The Road To Meaningful Use

1. HIMformatics The Road To Meaningful Use How Do We Get There?

2. Discussion Focus • About MU • How Do I Qualify? • Roadblocks • Next Steps

3. About MU • Under the Health Information Technology for Economic and Clinical Health (HITECH Act), enacted under the American Recovery and Reinvestment Act of 2009 (ARRA), incentive payments are available to eligible professionals (EPs) who demonstrate meaningful use of certified electronic health records (EHR). Meaningful Use (MU) requires three components : • Certified clinical system (EMR/EHR) • Health Information Exchange (HIE) • Clinical quality reporting

4. Stages of Meaningful Use Stage 1 • Data Capture and Sharing • Electronically capture data in coded format as well as report health information for tracking key clinical conditions Stage 2 • Advanced Clinical Processes • Guide and support care processes and coordination through the exchange of information Stage 3 • Improved Outcomes • Achieve improved performance through the effective adoption and use of care processes as well as advance key health system outcomes

5. Who is Eligible?

6. Medicare Incentives for EPs Incentive pays 75% of Medicare billings, up to the above annual cap

7. Qualification Year to Avoid Adjustments • EP (CY) who demonstrates MU in CY 2011 or 2012 • EP who demonstrates MU in CY 2013 for 1st Time • For EPs attesting in 2014 to avoid the 2015 payment adjustment, EP must attestno later than October 1, 2014, which means they must begin their 90 day EHR reporting period no later than July 1, 2014.

8. How much will I lose - EPs? • % Adjustment shown below assumes less than 75% of EPs are meaningful users for CY 2018 and subsequent years • % Adjustment shown below assumes more than 75% of EPs are meaningful users for CY 2018 and subsequent years

9. Payment Adjustments To Avoid Payment Adjustments in subsequent years, EPs & hospitals must continue to demonstrate meaningful use every year

10. Core and Menu Objectives

11. Stage 1 Meaningful Use • Core Requirements All 15 Core Requirements are needed to achieve Stage 1

12. Stage 1 Meaningful Use • Core Requirements (continued)

13. Stage 1 Meaningful Use • Menu Requirements 5 of 10 Menu Requirements are needed to achieve Stage 1, including at least one Public Health Reporting requirement

14. Stage 1 Meaningful Use • Menu Requirements (continued) * Public health reporting requirement

15. Clinical Quality Measures (CQM) • Patient and Family Engagement • Patient Safety • Care Coordination • Population and Public Health • Efficient Use of Healthcare Resources • Clinical Processes/Effectiveness * NQS healthcare policy domains:

16. Stage 1 CQMs • EPs must complete 3 of the following core measures (or 3 alternate core measures): • Hypertension – Blood Pressure Measurement • Preventive Care and Screening • Tobacco Use Assessment • Tobacco Cessation Intervention • Adult Weight Screening and Follow-up • (alt) Weight Assessment and Counseling for Children and Adolescents • (alt) Preventive Care and Screening • Influenza Immunization (> 50 years) • (alt) Childhood Immunization Status • Must also complete 3 of 38 in an additional set • This is the link to the CMS CQM Site: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/ClinicalQualityMeasures.html

17. Stage 1 CQMs Examples

18. Stage 1 CQM Examples • Certified in MOSAIQ

19. Registration • Good user guide available from CMS • http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/RegistrationandAttestation.html • Register EP’s now! • Before an EP registers, determine • Should they register for Medicare or Medicaid? • At this time, all EPs should be registering for Medicare • Will they use a proxy of attest for themselves? • If they use a proxy, who will it be? • Proxy and EP must create an I&A web user account if they don’t have one • Which Tax Identification Number (TIN) will the incentive payment go to? • In order to register, the provider must have an NPI and an NPPES web user account

20. Reporting & Attestation • Reporting mechanism in 2012 is “Attestation Methodology” • Attestation is via web­based Medicare and Medicaid EHR Incentive Program Registration and Attestation System • Fill in numerators and denominators for meaningful use objectives and clinical quality measures • Indicate if EP qualifies for exclusions to specific objectives • Legally attest that EP has successfully demonstrated meaningful use • Reference for detailed requirements: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf

21. Reporting & Attestation • Starting in 2014 • No longer allowed to count an exclusion toward the minimum of 5 menu objectives on which providers must report if there are other menu objectives which they can select. • Batch reporting for groups supported • Clinical Quality Measures reported electronically for all providers who are not in their first participation year

22. Audit Preparation Audit Information • Meaningful Use audits are a ‘when’ not an ‘if’ • Retain documentation for 6 years post-attestation • If found to not be eligible for an EHR incentive payment, payment will be recovered • Audit trail should include: • Relevant IT systems, system configurations, roles, and processes for each MU criteria • System certification documentation (versions, certification #s, etc.) • Reports/data for each reporting period • Confirmations or other communication for CMS or State • CMS reference site: http://www.cms.gov/EHRIncentivePrograms/32_Attestation.asp#10

23. Potential MU Roadblocks Process Redesign and Change Management MU criteria reporting generally requires significant process redesign and training in addition to application enhancements. • Added responsibility and process change for clinicians and administrative staff, such as: • CPOE • Smoking cessation counseling • Responding to patient requests for electronic copy of health record • Providing Clinical Visit Summaries for at least 50% of all encounters

24. Potential MU Roadblocks Clinical Quality Reporting • Data capture for clinical quality measures may require substantial workflow and clinical documentation changes • Most current electronic documentation does not capture everything needed to meet the MU measure specifications • To achieve these measures, EPs may need to implement additional functionality • Good news is that Stage 1 does not have any minimum thresholds

25. Potential MU Roadblocks By 2014, EPs will need a Patient Portal • EP Objective: Provide patients the ability to view online, download and transmit their health information within 4 business days of the information being available to the EP. • EP Measure: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (within 4 business days after the information is available to the EP) online access to their health information subject to the EP's discretion to withhold certain information.

26. Meaningful Use Next Exit HIMformatics Road To MU Success The Target Is In Sight

27. Each year, EP must attest within 2-months of end of reporting period (i.e.,Feb 28) EP Key Dates Tentative Plan: a 90 day period between Apr 1st – July 31st 90 Day Period for Baptist EP’s Reporting period options for 2014 attestation Full Year Reporting Required for 2015 Stage 2 Q1 Q2 Q3 Q4 90d 90d CY 2013 CY 2014 CY 2015 • Sep 30, 2014 • Latest date to have 2014 CEHRT in place and qualify for CY2014 incentives • Oct 1, 2014 • Latest date to attest for MU & avoid 2015 penalties • ICD-10 Deadline • Jan 1, 2014 • Other changes to Stage 1 criteria take effect • New CQM criteria take effect (Stage 1 & 2) • Jul 1, 2014 • Latest date to apply for 2015 hardship exemption • Latest date to start 90-day reporting period & avoid 2015 penalties (must have 2014 CEHRT in place) • Jan, 1, 2015 • Medicare Penalties begin for non-MU EP’s CQMs for CY2014 must be submitted electronically if reporting second year & beyond

28. Get In The Driver’s Seat • MU Checklist • Register with CMS https://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp • MU readiness assessment (Gap Analysis) • Completed for MOSAIQ Practices • Will begin in February for AllScripts Practices • BHS Timelines have been identified • Implement changes needed to successfully meet Stage 1 MU Objectives (all Core and Menu activities will be required for Stage 2 with additional complexities) • Core Objectives – all 15 functions • Menu Objectives– 5 of 10 functions • Report to CMS

29. AnyQuestions? • For MU Specific Questions: • Coleman Smith • HIMformatics • csmith@himformatics.com • For AllScripts Practices: • Tricia Julian • Tricia.julian@bhsi.com • For MOSAIQ Practices: • Mitchell D. Clemons • MCLEMONS@bhsi.com Thank you for your time!

30. Appendix

31. Definitions CCHIT- Certification Commission for Health Information Technology CPOE - Computerized Provider Order Entry EHR - Electronic Health Record; EMR - Electronic Medical Record EH - Eligible Hospital to receive stimulus funds EP - Eligible Professional -- one of five types of professionals legally authorized to practice their profession under state law HIE - Health Information Exchange HIPAA - Health Insurance Portability & Accountability Act HITECH - Health Information Technology for Economic and Clinical Health MU - Meaningful Use, the term used in ARRA to describe a hospital or physician who demonstrates achievement of specific goals and can earn Medicare and/or Medicaid incentive payments ONC - Office of the National Coordinator