Transcript Use Certified EHR Technology

Alaska Medicaid Electronic Health
Record (EHR) Incentive Program
EHR Incentive Program
A federal program that provides major financial support to incent providers to
adopt, implement, or upgrade to certified EHR technology and to meet
meaningful use standards
Goals:
Enhance care coordination and patient safety
Reduce paperwork and improve efficiencies
Facilitate information sharing across providers, payers, and state lines
Enable sharing using state Health Information Exchanges (HIE) and the
National Health Information Network (NHIN)
Purpose:
Improve outcomes, facilitate access, simplify care, and reduce
costs of health care nationwide
EHR Incentive Program Requirements
Incentive Requirements
Adopt, Implement or Upgrade “certified” EHR
technology
Meet the “meaningful use” criteria in the
employment of the certified EHR technology
Be an “eligible” professional (EP) or hospital
(EH)
Meet EP or EH Medicaid Patient Volume
Criteria
Use Certified EHR Technology
Adopt – Acquire, purchase, or secure access to
certified EHR technology
Implement – Install or commence utilization of
certified EHR technology capable of meeting
meaningful use requirements
Upgrade – Expand the availability functionality of
certified EHR technology capable of meeting
meaningful use requirements at the practice site,
including staffing, maintenance, and training, or
upgrade from existing EHR technology to certified
EHR technology per the Office of the National
Coordinator (ONC) EHR certification criteria
Meaningful Use
Use Certified EHR Technology
In a meaningful manner - have certain electronic capabilities, such as
e-prescribing
For electronic exchange of health information - to improve
quality/coordination of health care, reduce costs
To submit clinical quality and other measures - measures change over
time to show progress
Meaningful Use Criteria
Set of measures
Quality (outcomes)
Process ( use of best practices/data capture)
Capabilities (computerized functions)
Providers must submit and attest to these quality measures to receive
funds
Must use Federal Meaningful Use definition as a floor
Medicare or Medicaid Eligibility
Eligible Professionals (EPs)
Must choose to participate in Medicare or Medicaid
Program
Before 2015, EPs may switch programs once after the
first incentive payment
For Medicaid: Potentially as high as $63,750 over 6 yrs
For Medicare: Potentially as high as $48,000
Medicare or Medicaid Eligibility
Medicaid Eligible Professionals or Eligible Hospitals
may be eligible for the program if they:
adopt, implement or upgrade to a certified EHR
technology or
successfully demonstrate meaningful use of certified EHR
technology
Medicare Eligible Professionals or Eligible Hospitals
may be eligible for the program if they:
successfully demonstrate meaningful use of certified EHR
technology
Medicaid EHR Incentive Program
Eligible Provider Types
Medicaid Eligible Professionals
Physician (MD,DO)
Dentist
Certified Nurse Mid-Wife
Nurse Practitioner, and
Physician Assistant if practicing in a Rural Health Clinic or a
Federally Qualified Health Center led by a physician
assistant
Non-Hospital Based
Hospital-based EPs are not eligible for incentive payments
An EP is considered hospital-based if 90% or more of his
or her services are performed in a hospital inpatient (POS
21) or emergency room (POS 23) setting
Medicaid Patient Volume Criteria
For Eligible Professionals (EPs)
Provider Type
Minimum Medicaid Patient Volume Threshold
Physicians
30%
-Pediatrician
20%
Dentists
30%
Certified Nurse Midwife
30%
Nurse Practitioners
30%
PA's when practicing at an FQHC/RHC that is led by a PA
30%
** Or the Medicaid EP practices predominantly in an FQHC or RHC-30% needy
individuals patient volume threshold
For Eligible Hospitals (EHs)
Acute Care Hospital and Critical Access Hospitals
Children’s Hospital
10%
No Medicaid volume
requirement
Needy Individual Patient Volume
Needy Individual encounters can be used
by Eligible Professionals (EPs) who practice
predominately in an FQHC or RHC.
Needy Individual encounters include:
Services paid by TXIX Medicaid
Services paid by TXXI Children’s Health Insurance
Program (CHIP)
Furnished by the provider as uncompensated care
Furnished at either no cost or reduced cost based
on a sliding scale
Potential EP Payment Timeline
(for Medicaid EHR Incentive Program)
Potential EH Payment
EH payments are based on a number of factors, beginning
with a $2 million base payment.
Hospitals cannot initiate payments after 2016 and payment
years must be consecutive after 2016
EHR Incentive Program Enrollment
To enroll in the incentive program EPs and EHs
must:
Register at the CMS EHR Incentive Program
Registration site
Register and attest at the Alaska Medicaid State
Level Registry (SLR)
Alaska Medicaid
Provider Outreach Page
Centralized “one stop” launching pad of available tools for
Providers to manage their EHR Incentive Program
Information
The Provider Outreach portal provides:
A link "Want to get a jump start?" with step-by-step instructions on
how to complete the registration process by role (individual eligible
professional, eligible hospital or group administrator)
Attestation workbooks for Eligibility and Adopt / Implement /
Upgrade to help gather all the necessary information to register for
the program
Ability to access the CMS EHR Incentive Registration site
Ability to create an account with the Alaska Medicaid SLR
Ability for Eligible Professionals and Eligible Hospitals to attest to
information submitted
Alaska Medicaid SLR
Getting Started
Step by Step Instructions
Alaska Medicaid SLR Registration
To register in the SLR you must be:
An eligible professional, eligible hospital or a
group administrator
Enrolled in Alaska Medicaid
Have your National Provider Identifier (NPI) and
Tax Identifier Number (TIN)
The NPI and TIN used in the SLR needs to be the
same as what was entered for the CMS EHR
Incentive Registration
Attestation Preparation
Determine which method of Certified EHR technology you will be
attesting to — adopt, implement, or upgrade
Verify that your EHR is on the list from ONC as certified EHR
technology
Obtain a copy of your signed contract with a vendor for the
purchase, implementation or upgrade of a certified EHR system
Select the 90 day period to determine the Medicaid or needy
individual patient volume you will be reporting using the number of
encounters
Obtain your active Alaska Medicaid Provider number
Obtain your medical license number, licensing board name and
state in which it was issued
Eligible Hospitals (EHs) need to have four (4) years worth of cost
reports in order to complete the attestation process
Where do I go to log into the SLR?
SLR Create Account
SLR Create Login
Must be between 8 –
20 characters
No spaces / special
characters allowed
Must have between
8 - 20 characters,
at least 1 upper and
1 lower case letter, 1
number, 1 special
character (@ or # or
!), not your User ID
and not an old
password
SLR Login
Enter User ID and
Password you created
SLR – End User License Agreement
Legalese
User agrees and proceeds;
user disagrees and cannot
complete registration
SLR Home Page
Steps guide
users
through
Attestation
workflow
SLR Step 1 – Eligible Professional (EP)
About You
SLR Step 1 – EP About You
SLR Step 1 – Eligible Hospital (EH)
About You
SLR Step 2 – EP Confirm Eligibility
SLR Step 2 – EH Confirm Eligibility
SLR Step 2 – EH Hospital Demographics
SLR Step 3 – Attestation Method
SLR Step 3 – AIU Method
SLR Step 3 – EHR Certification
ONC CHPL
ONC CHPL
ONC CHPL
Add to SLR EHR Certification ID field
SLR Step 3 – Meaningful Use (MU)
EHR Reporting Period
SLR Step 3 – EP MU Core Objectives
EP will have to attest to each of the 15 Meaningful Use Core
Objectives
The 15 Meaningful Use Core Objectives are:
Use computerized provider order entry (CPOE) for medication
orders directly entered by any licensed healthcare professional
who can enter orders into the medical record per state, local and
professional guidelines
Implement drug-drug and drug-allergy interaction checks
Maintain an up-to-date problem list of current and active
diagnoses
Generate and transmit permissible prescriptions electronically
(eRx)
Maintain active medication list.
Maintain active medication allergy list
Record all the demographics
Record and chart changes in vital signs
SLR Step 3 – EP MU Core Objectives
Record smoking status for patients 13 years old or older
Report ambulatory clinical quality measures to the State
Implement one clinical decision support rule relevant to specialty
or high clinical priority along with the ability to track compliance
to that rule
Provide patients with an electronic copy of their health
information (including diagnostic test results, problem list,
medication lists, medication allergies), upon request
Provide clinical summaries for patients for each office visit
Capability to exchange key clinical information (for example,
problem list, medication list, allergies, diagnostic test results),
among providers of care and patient authorized entities
electronically
Protect electronic health information created or maintained by
the certified EHR technology through the implementation of
appropriate technical capabilities
SLR Step 3 – EP MU Core Objectives
SLR Step 3 – EH MU Core Objectives
EH will have to attest to each of the 14 Meaningful Use Core
Objectives
Use computerized physician order entry (CPOE)
Implement drug-drug and drug-allergy interaction checks
Maintain an up-to-date problem list of current and active diagnoses
Maintain active medication list
Maintain active medication allergy list
Record all of the demographics: preferred language, gender, race,
ethnicity, date of birth, date and preliminary cause of death in event of
mortality
Record and chart changes in vital signs
Record smoking status for patients 13 years or older
Report hospital clinical decision support rule related to a high priority
hospital condition
Provide patients with an electronic copy of their health information
Provide patients with an electronic copy of their discharge instructions
Capability to exchange key clinical information
Protect electronic health information created or maintained by
certified EHR technology through the implementation of appropriate
technical capabilities
SLR Step 3 – EH MU Core Objectives
SLR Step 3 – EP MU Menu Objectives
EP has to attest to at least one menu objective from the public health list,
even if the exclusion applies to both:
Capability to submit electronic data to immunization registry or
immunization information system
Capability to submit electronic syndromic surveillance data to public
health agencies
EP must attest to additional menu objectives until a total of 5 MU Menu
Objectives have been selected:
Implement drug formulary checks
Incorporate clinical lab-test results into EHR as structured data
Generate lists of patients by specific conditions
Send reminders to patients
Provide patients with timely electronic access to their health information
Use certified EHR technology to identify patient-specific education
resources
Perform medication reconciliation if patient is received from another care
setting or provider
Provide summary of care record for any transition of care or referral
SLR Step 3 – EP MU Menu Objectives
SLR Step 3 – EH MU Menu Objectives
EH has to attest to at least one menu objective from the public health list,
even if the exclusion applies to both:
Capability to submit electronic data to immunization registry or immunization
information system
Capability to submit electronic syndromic surveillance data to public health
agencies
Capability to submit electronic data on reportable lab results to public health
agencies
EP must attest to additional menu objectives until a total of 5 MU Menu
Objectives have been selected:
Implement drug formulary checks
Record advance directives for patients 65 years or older
Incorporate clinical lab-test results into certified EHR as structured data
Generate lists of patients by specific conditions
Use certified EHR technology to identify patient-specific education resources
Perform medication reconciliation if patient is received from another care setting
or provider
Provide summary of care record for any transition of care or referral
SLR Step 3 – EH MU Menu Objectives
SLR Step 3 – EP Core Clinical
Quality Measures
EP must attest to all three (3) Core Clinical Quality Measures
If any of the Core Clinical Quality Measures have a
denominator of zero (0) an Alternative Core Clinical Quality
Measure must also be submitted
Core Clinical Quality Measures:
Hypertension: Blood Pressure Measurement
Preventive Care and Screening Measure Pair
Adult Weight Screening and Follow-up
Alternate Clinical Quality Measures:
Weight Assessment and Counseling for Children and
Adolescents
Preventive Care and Screening: Influenza Immunization for
Patients > or = 50 years old
Childhood Immunization Status
SLR Step 3 – EP Core Clinical
Quality Measures
SLR Step 3 – EP Alternate Clinical
Quality Measures
SLR Step 3 – EP Additional
Clinical Quality Measures
EP must select three (3) Additional Clinical Quality Measures from list:
Asthma assessment
Appropriate testing for children with pharyngitis
Initiation and engagement of alcohol and other drug dependence treatment
Prenatal care: screening for HIV
Prenatal care: anti-D immune globulin
Controlling high blood pressure
Smoking and tobacco use cessation
Breast cancer screening
Cervical cancer screening
Chlamydia screening for women
Colorectal cancer screening
Use of appropriate medications for asthma
Pneumonia vaccination status for older adults
Asthma pharmacologic therapy
Low back pain: use of imaging studies
Diabetes: eye exam
Diabetes: foot exam
Diabetes: hemoglobin A1c poor control
Diabetes: blood pressure management
SLR Step 3 – EP Additional
Clinical Quality Measures
Additional clinical quality measures continued:
Diabetes: urine screening
Diabetes: low density lipoprotein (LDL) management and control
Coronary artery disease: oral antiplatelet therapy prescribed
Ischemic vascular disease: use of aspirin or another antithrombotic
Coronary artery disease: beta-blocker therapy
Ischemic vascular disease: blood pressure management
Coronary artery disease: drug therapy for lowering LDL-cholesterol
Ischemic vascular disease: complete lipid panel and LDL control
Heart failure: angiotensein
Heart failure: beta-blocker therapy for LVSD
Heart failure: Waifarin therapy for patients with atrial fibrillation
Primary open angle glaucoma: optic nerve evaluation
Diabetic retinopathy: documentation of presence or absences of macular edema and level of
severity
Diabetic retinopathy: communication with the physician mapping ongoing diabetes care
Anti-depressant medication management
Oncology colon cancer: chemotherapy for stage III colon cancer patients
Oncology breast cancer: hormonal therapy for stage IC-IIIC estrogen receptor/progesterone
receptor positive breast cncer
Prostate cancer: avoidance of overuse of bone scan for staging low risk prostate cancer
patients
Diabetes: hemoglobin A1c control
SLR Step 3 – EH Core Clinical
Quality Measures
EP must attest to all fifteen (15) Core Clinical Quality
Measures
Emergency department (ED): median time from ED arrival to
time of departure from ED
ED: median time from admit decision time to time of departure
from ED
Ischemic stroke: discharge on anti-thrombotics
Ischemic stroke: anticoagulation for A-fib/flutter
Ischemic stroke: thrombolytic therapy for patients arriving
within 2 hours of symptom onset
Ischemic or hemorrhagic stroke: antithrombotic therapy by day
2
Ischemic stroke: discharge on statins
SLR Step 3 – EH Core Clinical
Quality Measures
Ischemic or hemorrhagic stroke: stroke education
Ischemic or hemorrhagic stroke: rehabilitation assessment
VTE prophylaxis within 24 hours of arrival
Intensive care unit VTE prophylaxis
Anticoagulation overlap therapy
Platelet monitoring on unfractionated heparin
VTE discharge instructions
Incidence of potentially preventable VTE
SLR Step 4 - Attestation
Need to download Attestation, review for
accuracy, sign and upload to SLR. Original
signed Attestation must be mailed to SOA
EHR Incentive Program Office
SLR Step 5 – Submit Attestation
Don’t Forget To
Mail original signed EHR Incentive Program Attestation Agreement
Form, Substitute Form - W9 and EDI Payment Agreement Form (if
applicable) to:
State of Alaska
Department of Health and Social Services
Division of Health Care Services
EHR Incentive Program Office
1835 South Bragaw St., Suite 300
Anchorage, AK 99508-3469
Your attestation is not complete until the signed Attestation
Agreement has been received by the State of Alaska.
SLR – EP Payment Calculation Report
SLR – EH Payment Calculation Report
Where to Find Information?
DHSS HIT http://www.hss.state.ak.us/hit/
Preparation Checklist
Centers for Medicare & Medicaid (CMS) EHR Incentive Program
http://www.cms.gov/EHRIncentivePrograms
Program overview, eligibility, FAQs
CMS EHR Incentive Program Registration
https://ehrincentives.cms.gov/hitech/login.action
ONC Certified Health IT Product List (CHPL) http://oncchpl.force.com/ehrcert
Alaska Medicaid SLR Provider Outreach Portal / EHR Incentive
Program Registration http://ak.arraincentive.com/default.aspx
Centralized “one stop” launching pad of available tools for
Providers to manage their EHR Incentive Program Information
Contact Information
Paul Cartland, State HIT Coordinator
State of AK, DHSS
[email protected]
907-269-6097
Beth Davidson, HIT Deputy Coordinator
State of AK, DHSS
[email protected]
907-375-7725
JoLynn Cagle, EHR Program Manager
State of AK, DHSS
[email protected]
907-334-4489