Meaningful Use of Electronic Health Records

1. Meaningful Use of Electronic Health Records Tammy Geltmaker, RN, BSN, MHA EHR Consulting Manager November 17, 2010

2. Highlights • Eligible Professionals (EP) • Financial Incentives • Meaningful Use (MU) • Stage One Measures • Kentucky Resources 11/17/2010

3. American Recovery and Reinvestment Act (ARRA) • A Massive Stimulus for Health Information Technology (HIT) Adoption & Health Information Exchange (HIE) Expansion • Appropriations for HIT • Appropriations for HIE • New incentives for adoption • Community Health Centers • Broadband and Telehealth 11/17/2010

4. Eligible Professional (EP) • Eligible Providers- Medicare * Defined: Section 1861(r) Physician Definition 11/17/2010

5. Eligible Professional (EP)- Medicare Advantage (MA) • MA Eligible Professionals (EPs) • Must furnish, on average, at least 20 hours/week of patient-care services and . . . • Be employed by the qualifying MA organization Or . . . • Must be employed by, or a partner of, an entity contracting with the qualifying MA organization furnishing at least 80 percent of the entity’s Medicare patient care services to enrollees of the qualifying MA organization • Qualifying MA-Affiliated Eligible Hospitals • Will be paid under the Medicare Fee-for-service EHR incentive program 11/17/2010

6. Eligible Professional (EP) • Patient volume requirements for Medicaid incentives 11/17/2010

7. Registration Process • Register through the EHR Incentive Program Web site • Be enrolled in Medicare FFS, MA, or Medicaid (FFS or managed care) • Have a National Provider Identifier (NPI) • Use certified EHR technology to demonstrate MU • Medicaid providers may adopt, implement, or upgrade in their first year • All Medicare providers and Medicaid eligible hospitals must be enrolled in Provider Enrollment, Chain and Ownership System (PECOS) 11/17/2010

8. Registration: Medicaid • States will connect to the EHR Incentive Program Web site to verify provider eligibility and prevent duplicate payments • States will ask providers for additional information to make accurate and timely payments • Patient Volume • Licensure • A/I/U or Meaningful Use • Certified EHR Technology 11/17/2010

9. Financial Incentives • Includes financial incentives for health care providers who attain “meaningful use” with their EHR systems. • Medicare: Up to $44,000 per provider over five years • Medicaid: Up to $63,750 per provider over six years 11/17/2010

10. Medicare Incentives 11/17/2010

11. Medicare Incentives (Cont’d) • Pays 75% of “allowed charges” based on claims submitted to Medicare • MA providers qualify for the Medicare incentives using MA claims instead of part B claims 11/17/2010

12. Medicaid Incentives 11/17/2010

13. Medicaid Incentives (Cont’d) • EPs may receive up to 85 percent of the net average allowable costs for certified EHR technology, including support and training, up to a maximum level of $63,750. • Pediatricians must have a Medicaid patient volume of at least 20%. 11/17/2010

14. Medicaid Only: Adopt/Implement/Upgrade (A/I/U) • First participation year only for Medicaid providers • Adopted-Acquired and Installed • e.g., Evidence of installation prior to incentive • Implemented–Commended Utilization of • e.g., Staff training, data entry of patient demographic information into EHR • Upgraded–Expanded • e.g., Upgraded to certified EHR technology or added new functionality to meet the definition of certified EHR technology • Must use certified EHR technology • No EHR reporting period 11/17/2010

15. Meaningful Use Definition • Meaningful use is defined as . . . • Use of a certified EHR in a meaningful manner (ex: e-prescribing) • Use of certified EHR technology for electronic exchange of health information • Use of certified EHR technology to submit clinical quality and other measures 11/17/2010

16. Meaningful Use Stages * Stages 2 and 3 will be defined in future CMS rulemaking 11/17/2010

17. Meaningful Use Stages 11/17/2010

18. Stage One Priorities • Electronically capture information in a coded format • Use electronic information to track key clinical conditions • Implement clinical decision support tools to facilitate disease and medication management • Report clinical quality measures and public health information 11/17/2010

19. Stage One Measures • HIT functionality measures • Reported by attestation • Clinical quality measures • Reported by attestation for 2011 • Electronic submission to CMS for 2012 11/17/2010

20. HIT Functionality Measures • EPs must report on 20 of 25 MU objectives with associated measures • Core set of 15 • Menu set of 10 • An EP must successfully meet the measure for each objective in the core set and all but five in the menu set • Some MU objectives are not applicable to every provider’s clinical practice. In this case, the EP would be excluded from having to meet that measure. • e.g., Dentists who do not perform immunizations and chiropractors who do not have prescribing authority 11/17/2010

21. Meaningful Use: Core Set Objectives EPs –15 Core Objectives • Computerized physician order entry (CPOE) • E-Prescribing (eRx) • Report ambulatory clinical quality measures to CMS/States • Implement one clinical decision support rule • Provide patients with an electronic copy of their health information, upon request • Provide clinical summaries for patients for each office visit • Drug-drug and drug-allergy interaction checks • Record demographics • Maintain an up-to-date problem list of current and active diagnoses • Maintain active medication list • Maintain active medication allergy list • Record and chart changes in vital signs • Record smoking status for patients 13 years or older • Capability to exchange key clinical information among providers of care and patient-authorized entities electronically • Protect electronic health information 11/17/2010

22. Meaningful Use: Menu Set Objectives EPs – 10 Menu Objectives • Drug-formulary checks • Incorporate clinical lab test results as structured data • Generate lists of patients by specific conditions • Send reminders to patients per patient preference for preventive/follow up care • Provide patients with timely electronic access to their health information • Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate • Medication reconciliation • Summary of care record for each transition of care/referrals • Capability to submit electronic data to immunization registries/systems* • Capability to provide electronic syndromic surveillance data to public health agencies* *At least 1 public health objective must be selected 11/17/2010

23. Clinical Quality Measures • Ambulatory setting report on all (3) of the core measures as applicable for their patients • Inquiry regarding tobacco use • Blood pressure measurement • Adult weight screening and follow-up • Alternate core measures if denominator is zero • Preventative care and screening • Influenza immunization for patients ≥50 years old • Weight assessment and counseling for children and adolescents • Childhood Immunization status 11/17/2010

24. Clinical Quality Measures (Cont’d) • Second required measure set for each EP to submit information on three additional measures from at list of 38 clinical qualitymeasures • Specifications for the measures are published in the final rule • In sum, EPs must report on 6 total measures: 3 required core measures (substituting alternate core measures where necessary) and 3 additional measures 11/17/2010

25. Meaningful Use Reporting Period • First Year Incentive Qualifications • Any continuous 90-day period within a payment year in which an EP successfully demonstrates meaningful use of certified EHR • First opportunity to start demonstrating meaningful use is January 1, 2011 • “Attestation methodology” proposed in 2011 • Electronic Reporting starting in 2012 • Subsequent years reporting period • Entire 12 months (calendar year for EP) in the respective year 11/17/2010

26. Certification Process/Bodies • Temporary Process • Currently three certifying bodies • Certification Commission for Health Information Technology (CCHIT), Drummond Group Inc., InfoGard Laboratories Inc. • Certification process has begun • ONC is posting the certified EHR applications on its site • To obtain Medicare incentive dollars, must be a CERTIFIED EHR system 11/17/2010

27. Certification Process/Bodies (Cont’d) • Permanent Process • Accreditation of bodies expected to be completed through private entities with guidance from National Institute of Standards and Technology (NIST) • Expected timeframe for first bodies under permanent program to be accredited by January 2012 11/17/2010

28. Certified EHR Technology • Two Types of Certification of EHR Technology • Complete EHR • EHR must certify all requirements to certify as Complete EHR • Certified EHR Module • “..any service, component, or combination thereof that can meet the requirements of at least one certification criterion adopted by the Secretary” 11/17/2010

29. What happens if you do not adopt an EHR by 2015? 11/17/2010

30. Penalties • No incentive money available for implementation • Medicare cuts begin • 2015=1% • 2016=2% • 2017=3% • Evaluation of adoption rate in 2018 • No Medicaid cuts associated with non-adoption 11/17/2010

31. EHR Incentive Programs Milestone Timeline 11/17/2010

32. Comparison of Medicare and Medicaid Programs 11/17/2010

33. Participation in Other Incentive Programs 11/17/2010

34. Kentucky’s Efforts Kentucky Health Information Exchange • In 2005, Senate Bill 2 created the Kentucky eHealth Network (KeHN) Board to oversee the development, implementation, and operation of a statewide e-health network. • Kentucky also received a Medicaid Transformation Grant to develop the foundational components for a statewide health information exchange, the Kentucky Health Information Exchange (KHIE), to be completed by the second quarter of 2010. 11/17/2010

35. Kentucky’s Efforts (Cont’d) Regional Extension Centers • Providing basic resources for assisting practices with adopting EHRs and achieving meaningful use • Emphasis placed on • small practices (fewer than10 prescribers; physicians, PAs, ARNPs) • community health centers • rural clinicians that work with critical access hospitals • practices and clinics that serve the underserved 11/17/2010

36. Additional Assistance Kentucky Medical Association • More information regarding “EHR Planning Available for KMA Member Practices” on the KMA Web site https://www.kyma.org/content.asp 11/17/2010

37. Questions ? Tammy Geltmaker RN, BSN, MHA (502) 454-5112, ext. 2201 tgeltmaker@hce.org For further details regarding information found in this presentation, please visit http://www.cms.gov/EHRIncentivePrograms 11/17/2010