Transcript Document

2011 Patient Centered
Medical Home
Monthly Webinar Series
Electronic Health Record
Utilization—
Meaningful Use Criteria
Ashley Green– HIT Specialist, WHITEC
May 18, 2011
Objectives
1. Provide background about the American
Recovery and Reinvestment Act (ARRA),
specifically related to Meaningful Use
and health information technology
2. Outline Meaningful Use measures
3. Discuss Eligibility for Medicare &
Medicaid Incentive programs
Bipartisan Support
“… an Electronic
Health Record
for every
American
by the year
2014.
By computerizing health records, we
can avoid dangerous medical
mistakes, reduce costs,
and improve care.”
- State of the
Union address,
Jan. 20, 2004
“Computerize
All health
records
within five
years.”
- George Mason University
January 12, 2009
American Recovery and
Reinvestment Act (ARRA) of 2009
• Signed February 17, 2009
by President Obama
• Health Information
Technology for Economic
and Clinical Health
(HITECH) Act
HITECH Act: Catalyst for Transformation
Paper records
Pre 2009
A system plagued by
inefficiencies
HITECH Act
2009
EHR Incentive Program
and 60 Regional
Extension Centers
EHRs & HIE
2014
Widespread adoption
and meaningful use of
EHRs
Building an Interconnected,
Patient-Centric Care System
Snapshot of EHR Benefits
For Providers:
For Patients:
•
•
•
•
•
•
•
•
•
•
•
Dr. David Blumenthal, recent
National Coordinator of HIT,
emphasized:
“HIT is the means, but not the end.
Getting an EHR up and running in
health care is not the main objective
behind the incentives provided by
the federal government under
ARRA. Improving health is.
Promoting health care reform is.”
- At the National HIPAA Summit
in Washington, D.C.
on September 16, 2009
3 Major Components of
Meaningful Use Specified in HITECH
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
HITECH Act Initiatives
Adoption of EHRs
Medicare & Medicaid
Incentives and penalties
State grants for health
Information exchange
Standards & certification
framework
Meaningful Use
of EHRs
Exchange of health
information
Privacy & Security
framework
Blumenthal D. Launching HITECH. N Engl J Med. 2010 Jan 4.
Improved individual and
population health outcomes
Meaningful Use
of EHRs
Improved ability to study and
improve care delivery
Increased transparency
and efficiency
Snapshot: Stage 1 MU for EPs
Core Set: Must Do All
 Use CPOE
 e-prescribing
 Drug-drug & drug allergy
checks
 Medication list
 Allergy list
 Problem list
 Decision support
 Record demographics
 Smoking status
 Vital signs
 Clinical summaries to patient
 Electronic exchange
 Health info to patients
 Clinical quality measures
 Protect health information
Menu Set: Must Do 5 of 10
 Incorporate clinical labs
 Medication reconciliation
 Implement drug-formulary
checks
 Generate patient list
 Patient electronic access
 Send reminder
 Patient-specific education
 Clinical summaries to
provider
 Submit electronic data to
immunization registry*
 Submit electronic
syndromic surveillance
data*
*At least 1 public health
objective must be selected.
13
Meaningful Use
• 25 Objectives and Measures
– Core set (15)
– “Menu” (pick 5 of 10)
– 6 Clinical Quality Measures
• 3 core or alternate core
• 3 out of 38 additional
• Current rule applies for payment
years 2011 and 2012
• Reporting Period is 90 days for the
first year; one year subsequently
• Will evolve over next several years
Meaningful Use: Three Stages
Stage 3:
2015
Stage 2:
2013
Stage 1:
2011
Origin of MU Goals
• Adapted from National Priorities and Goals of
the National Priorities Partnership:
– Improving quality, safety, efficiency, and reducing
health disparities
– Engage patients and families in their health care
– Improve care coordination
– Improve population and public health
– Ensure adequate privacy and security protections for
personal health information
Core Criteria
• Providers must complete each of the core
criteria unless unable to due to scope of
practice, population served or number in
the denominator. For example:
– Chiropractor and ePrescribing
– CAH and no patients have requested
electronic access
Core: Improving quality, safety, efficiency, and
reducing health disparities
Core: Improving quality, safety, efficiency, and
reducing health disparities
Core: Engage patients and families in their
healthcare
Core: Improve care coordination
Core: Ensure adequate privacy and security
protections for personal health information
Menu Criteria
• Providers and hospitals may defer up
to 5 of the menu criteria until stage 2
• At least one of the criteria from
population and public health must be
included in order to qualify as a
meaningful user
Menu: Improving quality, safety, efficiency, and
reducing health disparities
Menu: Engage patients and families in their
healthcare
Menu: Improve care coordination
Menu: Improve population and public health
Reporting of CQMs
• EPs would be required to submit clinical data on 2
measure groups:
– A core set of 3 measures (or alternates)
– 3 additional measures selected from among 38 others
• EHs would be required to submit data on all 15 measures
• All measures have specifications for electronic reporting
• Patient information must be submitted regardless of
payer
Clinical Quality Measures – Core Set
NQF Measure Number & PQRI
Implementation Number
Clinical Quality Measure Title
NQF 0013
Hypertension: Blood Pressure
Measurement
NQF 0028
Preventive Care and Screening
Measure Pair: a) Tobacco Use
Assessment, b) Tobacco Cessation
Intervention
NQF 0421
PQRI 128
Adult Weight Screening and Followup
Clinical Quality Measures – Core Set
NQF Measure Number & PQRI
Implementation Number
Clinical Quality Measure Title
NQF 0024
Weight Assessment and Counseling
for Children and Adolescents
NQF 0041
PQRI 110
Preventive Care and Screening:
Influenza Immunization for Patients
50 Years Old or Older
NQF 0038
Childhood Immunization Status
Additional CQMs
• must complete 3
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 Angiotensin Receptor 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
Additional CQMs
8. Colorectal Cancer Screening
9. Coronary Artery Disease (CAD): Oral Antiplatelet Therapy
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
Additional CQMs
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) Positive Breast Cancer
Additional CQMs
19. Oncology Colon Cancer: Chemotherapy for Stage III
Colon Cancer Patients
20. Prostate Cancer: Avoidance of Overuse of Bone Scan for
Staging Low Risk Prostate Cancer Patients
21. Smoking and Tobacco Use Cessation, Medical
Assistance: a) Advising Smokers and Tobacco Users to
Quit, b) Discussing Smoking and Tobacco Use Cessation
Medications, c) Discussing Smoking and Tobacco Use
Cessation Strategies
22. Diabetes: Eye Exam
23. Diabetes: Urine Screening
Additional CQMs
24. Diabetes: Foot Exam
25. Coronary Artery Disease (CAD): Drug Therapy for
Lowering LDL-Cholesterol
26. Heart Failure (HF): Warfarin Therapy Patients with Atrial
Fibrillation
27. Ischemic Vascular Disease (IVD): Blood Pressure
Management
28. Ischemic Vascular Disease (IVD): Use of Aspirin or
Another Antithrombotic
Additional CQMs
29. Initiation and Engagement of Alcohol and Other Drug
Dependence Treatment: a) Initiation, b) Engagement
30. Prenatal Care: Screening for Human Immunodeficiency
Virus (HIV)
31. Prenatal Care: Anti-D Immune Globulin
32. Controlling High Blood Pressure
33. Cervical Cancer Screening
34. Chlamydia Screening for Women
Additional CQMs
35. Use of Appropriate Medications for Asthma
36. Low Back Pain: Use of Imaging Studies
37. Ischemic Vascular Disease (IVD): Complete Lipid Panel
and LDL Control
38. Diabetes: Hemoglobin A1c Control (<8.0%)
Reporting Process
– 2011 – Eligible Professionals seeking to demonstrate
Meaningful Use are required to submit aggregate
CQM numerator, denominator, and exclusion data to
CMS or the States by ATTESTATION.
– 2012 – Eligible Professionals seeking to demonstrate
Meaningful Use are required to electronically submit
aggregate CQM numerator, denominator, and
exclusion data to CMS or the States.
Applicability of Objectives & Measures
• Some MU objectives not applicable to every
provider’s clinical practice; 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 EP, eligible hospital, or CAH
would be excluded from having to meet that
measure
– e.g., Dentists who do not perform immunizations;
Chiropractors do not e-prescribe
Incentives
• Pay you for meaningful use*
• Awarded by Medicare
–
–
–
–
–
Maximum: $44,000 per provider
$48,400 if in a HPSA
Penalties begin in 2015
Attestation begins 4/11
Payments begin 5/11
• Awarded by Medicaid
– Maximum: $63,750 per provider
– *First year is AIU $21,250
Medicare-only Eligible
Professionals
Medicaid-only Eligible
Professionals
Could be eligible for both
Medicare & Medicaid
incentives
EP Eligibility: Medicare Basics
• Must be a physician (defined as MD, DO,
DDM/DDS, optometrist, podiatrist, chiropractor)
• Must have Part B Medicare allowed charges
• Must not be hospital-based
• Must be enrolled in PECOS, living
EP Eligibility: Medicaid Basics
• Must be one of 5 types of EPs
• Must either:
– Have ≥ 30% Medicaid patient volume (≥ 20%
for pediatricians only); or
– Practice predominantly in an FQHC or RHC
with ≥30% needy individual patient volume
• Licensed, credentialed
• No OIG exclusions, living
• Must not be hospital-based
Incentive Payments for Medicare EPs
• First Calendar Year (CY) for which the EP Receives an Incentive Payment
Incentive Payments for Medicaid EPs
Meaningful Use Requirements
• A Medicare Eligible Professional who does NOT
demonstrate meaningful use by 2015 will be
subject to payment reductions in their Medicare
reimbursement schedule
• Medicaid-only EPs are not subject to payment
reductions
• Payment reductions may apply for any EP who
accepts Medicare, even if you only participate in
the Medicaid EHR incentive program
Additional Information
• HHS HIT (ONC) website:
http://healthit.hhs.gov/portal/server.pt/community/healthit
_hhs_gov__home/1204
• CMS Incentive Program website:
http://www.cms.gov/ehrincentiveprograms/
• WI DHS website for eHealth Initiative:
http://www.dhs.wisconsin.gov/ehealth/index.htm
Contact Information
Ashley Green
HIT Specialist, WHITEC
Desk: (608) 729-2705
Fax: (608) 274-5008
[email protected]
2909 Landmark Place
Madison, WI 53713
www.whitec.org
Questions?
WHITEC, operated as a division of MetaStar, is funded through a cooperative agreement award from the
Office of the National Coordinator, Department of Health and Human Services Award No. 90RC0011/01
Thank You
210 Green Bay Road, Thiensville, WI 53092
Phone: (262) 512-0606
Email: [email protected]
www.wafp.org/pcmh
50