American Academy of Pediatrics Ohio Section

1. American Academy of Pediatrics Ohio Section Cathy Costello, JD OHIP Manager, REC Services May 13, 2011

2. Who is the Ohio Health Information Partnership?

3. The Ohio Health Information Partnership • Nonprofit partnership • State-designated Regional Extension Center and • Health Information Exchange • Federal funding through Office of National Coordinator of HIT, Department of Health & Human Services • Board members have vested interest in its success

4. OHIP’s Founders

5. How can we help achieve the State’s health transformation objectives?

6. Addressing the Hot Spots • Regional Extension Center Services • Helps providers adopt EHRs and achieve meaningful use • Available at no cost to pediatricians regardless of physician’s eligibility for Medicaid incentives • Health Information Exchange • Connects providers so they can electronically exchange data to better coordinate care

7. Regional Extension Center Services Care Summaries e-Prescribing

8. Regional Extension Center Physician Sign-ups 3,843 In ohio Over 60,000 physicians have signed up nationally to receive REC services

9. Preferred EHR Vendors

10. ProOhio Vendor Program • IT Support • Document Imaging • Human Resources • Billing & Coding • Security Controls • Change Management • Data Management

11. Loan Program

12. Health Information Exchange

13. What is a Health Information Exchange? An HIE moves patient information electronically among physician offices, hospitals and other health professionals directly involved in a patient’s care, such as pharmacies and labs.

14. What is OHIP’s Vision? • Create a secure, sustainable Health Information Exchange • To protect ALL patient records; • Enable providers to access necessary, patient-authorized health information; and • Improve the overall level of health care provided throughout the state of Ohio.

15. Phasing of HIE Services • 20 Hospitals • 200 Offices • 20 Hospitals • 200 Offices • 10 Hospitals • 100 Offices Confidential, For Internal Discussion Only

16. Community Model • Prioritize coordination of care; • Everyone pays a little; • No one pays a lot; and • Everyone helps enroll/implement physicians.

17. More Information on REC Servicesand HIE Development www.OHIPonline.org

18. Priorities for Meaningful Use Structured Lab Results Care Summaries e-Prescribing

19. Medicaid Adopt Implement Upgrade

20. Notable Differences Between the Medicare & Medicaid Incentives

21. Medicaid: 1st Payment Year For “Adopt, Implement, Upgrade” • Eligible professionals can receive incentives for adoption, implementation and upgrade of certified EHR technology in their first year of participation • “Adopt, implement, or upgrade” means: • Install or commence utilization of certified EHR technology capable of meeting meaningful use requirements; or • Expand the functionality of certified EHR technology capable of meeting meaningful use requirements at the practice site, including staffing, maintenance, and training. • Upgrade from existing EHR technology to certified EHR technology per the ONC EHR certification criteria.

22. Medicaid: 1st Payment Year For “Adopt, Implement, Upgrade” • All eligible Medicaid providers will be “deemed” to have met the cost-base of the Medicaid EHR incentives—need only to demonstrate that the EHR system is CMS certified under the ATCB certification program. • A practitioner can demonstrate that an EHR system is certified and the practitioner has Adopted/Implemented/Upgraded the system by uploading a copy of a: 1) Purchase order; 2) Contract; or 3) EHR software license to the Medicaid incentive program website during registration for the incentives.

23. Medicaid Eligible Professional Incentive • The Medicaid EHR incentive program reimbursement for eligible professionals is paid out over a six-year period. Professionals that meet Medicaid eligibility criteria will be paid the maximum incentive regardless of the cost of the certified EHR system that the professional is using. • Pediatricians that meet the Medicaid 20% patient volume threshold will be paid $14,160 for the first year with a total EHR incentive of $42,500. Pediatricians that meet the Medicaid 30% patient volume threshold will be paid $21,250 for the first year with a total EHR incentive of $63,750. • Pediatricians that fall between 20% and 30% Medicaid patient volume will be paid at the 20% threshold (i.e., $14,160 for the first year with a total incentive of $42,500).

24. Meaningful Use TimelineMedicaid Incentives

25. What is MPIP? Ohio’s EHR program is the Medicaid Provider Incentive Program (MPIP) • Who is eligible? • Eligible Hospitals: (acute care, cancer, children’s) • Eligible Professionals: (physician, dentist, certified nurse midwives, nurse practitioners, Physician Assistants when practicing at an FQHC/RHC so led by a PA) • The MPIP will be available through CY 2021, but participation in the program is for 6 years, which can be non-consecutive years. 25

26. Notes on Medicaid Incentive Program • Pediatricians (including subspecialists) that meet the eligibility requirements in Ohio will be eligible for Medicaid incentives at the 20% patient volume level. Must have pediatric board certification. All other physicians eligible at the Medicaid 30% patient volume level. • Patient volume will be calculated based on the Medicaid services rendered on any one day to an individual where Medicaid paid for part or all of the service.

27. Notes on Medicaid Incentive Program • Medicaid eligibility will be determined by a practitioner’s Medicaid patient volume over a 90 day period in the preceding calendar year. The practice can choose the 90 day period for eligibility, but it must be for 3 consecutive months (e.g., January 1 – March 31, 2010 Medicaid patient volume to draw down 2011 EHR incentives). • Medicaid will use an online attestation form that automatically calculates the eligibility based on patient volume totals entered by practitioner. There will be a slight adjustment to totals based on SCHIP population figures in the provider’s county.

28. MPIP will be open in June 2011 • In March, first milestone of the MPIP system build was the completion of testing of the interface between the federal system (the National Level Repository) and MPIP. • In April, Ohio’s State Medicaid Health Information Technology Plan (SMHP) was approved by CMS. • In May, ODJFS will be putting the finishing touches on the customized build of the MPIP system: • Ohio now appears in the state drop down box on CMS’ website, allowing Ohio providers to begin registration for Ohio’s program. • In June, the launch of MPIP will occur, allowing providers to complete enrollment at Ohio’s MPIP site and upon approval, be eligible to receive their 1st payment. 28

29. What is needed to register federallyfor either Medicare or Medicaid? • Confirmed National Provider Identifier and NPPES account and password https://nppes.cms.hhs.gov/NPPES/ • CMS/National Level Repository registration www.cms.gov/EHRIncentivePrograms/ • PECOS (for dual hospitals) 29

30. National Provider Identifier

31. CMS Registration

32. What is needed to enroll in MPIP? Once finished at the national registration website, providers will be sent to the Ohio site to begin MPIP enrollment. They will need: • An active Medicaid provider agreement. • Providers without one will be directed to: http://jfs.ohio.gov/OHP/provider.stm • MPIP uses only Electronic Funds Transfer (EFT). So providers who get paper warrants will have to go to Ohio Shared Services to sign up for EFT. 32

33. First-time User Registration First-time users will receive a link to begin Registration

34. First-time User RegistrationEnter NPI, TIN, CMS Confirmation Number Enter the NPI, TIN and CMS Confirmation Number and click Register

35. First-time User RegistrationEstablish Password Enter CMS Confirmation Number. Enter and confirm Password. Click Save to Continue.

36. Welcome Page After logging into MPIP the first time, the user will see the Welcome page Press Continue to proceed with the MPIP enrollment process

37. Adopt, Implement, Upgrade (AIU) Select AIU Designation Enter the CMS EHR Certification Number Select Supporting Documentation and Upload Upload AIU Documents

38. MPIP Registration

39. Stay in touch with Medicaid Visit the ODJFS MPIP Website at: http://jfs.ohio.gov/OHP/HIT%20Program.stm Send an email at MPIP@jfs.ohio.gov 39

40. Why Is This Work Important? MOVING TO MEANINGFUL USE

41. Meaningful Use TimelineMedicare Incentives

42. Meaningful Use Tips • Use Meaningful Use Attestation Calculator before going to actually register: http://www.cms.gov/apps/ehr/ • Print out calculator’s summary page to see how close you are to meeting meaningful use • Use the calculator as a guide for explaining the MU core and menu items and the exclusions

43. Core and Menu Criteria • Professionals must complete each of the core criteria unless unable to, due to scope of practice, population served or number in the denominator. For example: • Chiropractor and e-prescribing • CAH and no patients have requested electronic access • Professionals may defer up to 5 of the menu criteria until stage 2

44. Core Criteria (15): All Patients: • Record demographics • Maintain an up-to-date problem list • Maintain active medication list • Maintain active medication allergy list EHR Patients: • CPOE • E-Prescribing • Record and chart changes in vital signs • Record smoking status • Provide patients with an electronic copy of their health information • Provide clinical summaries for patients for each office visit Implemented (Yes or No): • Report Clinical Quality Measures • Drug (D-A, D-D) Interactions • Implement one clinical decision support rule • Electronically exchange key clinical information • Protect electronic health information created or maintained by certified EHR

45. Menu Criteria • Professionals and hospitals may defer up to 5 of the menu criteria until stage 2 • At least one of the criteria from population and public health must be included in order to qualify as a meaningful user

46. Menu Criteria (5 of 10): All Patients: • Provide patients timely electronic access to their health information. • Provide patient-specific education resources through the use of certified EHR technology. EHR Patients: • Lab test results are stored as structured data • Send appropriate reminders for preventive/follow up care • Perform medication reconciliation on > 50% of transitions of care or relevant encounters. • Provide a summary of care record for transitions of care and referrals. Implemented (Yes or No): • Implement drug -formulary checks • Generate at least one report of patients by specific condition • Perform at least one test of submission of electronic data to immunization registries/systems. * • Perform at least one test of providing electronic syndromic surveillance data to public health agencies. * * At least 1 public health objective must be selected

47. Reporting of Clinical Quality Measures • EPs would be required to provide clinical data on 2 measure groups: • A core set of 3 measures (or alternates) (3 of 6) • 3 additional measures selected from among 38 others (3 of 38) • EHR must be certified for these measures (ONC ‘CHPL’ website for confirmation)http://onc-chpl.force.com/ehrcert

48. Core Quality Measures for EPs

49. Alternate Core Quality Measures for EPs

50. Menu Quality Measures • 38 other measures addressing: • Diabetes • Cardiovascular disease • Prevention • Asthma • Appropriate use of teste • Smoking and Tobacco use • Alcohol and Drug dependence • Oncology • Depression management • Others