary’s estimate of the Medicare allowed charges for covered professional services furnished by the EP during the relevant payment year

Eligible Professionals providing services mostly in health professional shortage areas (HPSA) will have their incentive payments increased by 10% for each payment year

No payments will be made after 2016

Medicare Maximum Incentive Payments by Calendar Year

http://www.cms.gov/MLNProducts/downloads/CMS_eHR_Tip_Sheet.pdf

Final Rule Change Note: Calendar year 1 = $18,000 (*only if the EP’s first payment year is 2011 or 2012); if not $15,000 to begin in 2013, $12,000 to begin in 2014.

The Incentives – Medicaid EPsIncentive Payments

To qualify for Medicaid incentive payments, Medicaid eligible professionals must adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology in the first year of participation. Medicaid EPs must demonstrate meaningful use in years 2-6 of

participation. For calendar years 2011-2021, EPs can receive up to $63,750

over 6 years under the Medicaid EHR incentive program. Incentive payments are made by the State based on the

calendar year and will be available for no more than a 6-year period. EPs under Medicaid may only receive incentive funding from one

state in any payment year.

Medicaid Maximum Incentive Payments by Calendar Year

http://www.cms.gov/MLNProducts/downloads/EHRIP_Eligible_Professionals_Tip_Sheet.pdf

The Incentive LimitationsQuestion:Does an eligible provider qualify for the Medicare ePrescribing Incentive

monies if they are applying for EHR Meaningful Use based on being a qualified Medicare or qualified Medicaid provider?

Final Regulation Answers: If you participate as a Medicare EP, you cannot receive incentive payments

from both the Medicare EHR incentive program and the e-Prescribing program in the same year. If you participate as a Medicaid EP, you may participate in both the Medicaid

EHR incentive program and the e-Prescribing program at the same time, as long as you meet the eligibility requirements for both programs. If you want to participate in the Medicare EHR incentive program AND are

currently participating in the e-Prescribing incentive program, you need to decide which incentive program you want to participate. The e-Prescribing incentive program is based on allowable submitted charges during the reporting period, while the EHR incentive program provides a determined incentive payment if the requirements of the program are met. For most, the EHR incentive program will provide the greater monetary value.

(http://www.cms.gov/EHRIncentivePrograms/60_Medicare_Eligibile_Professional.asp)

The Incentive LimitationsQuestion:Does an eligible provider (EP) qualify for the PQRI Incentive

monies if they are applying for EHR Meaningful Use based on being a qualified Medicare provider? Medicaid provider?

Answers:As the HITECH Act does not specify any other restrictions on

participation in other programs and participation in the Medicare and Medicaid EHR incentive programs, we do not propose any other restrictions. (page 130 of 276 Final Regulation)

There may be opportunities to avoid duplication of reporting requirements among our various programs. In section II.A.3. of this final rule, we discuss how we will avoid duplication of reporting requirements for clinical quality measures. (page 130 of 276 Final Regulation)

Payment Adjustments for the FutureMedicare: Fee schedule amount will be reduced by 1% in 2015, by 2% in

2016, by 3% in 2017, and by 3 – 5% in subsequent years If the Secretary finds in 2018 that the amount of eligible

professionals who are meaningful EHR users is less than 75%, then the adjustments will increase by 1% each year, but not more than 5% overall

Medicaid: No fee schedules reductions noted in Final Regulation If an EP first applies for the Medicaid EHR Incentive in 2016

(the latest you may begin) your Medicare fee schedule will be impacted by 1% in 2015 as you would not have applied for meaningful use until 2016.

The Three Stages of Meaningful UseStage 1- effective for 2011 – 2012:Electronically capturing health information in a coded formatUse electronically captured health information to track key clinical conditions and communicating information for care coordination purposesImplementing clinical decision support tools to facilitate disease and medication managementReporting information for quality improvement and public health information

Stage 2 – effective for 2013 – 2014:Expand upon Stage 1 criteria to encourage the use of health IT for continuous quality improvement at the point of care and the exchange of health information in the most structured format possible

Stage 3 – effective for 2015+:Focus on promoting improvements in quality, safety and efficiency Focus on clinical decision support for national high priority conditionsPatient access to self management toolsImproving population health

The Next Steps for an Eligible Professional Using CareTracker EHR

1. Decide if you, as an Eligible Provider, plan to apply for Medicare or Medicaid Incentive funding

2. Define those users / staff members in your practice who must participate in meeting the requirements that will be reviewed in detail in the next training sessions

3. Set aside time for you and your identified users to participate in the CareTracker Meaningful Use Session 2 and Session 3:a. Recorded Training: CareTracker DOC Button > Training Drop Down

> Meaningful Use Sessionsb. Scheduled Instructor Led WebEx Training: CareTracker Help > Live

Webinars > View Webinar Schedule > Find “Meaningful Use” –Please register for the sessions of your choosing (when available)

The Next Steps After Session 2 & 3 Training1. Choose the 5 menu set items you plan to use to meet “Meaningful Use”2. Complete any set up needed in order to fully use CareTracker EHR:

a. Set up your Appointment Types to include Flag for Transition in Care when it is a type for which you determine medication reconcilation to be relevant (If you are choosing M 20 this needs to be done)

b. Set up Custom Encounters (if used) to indicate which types are considered visits to be included in reporting (For Standard Encounter Types the “Visit” in included automatically)

c. Notify CareTracker Support that you need the “MU” flag set to trigger Patient Alerts for Demographics that are required

d. Have you activated Patient Care Management for your practice?i. If not, please follow the steps in Session 2 to activate and

populate your chosen registriese. Have you set up Health Tracker and started to enroll your patients?

i. If you are not, you need to view the PM Health Tracker Recorded Training Session and then begin to actively enroll your patients

f. Have you started to use the Referral Network for provider to provider communications?i. If you have not, you need to view the RPNP Recorded Training

Session and then begin to actively invite other providers

The Next Steps After Session 2 & 3 Training3. Determine who will be responsible to conduct and review the required

“Security Risk Analysis” for your practice and what processes or policies must be implemented to self attest to meeting this requirement

4. Contact your assigned Implementation Specialist or CareTracker Support if you have completed your EHR implementation if you have questions about a particular area

5. Remember the purpose of this regulation is to promote use of EHR. Meaningful use of an EHR application should promote better care and access to information for patients and providers. All clinical users contribute to your success so work as a team and use CareTracker to help your practice achieve your goals

6. Watch for communication in “CareTracker News”about measuring your progress with KPI Reports and in our new dashboard as you move forward with “Meaningful Use of CareTracker EHR” and prepare to

Conclusion Session One:Eligible Provider Meaningful Use Overview

Thank you for your time and attention anddon't forget to plan time for Session 2!