How to Achieve Meaningful Use Stage 1: Hot Topics and FAQs Presented by: - Robert Anthony, Office of E-Health Standards and Services, CMS Moderated by: - Kate Berry, CEO, NeHC July 23, 2012 Join the new NeHC membership program Benefits of being a NeHC member include: • • • Visibility and public recognition as participating with an influential national health IT organization Members-only opportunities for networking with public and private sector health IT thought leaders Strategic workgroup and program-level leadership opportunities • • • • Unlimited access to NeHC University classes and materials at no charge Access to additional informational resources through members-only website content and email newsletter Discounted sponsorship of NeHC conferences and meetings Semi-annual member briefings Learn more at www.nationalehealth.org/NeHC-membership or email us at [email protected] Current NeHC Members My-Villages, Inc. 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Regina Holliday – Consumer HIT activist Linda Kloss – Kloss Strategic Advisors Dianne Lee – St. Louis Community College/Region C Community College Consortia Patricia MacTaggart – George Washington University Chuck Parker – Continua Health Alliance Andrea Sodano, PhD – School of Management, Boston University Timothy A. 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Full transcript will be available in approximately 7 to 10 days. All NeHC University materials are free of charge for NeHC members. Want more? You can also continue today’s discussion by joining the Meaningful Use group in NeHC’s online community: http://www.nationalehealth.org/collaborate/groups/meaningful-use-stages1-and-2 Please enter your questions or comments in the Q&A window at the bottom right of your screen You can also send us an email at [email protected], tweet a question using hashtag #NeHC, or comment on our Facebook page at www.facebook.com/nationalehealth Medicare and Medicaid EHR Incentive Programs: Stage 1 Meaningful Use Robert Anthony Office of E-Health Standards and Services Centers for Medicare & Medicaid Services 9 What are the Three Main Components of Meaningful Use? The Recovery Act specifies the following 3 components of Meaningful Use: 1. Use of certified EHR in a meaningful manner (e.g., e-prescribing) 2. Use of certified EHR technology for electronic exchange of health information to improve quality of health care 3. Use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by the Secretary 10 What is Meaningful Use? • Meaningful Use is using certified EHR technology to • Improve quality, safety, efficiency, and reduce health disparities • Engage patients and families in their health care • Improve care coordination • Improve population and public health • All the while maintaining privacy and security • Meaningful Use mandated in law to receive incentives 11 What are the Requirements of Stage 1 Meaningful Use? 15 + 5 + 6 = MU Eligible Professionals must complete: • 15 core objectives • 5 objectives out of 10 from menu set • 6 total Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from menu set) 12 What are the Requirements of Stage 1 Meaningful Use? Basic Overview of Stage 1 Meaningful Use: • Reporting period is 90 days for first year and 1 year subsequently • Reporting through attestation • Objectives and Clinical Quality Measures • Reporting may be yes/no or numerator/denominator attestation • To meet certain objectives/measures, 80% of patients must have records in the certified EHR technology 13 EP Core Objectives 15 Core Objectives 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Computerized provider 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 14 EP Menu Objectives 5 of 10 Menu Objectives 1. 2. 3. 4. 5. 6. 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 7. Medication reconciliation 8. Summary of care record for each transition of care/referrals 9. Capability to submit electronic data to immunization registries/systems* 10. Capability to provide electronic syndromic surveillance data to public health agencies* * At least 1 public health menu objective + 4 others 15 Meaningful Use Spec Sheets You can find detailed information on all the meaningful use objectives and measure in our Meaningful Use Specification Sheets. To find the specification sheets: • Visit our website (www.cms.gov/EHRIncentivePro grams) • Click on the ‘CMS EHR Meaningful Use Overview’ tab • Scroll to the bottom • Select either “Eligible Professional” or “Eligible Hospital” 16 Exclusions for Meaningful Use Objectives • Some MU objectives not applicable to every provider’s clinical practice, thus they would not have any eligible patients or actions for the measure denominator. Exclusions do not count against the 5 deferred measures • In these cases, the eligible professional, eligible hospital or CAH would be excluded from having to meet that measure • Eg: Dentists who do not perform immunizations; Chiropractors do not e-prescribe 17 Clinical Quality Measures 3 Core CQMs (or 3 Alternate Core CQMs) Choose 3 Additional CQMs (from a list of 38) Things you should know: • There are no thresholds to meet for CQMs • Always report directly out of your certified EHR • Reporting zeros is acceptable • There may not be CQMs applicable to everyone (e.g., specialists) 18 Primary Barriers to AIU/MU Knowledge Gaps 43 States now have active programs, with the others expected to onboard in 2012. State Onboarding ROI and Productivity Technical Support Vendor Support Specialty Info 19 Technical Support • Knowledge gap about certified EHRs • Product selection “What do I look for in an EHR?” “Which EHR should I buy?” “How do I use my EHR effectively?” 20 Vendor Support • Vendor support for technical/MU issues • Onboarding delay for software implementation 21 FAQs 22 FAQs Nearly 200 FAQs on our website (www.cms.gov/EHRIncentivePrograms) Basic to advanced Learn about new FAQs from our listserv (sign up on our website) 23 The CMS Top 10 List 10. How should an EP who orders meds infrequently calculate CPOE? (formerly FAQ #10639) Prescribe more than 100 meds during the reporting period Maintain med list that includes meds they didn’t order Orders meds for less than 30 percent of patients with a med in their med list If all the above apply, limit the denominator to patients for whom EP has previously ordered meds. 24 The CMS Top 10 List 9. How do you determine whether a patient has been “seen by the EP”? (formerly FAQ #10664) All cases where EP-patient physical encounter Telemedicine = “seen by the EP” When an EP does not have face-to-face or telemedicine encounters, EP should establish a consistent definition for the denominator 25 The CMS Top 10 List 8. If I see patients in a setting without EHR, can I enter their info into the EHR once I get back to my practice? (formerly FAQ #10475) Yes, but . . . CPOE CPOE must be entered before action can be taken on the order 26 The CMS Top 10 List 7. Can I exchange key clinical information electronically using a CD-ROM, USB, or a printout? (formerly FAQ #10638) NO 27 The CMS Top 10 List 6. OK . . . so what methods can I use to electronically exchange information? (formerly FAQ #10691) Must do 2 things: 1. Use certified EHR to generate the CCD/CCR 2. Electronically transmit the CCD/CCR 28 The CMS Top 10 List 5. If I share an EHR with another EP, can I “exchange” information with her? (formerly FAQ #10270) Different legal entities Distinct certified EHR 29 The CMS Top 10 List 4. Do you have to capture all of the clinical data for CQMs to meet the requirements of the program? (formerly FAQ #10839) Although we encourage providers to capture complete clinical data . . . CMS does not require providers to record all clinical data in their certified EHR technology at this time. CMS requires providers to report the CQM data exactly as it is generated as output from the certified EHR technology 30 The CMS Top 10 List 3. Who can enter information? Who can enter CPOE medication orders? (formerly FAQs #10071 and #10134) Any licensed healthcare professional if allowed per state, local, and professional guidelines Someone who can exercise clinical judgment in case of an alert CPOE must happen when order first becomes part of the record and before any action can be taken on the order. 31 The CMS Top 10 List 2. If I don’t regularly perform an objective as part of my practice, can I be excluded from meeting it? (formerly FAQ #10151) Exclusions are available only when our regulations specifically provide for an exclusion. EPs may be excluded from meeting an objective if they meet the circumstances of the exclusion. If an EP is unable to meet a Meaningful Use objective for which no exclusion is available, then that EP would not be able to successfully demonstrate Meaningful Use 32 The CMS Top 10 List 1. Can drug-drug and drug-allergy interaction alerts also be used to meet the clinical decision support measure? NO 33 New FAQs! How can I change my attestation information after I have attested and/or received an incentive payment? (FAQ #10982) For “Incorporate clinical lab-test results”, how should a provider attest if the numerator displayed by their certified EHR technology is larger than the denominator? (FAQ #10981) For “Provide summary care record for each transition of care or referral “, should transitions of care between EPs within the same practice who share certified EHR technology be included in the numerator or denominator of the measure? (FAQ #10980) 34 New FAQs! For objectives that require a provider to test the transfer of data, such as "capability to exchange key clinical information" and testing submission of data to public health agencies, if multiple EPs are using the same certified EHR technology across several physical locations, can a single test serve to meet the measures of these objectives? For meaningful use objectives that require a provider to test the transfer of data can the provider conduct the test from a test environment or test domain? For the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, how should an eligible professional (EP), eligible hospital, or critical access hospital (CAH) that sees patients in multiple practice locations equipped with certified EHR technology calculate numerators and denominators for the meaningful use objectives and measures? 35 Newer FAQs! How can I change my attestation information after I have attested and/or received an incentive payment? (FAQ #10982) For “Provide summary care record for each transition of care or referral “, should transitions of care between EPs within the same practice who share certified EHR technology be included in the numerator or denominator of the measure? (FAQ #10980) For the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, how should an eligible professional (EP), eligible hospital, or critical access hospital (CAH) that sees patients in multiple practice locations equipped with certified EHR technology calculate numerators and denominators for the meaningful use objectives and measures? NEW! Can an EP use inpatient or ED certified EHR technology to meet meaningful use? 36 Newest FAQs! Does a capital lease for Certified EHR Technology count as a reasonable cost for Critical Access Hospitals (CAHs)? NO YES Can an EP use inpatient Certified EHR technology to achieve MU? YES . . . BUT Inpatient CEHRT is not complete for all EP MU Objectives and no CQMs 37 Audits Basic Principles: • Catch the obvious • Focus on substantial non-compliance • Employ smart risk-profiling • Find the balance between cost of oversight and total incentive payment • Find the balance between hi-tech and hands-on approaches (cost and LOE) • Maximize existing/3rd party data sources where appropriate 38 Audits What You Can Do: Check and double-check Retain all relevant supporting documentation for 6 years post-attestation • Electronic and paper documentation • CQM documentation 39 Helpful Resources • CMS EHR Incentive Programs website www.cms.gov/EHRIncentivePrograms • • • • • Introduction to EHR Incentive Programs Frequently Asked Questions (FAQs) Meaningful Use Attestation Calculator Registration & Attestation User Guides Listserv • PAHCOM.com > Education > CMS Webinar Series • http://www.pahcom.com/education/ehr-incentive-training.html •HHS Office of National Coordinator Health IT certified EHR technology list http://healthit.hhs.gov/CHPL 40 User Guides and Other Resources • New Screens in the CMS Registration & Attestation Module • User Guides have been updated with the new screens 41 Please enter your questions or comments in the Q&A window at the bottom right of your screen You can also send us an email at [email protected], tweet a question using hashtag #NeHC, or comment on our Facebook page at www.facebook.com/nationalehealth Please take a moment to fill out the survey that will appear once you log out of the webinar. 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