Meaningful Use: Moving Toward Stage 2
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Transcript of Meaningful Use: Moving Toward Stage 2
Meaningful Use – Moving Toward Stage 2Adele AllisonNational Director of Government Affairs, SuccessEHS
Background – ARRA/HITECH
• Signed 2/17/09 in Denver, CO• Purpose: Stimulate the
economy through investments in infrastructure, unemployment benefits, transportation, education, and healthcare.
• Health Care is in the Spotlight–Affordable Care Act - Health Care Reform
($828B)
– Fueling push for HIT ($54B per year savings)
–Rapid market movement and positioning
• Up to $45B for direct EHR adoption: –$20B in Medicare Incentives–$14B in Medicaid Incentives
HITECH Goals
1. Push Provider Adoption of approved (certified) EHR Technology
2. Capture DATA3. Move DATA – Interoperability4. Report DATA• $27B in “Carrots” - incentives:– Up to $48,400 through Medicare– Up to $63,750 through Medicaid
Meaningful Use: 3-part equation
• 3-Part Equation for MU:• Part 1: Certified EHR
Technology – The Tool • Part 2: Implementation –
Practice Reengineering / Redesign• Part 3: Support – Available,
Responsive and Ongoing
Meaningful Example
Stage 1 – Objectives & Measures
•Objectives are broad spanning goals/activities•Measures are specific task(s) requirements•Meeting the measures = meeting the Objectives for that Stage•Stage 1 MU–15 Core Measures required by all EP’s–10 Menu Measures from which EP’s choose 5
•13 Exclusion Clauses – Exclusions will reduce the number of Objectives required by EP
Stage 1 – Medicare Incentive
•Types of Providers - §495.100:Medicare: MD, DO, DDS, DMD, DPM, OD, DC
•Must have PECOS Number with CMS•Must register with CMS
Registration Website: cms.gov/EHRIncentivePrograms/
•Year 1: 15 Core + 5 Menu Objectives/Measures for continuous 90-days
Stage 1 – Medicare Incentive
•Year 2 and Beyond: Full Year of MU•CY2011-12 - Must gather data, run calculations, attest and send to CMS•CY2013 and Beyond – Electronic Submission of CQMs•Qualification is reviewed annually
Potential Medicare Incentives
Calendar Year
First Calendar Year in which the EP Receives an Incentive Payment
2011 2012 2013 20142015 and
subsequent years
2011 $18,000
2012 $12,000 $18,000
2013 $8,000 $12,000 $15,000
2014 $4,000 $8,000 $12,000 $12,000
2015 $2,000 $4,000 $8,000 $8,000 $0
2016 $2,000 $4,000 $4,000 $0
TOTAL $44,000 $44,000 $39,000 $24,000 $0Shortage Area
Totals* $48,400 $48,400 $42,900 $26,400 $0
* Providers practicing in a federally identified shortage area are eligible for a 10% increase.
Stage 1 – Medicaid Incentive•Types of Providers - §495.100:–Medicaid: Physicians, Dentists, Certified Nurse Midwives, Nurse Practitioners, Physician Assistants (in FQHC/RHC led by a PA)
•Year 1: Adopt, Implement, Upgrade - §495.302:–Acquire, purchase, or secure access to certified EHR technology;–Install/use certified EHR technology capable of MU; or–Expand functionality of certified EHR solution at the practice with:
•Staffing, Maintenance, Training, or Upgrading from existing EHR to certified EHR technology.
Stage 1 – Medicaid Incentive
•Year 2: MU for 90 continuous days
•Years 3 through 6: MU for full year
Potential Medicaid IncentivesCalendar
Year
First Calendar Year in which the EP Receives an Incentive Payment
2011 2012 2013 2014 2015 2016
2011 $21,250
2012 $8,500 $21,250
2013 $8,500 $8,500 $21,250
2014 $8,500 $8,500 $8,500 $21,250
2015 $8,500 $8,500 $8,500 $8,500 $21,250
2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,2502017 $0 $8,500 $8,500 $8,500 $8,500 $8,5002018 $0 $0 $8,500 $8,500 $8,500 $8,5002019 $0 $0 $0 $8,500 $8,500 $8,5002020 $0 $0 $0 $0 $8,500 $8,5002021 $0 $0 $0 $0 $0 $8,500
TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750
Forecasting Stage 2
Since Stage 1 Final Rule•ONC - Exit Dr. Blumenthal, Enter Dr. Farzad Mostashari •Stage 2 – Tactical Deployment•Rapid Market Positioning in HC Orgs•New Payment Models Developing–CMMI–ACOs–Bundled Payments → Revenue Cycle Mgmt (RCM) and Enterprise Resource Planning (ERP)
Since Stage 1 Final Rule•State Initiatives Challenged (RECs, HIEs)•Enter the iPad clinicians’ companion device•NHIN Direct Project launched Jan. 2011•Industry Hungry for Data
Since Stage 1 Final Rule•HITPC → Recommendations to CMS June 16th •Push Stage 2 Launch to CY2014•ONC NPRM for Vendors (Certification) → Q4 2011•CMS NPRM for Providers → Q1 2012 – Final Rule June, 2012
Since Stage 1 Final Rule•5 Categories for Stage 2 Recommendations:
o Static MeasuresoMenu Measures Converted to Coreo Expansion of Stage 1 Thresholds and
ScopeoNew Stage 2 MeasuresoRemoved Measures
Data Capture
Non-Structured Information•Example: Narrative Typing or Speech-to-Text•Pros: Personalized Note, Ultimate Flexibility, “The Patient is still a Human”•Cons: Not Reportable, Not Researchable, Not Machine Process-able, Non-Standard, ↑ Risk
Structured Data•Example: Combo or Drop-Down Boxes; User-defined Fields•Pros: Typically Customizable, Information Uniformity, Supports Reporting•Cons: Not conducive to Interoperability and Industry-wide Standards
Codified/Object-Oriented Data•Example: Vocabularies such as ICD9, SnoMed, LOINC•Pros: Very Reportable, Researchable, Machine Process-able, Standardize, Interoperable•Cons: Limits Flexibility in Documentation, “Cookie-Cutter” Notes
Meaningful Use – Stage 1 vs. Stage 2
Stage 1 – About Starting Adoption•No Encounter Note•Flexibility – Menu Measures•Flexibility – Clinical Quality Measures (CQMs)•“Tests” in Moving Data
Stage 2 – Tactical Use•Patient Engagement – “Behavioral Economics”•Production Mode for Moving Data – Focus on Transitions of Care•Increased Threshold and Measure Scope•Expansion through New Measures•Electronic Reporting of CQMs•CQMs broader in scope
Static Measures – Stage 2
• 80% of Patients have Active Problem Listo 1 entry as structured data; oro “No Known Problems” as structured data
• 80% of Patients have Active Medications Listo 1 entry as structured data; oro “No Medications” as structured data
• 80% of Patients have Active Medications Allergy Listo 1 entry as structured data; oro “No Known Allergies” as structured data
• Enable Alerting of Drug-Drug and Drug-Allergy Checks
Menu into Core Measures – Stage 2
• Implement Drug Formulary Checks• 40% of Lab Results Ordered in EHR as
Structured Datao Recorded as Positive / Negative, oro Numerical Format
• 50% of Transition in Care with Medications Reconciledo When receiving patient in transitiono Example: Hospital Discharge
• 50% of Transitions Show Provision of Care Record Summary Providedo Provided in Paper or Electronic
Expanded Stage 1 Measures – Stage 2
• 60% Patients with Rx – 1+ Rx Ordered through CPOE (↑ from 30%)
• 80% Patients with Demographics with ability to Stratify (↑ from 50%)
• 80% Patients with Vitals recorded (↑ from 50%)
• CDS for improvement on high-priority conditions (↑ from 1 CDS Rule)
• Patient Lists for multiple parameters (↑ from 1 list with specific condition)
• 10% Patient given Patient-Specific Education (“If Appropriate” Removed)
• Actual Immunization Data Submitted (No longer “Test” Data)
• CQMs Reported to CMS or State (Expanding)
• Attest to encryption/security “at rest” (↑ from simple assessment)
• 50% Patient Rx ePrescribed (↑ from 30%)
• 10% All Patients sent clinical reminder (↓ from 20%, but now “All” Patients)
• 50% Patients provided Clinical Summary in 24 hours (↑ 3 Business Days)
• 10% Patients/Family can view and download longitudinal health information within 24 hours of encounter (↑4 Business Days)
• Actual submission of Syndromic Surveillance Data
• Actual submission of Reportable Cancer Conditions
New Measures – Stage 2
• 60% Patients with Lab Results – 1+ Lab Ordered through CPOE• 1 Radiology Test Ordered through
CPOE• 10% Patients recorded Care Plans
(Including Goals and Instructions)• 10% Patients recorded Care Team
Members (Including PCP)• 25 Patients have Advance Directive
and ability to access
• 30% of Visits have an Electronic Note (no scanning/non-searchable)• 25 Patients have been sent Secured
Online Messages• 20% Patients have Communication
Preferences recorded• 25 Transactions of Electronic
Summary of Care Record sent
Removed Measures – Stage 2
•50% Patients requesting Electronic Copy of Record – provided in 3 Business Days•Perform 1 Test of
Exchanging Electronic Information
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