Meaningful Use (MU): Stage 2 and 2014 Changes

1. Meaningful Use (MU): Stage 2 and 2014 Changes Shannon Means, MPA Health Informatics Specialist II Health Services Advisory Group of California, Inc. (HSAG of California)

2. HSAG of California • Quality Improvement Organization for Arizona, California, and Florida • Local extension center (LEC) for California Health Information Partnership & Services Organization (CalHIPSO) • Service partner for Health Information Technology Extension Center for Los Angeles County (HITEC-LA)

3. HSAG of California (cont’d) • Dedicated to improving quality of care delivery and health outcomes through information, education, and assistance • Partners with physicians, health plans, nursing homes, and hospitals

4. Agenda • 2014 changes to Stage 1 MU • Stage 2 MU overview • Comparison from Stage 1 to Stage 2 • Barriers to rural users • 2014 exclusion • Overcoming barriers and preparing now • Q&A

5. MU Timeline EPs: Report on calendar year (January 1–December 31, 2014) EHs: Report on Federal Fiscal Year (October 1–September 30, 2014) *Reporting period in 2014 is 90 days (Medicare Calendar Quarter)

6. 2014 Changes to Stage 1 • Menu measures cannot be met by exclusion. • Public health measures must be reported. • All Clinical Quality Measures (CQMs) must be submitted electronically for Medicare-Eligible Providers (EPs): • Beyond their first year • Two choices: Physician Quality Reporting System (PQRS) or Centers for Medicare & Medicaid Services (CMS) Portal • If Medicare EPs didn’t report in 2013 for PQRS, there will be a payment adjustment in 2015

7. 2014 Changes to Stage 1 (cont’d) • Medi-Cal won’t accept electronic CQM submission • Must have a 2014 MU-certified system • Regardless of stage in 2014, all providers report for 90 days • Medicare: calendar quarter • Medicaid: any 90-day period • EPs may be eligible for an exclusion from the 2016 payment adjustment if they are not able to implement 2014 Certified Electronic Health Record Technology (CEHRT). • Must have a patient portal • Providers who have met Stage 1 for two or three years must meet Stage 2 criteria

8. Comparison from Stage 1 and Stage 2 Stage 2 MU Overview Stage 2 Stage 1 * * *CAHs = Critical access hospitals

9. Changes to CQMs Reporting • All providers must select CQMs from at least three of the six Health and Human Services National Quality Strategy (NQS) domains: • Patient and family engagement • Patient safety • Care coordination • Population and public health • Efficient use of healthcare resources • Clinical processes/effectiveness

10. Stage 2 CQM Objectives • Changes: nine versus six, aligned with NQS

11. Stage 2 EP Core Objectives

12. Stage 2 EP Core Objectives (cont’d)

13. Stage 2 EP Menu Objectives EPs must select three out of the following six:

14. Stage 2 Hospital Core Objectives

15. Stage 2 Hospital Core Objectives (cont’d)

16. Stage 2 Hospital Menu Objectives Eligible Hospitals must select three out of the six:

17. 2014 Vendor Issues Exclusion • New participants in 2014 • If you are new to the program and intend to demonstrate MU for the first time in 2014, but you are not able to implement 2014 certified EHR technology for the 2014 reporting year, you may apply for a hardship exception for the 2015 payment adjustment. • Use the EP hardship exception form for 2015. • Indicate the reason you are applying for a hardship. • Select “2014 Vendor Issues.” • Submit your application by July 1, 2014.

18. 2014 Vendor Issues Exclusion (cont’d) • Returning MU Users in 2014 • If you successfully demonstrated MU for the 2013 reporting year, you will not be subject to the 2015 payment adjustment. If you are not able to implement 2014-certified EHR technology for a 2014 reporting period, you may apply for a hardship exception for the 2016 payment adjustment. • Use the EP hardship exception form for 2016, which will be available after July 1, 2014. • Indicate the reason you are applying for a hardship. • Select “2014 Vendor Issues.” • Submit your application by July 1, 2015.

19. Barriers for Rural Meaningful Users • Monetary • Patient portal • 2014-certified EHR • Interfaces (labs, registries, etc.) • Patient engagement • Patients using the patient portal • EHR vendors releasing 2014 edition • Broadband access • Implementing and training of new measures

20. Overcoming Barriers and Fulfilling MU Stage 2

21. Overcoming Barriers: 2014 Editions • What is the cost for the upgrade? • Does your vendor have a 2014-certified version? • Currently, this is not an exhaustive list. Many outpatient EHRs are currently not 2014-certified. • http://www.healthit.gov/buzz-blog/meaningful-use/certified-ehr-health-it-products-list-available/ • Training on upgraded version? • Workflow redesign to capture new measures? • PQRS?

22. Overcoming Barriers: Patient Engagement • Patient portal does not have to be through your EHR, but it does have to meet certain requirements. • Explore different options to find a best fit and if it can interface with your EHR. • Explore using a Health Information Organization (HIO), i.e. http://www.californiadirect.org/ or your local HIO. • Discuss with your patients (encourage login, viewing) and confirm access with message to the provider

23. Overcoming Barriers: Patient Broadband Access • You may be eligible for an exclusion

24. Workflow and Planning • Workflow • Assess existing workflow (“as-is”) and create Stage 2 workflows (“to-be”). • Plan for coordination of interfaces and patient portal. • Project management planning • Create Stage 2 implementation schedule to cover upgrades, training, workflow redesign, monitoring of Stage 2 achievement, and attestation. • Assign a staff person responsible for monitoring Stage 2 progress and updates. • Ask for help • CalHIPSO • HSAG of California

25. Stage 2 Prep To-Do List: • Coordinate with your vendor on your upgrade to the 2014-certified system. • Coordinate with your vendor on your immunization interface. • Explore which patient portal you will be implementing. • Pull monthly reports, review for deficiencies, and adjust workflow as needed. • Ask for help. We are here!

26. Stage 2 Resources • CMS Stage 2 Webpage (tip sheets are available): http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html • Patient Engagement Fact Sheet http://www.healthit.gov/sites/default/files/key_considerations_for_health_information_organizations_vdt.pdf • Certified HIT Product List http://oncchpl.force.com/ehrcert?q=chpl • Payment Adjustments and Hardship Exceptionshttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/PaymentAdj_HardshipExcepTipSheetforEP.pdf

27. Additional Questions? Shannon Means, MPA Health Informatics Specialist II HSAG of California Smeans@hsag.com For information about rural health, visit http://www.dhcs.ca.gov/services/rural/Pages/StateOfficeofRuralHealth.aspx www.hsag.com This material was prepared by Health Services Advisory Group of California, Inc., the Medicare Quality Improvement Organization for California, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. CA-10SOW-9.0-040914-01

28. Register for the next event! • May 27, 2014 (Tuesday) • Noon to 1 p.m. PT • Register at http://bit.ly/1ntaylQ