Meaningful Use

1. Meaningful Use Indiana Association for Health Care Quality, May 2013

2. What’s all this Meaningful Use stuff?

3. The Compelling Why…..of HITECH Why does America need to modernize using Health IT? What is America doing to modernize its Healthcare System through Health IT? • Enable providers to securely and efficiently exchange patient health information. • Give providers the right information, at the right time to offer their patients the right care. • Give consumers tools to know their health information so that they can improve their health. • Foundational to building a truly 21st century health system where we pay for the right care, not just more care. Showing Outcomes Engaging Consumers Promoting Exchange Keeping Patients Safe Protecting Privacy and Security Accelerating Meaningful Use 2012 Source: Doug Fridsma, MD, Chief Science Officer, Director, Office of Science & Technology, ONC

4. 2009 Hitech Act-ARRA • The Hitech Act of the American Recovery & Reinvestment Act (ARRA) was signed into law by President Obama in Feb. 2009 “It's an investment that will take the long overdue step of computerizing America's medical records, to reduce the duplication and waste that costs billions of healthcare dollars and medical errors that cost thousands of lives each year. ... We have done more in 30 days to advance the cause of health- care reform than this country has done in an entire decade.“ February 17, 2009 • Appointed the Center for Medicare & Medicaid (CMS) to govern the clinical side of the program • The Office of the National Coordinator (ONC) governs the technical side: certification of the EHR at the code level. • Both sets of guidelines must be met to qualify for MU • Stage One Guidelines: Released July 2010. • Stage Two Guidelines: Preliminary Release Feb. 2012, Final Release: Aug, 2012

5. 2009 Hitech Act-ARRA • Three progressive stages of “meaningful use” over next 5+ years • Stage 1: Capture and track basic data, communication and coordination, sets stage for electronic quality reporting • Stage 2: Quality improvement at the point of care, clinical data exchange • Stage 3: Advanced clinical decision support to promote safety, quality and efficiency (e.g. national high priority conditions, patient access to self‐management tools, comprehensive patient data and improving population health) • Medicare $$ Incentives: payment for “Meaningful Use”(MU) of an electronic health record (EHR)-by Hospital or Physician • Medicaid $$ Incentives: Demonstrate “AIU” -Adoption, Implementation, Upgrade (first year only), or “Meaningful Use”

6. Eligibility • Medicare Fee for Service, Medicare Advantage and Medicaid providers • Eligible Professionals (EP) include: Doctors of Medicine or Osteopathy, Dentists, Podiatrists, Optometrists and Chiropractors. Medicaid also includes NPs, Certified Nurse Midwives & PAs. • Hospital based EPs are not included (90% or > services are provided on an Inpatient or ED setting). • Eligible Hospitals include: Acute Care Hospitals and Critical Access Hospitals, including Emergency Departments(pts being admitted or in an extended Observation status).

7. The Carrot…. • Eligible Providers: • Medicare Incentives: ~$44K/eligible provider/5 years • Medicaid Incentives: ~$64K/eligible provider/6 years

8. …….and the Stick • Hospitals: Incentive calculated based on cost reporting to CMS • After 2015, Medicare penalties for Hospitals and EPs

9. Health Outcomes Priorities • Improve quality, safety, efficiency and reduce health disparities • Engage patients and families in their health care • Improve care coordination • Improve population & public health • Ensure adequate privacy and security protection of personal health information

10. Final Rulings-Stage 1 • Stage 1: • 1st Submission-90 days of data • 2nd submission-12 consecutive months • Mandatory Core Measures-15 for Eligible Providers, 14 for Hospitals • Menu Set-10 to choose from; 5 deferred until Stage II. • Total reporting requirements: • Eligible Providers: report on 20 of 25 MU Measures. • Hospitals: report on 19 of 24 MU Measures.

11. Stage 1 Core Measures-Mandatory

12. Stage 1 Core Measures-Mandatory

13. Stage 1 Menu Measures-5 Optional

14. What’s Coming with Stage 2? • Goes into effect October 1, 2013. • Thresholds and complexity increases • Second year added to stage 2 with a 90 day quarterly measurement period; no change in payment model • 2015 Payment adjustments confirmed (complete attestation by Oct 2014 to avoid penalties) • Hospitals-Report on 19 out of 22 measures EPs-Report on 20 out of 23 measures

15. What’s Coming with Stage 2? Focus on Patient Engagement-Portal access; view, download or transmit Exclusions will not count toward Menu Items Batch reporting for EPs CPOE changes in denominator, addition of radiology and labs Addition of electronic notes, capturing care team, functional and cognitive status in the summary or care. Better Alignment of Quality measures against other CMS requirements: ACO, PQRS, CHIPRA etc

16. The Details

17. The Details

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19. The Details

20. Other Related Initiatives; Similar…..but not quite! • ICD-9 vs ICD-10 -DEADLINE OCTOBER 2014 -Dx Codes: from 14,315 to 69,099 (483%) -Px Codes: from 3,838 to 71,957 (1875%) Angioplasty-Moving from 1 code to 854 codes based on site, device & approach! • Value Based Purchasing • Medical Home • Impact of Hospital Acquired Conditions • Payment cuts for readmissions • PQRI • ePrescribing • Bundled payments • Quality Bonus Payments for Medicare Advantage • Accountable Care Organization Mandates……..

21. Take Home Concepts • Meaningful Use and EHR adoption is a clinical care initiative supported by IT, not an IT program. It will forever change how we provide service to our patients. • Our success or failure will depend in great part on our ability to define and standardize our best practice clinical workflows throughout our system. • Physician and clinical operation’s leadership will be crucial in each clinic’s, service line’s and facility’s success or failure.

22. Resources • CMS Attestation resources (including Calculator) available at: http://www.cms.gov/EHRIncentivePrograms/32_Attestation.asp#TopOfPage • Beginners guide for MU at: https://www.cms.gov/EHRIncentivePrograms/Downloads/Beginners_Guide.pdf • http://www.cms.gov/EHRIncentivePrograms • http://healthit.hhs.gov • www.himss.org/economicstimulus • http://www.himss.org/ASP/topics_meaningfuluse.asp • Payment Webpage: https://www.cms.gov/EHRIncentivePrograms/56_DataAndReports.asp#TopOfPage

23. So, in a nutshell………

24. Thank You Kathy Mathena, MSN, RN Executive Director, Clinical Information Systems KMathena@iuhealth.org Office: 317-963-7854