Successehs webinar-stage-2-and-3-mu-130424105245-phpapp02 (1)

888.879.7302 • www.SuccessEHS.com

Adele Allison

National Director of Government Affairs

April 10, 2013

Meaningful Use Stages 2 and 3 –

Eligible Professionals


MU2 and 3 – Eligible Professionals

•

•

•

•

•

•

•

•


Meaningful Use – State of the Union

• $11.8 Billion in Total Incentives Program to Dateo ↑ $2.4 Billion in Medicare Incentives Paid – Hospitals/Providers

o ↑ $1.8 Billion in Medicaid Incentives Paid – Hospitals/Providers

o ↑ $7.3 Billion in Medicare/Medicaid to Hospitals

• ↑ 372,000 Hospitals / Professionals registered

• 49 States, D.C. and PR have launched Medicaid Programso Hawaii, Guam, Am. Samoa – Unknown

o Virgin Islands – Unknown


Meaningful Use – State of the Union

• Active Registrations

o Hospitals → 4,257 (5,724 in U.S. – 74%)

o Medicare Eligible Providers → 253,477 (834,769 U.S. Physicians – 30%)

o Medicaid Eligible Providers → 114,866 (U.S. Physicians – 14%)

• Hospital Attestation → $7,861,299,090

• Medicare EP Stage 1 Attestation → $2,134,906,925

• Medicaid EP Year 1 & Year 2 Attestation → $1,595,896,115

Program to Date Top 10 Physician Specialties – Payments 21,685 Internal Med. 22,565 Family Med. 8,416 Cardiology 3,643 OB/Gyn 4,886 Gastro

3,356 Urology 3,354 Ophthal. 4,222 Gen’l Surgery 5,716 Ortho 3,301 Neurology

29,778 Other

Program to Date Eligible Professionals – Payments

AIU 53,337 Physicians 12,443 Nurse Prac. 1,527 Mid-Wives 5,247 Dentists 833 Physician Asst.

MU 4,964 Physicians 1,126 Nurse Prac. 181 Mid-Wives 70 Dentists 68 Physician Asst.


Meaningful Use – Highest / Lowest

• Top 5 States – Hospitals/Providers (34%)

• Lowest 5 States – Hospitals/Providers (7%)

State Medicare Medicaid Paid Count TotalTexas $501,037,496 $481,333,892 14,288 $982,371,388

California $479,811,536 $461,003,962 15,717 $940,815,499

Florida $530,306,093 $299,686,531 12,443 $829,992,624

New York $370,073,044 $276,918,295 11,207 $646,991,338

Pennsylvania $374,894,112 $169,392,763 11,617 $544,286,875

State Medicare Medicaid Paid Count TotalHawaii $29,956,453 $0 482 $29,956,453

Vermont $10,157,423 $19,555,139 793 $29,712,562

North Dakota $16,408,274 $3,254,834 341 $19,663,108

Wyoming $5,766,153 $9,718,002 214 $15,484,155

District of Columbia $8,585,360 $0 392 $8,585,360


Polling the Audience



•

•

•

•

•

•

•

•


4 Marks of Meaningful Use

Adopt and

Use CEHRT

Capture

DATA

Report

DATA

Move

DATA

Sta

ge 1

Sta

ge 2


Stage 1 Changes – CY2013-14

• Core CPOE Denominator – CY2013 and beyond → “New” Option: # of orders for Rx during EHR Reporting Period

• Core Vitals Exclusion Clause – CY2014 → “New”: EP can split to exclude 1 only of BP and/or Height-Weight

• Core Vitals Age Requirements – CY2014 → “New”: BP patients age 3+

• Core Test of Exchanging Key Clinical Information → Removed

• Core ePrescribing Exclusion → Added where EP not within 10 mile

radius of ePharmacy effective CY2013

• 3 Menu Measures → Public Health for Immunizations, Reportable Labs and Syndromic Surveillance → Removed “except where prohibited”

• Core Electronic Copy and Menu Timely Electronic Access → Replaced with CY2014 Stage 2 measure of Patient View, Download and Transfer

• Core Submission of CQMs part of MU definition

• Stage 1 EPs must choose 5 Menu Measures if available



Adopt and

Use CEHRT

• Cultural Shifto Change is hard → “We’ve

always done it this way.”

o Leadership and Professionalism

• Redesign will create temporary Chaos

• Address techno-challenged userso Scribes

o Focused training

o Super-users

• Celebrate your success!



Capture

DATA

• Workflows must be consistent

• 3 Data-entry Types1. Narrative Text

2. Structured Data

3. Object-oriented, Codified Data

• Apply the 5-Rights1. Right Information

2. Right Person Capturing

3. Right Data Format

4. Right Technology Channel

5. Right Time in Workflow



Move

DATA

• Define your Use Cases o Referral Management

o ED/Hospitalization Notification

o Emergency – “Break-the-Glass”

o New/Unknown Patient

• Use Cases → 2 Clear Goalso ↑ Quality

o ↓ Costs

• Interface vs. HIE

• Health Information Exchangeo Sustainability Model

o Emerging Technology


• Clinical Data Reporting is Crucial!o Drive Reimbursement Reform

under ACA (E.g. VBM)

o Physician Compare Website

• CQMs to be electronically submitted by CY2014

• Medicare Data → PQRSo Claims-based

o Registry-based

o EHR Direct

• Medicaid Data → Ind. Stateo Process and Timelines

o Interface or HIE


Report

DATA


MU2 Health IT Implementation List

• CPOE

• Rx Database

• Master Patient Index

• Patient Administration

• Detailed Vitals

• Smoking Status

• Population Health Mgmt.

• Thin-Client Operations

• Data Encryption Technology

• Internet Enabled Technology

• Structured Knowledge Base

• Documentation Tools

• eRx, Rx History and Formulary

(E.g., Surescripts / RxHub)

• Evidence-based Guidelines

• Advanced Patient Portal

• Patient Education

• HIE → Direct / Exchange

• Bidirectional Lab Interface / HIE

• Immunization Interface / HIE

• PACS Interface / HIE

• Public Health, Cancer and/or

Specialty Registry Interface / HIE

• Hosting / Emergency Backup

CEHRT

Standard Offerings

CEHRT

Extensions




•

•

•

•

•

•

•

•


Medicare Penalties

• Applies to EPs treating Medicare Part B PFS Patients

• HITECH requires Payment Adjustment if no MU by 2015

• Adopt, Implement or Upgrade (AIU) is NOT MU

• Payment Adjustment based on prior year’s reporting period – 2year lag

• MU in 2011/2012 = Full Year of MU in 2013 to avoid penalty

• Any MU in 2013 = No Adjustment in 2015

• Medicare MU registration & attestation by 10.1.2014 = No Adjustment in 2015

• This means 90-day reporting period no later than 7.1.2014

• EP must continue to meet MU annually to avoid adjustments in subsequent years

• Hospital-based EPs (90% of Services) not eligible so not subject to penalties


Medicare Penalties

• Penalties are cumulative with other CMS Programs

• EP Hardship Exceptions1. Infrastructure → E.g. Lack of Broadband

2. New EP → 2-year limited exception

3. Unforeseen Circumstances → E.g. Natural Disaster

4. Lack of Face-to-Face or F/up Need with Patients → E.g. Pathology, Radiology, Anesthesiology

5. Multiple Locations and Lack of control over availability of CEHRT for more than 50% of patient encounters

2015 2016 2017 2018 2019 2020+

EP subject to MU adjustment only 99% 98% 97% 96% 95% 95%

EP also subject to eRx adjustment 98% 98% 97% 96% 95% 95%

EP also subject to PQRS adjustment 96.5% 96% 95% 94% 93% 93%

EP also subject to Value-Based

Modifiers (VBM)

+/-

TBD

+/-

TBD

+/-

TBD

+/-

TBD

+/-

TBD

+/-

TBD




•

•

•

•

•

•

•

•


Clinical Quality Measures (CQMs)

• Removed as MU Measure → Now Part of Definition of “Meaningful EHR User”

• Electronic reporting by CY2014 for ‘Care regardless of Stage

• PQRS will be the vehicle for Clinical Reporting for ‘Care

• Clinical Reporting will drive VBM under ACA

• Reporting will be reported publicly on “Physician Compare”

• ACA requires CMS to align MU with other Federal programs (E.g.

PQRS and eRx)

• No change in ‘Care CQMs through CY2013 → 2 Reporting Methodso Manual calculation / Attestation on CMS website

o eReporting under PQRS EHR Incentive Program Pilot

• ‘Caid EPs → Look to State on process and timelines


Clinical Quality Measures (CQMs)

• Prior to CY2014 → Manual attestation of 6:44 CQMs

• CY2014 and Beyond → Electronic submission of 9:64 CQMso First year EP → Aggregated data for All Payers through attestation

o Subsequent Years, 2 Options Electronic reporting of Aggregate data for All Payers, or

Individual Continuity-of-Care Document (CCD) on Medicare only through PQRS EHR Direct using CEHRT

• 9 CQMs must include 1 measure in 3 Nat’l Quality Strategy Domains, minimal (Core Sets of 9 Recommended)

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




•

•

•

•

•

•

•

•


Plugging into the Matrix

• Americans are plug into the Matrix more than ever

• 88% Age 18+ have a cell phone (77% of Rural Residents)

• 67% Texting → Dominates, especially with Teens

o 75% of all Teens text

o Teens average 60 texts per day

o Girls text more than boys at 100 / day compared to 50 / day

o Black teens text average of 80 / day

• 57% have a Laptop

• 19% have a Tablet Computer

• 19% Own and e-book Reader

• 52% Adult Americans use phones while watching TV


Plugging into the Matrix

• Is Patient Decision-making Affected? Yes!

• 49% Influences view of diet, exercise, stress mgmt.

• 38% Affected decision about seeing a doctor

• 38% Altered way of coping with Chronic Condition / Pain

Area of

Advice SoughtProfessional

Family, Friends,

Fellow Patients

Both Equally

Accurate Diagnosis 91% 5% 2%

Rx Information 85% 9% 3%

Alternative Treatment 63% 24% 5%

Specialist Recommendation 62% 27% 6%

Hospital Recommendation 62% 27% 6%

Illness Emotional Support 30% 59% 5%

Quick Remedy for Health

Issues

41% 51% 4%


Gov’t and PPC – By the Numbers

• 23 percent of federal budget goes to health care

• 36 times ACA mentions Patient Centeredness

• 15 times ACA references the Medical Home

• 93 times ACA references Quality Measures

• 29 times ACA links Quality to reporting Clinical Data

• 100 times ACA discusses Value-Based and Payment

Modifiers as relates to Hospital/MD Reimbursement and Measures*

* Commercial payers are now launching VBP payment models.


Patient Centered Care and the Gov’t

• Behavioral Economics is about an Engaged Patiento Effects of social, cognitive, emotion factors on patient decision-making

o E.g., Airport McDonalds Story, MyFitnessPal

• Federal Gov’t → Leadership role in Health Care Reform

• Transition → Episodic Care to Long-Term Healing and Wellness

• Patient Centered Care → Measured Quality Performance

• Federal Policymaking grounded in Patient Centered Careo Regs CMS Meaningful Use Stage 2 - 7 Measures

o Regs CMS Accountable Care Organizations (ACOs) – 7 Measures

o Regs CMS Value-based Purchasing – Differential Payment Based on Quality

o Regs CMS Public Measure Transparency – Physician Compare Website

o Other Agency Initiatives – CMS PCORI, HRSA PCMH and VA PACT


Fed. Programs & Patient Engagement Proposed Stage 2 Core Measures

No. Objective Measure Threshold Exclusions

1Implement Clinical Decision

Support and Track Compliance

Implement CDS to improve on high-priority

condition:

1. 5 CDS interventions for 4 or more CQMs

during entire reporting period; and

2. Enable drug-drug and drug-allergy checks

for entire reporting period.

5 Rules and Rx alerting

by attestation

None

2Provide Patients with Clinical

Summaries

For each office visit to patients within 24 hours,

which includes up-to-date lists of problems,

medications and Rx allergies (paper and electronic

must be avail. to pt.)

50% (Unchanged)

EP has no office visit

during EHR reporting

period

3Use EHR for Patient-Specific

Education Resources

Provide patient-specific education resources to all

patients

10% (Unchanged but

made Core and “if

appropriate removed)



period

4Generate Lists of Patients by

Condition

1 List with a Specific Condition for use in quality

improvement, reduction of disparities, research

or outreach

By attestation (Made

Core) None

5Use of secured messaging with

Patients

Send secured messages to patients seen during

reporting period10%



period

6Timely Electronic Access to Health

Information

Patients can view online, download and transfer

info within 4 days of being available to EP, subject

to EPs discretion to withhold certain info

1. 50% of all pts.,

and

2. 5% of pts. access

EP has no orders /

creates info required

>50% visit in county

with >50% with

4Mbps broadband

avail.

7 Send Reminders to Patients

Preventative and follow-up care for all patients

based on clinically relevant info for anyone with 2

or more office visits in past 24 months

10% (↓ from 20%, all

patients and Made

Core)

EP has no office visit in

previous 24 months


ACOs and Patient Engagement

• 33 Quality Performance Measures

• 7 Patient / Caregiver Experience

• Final Rule requires CMS qualified Survey Vendor by 2014

• HITPC Preliminary Stage 3 Draft (Aug → Final Recommendations expected in Nov)

o Patients Option to submit data online → 10% submit Medical Histories

o Patient education in non-English languages

o 10% of Patients ability to update and correct information online

Measure Method of Data Submission

Getting Timely Care, Appointments and Information Survey

How Well Your Doctors Communicate Survey

Patients’ Rating of Doctor Survey

Access to Specialists Survey

Health Promotion and Education Survey

Shared Decision-Making Survey

Health Promotion and Education Survey


PCMH and Patient Engagement

• NCQA now offers a new Distinction in Patient Experience

o Optional with PCMH Recognition

o “Consumer Experience is Critical Component of Quality of Care”

o Uses CAHPS PCMH Survey to access:

Access

Information

Communication

Coordination of Care

Comprehensiveness

Self-Management Support and Shared Decision-Making

PointsNCQA PCMH 2011

Standard and ElementNumber

of FactorsMust Pass?

20 PCMH Standard 1: Enhance Access and Continuity 344 Element A: Access during office hours 4 Yes4 Element B: Access after hours 5 No2 Element C: Electronic Access 6 No2 Element D: Continuity 3 No2 Element E: Medical Home Responsibilities 4 No2 Element F: Culturally & Linguistically Appropriate Services (CLAS) 4 No4 Element G: Practice Organization 8 No

17 PCMH Standard 2: Identify and Manage Patient Populations 353 Element A: Patient Information 12 No4 Element B: Clinical Data 9 No4 Element C: Comprehensive Health Assessment 10 No5 Element D: Using Data for Population Management 4 Yes

17 PCMH Standard 3: Plan and Manage Care 234 Element A: Implement evidence-based guidelines 3 No3 Element B: Identify High-Risk Patients 2 No4 Element C: Manage Care 7 Yes3 Element D: Management Medications 5 No3 Element E: Electronic Prescribing 6 No9 PCMH Standard 4: Provide Self-Care and Community Support 106 Element A: Self-Care Process 6 Yes3 Element B: Referrals to Community Resources 4 No

18 PCMH Standard 5: Track and Coordinate Care 256 Element A: Test Tracking and Follow-up 10 No6 Element B: Referral Tracking and Follow-up 7 Yes6 Element C: Coordinate with Facilities / Care Transitions 8 No

20 PCMH Standard 6: Measure and Improve Performance 224 Element A: Measures of performance 4 No4 Element B: Patient / Family feedback 4 No4 Element C: Implements Continuous Quality Improvement 4 Yes3 Element D: Demonstrates Continuous Quality Improvement 4 No3 Element E: Performance Reporting 3 No2 Element F: Report Data Externally 3 No

100 149 6


VBP & Patient Engagement

• Hospitals → CMS payment adjustments based on patient experience – Oct. 1, 2012

• Evaluated / Scored on performance improvements over baseline

• Patient Experience → HCAHPS scores

• Hospital staff → patient satisfaction, customer service and communication training

• Results published on Hospital Compare website

• ACA has Physician VBM program starting in 2015based on 2013 performance

• Physician Compare website now in place to show performance metrics - first publishing (limited) in CY2013

• CMS launching CAPHS survey for MDs – FR 3.22.2013


Communication Shift

• Patient Portals have existed since 1990o Patient Engagement was transactional – Financial Focus

o 56M accessed records through Patient Portal (Oct 2011)

• Paradigm shift in the way health information disseminated

Pull Information Model

Push Information Model




•

•

•

•

•

•

•

•


Stage 3 Policymaking – CY2015

• ONC Draft Recommendations → Comments from Nov. 2012 through Jan. 2013

• CPOE

o “Never” Drug-Drug Interactions (DDI)

o Delinquency Results Tracking

o Recording of Date/Time Reviewed

o Bidirectional Lab Interface

o Orders for Referrals/TOC

• ePrescribing → 50% Formulary Checking

• Demographics EHR Certification Criteria

o Occupation/Industry Codes

o Sexual orientation, gender identity

o Disability status (patient reported v. medically determined)



• Problems, Meds, Allergies EHR Certification Criteriao CDS to support additions, edits, deletions (E.g., Hypoglycemic Rx → DM Dx?)

o Coding of Rx allergies and linkage to drug family

• Advanced Directives recorded → Patients 65+

• CDS Greatly Expandedo 15 CDS Interventions linked to CQMs

o EHR Certification Criteria – “Ingesting” interventions from repositories

o Patient-oriented dashboards for QI

• Accessibility of ALL imaged results (E.g. ECGs)

• High-priority Family Histories

• Patient-Preference Automated “Transmit” Care Record Summary

• Patient generated health information into EHR (E.g. Questionnaires)



• Patient requested “amendment” to health record

• Patient-Ed available in top 5 non-English languages

• 10% of Patients using electronic messaging with EP

• Received TOCo Reconcile Rx, Rx Allergies, Problems

o Data Sets defined in Continuity of Care Record for TOCs

o Acknowledged “Receipt” of Electronic Results

• Inbound Immunization Data and baseline recommendations by age

• Query/Retrieve Production HIE

• Population Managemento ID undiagnosed patients with HTN, BP control

o Referral of Smoker to quit-line services




•

•

•

•

•

•

•

•


5 Tips for Success – Patient Engagement

• Tip 1: Measure Patient Satisfaction Pre- and Post-Project

• Tip 2: Involve the Provider(s)o They must drive the medical responses

o They are going to get mad with some survey results

• Tip 3: Address Cultural-Change Challengeso “One more thing I have to do!”

o “Our patients will never go online”

o Creates a mutual interdependence between Providers and Patients

• Tip 4: Add a “filter” and Map the Workflowo Make the workflow someone’s job (Think “Care Team”)

o Get Providers into a routine (E.g. See patients, answer emails / flags, cycle again)

o Perhaps schedule time on the Provider’s calendar


5 Tips for Success – Patient Engagement

• Tip 5: Promote, Promote, Promote!o Refine the Message → Faster way to get lab results, refills, etc.;

No more Phone-Tag!

o Strategically place Brochures (E.g., Ck-in / Ck-out, Waiting Room)

o Add information on appt. reminder cards → “Use our online scheduling!”

o Remind patients of ability to request refills online when they call for refills

o Computer in waiting room to assist patients in registering, completing paperwork, etc.

o Replace “on-hold” music with introduction to patient portal

o Add-on announcements with all statements, newsletters and ePublications

o Improve organizational branding


5 Tips for Success – HIE and TOC

• Tip 1: Define your Use Caseso Does it improve quality?

o Does it decrease costs?

• Tip 2: Involve the Stakeholders

o Hospital

o Specialty Providers

• Tip 3: Understand your HIE Market

o Statewide / Local Market Progress and Barriers

o HISP Providers for Direct

o Exchange for more advance Query / Retrieve HIE

• Tip 4: Allow ample bandwidth to plan and implement

o Data-Sharing Agreements, SOW

o Understand related Costs


6 Health IT Tips – Your IT Vendor

• Tip 1: Meaningful Use, PQRS and Other Dashboards?o Metrics / Analytics by Provider

o Facilitates quick numerators/denominators for MU attestation

o Clinic analytics with drill-through details

• Tip 2: Patient Portal Inherent with System?o Should be part of Core Offering

o Avoids Additional vendor and integration considerations

• Tip 3: Single database solution for PM and EHR

• Tip 4: EHR Direct PQRS

• Tip 5: More than just first call supporto Initiative Toolkits (E.g. MU, PCMH, PQRS)

o Consulting Support with domain experts

• Tip 6: Ongoing Client Educational Offerings


CEUs available at:[email protected]

Copies available on SlideShare or

www.SuccessEHS.com/webinars

Added to The BRIEF or Questions:

[email protected]

Follow me on Twitter:

www.twitter.com/Adele_Allison

Health & Medicine

Successehs webinar-stage-2-and-3-mu-130424105245-phpapp02 (1)