And Electronic Health Records

Purpose of the IncentiveThe HITECH Act established the $17.2 billion

fund for EHR incentives. It's purpose is two fold:

Move physicians and hospitals toward the meaningful use of a certified EHR,

Establish a mechanism to actively exchange patient information among providers

Meaningful Use is driven by five principles

• Improving quality, safety and efficiency• Engaging patients in their care• Increasing coordination of care• Improving the health status of the

population• Ensuring privacy and security

Who Is Eligible Doctors of medicine or osteopathy Doctors of dental surgery or dental medicine Doctors of podiatric medicine Doctors of optometry ChiropractorsNOTE: Hospital based practitioners are NOT

eligible

Physicians wrestle with technical details of meaningful use

www.NHINWatch.comThursday, January 20, 2011

Healthcare providers have discovered that identifying the technologies to perform some meaningful use measures is not as easy as federal rules might suggest.

How much is paid? Medicare – 75% of the allowed charges for

professional services provided by physicians up to a total of $44,000 over five years

Medicaid – Must have minimum of 30% of Medicaid patient volume unless Pediatrician then only 20% Medicaid volume (Only 2/3)

Can receive up to $63,750 over 6 years

Must Choose Medicare or Medicaid For obvious reasons, you must choose to

participate under one program or the other. Cannot participate in both.

You will receive one payment per year regardless of which program you choose.

Why Medicaid is EasierMEDICAID –Only for first participation year• Adopted –Acquired and Installed Eg: Evidence of installation prior to incentive

• Implemented –Commenced Utilization of Eg: Staff training, data entry of patient demographic information into EHR

• Upgraded –Expanded Upgraded 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• No EHR reporting period

28

Medicare Reporting Period: The reporting period for the

EHR Incentive program using a certified EHR is any continuous 90 day period during the first payment year.

Note that although the measure specifications assume a full calendar year you should only calculate the denominator and numerator from the first day of the 90 day reporting period to the last day of the 90 day reporting period.

Medicare Payment Details

CY 2011 CY 2012 CY 2013 CY 2014 CY 2015CY 2011 $18,000CY 2012 $12,000 $18,000CY 2013 $8,000 $12,000 $15,000CY 2014 $4,000 $8,000 $12,000 $12,000CY 2015 $2,000 $4,000 $8,000 $8,000CY 2016 $2,000 $4,000 $4,000 $0TOTAL $44,000 $44,000 $39,000 $24,000 $0

Must Start by 2012 to get full payment

Must Start by 2014 to get any payments at all

Last payment in 2016

Medicaid Payment DetailsCY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016

CY 2011 $21,250CY 2012 $8,500 $21,250CY 2013 $8,500 $8,500 $21,250CY 2014 $8,500 $8,500 $8,500 $21,250CY 2015 $8,500 $8,500 $8,500 $8,500 $21,250CY 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250CY 2017 $8,500 $8,500 $8,500 $8,500 $8,500CY 2018 $8,500 $8,500 $8,500 $8,500CY 2019 $8,500 $8,500 $8,500CY 2020 $8,500 $8,500CY 2021 $8,500TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750

Payments do NOT decrease like Medicare payments do.

Total Payments are same Regardless of start year

What are the requirements for “meaningful use”?

1. Use certified EHR in a meaningful manner2. Use certified EHR to exchange patient health data electronically 3. Use certified EHR to submit clinical quality measures

Certified EHRs

Must be certified by an ONC-Authorized Testing and Certification Bodies (ONC-ATCBs).

You must get the certification number in order to register for incentive payments

Approximately 260 certified ambulatory care EHRs (number is growing every day)

Two Types of Criteria

EHR Functionality

Clinical Quality Measures

Functionality Meaningful Use Criteria Defined

For eligible professionals, there are a total of 25 meaningful use objectives.

To qualify for an incentive payment, 20 of these 25 objectives must be met.

There are 15 required core objectives. The remaining 5 objectives may be chosen from

the list of 10 menu set objectives. 80% of patients in EHR

EHR Functionality Criteria

Core Set 15Mandatory

Menu Set 10Select 5 20 Criteria

Needed

• 1. Computerized provider order entry (CPOE)• 2. E-Prescribing (eRx)• 3. Report ambulatory clinical quality measures to CMS/States• 4. Implement one clinical decision support rule• 5. Provide patients with an electronic copy of their health information, upon

request• 6. Provide clinical summaries for patients for each office visit• 7. Drug-drug and drug-allergy interaction checks• 8. Record demographics• 9. Maintain an up-to-date problem list of current and active diagnoses• 10. Maintain active medication list• 11. Maintain active medication allergy list• 12. Record and chart changes in vital signs• 13. Record smoking status for patients13 years or older• 14. Capability to exchange key clinical information among providers of care and

patient-authorized entities electronically• 15. Protect electronic health information

15 Required MU Criteria

Menu Objectives(Choose 5)• 1. Drug-formulary checks

• 2. Incorporate clinical lab test results as structured data• 3. Generate lists of patients by specific conditions• 4. Send reminders to patients per patient preference for preventive/follow up

care• 5. Provide patients with timely electronic access to their health information• 6. Use certified EHR technology to identify patient-specific education resources

and provide to patient, if appropriate• 7. Medication reconciliation• 8. Summary of care record for each transition of care/referrals• 9. Capability to submit electronic data to immunization registries/systems*• 10. Capability to provide electronic syndromicsurveillance data to public health

agencies*

• * At least 1 public health objective must be selected.

Clinical Quality Measures

6 total Clinical Quality Measures 3 core or alternate core, and 3 out of 38 from additional set

2011 –Eligible Professionals are required to submit aggregate CQM numerator, denominator, and exclusion data to CMS or the States by ATTESTATION.

2012 –Eligible Professionals are required to electronically submit aggregate CQM numerator, denominator, and exclusion data to CMS or the States.

Clinical Quality MeasuresCore

Hypertension: Blood Pressure MeasurementPreventive Care and Screening Measure Pair:

a) Tobacco Use Assessment, b) Tobacco Cessation Intervention

Adult Weight Screening andFollow-up

Clinical Quality MeasuresAlternate Core

Weight Assessment and Counseling for Children and Adolescents

Preventive Care and Screening: Influenza Immunization for Patients 50 years and older

Childhood Immunization Status

• 1. Diabetes: Hemoglobin A1c Poor Control • 2. Diabetes: Low Density Lipoprotein (LDL) Management and Control • 3. Diabetes: Blood Pressure Management• 4. Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or AngiotensinReceptor

Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) • 5. Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior

Myocardial Infarction (MI)• 6 Pneumonia Vaccination Status for Older Adults• 7. Breast Cancer Screening• 8. Colorectal Cancer Screening• 9. Coronary Artery Disease (CAD): Oral AntiplateletTherapy Prescribed for Patients with CAD• 10. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)• 11. Anti-depressant medication management: (a) Effective Acute Phase Treatment,

(b)Effective Continuation Phase Treatment• 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 the Physician Managing Ongoing Diabetes

Care• 15. Asthma Pharmacologic Therapy • 16. Asthma Assessment• 17. Appropriate Testing for Children with Pharyngitis• 18. Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen

Receptor/Progesterone Receptor (ER/PR)

Additional Set CQM–EPs must complete 3 of 38

Best Practices

Decide if you want to go for the Medicare or Medicaid incentive program by looking at your numbers. Medicaid is best.

Determine the MU and CQM you want to report on. Give this one some thought – big brother is watching.

Create a “Meaningful Use” folder on your computer and in your filing cabinet. Document everything. Capture and save/print screen shots of registration. Copy/scan agreements.

Seek help.

What Next??

Step 1: Familiarize yourself with the CMS EHR Incentive Program websiteStep 2: Contact us for help with registration

and attestation.Step 3: Collect EHR Incentive Payments

Frequently Asked Questions• Who is responsible for demonstrating meaningful

use of certified EHR technology, the provider or the vendor?

• “To receive an EHR incentive payment, the provider (eligible professional (EP), eligible hospital or critical access hospital (CAH)) is responsible for demonstrating meaningful use of certified EHR technology under both the Medicare and Medicaid EHR incentive programs.” CMS Website

• In plain English, you are.

•

Frequently Asked Questions• What if my electronic health record (EHR) system

costs much more than the incentive the government will pay? May I request additional funds?

• “The Medicare and Medicaid EHR Incentive Programs provide incentives for the meaningful use of certified EHR technology. The incentives are not a reimbursement of costs, and maximum payments have been set.” CMS Website

•

Frequently Asked Questions• Is the physician the only person who can enter

information in the EHR in order to qualify for the Medicare and Medicaid EHR Incentive Programs?

• “No. Any licensed healthcare professional can enter orders into the medical record per state, local, and professional guidelines. The remaining meaningful use objectives do not specify any requirement for who must enter information.” CMS Website

•

Frequently Asked Questions• Are payments from the Medicare and Medicaid

EHR Incentive Programs subject to federal income tax?

• “We note that nothing in the Act excludes such payments from taxation or as tax-free income. Therefore, it is our belief that incentive payments would be treated like any other income. Providers should consult with a tax advisor or the Internal Revenue Service regarding how to properly report this income on their filings.”

• CMS Website

•

Frequently Asked Questions• In a group practice, will each provider need to

demonstrate meaningful use in order to get Medicare and Medicaid electronic health record (EHR) incentive payments or can meaningful use be calculated or averaged at the group level?

• “Yes. Medicare and Medicaid incentive payments are made on a per EP basis, not by practice. Each EP will need to demonstrate the full requirements of meaningful use in order to qualify for the EHR incentive payments”. CMS Website

•

We will provide you with a free consultation to help you with Meaningful Use issue and to document your clinical and financial goals as

they relate to EHR technology, develop a roadmap for success and help you to get the

most out of your EHR investment.

We can help you.

Contact us at (800) 431-3454.www.healthinfotexas.com

info@healthinfotexas.com