Transcript Use of best-in class evidence-based care - Consumer

Meaningful Use:
Progress Report and Defining Success
Briefing
March 1, 2012
Christine Bechtel, Vice President,
National Partnership for Women & Families
David Lansky, President and Chief Executive Officer,
Pacific Business Group on Health
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Agenda
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Introduction
Background
Window of opportunity
Stage 1 experiences
Discussion on what consumers and purchasers expect
Meaningful Use to achieve by 2015
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Introduction
• First of two briefings on the Meaningful Use incentive program
– Today:
• Review Meaningful Use program background, structure, and progress to
date
• Discuss long-term goals for the program in order to provide feedback on
short-term program design
– Second briefing:
• Review CPDP’s specific recommendations on the notice of proposed
rule making (NPRM) for Stage 2 -- late March/early April
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Background
• Health IT is a critical platform for improving patient care
• Robust use of health IT will result in big gains in care coordination,
efficiency, and quality
• Congress recognized this when it passed HITECH Act of 2009 to
reward Medicare and Medicaid providers for “Meaningful Use” of
certified electronic health records (EHRs)
• Meaningful Use is intended to drive use of EHRs in a way that
serves the interests of patients and the public -- traditionally, EHRs
were employed by providers for largely administrative purposes
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Background
• Meaningful Use is a gradual, escalating program – and providers
can get on the escalator whenever they want
• Who can participate?
Medicare
– Clinicians: Physicians,
osteopaths, dentists,
podiatrists, optometrists and
chiropractors
– Hospitals: Acute care and
critical access hospitals
Medicaid
– Clinicians: Physicians, dentists,
certified nurse-midwives, nurse
practitioners, and physician
assistants
– Hospitals: Acute care and
children’s hospitals
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Staging of Meaningful Use
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Window of Opportunity
• Meaningful Use is a crucial opportunity for consumers and
purchasers to make significant changes to the way care is
delivered
– Reaches a large swath of Medicare and Medicaid clinicians and
hospitals
– Has $44B in taxpayer funding behind it
– Influences and supports other key federal programs
– Impacts care for patients in the private sector
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Timing Is Everything
• By 2015, Medicare incentive dollars run out (payment
reductions begin)
• For Medicaid, providers don’t experience payment cuts and
incentive payment continue until 2021
• Calls from other stakeholders for ONC to slow down
• Consumers and purchasers must make a strong push so the
program reflects what matters and to ensure health IT supports
new delivery and payment models (Stages 2 and 3)
• The wheels for future phases are already in motion:
– Stage 2 notice of proposed rule making is out for public comment
– Stage 3 criteria are being discussed
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Program Structure
• To receive incentive dollars, providers must:
– Register for program
– Fulfill functional criteria and submit clinical quality measures
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Eligible professionals
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20 Functional criteria (15 core, 5 menu)
6 Clinical quality measures (3 core/alternate core, 3 alternate set)
• Eligible hospitals
• 19 Functional criteria (14 core, 5 menu)
• 15 Clinical quality measures (all core)
– Attest that they successfully met Meaningful Use requirements
using certified EHR technology
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Lessons From Stage 1 Implementation
• Program is reaching a lot of providers
– Active registrants in 2011
 120,000 Medicare clinicians
 50,000 Medicaid clinicians
 2,800 Medicare/Medicaid hospitals
– Big ripple effect on health care industry
 Number of hospitals using health IT more than doubled in the last
two years
 Many health systems and doctor’s offices implementing health IT -even those not eligible for Meaningful Use incentive payments
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Experiences with Stage 1 Implementation to Date
• Requirements not as tough as expected (i.e., objectives and
thresholds) for early adopters
• Providers attesting to date have been successful
– 99.99% success rate among Medicare clinicians
– 100% success rate among Medicare hospitals
• Providers have the most challenges with
– Criteria that require them to create or modify workflows
 Patient engagement
 Care Coordination
– Quality measurement
Source: CMS, “Medicare & Medicaid EHR Incentive Program,” January 2012
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Deferral and Exclusion Rates for Stage 1 Criteria
Objective
Deferral rates
for EPs
Deferral rates
for EHs
Summary of care transitions
85%
93%
Send reminders to patients
77%
NA
Medication reconciliation
56%
75%
Syndromic surveillance
70%
79%
Patient education resources
49%
62%
Patient lists
27%
34%
Objective
Exclusion rates for
EPs
Exclusion rates for
EHs
E-copy of health information
75%
68%
Office visit summaries
2%
N/A
E-copy of discharge summaries
N/A
59%
Source: CMS, “Medicare & Medicaid EHR Incentive Program,” January 2012
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Stage 1 Quality Measurement
• A number of providers’ concerns about quality measurement
are about technical challenges, and the Health IT Policy
Committee is working to address them
− EHR products often require significant customization/
reprogramming to retrieve data submission of quality metrics
− EHR calculated quality measurement results are often inaccurate
− Measure specifications aren’t clear and there are errors in
measure definitions (occurred during retooling these measures for
e-reporting)
Source: ONC, “HIT Policy Committee Meaningful Use Workgroup, Presentation to HIT Policy Committee,” November
2011
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Is Stage 1 Improving Patient Care?
• Stage 1 (data collection) lays an important foundation
• To realize the full value of Stage 1, must put the pedal to the metal in
Stages 2 and 3 (information exchange and improvement)
• Key wins from Stage 1
– 5 Part Framework includes quality/safety/disparities, patient engagement,
care coordination, population health and privacy -- for example:
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CPOE
Drug-drug and drug-allergy interaction checks
Medication reconciliation at transitions in care*
Reminders for preventive and follow-up visits*
Patient-specific educational resources*
Patient access to electronic health information*
Collection of RELG, smoking status, and vital signs
* = Menu option
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Back To The Future
• Consumers and purchasers need to make it clear what they expect
Meaningful Use to achieve by 2015
– Then use 2013 criteria as the launch pad
• A cohesive and robust advocacy strategy is needed to hold the line
and ensure the biggest gains
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Four Goals Meaningful Use Should
Achieve By 2015
• Welcome audience feedback on where they think these goals
hit the target, and where they miss it
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The Goals
1. Longitudinal EHR contains information needed to support high quality
care and decision-making, and data to support quality measurement
and public reporting
2. Improve care coordination and efficiency by sending and receiving
appropriate personal health information to and from all participants in
the care process, including patients, caregivers, providers, and others
3. Apply best-in-class evidence-based care practices to promote safety,
efficiency, effectiveness, and patient-centered care
4. Report and improve key indicators of quality and efficiency (multi-site
and longitudinal) for consumer choice, quality improvement, and
accountability
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Goal #1
Longitudinal EHR contains information needed to support high
quality care and decision-making, and data to support quality
measurement and public reporting
Examples:
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Patient-reported outcomes
Granular data categories
related to disparities
Patient-reported symptoms
Care plans
Care team members
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Patient preferences
Lab results – esp. hospital labs
Health risks
Formulary linkage
Email address
Indications for assessing
appropriateness
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Goal #2
Improve care coordination and efficiency by sending and receiving
appropriate personal health information to and from all
participants in the care process, including patients, caregivers,
providers, and others
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Networked information model for sharing and querying of data residing in
multiple locations (include a focus on specialty registries)
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Electronic platform to collect patient-reported outcomes, patient experience,
and quality of shared decision-making
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Secure, user-friendly platforms for patients to access information, share
information with their providers, and gain easier access to the health care
system itself
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Goal #3
Apply best-in-class evidence-based care practices to promote
safety, efficiency, effectiveness, and patient-centered care
Examples:
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For clinicians
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Decision support for prescribing and adjusting medications
Decision support algorithms for test ordering (e.g., MRI for back pain)
Reminders for preventive screenings, follow-up care
For patients
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Use of mobile phone texts for reminders and follow-up care
Personalized, customized education resources
Shared decision-making tools and resources
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Goal #4
Report and improve key indicators of quality and efficiency (multisite and longitudinal) for consumer choice, quality improvement,
and accountability
Examples:
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Clinical outcomes
Patient-reported outcomes
Patient experience
Patient activation and engagement
Disparities (Measures that are
considered “disparities sensitive”
and stratifying quality reports by
demographic data to reduce
disparities)
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Appropriateness of care
Care coordination and care
transitions
Patient safety
Efficiency of resource use
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How the world would look for a knee replacement patient in 2015
Data capture (Goal 1)
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Race, ethnicity, language, gender (RELG)
Patient preferences
Care team members
Care plan
Patient’s risk factors
Patient’s symptoms and function prior to
and after surgery
Information exchange (Goal 2)
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Use of best-in class
evidence-based care (Goal 3)
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Selection of appropriate patients and
implants based on patient requirements
and evidence of effectiveness
Most cost-effective drug is applied
Care is aligned with patient values and
preferences
Rehabilitation center and specialists all
have access to needed information
Consumers have online access
to their health information
Care summary and plan sent to primary
care post-surgery
Reporting and improving quality
indicators (Goal 4)
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Providers display performance
dashboard
Robust quality and outcomes data used
for payment
CMS publicly reports which surgeons are
improving patient functioning and
providing cost-effective care
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Discussion On 2015 Strategy
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Opportunities To Get Involved
• CPDP is active in ONC’s Health IT Policy Committee and
other forums
• CMS and ONC notice of proposed rule making (NPRM) for
Stage 2 requirements (February-April)
• Advanced notice of proposed rule making (ANPRM) on
governance of health information exchange (March/April)
• Health IT Policy Committee request for comments (RFC)
for Stage 3 (later this year)
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About the Consumer-Purchaser Disclosure Project
The Consumer-Purchaser Disclosure Project is a coalition dedicated to improving the quality and
affordability of health care in America for consumers and health care purchasers. The project’s mission
is to put the patient in the driver’s seat — to share useful information about provider performance so
that patients can make informed choices and the health care system can better reward the best
performing providers. The coalition is comprised of leading national and local consumer organizations,
employers and labor organizations. The Consumer-Purchaser Disclosure Project is funded by the Robert
Wood Johnson Foundation along with support from participating organizations.
For more information go to http://healthcaredisclosure.org
Or Contact:
Christine Chen
Senior Policy Analyst
Consumer-Purchaser Disclosure Project
[email protected]
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