Transcript PowerPoint Slides Here

Meaningful Use in 2016 – 2017
Presented by Christina Jones
What You Need to Know
In October 2015, CMS published the Modifications to Meaningful
Use 2015 – 2017 Final Rule which revised requirements for Eligible
Professionals (EPs) participating in the Meaningful Use program for
the years 2015 – 2017.
The modifications reflect changes to the objectives and measures of
Stage 1 and Stage 2 to align with Stage 3, which focuses on the
advanced use of EHR’s. The changes also aid to reduce the
complexity of the program and work toward a shift to a single set of
sustainable objectives and measures in 2018.
Key Concepts of the Modifications
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Restructured Stage 1 and Stage 2 objectives and measures to align
with Stage 3. Ten objectives for EPs, including one consolidated
public health reporting objective with measure options.
The reporting period aligns with the calendar year for all EPs, except
first year EPs which are allowed a 90-day reporting period.
Modified Stage 2 patient engagement objectives that require “patient
action”.
Streamlined the program by removing redundant, duplicative, and
topped out measures.
Important Dates
EHR Timeline
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In 2016, EPs will attest to “Modified Stage 2” measures for the Meaningful Use Incentive Program
in 2017.
In 2017, EPs will attest to “Modified Stage 2 OR Stage 3” measures.
Certified EHR Technology
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In 2016 and 2017, EPs can choose to use technology certified to the 2014 or the 2015 edition.
Reporting Periods
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In 2016, the reporting period would be for one full calendar year (Janauary 1 – December 31st),
except new participants who are allowed any 90-day continuous period.
In 2017, the reporting period would be for one full calendar year (January 1 – December 31st),
except for new participants and/or EPs who choose to implement Stage 3, who are allowed a 90day reporting period.
What is Required in 2016?
With the removal of measures and consolidation of Stage 1 and Stage 2, all EPs in
2016 – 2017 will be required to successfully meet a total of 9 Clinical Measures,
the Public Health Measure, and the 9 Clinical Quality Measure (CQM).
9 Core Clinical
Measures
+
1 Public Health
Measure
+
9 Clinical Quality
Measures
What are the 9 Clinical
Measures?
1 – Protect Electronic Health Information
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Measure - Conduct or review a security risk analysis in accordance with the
requirements in 45 CFR 164.308(a)(1), including addressing the security (to
include data encryption on the server) of ePHI created or maintained in CEHRT in
accordance with requirements under 45 CFR 164.312(a)(iv) and 45 164.306(d)(3),
and implement security updates as necessary and correct identified security
deficiencies as part of the EPs risk management process.
Helpful Resources:
https://www.healthit.gov/providers-professionals/security-risk-assessment-tool
2 – Clinical Decision Support Rule
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Measure 1 - Implement five clinical decision support interventions related to
four or more clinical quality measures at a relevant point in patient care for the
entire EHR reporting period. Absent four clinical quality measures related to an
EPs scope of practice or patient population, the clinical decision support
interventions must be related to high-priority health conditions.
Measure 2 - The EP has enabled and implemented the functionality for drug-todrug and drug all-to-allergy interaction checks for the entire EHR reporting period.
Exclusion: Applies to Measure 2 only, any EP who writes fewer than 100
medication orders during the EHR reporting period.
Helpful Resources:
http://www.uspreventiveservicestaskforce.org/Page/Name/recommendations
CDS is achieved in IMS through the Health Maintenance Module. The CDS can be set to
specific criteria that providers may wish to see. The filter criteria can be a CPT, a Drug
Category, a Drug, an ICD (both ICD9 and ICD10), a Lab Result, a POS, a SNOMED
Code, Vitals, or a question in a Visit Note Template.
When the provider signs off a visit note that matches the criteria being setup with CDS, the CDS
appears with the linked information OR the provider can select CDS from the right frame options
to see what CDS rules apply to this patient.
3 – Computerized Provider Order Entry (CPOE)
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Measure 1 - More than 60% of medication orders created by the EP during the
EHR reporting period are recorded using CPOE.
Measure 2 - More than 30% of laboratory orders created by the EP during the EHR
reporting period are recorded using CPOE (Stage 1 EPs may claim the exclusion
on this measure.).
Measure 3 – More than 30% of radiology orders created by the EP during the EHR
reporting period are recorded using CPOE (Stage 1 EPs may claim the exclusion
for this measure.).
Exclusion: Any EP who writes fewer than 100 medication orders is excluded from
Measure 1, any EP who writes fewer than 100 laboratory orders is excluded from
Measure 2, and any EP who writes fewer than 100 radiology orders is excluded
from Measure 3. *Exclusion applies to the entire EHR reporting period.
Measure 1 – Add a drug in the Prescription Tab
Measure 2 and Measure 3 – Use the Diagnostic/Lab Tab
4 – e-Prescribing (eRx)
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Measure – More than 50% of all permissible prescriptions written by the EP are queried
for a drug formulary and transmitted electronically using CEHRT.
Exclusion: Any EP who writes fewer than 100 permissible prescriptions during the EHR
reporting period; or does not have a pharmacy within his/her organization and there are
no pharmacies that accept e-prescriptions within 10 miles of the EPs practice location
at the start of his/her EHR reporting period.
IMPORTANT: If the EP is participating in the EPCS Program than ALL drugs are
considered permissible to him/her. This means, the EP will be required to e-prescribe
ALL medication orders within the EHR reporting period.
Automated Drug Formularies and eRx History Download are available as a Value Added Services. Please
contact Sales Representative for details.
To send a new prescription, in the patient’s visit note, click Prescription in the left frame
options. When the prescription window appears, click Add to enter the details of a new
prescription. When finished, select the prescriptions you want to send by selecting its check
box below the S column. In the upper pane, click Fax/Print/eSend, and then click eSend from
the drop-down list.
Helpful Tip: This is for NEW prescriptions. If refilling , use the Approve Refill tab in the lower pane to
approve the refill and eSend.
5 – Health Information Exchange (HIE)
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Measure - The EP that transitions or refers their patient to another setting of care
or provider of care must (1) use CEHRT to create a summary of care record
(CCDA), and (2) electronically transmit summary of care to a receiving provider for
more than 10% of transitions of care and referrals.
Exclusion: Any EP who transfers a patient to another setting of care or refers a
patient to another provider less than 100 times during the EHR reporting period.
SNOMED CT Codes – CMS requires that SNOMED CT Codes are used when
referring the patient out of your practice. SNOMED CT Codes are required to be
coded on the patients smoking status.
Smoking Status
SNOMED CT Codes that need to be setup in your database:
Current every day smoker – 449868002
Current some day smoker – 428041000124106
Former smoker – 8517006
Never smoked – 26919005
Smoker, Current status unknown – 77176002
Unknown if ever smoked – 266927001
Heavy tobacco smoker – 428071000124103
Light tobacco smoker - 428061000124105
This measure aims to provide at least 10% of summary of care records (CCDA) be
transmitted electronically using the CEHRT via NwHIN Exchange (HIE) participant (IMS
HIE is powered by Surescripts). This measure can be achieved through the visit note
referrals and the HIE feature. In order to achieve numerator counts the under would need
to send the referral letter through the HIE function in the Visit Note.
HIE is a value added service that must purchased before module can be enabled. Once module is enabled,
additional training will be provided by Computer Zone. Please contact your Sales Representative for details.
6 – Patient Education
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Measure – Patient-specific education resources identified by CEHRT are provided
to patients for more than 10% of all unique patients with office visits seen by the
EP during the EHR reporting period.
Exclusion: Any EP who has no office visits during the EHR reporting period.
In IMS, EPs can add patientspecific education resources for
the patient through the Visit Note.
In the patient’s Visit Note, click
the Careplan (this tab might be
renamed to, Educational
Handouts in your database) from
the left frame which opens the
Careplan pane, select the
category of the desired plan.
Select the desired Careplan in
the upper right pane by checking
the corresponding check box.
Once done, click the Add to
Careplan to select the careplan
for the patient. The careplan will
be added in the Selected
Careplan pane, and a preview of
the careplan will be displayed in
the lower right pane.
Helpful Tip: To make this process more efficient, we recommend linking you desired careplans to visit note
question templates and/or diagnosis codes. This area can also be customized with handouts the EP has
created his/her self.
7 – Medication Reconciliation
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Measure – The EP performs medication reconciliation for more than 50% of
transitions of care in which the patient is transitioned into the care of the EP.
Exclusion: Any EP who was not the recipient of any transitions of care during the
EHR reporting period.
Definition of ‘Transition of Care’ changed from what it use to be. Use to be, we did
a referral and that was the transition. Now, it is any way a patient comes to the EP
(e.g., New Patient, Incoming-Referral, Returning-Referrals(patients the EP has
referred back to PCP that are returning), etc.).
This can be done easily in the Visit Note. In either the Current Medications Tab or the
Prescription Tab, users can click on the Medication Reconciliation Done check box in the
top right pane.
If you have imported a CCDA for the patient, we can reconcile the medications under the
Current Medication or Prescription Tab by clicking on the Reconcile Symbol. The
medications can be imported from the CCDA by selecting the S box and then Add to Rx
button.
8 – Patient Electronic Access
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Measure 1 – More than 50% of all unique patients seen by the EP during the EHR
reporting period are provided timely access (within 4 business days after the
information is available to the EP) to view online, download, and transmit to a third
party their information subject to the EP’s discretion to withhold certain information.
Measure 2 – For an EHR reporting period in 2016, at least one patient seen by the EP
during the EHR reporting period (or patient-authorized representatives) views online,
downloads, or transmits to a third party his/her health information during the reporting
period.
Exclusions: Any EP who neither orders nor creates any of the information listed in the
inclusion as part of the measures; or conducts 50% or more of his/her patient
encounters in a county that does not have 50% or more of its housing units with 4Mbps
broadband availability according to the latest information available from the FCC on the
first day of the EHR reporting period (This section of the exclusion only applies to
Measure 2.).
Patient portal access is given via the Patient Master Screen, listed under Other Options in
the lower right pane.
Helpful Tip: We recommend to continue generating Clinical Summary letters to ensure the patient has
information available to view online, download or transmit within 4 business days. The user does not need
to print it but they do need to generate and save it for it to appear on the patient portal (Make sure your
document category is defaulted to show on the portal for summary letters.).
9 – Secure Electronic Messaging
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Measure – During the EHR reporting period, the capability for patients to send and
receive a secure electronic message with the EP was fully enabled (Stage 1 EPs
may claim an exclusion on this measure.).
Exclusion: Any EP who has no office visits during the reporting period; or conducts
50% or more of his/her patient encounters in a county that does not have 50% or
more of its housing units with 4Mbps broadband availability according to the latest
information available from the FCC on the first day of the EHR reporting period.
What is the Public Health
Measure?
Public Health Measures
CMS has 3 possible measures for this objective. Beginning in 2016, EPs will be required to
successfully attest to any combination of two measures. An exclusion does not qualify as
having met the measure.
For purposes of meeting this new objective, EPs would be required to demonstrate that
“Active Engagement” with a Public Health Agency or a Specialized Reporting Registry has
occurred. Active Engagement means that the provider is in the process of moving towards
sending “production data” to a Registry, or is sending production data to a Registry. Note
that the term “production data” refers to data generated through clinical processes involving
patient care, and it is used here to distinguish between this data and “test data” which may
be submitted for the purposes of enrolling in and testing electronic data transfers.
This change in definition is intended to better capture the activities a provider may conduct
in order to engage with a Registry, and that any prior action taken to meet the public health
reporting objectives of meaningful use Stages 1 and 2 would count toward meeting the
active engagement requirement of this objective.
Active Engagement Can Be Demonstrated 3 Ways
Option 1 – Completed Registration to Submit Data:
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The EP registered to submit data with the Specialized Registry to which the information is being
submitted; registration was completed within 60 days after the start of the EHR reporting period;
and the EP is awaiting an invitation from the Specialized Registry to begin testing and validation. This
option allows providers to meet the measure when the Specialized Registry has limited resources to
initiate the testing and validation. Providers that registered in previous years do not need to add an
additional registration to meet this requirement for each EHR reporting period.
Option 2 – Testing and Validation:
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The EP is in the process of testing and validation of the electronic submission of data. Providers must
respond to requests from the Specialized Registry within 30 days; failure to respond twice within
an EHR reporting period would result in that provider not meeting the measure.
Option 3 – Production:
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The EP has completed testing and validation of the electronic submission and is electronically
submitting production data to the Specialized Registry.
Measure Option 1 – Immunization Registry
Reporting - The EP is in “Active Engagement” with a public health agency to
submit immunization data.
Exclusions: Any EP meeting one or more of the following criteria may be
excluded from the immunization registry reporting measure if the EP:
1. Does not administer any immunizations to any of the populations for
which data is collected by its jurisdiction’s immunization registry or
immunization information system during the EHR reporting period.
2. Operates in a jurisdiction for which no immunization registry or
immunization information system is capable of accepting the specific
standards required to meet the CEHRT definition at the start of the EHR
reporting period.
3. Operates in a jurisdiction where no immunization registry or immunization
information system has declared readiness to receive immunization data
from the EP at the start of the EHR reporting period.
Measure Option 2 – Syndromic Surveillance
Reporting – The EP is in “Active Engagement” with a public health agency to submit
syndromic surveillance data from a non-urgent care ambulatory setting for EP.
Exclusions: Any EP meeting one or more of the following criteria may be excluded
from the syndromic surveillance reporting measure if the EP:
1. Is not in a category of providers from which ambulatory syndromic
surveillance data is collected by its jurisdiction’s syndromic surveillance
system.
2. Operates in a jurisdiction for which no public health agency is capable of
receiving electronic syndromic surveillance data from EP’s in the specific
standards required to meet the CEHRT definition (HL7) at the start of the EHR
reporting period.
3. Operates in a jurisdiction where no public health agency has declared
readiness to receive syndromic surveillance data from the EP’s at the
start of the EHR reporting period.
Measure 3 – Specialized Registry
Reporting - The EP is in “Active Engagement” with a public health agency to
submit specialized data.
Exclusions: Any EP meeting one or more of the following criteria may be
excluded from the specialized registry reporting measure if the EP:
1. Does not diagnose or treat any disease or condition associated with, or
collected relevant data that is collected by, a specialized registry in their
jurisdiction during the EHR reporting period.
2. Operates in a jurisdiction for which no specialized registry is capable of
accepting electronic registry transaction in the specific standards required
to meet the CEHRT definition at the start of the EHR reporting period.
3. Operates in a jurisdiction where no specialized registry for which the EP is
eligible has declared readiness to receive electronic registry transactions
at the beginning of the EHR reporting period.
Additional Information
IMS is compatible with specialized registries with which our providers would like to work. We do store all
the information in the IMS database, which the registries might need for a quality evaluation, and hence,
an accurate data submission. However, since, every registry has its own specifications list (their own
developed measures), we can work on the EP’s request, to develop the custom data extraction, with the
registries of the EP’s choice. The EP is responsible for researching the registries of their choice.
However, as support to our clients, we are continuing to research public health registries available for
EP participation. Please contact your MU Specialist to partner with you in finding registries appropriate
to your specialty.
Please note every specialized registry does charge a per provider fee for registering the intent to submit
data to them. There may also be additional charges associated at the EHR’s side for developing the
registry specific custom data extraction. Additionally, HL7 interfacing is a one time fee, whereas,
specialized registries charge annual participation fees. That is to say, if you can report to immunization
and syndromic surveillance registries, in the long run this may be the better option for you.
You must register your intent to submit your “specialized registry” no later than the 60th day of your EHR
reporting period. If there is no registry available in your jurisdiction and you are certain that there isn’t,
then you may take the exclusion.
How Do I Keep Track of the
New Measures in IMS?
Meditab has released a new Meaningful Use Dashboard to incorporate these changes. To
access the new dashboard click on Reports then select the Meaningful Use report. Once in
the Meaningful Use report, the user will use the gold filter bar to select their stage and year.
Additionally you can filter by office and provider then group by the office or provider.
To set the parameters
for the Meaningful
Use Report, Click on
Reports and then Set
Parameter at the
bottom left of the MU
Report Screen.
Next, run your report. You’ll notice below there will be measures where the system cannot generate a
numerator/denominator. What this means is that there is something, outside of this report, that you need to
completed for the measure to be achieved, even if by an exclusion.
EPs are required to keep audit support documentation for 6 years after attestation. If you need assistance with your audit support
documentation contact your MU Specialist for more information.
Users can set a parameter
to default to your specific
stage and year for your
Meaningful Use Report.
To do this, click on:
Setup > User Parameters >
Other
Then, select the
appropriate stage and year
under the “Default
Meaningful Use stage for
MU reports dashboard and
the MU check window”
drop down list.
The MU Report has a feature in the dashboard where a provider can save a copy of their MU
report for future reference. In order to save a report in IMS, run the report, click on the Save As
tab at the bottom of the page and in the pop-up window, type in a name for your report and
then click OK.
To retrieve a previously saved Meaningful Use Report, Open the Meaningful Use report for the
appropriate period. Click the History button on the bottom. In the pop-up window under the
Description, Select the report name that you have saved and Select retrieve.
What Are CQMs and How Do I
Report Them?
What is a CQM?
Clinical Quality Measures (CQMs) are tools that help measure and track the quality of care services provided by the
EP.
What is the Reporting Period?
The reporting period will be for the EPs entire reporting period in 2016.
- Returning EPs will report the entire CY in 2016.
- New EPs will report on any 90-day continuous reporting period.
What Measures Does An EP Need to Report?
EPs will need to report on a total of 9 CQM measures.
The quality measures selected must cover at least 3 of the 6 available National Quality Strategy (NQS) domains,
which represent the Department of Health and Human Services priorities for health care quality improvement.
1. Patient and Family Engagement
2. Patient Safety
3. Care Coordination
4. Population/Public Health
5. Efficient Use of Healthcare Resources
6. Clinical Process/Effectiveness
To run CQM
Reports:
Go to Reports >
PQRS/NQF/Other
First, choose NQF
category and Year
2014 from the left
pane.
Then, select
NQF/CQM Report
from the left pane
pick list.
Next, set filters in
the gold filter bar
and select retrieve.
Additional setup is often required to generate accurate counts on these reports. Before running
reports check with your MU Specialist to ensure setup has been completed.
Payment Adjustments
Payment Adjustments for Medicare EPs who are not Meaningful Use users were subject to a
payment adjustment beginning on January 1, 2015. This payment adjustment will be applied to the
Medicare Physician Fee Schedule (PFS) amount for covered professional services furnished by the
EP during the year. EPs receive the payment adjustment amount that is tied to the year that they did
not demonstrate Meaningful Use. Depending on the total number of Medicare EPs who are
Meaningful Use users under the EHR Incentive Programs after 2018, the maximum payment
adjustment can reach as high as 5%.
Eligible professionals must continue to demonstrate Meaningful Use every year to avoid payment
adjustments in subsequent years. The table below illustrates the timeline.
Under HR3940, the Meaningful Use Hardship Relief Act of 2015 which was passed by
Congress, CMS would be able to grant blanket hardship exemptions to EPs that are unable to
attest to the Meaningful Use Program in 2015 because of CMS delay in releasing the final rule
for program modifications for 2015 through 2017. This will help EPs avoid any penalties in 2017
for not meeting MU in 2015. In the past CMS could grant such exemptions on a case-by-case
basis. EPs must apply for the exemption by March 15, 2016 to be included in batch processing
for the blanket exemption. If you apply after March 15, 2016 your application will be reviewed
on a case-by-case basis. Keep in mind that if you do not meet Meaningful Use in 2015 you will
not receive any incentives that may have been due.
Additional Resources
Need to get more Program Information?
Visit http://computerzonesupport.net/meaningful-use to download the most current, CMS published,
documentation along with IMS-specific Help Guides.
Need Setup Completed for 2016 Reporting, Additional Training or Other Have Questions?
Visit http://computerzonesupport.net/ to open a Support Ticket.
Need to Contact CMS Directly?
Visit https://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/2015ProgramRequirements.html
EHR Information Center Hours of Operations:
7:30am – 6:30pm CST Monday through Friday, except federal holidays
1-888-734-6433 (primary number) *(press option 1) or 888-734-6563 (TTY number)
Please Note, Medicaid participating EPs will need to go the DHHS website per their state for
complete program details, as MCD Program details will vary state to state.
Thank You