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

Medicare & Medicaid EHR Incentive Programs

HIT Policy CommitteeJuly 9, 2013

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

Registration and Payment Data

2

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

Active Registrations – May 2013Active Registrations – May 2013

3

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

Medicaid Incentive Payments

4

Medicaid Incentive Payments – May 2013 (Both MU and AIU)

For final CMS reports, please visit: http://www.cms.gov/EHRIncentivePrograms/56_DataAndReports.asp

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

Medicare EPs by Specialty – May 2013

5

61% of all Medicare EPs who are MUers are non-primary care

20%

18%

7%5%4%

4%3%

3%

4%3%

2%

2%2%2%2%

17%FAMILY PRACTICE

INTERNAL MEDICINE

CARDIOVASCULAR DISEASE (CARDIOLOGY)

ORTHOPEDIC SURGERY

GASTROENTEROLOGY

GENERAL SURGERY

UROLOGY

OPHTHALMOLOGY

OBSTETRICS/GYNECOLOGY

NEUROLOGY

OTOLARYNGOLOGY

PULMONARY DISEASE

NEPHROLOGY

DERMATOLOGY

HEMATOLOGY/ONCOLOGY

OTHER

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

EHR Incentive Programs

6

EHR Incentive Programs – May 2013 Totals

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

EHR Incentive Programs

7

EHR Incentive Programs – May 2013 Totals

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

May – By the Numbers May – By the Numbers

11.69%

88.31%

Registered Eligible Hospitals

5,011 Total HospitalsRegistered Hospitals

8

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

May – By the Numbers May – By the Numbers

21.29%

78.71%

Paid Eligible Hospitals

5,011 Total HospitalsHospitals Paid

9

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

May – By the Numbers May – By the Numbers

25.06%

50.44%

24.50%

Registered Eligible Professionals

527,200 Total EPsRegistered Medicare EPs (265,919)Registered Medicaid EPs (129,140)

10

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

May – By the Numbers May – By the Numbers

44.32%

36.53%

16.75% 2.40%

Paid Eligible Professionals

527,200 Total EPsMedicare EPs (192,566)Medicaid EPs (88,321)MAO EPs (12,670)

11

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

May – By the Numbers

• Approximately 79% of all eligible hospitals have received an EHR incentive payment for either MU or AIU • About 8 out of 10 eligible hospitals have made a financial commitment to an

EHR

• Approximately 56% or 1 out of every 2 Medicare EPs are meaningful users of EHRs

• Approximately 63% of all Medicaid EPs have received an EHR incentive payment

• 11% of Medicaid EPs are meaningful users

• Over 53% -- 1 out of every 2 Medicare and Medicaid EPs have made a financial commitment to an EHR

• Over 297,000 Medicare and Medicaid EPs have received an EHR incentive payment

12

May – By the Numbers

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

Medicare & Medicaid Payments

13

Medicare & Medicaid Payments for June 2013DRAFT ESTIMATES ONLY

Providers Paid June-13

Medicare EPs [ESTIMATED] 6,250

Medicaid EPs [ESTIMATED] 3,750

Medicaid/Medicare Hospitals** [ESTIMATED] 175

Total 10,175

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

EHR Incentive Programs Attestation Data

14

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

Providers Included

At the time of the analysis• 195,337 Medicare EPs had attested

• 195,124 Successfully• 213 Unsuccessfully

• 3,046 Hospital had attested• All successfully

• 5,720 Medicaid EPs had attested (2012 only)

15

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

Medicare Highlights• On average all thresholds were greatly exceeded, but

every threshold had some providers on the borderline• Drug formulary, immunization registries and patient list

are the most popular menu objectives for EPs• Advance Directives, Clinical Lab Test Results, and Drug

Formulary for hospitals

• Transition of care summary and patient reminders were the least popular menu objectives for EPs• Transition of Care and Reportable Lab Results for hospitals

• Little difference between EP and hospitals• Little difference among specialties in performance, but

differences in exclusions and deferrals

16

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

90 Day Performance Data

17

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

EP 2011, 2012, and 2013 90 DaysCore Objective Performance

18

CPOE for M

edication O

rders

Maintain Pro

blem List

ePrescr

ibing

Active

Medica

tion List

Medica

tion Allerg

y List

Record

Demogra

phics

Record

Vital S

igns

Record

Smokin

g Status

Electronic

Copy of H

ealth In

formation

Clinica

l Summarie

s70%

75%

80%

85%

90%

95%

100%

201120122013

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

EP 2011, 2012, and 2013 90 DaysMenu Objective Performance

19

Clinica

l Lab Test

Results

Patient Reminders

Patient Electr

onic Acc

ess

Patient-Specifi

c Educa

tion Resource

s

Medica

tion Reconcil

iation

Transiti

on of Care

Summary

Immuniza

tion Registrie

s Data Su

bmission

Syndro

mic Su

rveilla

nce D

ata Submiss

ion0%

10%20%30%40%50%60%70%80%90%

100%

201120122013

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

Hospital 2011, 2012, and 2013, 90 Days, Core Objective Performance

20

CPOE for M

edica

tion Ord

ers

Main

tain Pro

blem Lis

t

Active

Medica

tion List

Med

ication Alle

rgy Lis

t

Record

Demogra

phics

Record

Vital S

igns

Record

Smokin

g Statu

s

Electr

onic Copy o

f Hea

lth In

form

ation

Electr

onic Copy o

f Disc

harge I

nstructi

ons75%

80%

85%

90%

95%

100%

201120122013

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

Hospital 2011, 2012, and 2013, 90 Days, Menu Objective Performance

21

Advance

Dire

ctive

s

Clinica

l Lab Test

Results

Patient-Specifi

c Educa

tion Resource

s

Medica

tion Reconcil

iation

Transiti

on of Care

Summary

Immuniza

tion Registrie

s Data Su

bmission

Reportable La

b Results

to Public

Health

Agencies

Syndro

mic Su

rveilla

nce D

ata Submiss

ion0%

10%20%30%40%50%60%70%80%90%

100%

201120122013

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

Non-Returning Medicare Providers

22

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

2011 to 2012 Non-Returning Providers

23

5%17%

28%

50% Retiring EPs

Switched to practice without EHRDid not meet deadlineMultiple factors

Approximately 10,000 Medicare EPs who attested in 2011 did not return for the 2012 program year.

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

Multiple Factors: Non-Returning Providers

24

Intended to attest, missed deadline

Too time-consuming

Waiting for Stage 2 information

Too complicated

Could not meet 1+ objectives

Problem/dissatisfaction with EHR vendor

Too expensive to invest in and maintain EHRs

Program doesn't fit medical specialty

Changed to different EHR system

0% 5% 10% 15% 20% 25% 30% 35% 40%

37%36%

35%32%

25%15%

10%9%

6%

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

Next Steps

25

• Majority of providers intend to become MUers again

• Over half of EPs who switched practices plan to attest in 2013

• More information needs: Small and Rural Practices

• CMS will be issuing more basic resources through its website (www.cms.gov/EHRIncentivePrograms)

• CMS “Ask the Expert” webinars twice each month

• Partnership with health care associations

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

Medicaid EP Performance Data

26

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

Medicaid vs. Medicare EP 2012,90 Day Core Performance

27

CPOE for M

edica

tion Ord

ers

Maintai

n Problem

List

ePres

cribing

Active

Med

ication Lis

t

Medica

tion Allergy

List

Record

s Dem

ographics

Record

Vital S

igns

Record

Smokin

g Stat

us

Electr

onic Copy o

f Hea

lth In

formati

on

Clinica

l Summari

es 0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Medicaid EPsMedicare EPs

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

Medicaid EP 2012 Core Measure Exclusions

28

EPCMU 01

EPCMU 02

EPCMU 03

EPCMU 04

EPCMU 05

EPCMU 06

EPCMU 07

EPCMU 08

EPCMU 09

EPCMU 10

EPCMU 11

EPCMU 12

EPCMU 13

EPCMU 14

EPCMU 150

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

558

0 0

703

0 0 45 114 59 0 0

4,168

111 0 0

Core Measures

Medicaid EPs

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

Medicaid vs. Medicare EP 2012,90 Day Menu Performance

29

Clinica

l Lab Test

Results

Patient Reminders

Patient Electr

onic Acc

ess

Patient Specifi

c Educa

tion Resource

s

Medica

tion Reconcil

iation

Transiti

on of Care

Summary

0%10%20%30%40%50%60%70%80%90%

100%

Medicaid EPsMedicare EPs

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

Medicaid EP 2012 Menu Measure Deferrals

30

EPMMU 01

EPMMU 02

EPMMU 03

EPMMU 04

EPMMU 05

EPMMU 06

EPMMU 07

EPMMU 08

EPMMU 09

EPMMU 10

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

899

1,3141,182

4,1794,041

2,233

2,537

4,027

708

3,979

Menu Measures

Medicaid EPs

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

2012 Medicaid EP Menu Measures

31

EPMMU 01

EPMMU 02

EPMMU 03

EPMMU 04

EPMMU 05

EPMMU 06

EPMMU 07

EPMMU 08

EPMMU 09

EPMMU 10

Total Universe

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

8991314 1182

4179 4041

22332537

4027

708

3979

0

419

133

2781

256

161

1923

1097

0

4402 42734538

1514 1598

3487

2927

1532

3089

644

Total ProvidersPassedExclusionsDeferrals

Menu Measures

5720

31

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

Full slide deck and report will be available for download on CMS website:

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

For questions, please contact:Robert AnthonyOffice of E-Health Standards and ServicesCenters for Medicare & Medicaid Servicesrobert.anthony@cms.hhs.gov

32