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Medicare & Medicaid EHR Incentives NPRM. Implementing the American Reinvestment & Recovery Act of 2009. Overview. American Reinvestment & Recovery Act – February 2009 EHR Incentive NPRM on Display – December 30, 2009; published January 13, 2010 NPRM Comment Period Closes – March 15, 2010.

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Medicare & Medicaid EHR Incentives NPRM

Implementing the American

Reinvestment & Recovery Act of 2009


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Overview

  • American Reinvestment & Recovery Act – February 2009

  • EHR Incentive NPRM on Display – December 30, 2009; published January 13, 2010

  • NPRM Comment Period Closes – March 15, 2010


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What is in the CMS EHR Incentive program NPRM?

  • Definition of Meaningful Use

  • Definition of Hospital-Based Eligible Professional

  • Medicare FFS EHR Incentive Program

  • Medicare Advantage EHR Incentive Program

  • Medicaid EHR Incentive Program

  • Collection of Information Analysis (Paperwork Reduction Act)

  • Regulatory Impact Analysis


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What is not in the CMS NPRM?

  • Information about applying for grants

  • Changes to HIPAA

  • Office of the National Coordinator (ONC) Interim Final Rule – HIT: Initial Set of Standards, Implementation Specifications, and Certification Criteria for EHR Technology

  • EHR certification requirements

  • ONC NPRM - Establishment of Certification Programs for Health Information Technology

  • Procedures to become a certifying body


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What the NPRM Does

  • Harmonizes MU criteria across CMS programs as much as possible

  • Closely links with the ONC certification and standards IFR

  • Builds on the recommendations of the HIT Policy Committee

  • Coordinates with the existing CMS quality initiatives

  • Provides a platform that allows for a staged implementation over time


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Defining Meaningful Use

  • Definition

    • To be determined by Secretary

    • Must include quality reporting, electronic prescribing, information exchange

  • Process of defining

    • NCVHS Hearings

    • HIT Policy Committee recommendations

    • Listening Sessions with providers/organizations

    • Public Comments on the HIT Policy Committee recommendations

    • NPRM comments received from the Department and OMB


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Conceptual Approach toMeaningful Use


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Meaningful Use Stages

  • Meaningful Use will be defined in 3 stages through rulemaking

    • Stage 1 – 2011

    • Stage 2 – 2013*

    • Stage 3 – 2015*

      *Stages 2 and 3 will be defined in future CMS rulemaking.


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Stage 1 – Health Outcome Priorities*

  • Improving quality, safety, efficiency, and reducing health disparities

  • Engage patients and families in their health care

  • Improve care coordination

  • Improve population and public health

  • Ensure adequate privacy and security protections for personal health information

    *Adapted from National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America’s Healthcare. Washington, DC: National Quality Forum; 2008.


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Proposed Stages of Meaningful Use Timeline

*Avoids payment adjustments only for EPs in Medicare EHR Incentive Program

**Stage 3 criteria of meaningful use or a subsequent update to criteria if one is established


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Meaningful Use Summary

  • EPs

    • 25 Objectives and Measures

    • 8 Measures require ‘Yes’ or ‘No’ as structured data

    • 17 Measures require numerator and denominator

  • Eligible Hospitals and CAHs

    • 23 Objectives and Measures

    • 10 Measures require ‘Yes’ or ‘No’ as structured data

    • 13 Measures require numerator and denominator

  • Reporting Period – 90 days for first year; one year subsequently


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Clinical Quality Measures Overview

  • 2011 – Providers required submit summary quality measure data to CMS by attestation

  • 2012 – Providers required to electronically submit summary quality measure data to CMS

  • EPs are required to submit clinical data on the 2 measure groups: core measures and a subset of clinical measures most appropriate to the EP’s specialty

  • Eligible hospitals are required to report summary quality measures for applicable cases


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Core Quality Measures for EPs

  • Preventive care and screening: Inquiry regarding tobacco use

  • Blood pressure management

  • Drugs to be avoided by the elderly:

    • Patients who receive at least one drug to be avoided

    • Patients who receive at least two different drugs to be avoided


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EPS will need to select one of the following specialties:

Cardiology Obstetrics and Gynecology

Pulmonology Neurology

Endocrinology Psychiatry

Oncology Ophthalmology

Proceduralist/Surgery Podiatry

Primary Care Radiology

Pediatrics Gastroenterology

Nephrology

Specialty Quality Measures for EPs


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Clinical Quality Measures for Eligible Hospitals

  • Hospitals are required to report summary data on 43 clinical quality measures to CMS

  • Hospitals only eligible for Medicaid will report directly to the States

  • For hospitals in which the measures don’t apply, they will have the option of selecting an alternative set of Medicaid clinical quality measures


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Notable Differences Between the Medicare & Medicaid EHR Programs

Medicare

  • Feds will implement (will be an option nationally)

  • Fee schedule reductions begin in 2015 for providers that are not Meaningful Users

  • Must be a meaningful user in Year 1

  • Maximum incentive is $44,000 for EPs

  • MU definition will be common for Medicare

  • Medicare Advantage EPs have special eligibility accommodations

  • Last year an EP may initiate program is 2014; Last payment in program is 2016. Payment adjustments begin in 2015

  • Only physicians, subsection (d) hospitals and CAHs

Medicaid

  • Voluntary for States to implement (may not be an option in every State)

  • No Medicaid fee schedule reductions

  • Adopt/Implement/Upgrade option for 1st participation year

  • Maximum incentive is $63,750 for EPs

  • States can adopt a more rigorous definition (based on common definition)

  • Medicaid managed care providers must meet regular eligibility requirements

  • Last year an EP may initiate program is 2016; Last payment in program is 2021

  • 5 types of EPs, 3 types of hospitals


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NPRM changes from HITPC Recommendations Programs

Deletions

  • Record advance directives

  • Document a progress note for each encounter

  • Provide access to patient-specific education resources

    Additions

  • Provide summary care record for each transition of care and referral

    Changes

  • Adding DOB to record demographics and cause and date of death for hospitals

  • Adding growth charts to record vital signs

  • Limiting smoking status to age 13+

  • Increasing CDS rules from 1 to 5

  • Removed “where possible” from insurance eligibility checks

  • Changed the provision of clinical summaries from “each encounter” to “each office visit”

  • Changed compliance with HIPAA to Protect electronic health information maintained by certified EHR technology


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NPRM changes from the HITPC Recommendations Programs

Measures

  • Ensured every objective is matched to a measure

  • Added a % threshold to measures recommended as “% of …”

  • Calculated some % based on “unique patients seen” as not every action would be taken for every office visit

  • Narrowed lab results to those “whose results are in a positive/negative or numeric format”

  • For exchange of information changed “implemented ability” to “Performed at least one test”

  • Clinical quality measures were greatly expanded to accommodate the diversity of specialists meeting the definition of an eligible professional


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Incentive Payment Timeline Programs

  • Medicare can pay incentives to EPs no sooner than January 2011

  • Medicare can pay eligible hospitals and CAHs no sooner than October 2010

  • Medicaid EPs can potentially receive payments as early as 2010 for Adopting/implementing or upgrading


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Next Steps Programs

  • HIT Policy and Standards Committees Input-March 1, 2010

  • Public comment period ends March 15, 2010

  • CMS review of comments

  • Draft final regulation

  • CMS/HHS/OMB clearance

  • Final rule publication-Spring 2010


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