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CMS Final Rules: Meaningful Use Criteria. VITL Webinar August 5, 2010 Tonya H. Howard, MSN, FNP-C VITL Clinical Consultant. Today’s Objectives. Covering rules only for Eligible Professionals (EP’s) Brief overview of the Final Rules Meaningful Use Criteria

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CMS Final Rules: Meaningful Use Criteria

VITL Webinar August 5, 2010

Tonya H. Howard, MSN, FNP-C

VITL Clinical Consultant


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Today’s Objectives

  • Covering rules only for Eligible Professionals (EP’s)

  • Brief overview of the Final Rules Meaningful Use Criteria

  • Look specifically at the Clinical Quality Measures reporting requirements

  • Recommended next steps


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What Was Changed?

Changes based on 2000+ Comments

Fewer requirements (20 vs. 25 for EP’s)

Percentages required for meeting compliance lowered

More clarity for some of the rules



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Overview

  • 15 Objectives in the Core Set

  • Reporting on 3 Core and 3 Selected Clinical Quality Measures

  • 10 “Menu” Objectives—select 5 to “defer”

  • State may add up to 4 additional public health objectives to list of core objectives

  • “Structured Data”—in a data field with limited or controlled entry possibilities; reportable, exchange-able; NOT free text or narrative


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Health Outcomes Priority: Improve quality, safety, efficiency, reduce health disparities

1. CPOE (Computerized Physician Order Entry) for medication orders (>30%)

  • Implement drug-drug and drug-allergy interaction checks (Function enabled? Yes or No)

  • ePrescribing (>40%)

  • Record demographics (including Language, Race, Ethnicity) (50%)


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Health Outcomes Priority: Improve quality, safety, efficiency, reduce health disparities

5. Up-to-date problem list of current and active diagnoses (>80%)

6. Maintain active medication list (>80%)

  • Maintain active medication allergy list (>80%)

  • Record and chart changes in vital signs: (>50%)

    • Height, Weight, BP

    • BMI for Adults

    • Plot and Display BMI for Children


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Health Outcomes Priority: Improve quality, safety, efficiency, reduce health disparities

  • Record smoking status for patients 13 and older (>50%)

    10. Implement one clinical decision support rule with ability to track compliance with that rule (Implented? Yes or No)

    11. Report ambulatory clinical quality measures to CMS or the States (Provide numerator, denominator, and exclusions in 2011 2012 electronic submission)


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Health Outcomes Priority: Engage Patients and Families in their Health Care

  • 12. Provide patients with an electronic copy of their health information within 3 days(e.g., CD, Flash Drive, Web Portal, etc. (>50%)

    • Diagnostic test results

    • Problem List

    • Med List

    • Med Allergies

  • 13. Clinical summaries for pts for each office visit within 3 days(>50%)


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Health Outcomes Priority: their Health CareImprove care coordination

14. Capability to exchange key clinical information among providers and patient authorized entities electronically (one test of capacity of EHR to exchange information)


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Health Outcomes Priority: their Health CareEnsure adequate privacy and security protections for PHI

15. Privacy and Security Risk Analysis (address risks)


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Menu Set of Stage 1 Objectives: Choose 5 to eliminate their Health Care

  • Drug-formulary checks

  • Lab results as structured data

  • Generate lists of patients by condition

  • Send reminders per patient preference for preventive/follow-up care

  • Patient access to health information within 4 days


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Menu Set of Stage 1 Objectives: Continued their Health Care

6. Electronic patient education/Resources

7. Medication reconciliation

8. Provide summary of care record

9. Submit data to immunization registries*

10. Submit syndromic surveillance data to* public health


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Clinical Quality Measures Reporting their Health Care

**If you do not have patients for whom one or more of these measures applies, the measure(s) may be substituted for an Alternate Core Measure (e.g., Pediatrics)

3 Core Measures**

Hypertension: BP recorded

Tobacco Use Assessment and Cessation Intervention

Adult Weight Screening and Follow-up


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Clinical Quality Measures Reporting their Health Care

3 Alternate Core Measures

Weight Assessment and Counseling for Children and Adolescents

Influenza Immunization for Patients > 50 y/o

Childhood Immunization Status


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Clinical Quality Measures Reporting their Health Care

3 Selected Measures from a list of 38 (vs. 90 in the preliminary rules—no longer divided by specialty)


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CQM: Additional Set for EP’s their Health Care

1. Diabetes: Hemoglobin A1C poor control

2. Diabetes: LDL Management and Control

3. Diabetes: BP Management

4. Heart Failure: Ace/ARB Rx for LVSD

5. CAD: Beta Blocker for prior MI

6. Pneumonia Vaccination for Older Adults

7. Breast CA screening

8. Colorectal Cancer screening

9. CAD: Oral Antiplatelet Rx

10. Heart Failure: Beta Blocker for LVSD

11. Anti-depressant medication mgmt

12. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation

13. Diabetic Retinopathy: Documentation of presence or absence of Macular Edema and Level of Severity of Retinopathy

  • Diabetic Retinopathy: Communication with Managing Physician

  • Asthma Pharmacologic Therapy

  • Asthma Assessment

  • Appropriate testing for children with pharyngitis

  • Oncology Breast Cancer: Hormonal Tx for Estrogen/Progesterone Receptor Positive CA


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CQM: Additional Set for EP’s (Cont’d) their Health Care

19. Oncology Colon Cancer: Chemo for Stage III CA patients

20. Prostate CA: Avoid overuse of Bone Scan for Staging Low Risk pts

21. Smoking and Tobacco Use Cessation, Medical Assistance

22. Diabetes: Eye Exam

23. Diabetes: Urine screening

24. Diabetes: Foot Exam

25. CAD: Statin Rx for lowering LDL

26. Heart Failure: Warfarin for A-Fib

27. IVD: BP Management

28. IVD: Use of ASA/Antiplatelet

29. Initiate ETOH/Drug Abuse Tx

30. Prenatal Care: Screening for HIV

31. Prenatal Care: Anti-D Immunoglob

32. Controlling High BP

33. Cervical Cancer Screening

34. Chlamydia Screening for Women

35. Use of Appropriate Meds for Asthma

36. Low Back Pain: Use of Imaging Studies

37. IVD: Complete Lipid Panel and LDL Control

38. Diabetes: HBA1C Control (<8.0%)


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Stage 1: Reporting Requirements their Health Care

Hypertension

Tobacco use

Adult weight

15 Core

Objectives

44Clinical Quality Measures

PQRI/NQF

Measures

15 measures

3 core

3 additional

or 3 alternate

CMS/State

State can move 4 from menu to core

5 measures

1 must be public health measure

10 Menu Set

Objectives

Alternate: Children Weight

Flu Immunization > 50 yrs

Children Immunization

VITL


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Meaningful Use Assessment Tool their Health Care

Will be available on the VITL website in the next few days


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