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An EHR Incentive Crosswalk: Additional Incentives Beyond Meaningful Use

An EHR Incentive Crosswalk: Additional Incentives Beyond Meaningful Use. Sharon Rose, RN MAM BSOE HIT Pro-CP Regional Coordinator, Lubbock Bruce Edmunds, MEd Director of Regional Coordinators West Texas Health Information Exchange Regional Extension Center June 6, 2013. Objectives.

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An EHR Incentive Crosswalk: Additional Incentives Beyond Meaningful Use

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  1. An EHR Incentive Crosswalk: Additional Incentives Beyond Meaningful Use Sharon Rose, RN MAM BSOE HIT Pro-CP Regional Coordinator, Lubbock Bruce Edmunds, MEd Director of Regional Coordinators West Texas Health Information Exchange Regional Extension Center June 6, 2013

  2. Objectives Explain the requirements and goals of Meaningful Use Stage 2 objectives List the changes beginning in 2013 for Meaningful Use Stage 1 objectives Discuss recommendations on how to encourage patient and family engagement Identify what needs to be done now to prepare for Stage 2 Discovery what the REC can do for you beyond Meaningful Use

  3. Meaningful Use Stage 2 Summary Final Rule Released, August, 2012 Stage 2 begins in 2014 Most of the Stage 1 Menu Set Objectives have been moved to Stage 2 Core Set Objectives Most of the thresholds have been increased Inclusion of patient portals and electronic access to health information

  4. Stage 2 Goals • Increase health information exchange between providers to: • Improve coordination of care • Reduce medical errors • Eliminate duplication of tests and screening • Increase patient engagement by: • Providing access and means to view, download, transmit their health information • Sending preventative and follow-up reminders • Providing opportunities for electronic communication with the provider

  5. Changes to Stage 1 for 2013 https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1ChangesTipsheet.pdf Optional alternate measure added for CPOE Exclusion added for Electronic Prescribing Optional changes for Blood Pressure age limit Optional new exclusions for EPs Electronic exchange of key clinical information not required in Stage 1 No longer a separate objective for reporting CQM Public Health Reporting

  6. Stage 2 Requirements Eligible Professional 17 core objectives 3 of 6 menu objectives 20 total objectives Eligible Professionals 15 core objectives 5 of 10 menu objectives 20 total objectives Eligible Hospitals & CAHs 14 core objectives 5 of 10 menu objectives 19 total objectives Eligible Hospitals & CAHs 16 core objectives 3 of 6 menu objectives 19 total objectives http://www.cms.gov/EHRIncentivePrograms/

  7. More of The Same: Same Objective, New Expectations

  8. Security Risk Analysis http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html ALL Stage 2 EHR Meaningful Use Specification Sheets for Eligible Professionals • Conduct or review SRA of CEHRT • Address encryption/security of data stored in CEHRT • Implement updates as necessary at least once prior to end of reporting period • Correct identified security deficiencies as part of risk management process • Parameters of SRA are defined 45 CFR 164.308(a)(1) created by the HIPAA Security rule • http://www.hhs.gov/ocr/privacy/hipaa/administrative/ securityrule/

  9. Security www.capitol.state.tx.us/tlodocs/82R/billtext/pdf/HB00300F.pdf Texas HIPAA (HB300) also known as “HIPAA on STEROIDS!” Went into effect 9/1/2012; 21 pages Dramatically Impacts ALL Texans Requires PHI training customized to each employees role within 60 days of hire and at least every 2 years Audits from Federal and State agencies

  10. Menu to Core

  11. Menu to Core

  12. New Core Objectives

  13. New & Updated Menu Objectives For Eligible Providers

  14. New & Updated Menu Objectives For Eligible Hospitals

  15. Going Elsewhere Or made easier…

  16. Clinical Quality Measures 2014 for EPs http://www.himss.org/policy/d/20120829_HIMSS_Stage2_MU_FinalRule_ExecSummary.pdf • No longer a core objective • Required to report to demonstrate meaningful use • Submit CQM data electronically • Potential list of 64 CQMs from 6 National Quality Strategy domains • Submit 9 CQMs from at least 3 domains • Aligning Quality Measures and reporting among programs • HIQRP • PQRS • CHIPRA • ACO

  17. Clinical Quality Measures 2014 for EHs http://www.himss.org/policy/d/20120829_HIMSS_Stage2_MU_FinalRule_ExecSummary.pdf No longer a core objective Required to report to demonstrate meaningful use Submit CQM data electronically Potential list of 29 CQMs from 6 National Quality Strategy domains Submit 16 CQMs from at least 3 domains Aligning Quality Measures and reporting electronically

  18. CQM Reporting for 2014 • Eligible Professionals • Calendar year quarter: • January 1 – March 31 • April 1 – June 30 • July 1 – September 30 • October 1 – December 31 • Eligible Hospitals & CAHs • Fiscal year quarter: • October 1 – December 31 • January 1 – March 31 • April 1 – June 30 • July 1 – September 30 Optional Reporting Period in 2014*

  19. Benefits Decreased medical record keeping costs Fewer repeated tests Decrease in medical errors Increase patient safety Increase quality of care Incentive payments for doing the “right thing” • http://www.himss.org/policy/d/20120829_HIMSS_Stage2_MU_FinalRule_ExecSummary.pdf

  20. Complications Installing/upgrading systems to meet 2014 EHR certification standards More workflow adjustments No longer have full control over qualifying for measures

  21. Patient and Family Engagement • Get patients and their family • More involved in their Healthcare • Better informed and more active in monitoring their care • Secure Messaging • Improve patient following treatment plans • Follow up with questions regarding treatment plan or questions forgotten during visit • Increase patient satisfaction • Allows for pressure free setting which may increase comfort of communication especially with sensitive issues

  22. What This Means to Your Practice Clinical Summaries 3 Days in1 Day in Stage 1 Stage 2 Patient Education From Menu To Core Data Access View, Download, Transmit Secure Electronic Messaging Secure and protected transmission of information between patients and their providers

  23. Secure Messaging Benefits to Provider Reduce time spent answering phone calls and getting connected with Chatty Cathy Documents communication in patient record automatically Increases patient satisfaction Ability to send auto-reply for routine issues More appropriate and relevant questions Improved quality outcomes

  24. Stage 2 To Do List

  25. More Stage 2 To Do List

  26. CQM Crosswalk Quality Programs

  27. CMS Obesity Funding • CMS supports Intensive Behavioral Therapy (IBT) for obesity consistent with framework developed by the the U.S. Preventive Services Task Force (USPSTF) - an independent group of national experts – that work to improve the health of Americans by making evidence-based recommendations about clinical preventive services. • CMS has determined there is adequate evidence to conclude that IBT is reasonable and necessary for the prevention or early detection of illness or disability and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B.

  28. CMS Obesity Funding • IBT for obesity consists of: • Screening for obesity in adults using measurement of Body Mass Index (BMI); *CDS • Dietary (nutritional) assessment; and • Intensive behavioral counseling and behavioral therapy to promote sustained weight loss through high intensive interventions on diet and exercise. • Intensive behavioral intervention for obesity should be consistent with the 5-A framework highlighted by the USPSTF outlined on the next slide.

  29. CMS Obesity Funding IBT 5A Framework • Assess behavioral health risk and factors affecting choice of behavior change goals; • Adviseprovide clear, specific, personalized behavior change advice including information about personal health harms and benefits; • Agreecollaboratively on appropriate treatment goals and methods based on the patient’s interest and willingness to change; • Assistpatientusing behavioral change techniques, aid the patient in achieving agreed-upon goals by acquiring the skills, confidence and social/environmental support for behavior change, supplemented with adjunctive medical treatments; and • Arrange scheduled follow-up contacts to provide support, plan adjustments and referrals for more specialized treatments.

  30. CMS Obesity Funding How Does it Work? • For Medicare beneficiaries who are competent and alert at the time that counseling is provided and whose counseling is furnished by a qualified primary care physician or other primary care practitioner and in a primary care setting; CMS provides reimbursement for: • One face-to-face visit every week for the first month; • One face-to-face visit every other week for months 2 through 6; and • One face-to-face visit every three months for months 7 through 12, if the beneficiary meets a 3kg weight loss within the first six month. • A timeline for office visits is outlined on the next slide.

  31. CMS Obesity Funding Timeline Example: If you have 100 patients that are Obese then you get 20 paid visits a year which equals 2000 total visits x Medicare reimbursement rate of approximately $25 = $50,000 in additional revenue per year

  32. CMS Obesity Funding Sites Do you qualify? • CMS covers IBT for obesity provided in primary care settings: • Independent Clinics • Outpatient Hospitals • Physician Offices • State or Local Public Health Clinics • CMS defines a primary care setting as one that provides integrated,accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients and practicing in the context of family and community.

  33. CMS Obesity Funding Providers • Primary care physicians include: • 01 – General Practitioner • 08 – Family Practice • 11 – Internal Medicine • 16 – Obstetrics/Gynecology • 38 – Geriatric Medicine • 37 - Pediatric Medicine • Other primary care practitioners include: • 50 – Nurse Practitioner • 89 – Certified Clinical Nurse Specialist • 97 – Physician Assistant

  34. CMS Obesity Funding Sites Excluded • Sites excluded from CMS obesity funding include: • Emergency Departments • Inpatient Hospital Settings • Ambulatory Surgical Centers • Independent Diagnostic Testing Facilities • Skilled Nursing Facilities • Inpatient Rehabilitation Facilities • Hospice

  35. CMS Obesity Funding Billing CMS Obesity Funding is effective for claims with service on or after November 29, 2011. Patient progress, including the six month patient assessment, must be documented in the physician office records. Compensation works out to be about $25 per visit for what is supposed to be a 15 minute average. Medicare coinsurance and Part B deductible are waived for these services. Obesity counseling is not separately payable with another encounter/visit on the same day. Claims must be submitted with HCPCS code G0447 and must contain an ICD-9-CM diagnosis code indicating BMI ≥ 30 V85.30 – V85.39 or V85.41 – V85.45.

  36. WTxHITREC Services Snapshot • MU Stage 1 and Stage 2 • Assessment • Meaningful Use Gap Analysis • Documentation • Registration • Attestation • Post Attestation analysis • EHR Implementation Assistance • Security and Risk Assessment tools and guidance • Clinical Workflow Analysis • Post Attestation Checklist and Audit Documentation • Assistance in avoiding penalties • Pay for performance metrics Education • Introduction to Additional Incentive and Certification Opportunities • CMS and TMHP direct line of contact to resolve issues • Vendor Issue assistance

  37. References and Resources http://www.himss.org/policy/d/20120829_HIMSS_Stage2_MU_FinalRule_ExecSummary.pdf http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html http://www.cms.gov/EHRIncentivePrograms/ https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1ChangesTipsheet.pdf www.capitol.state.tx.us/tlodocs/82R/billtext/pdf/HB00300F.pdf

  38. CQM Resources CLINICAL QUALITY MEASURES FOR 2014 CMS EHR INCENTIVE PROGRAMS FOR ELIGIBLE PROFESSIONALS http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EP_MeasuresTable_Posting_CQMs.pdf 2014 Clinical Quality Measures (CQMs) Pediatric Recommended Core Measures http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_PrediatricRecommended_CoreSetTable.pdf 2014 Clinical Quality Measures (CQMs) Adult Recommended Core Measures http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_AdultRecommend_CoreSetTable.pdf CLINICAL QUALITY MEASURES FINALIZED FOR ELIGIBLE HOSPITALS AND CRITICAL ACCESS HOSPITALS BEGINNING WITH FY 2014 http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_EH_FinalRule.pdf 2014 Clinical Quality Measures (CQMS) & eCQM Resources (for web pages and publications links) http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/CQM_ResourceTable_2012_10.pdf

  39. Questions?

  40. Contact Us West Texas Health Information Technology Regional Extension Center (WTxHITREC) 4430 South Loop 289, Suite 300 806-743-7960 Carson Scott www.wtxhitrec.org

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