2013 EHR INCENTIVE PROGRAM MANUAL Billing Technology
2013 EHR INCENTIVE PROGRAM MANUAL Billing Technology Results® ahsrcm.com | [email protected] | 877 501 1611 2013 EHR Incentive Program Manual Table of Contents INTRODUCTION TO EHR & MEANINGFUL USE .............................................................................1 CMS’ EHR INCENTIVE PROGRAM - PARTICIPATION .....................................................................3 COMPARISON - MEDICARE & MEDICAID PROGRAMS .................................................................5 THE 2013 MEDICARE EHR INCENTIVE PROGRAM ........................................................................5 INCENTIVE P PAYMENTS & PENALTY ADJUSTMENTS ....................................................................7 HARDSHIP EXEMPTIONS ...........................................................................................................8 2013 REQUIREMENTS FOR REPORTING MEANINGFUL USE ........................................................ 9 EHR SYSTEM CERTIFICATION ....................................................................................................9 STAGE 1 OBJECTIVE REQUIREMENTS ....................................................................................10 ST CLINICAL QUALITY MEASURES ................................................................................................ 12 EHR PROGRAM REGISTRA REGISTRATION & ATTESTATION ........................................................................ 15 2014 ST STAGE 2 REQUIREMENTS ..................................................................................................... 17 ADDENDUM 1 – ST STAGE 2 OBJECTIVES ......................................................................................... 18 21 ADDENDUM 2 – 2014 CLINICAL QUALITY MEASURES ................................................................ EHR INCENTIVE PROGRAM MANUAL Thismanualcontainsinformationforthe2013EHRIncentiveProgramforphysiciansandclinicians,referredtobyCMSaseligibleprofessionalsorEPs.(Hospitalsparticipateintheirownversionoftheprogram)UpdatestoStage1,handeddownintheStage2rulingonAugust23,2012, areincludedinthismanual. Stage2oftheprogramdoesnotbeginuntilJanuary1,2014.Wehaveincludedsomeinformation onStage2attheendofthemanual.However,thismanualisprimarilydesignedforEPsparticipatingintheprogramin2013. INTRODUCTION TO EHR (ELECTRONIC HEALTH RECORDS) & MEANINGFUL USE (MU) TheAmericanRecoveryandReinvestmentActof2009(RecoveryAct)(ARRA)wassignedintolaw byPresidentObamaonFebruary17,2009.ThelawincludestheHealthInformationTechnology forEconomicandClinicalHealthAct,orthe“HITECHAct,”whichestablishedprogramsunder MedicareandMedicaidtoprovideincentivepaymentsforthe“meaningfuluse”or“MU”ofcertifiedelectronichealthrecords(EHR)technology. OnDecember20,2009,CMS(TheCentersforMedicareandMedicaid)and ONC(OfficeoftheNa1 ahsrcm.com | 908-279-8120 2013 EHR Incentive Program Manual tionalCoordinatorforHealthInformationTechnology)issuedtworegulationsthatlaidthefoundationforimprovingquality,efficiencyandsafetythrough“meaningfuluse”ofcertifiedelectronic healthrecords(EHR)technology. TheCMS’ regulation: •DefinesandspecifieshowtodemonstrateMUofEHRtechnology,whichisapre-requisiteforreceivingtheMedicareorMedicaidincentivepayments. •OutlinestheproposedpaymentmethodologiesforboththeMedicareandMedicaidincentiveprograms. TheONC regulation: •Setsinitialstandards, •Implementsspecificationsand •CreatescertificationcriteriaforEHRtechnologythatshouldenhancetheinteroperability,functionality,utilityandsecurityofhealthinformationtechnology. The Recovery Act specifies the following 3 components of Meaningful Use: 1.UseofcertifiedEHRinameaningfulmannerwhichincludes: a.theabilitytoelectronicallycapturehealthinformationinacodedformat, b.usageofthatinformationtotrackkeyclinicalconditions, c.implementationofclinicaldecisionsupporttoolstofacilitatediseaseandmedicationmanagement,and d.theabilitytoreportclinicalqualitymeasuresandpublichealthinformation 2.UseofcertifiedEHRtechnologyforelectronicexchangeofhealthinformationtoimprovequalityofhealthcarewhichincludes: a. exchanginghealthdataamongproviders, b.providingsecurityofthatdata 3. UseofcertifiedEHRtechnologytosubmitclinicalqualitymeasures(CQM)andother suchselectedmeasureswhichincludes: a.usingstandardformatsforclinicalsummariesandprescriptionsandstandard termstodescribeclinicalproblems,proceduresandtests EHR IMPLEMENTATION STAGES InJuly2010,CMSissuedafinalrulefortheElectronicHealthRecordsIncentiveProgramfor Medicare and Medicaid, establishing a three-phase approach to implementing the requireahsrcm.com | 908-279-8120 2 2013 EHR Incentive Program Manual mentsfordemonstratingmeaningfuluse.Stage1wouldbeginonJanuary1,2011andthrough arecentrulingwas extendedthrough2013. Stage 2was finalized by both CMSand ONCon August23,2012tobeginonJanuary1,2014.Stage3isnowinthedesignstageandisslatedto befinalizedin2016. • Stage 1-meaningfulusecriteriafocusesonelectronicallycapturinghealthinformation inacodedformat,usingthatinformationtotrackkeyclinicalconditionsandcommunicatingthatinformationforcarecoordinationpurposes.Italsocallsforimplementing clinical decision support tools to facilitate disease and medication management and reportingclinicalqualitymeasuresandpublichealthinformation. •Stage 2 -expandsupontheStage1criteriatoencouragetheuseofhealthITforcontinuous quality improvement at the point of care and the exchange of information in themoststructuredformatpossible,suchastheelectronictransmissionofordersenteredusingcomputerizedproviderorderentry(CPOE)andtheelectronictransmission ofdiagnostictestresults(suchasbloodtests,microbiology,urinalysis,pathologytests, radiology,cardiacimaging,nuclearmedicinetests,pulmonaryfunctiontestsandother suchdataneededtodiagnoseandtreatdisease).Additionallytheymayconsiderapplyingthecriteriamorebroadlytoboththeinpatientandoutpatientsettings. •Stage 3-focusesonpromotingimprovementsinquality,safetyandefficiencyandon decisionsupportfornationalhighpriorityconditions,patientaccesstoselfmanagementtools,accesstocomprehensivepatientdataandimprovingpopulationhealth. THE 2013 EHR INCENTIVE PROGRAM - PARTICIPATION InordertoencouragetheuseofEHRsystemsinthemedicalcommunity,Medicare&Medicaid will provide incentive payments to eligible professionals that are meaningful users of certified EHRsystemsinordertohelpdefraythecostofinstitutingacceptableEHRsystems.TheparticipationregulationsforEPsintheMedicareandMedicaidprogramsare: 1.AnEPcanonlyparticipateineithertheMedicareorMedicaidprogram–notboth.However,aftertheinitialdesignationtoapplyforeithertheMedicareorMedicaidincentive, EPsareallowedtochangetheirselectiononceduringpaymentyears2012-2014. 2.MedicareEligibleProfessionals’Criteria a.Physicians-DoctorsofMedicineorOsteopathy,DentalSurgery/Medicine,PodiatristsMedicine,Optometry&Chiropractors b.HospitalbasedEPsdoNOTqualifyforMedicareEHRincentivepayments.A hospitalbasedEPisonewhofurnishes90%ormoreoftheirservicesinan inpatientoremergencyroomhospitalsetting. 3 ahsrcm.com | 908-279-8120 2013 EHR Incentive Program Manual c.Toreceivethemaximumincentive,anEPmustbeginparticipationby2012 3. MedicaidEligibleProfessionals’Criteria a.Physicians – primarily medicine and osteopathy (Pediatricians have special eligibility&paymentrules) b.NursePractitioners(NPs),CertifiedNurse-Midwives,Dentists, c. PhysicianAssistantswhopracticeinaFederallyQualifiedHealthCenter(FQHC) orRuralHealthCenter(RHC)thatisledbyaPhysicianAssistant. d. M edicaid population must be 30% of an EPs total patient volume (billed en- counters)toqualifyfortheMedicaidincentiveprogram(20%forpediatricians) e.AnEPthatpracticespredominantlyinanFQHCorRHCandhavea30%patient volumeattributabletoneedyindividuals f.Children’s’HealthInsurancePrograms(CHIP)donotcounttowardstheMedicaidpatientvolume 4. MedicareAdvantage(MA)IncentiveCriteria a.PaymentsmaybemadetoqualifyingMAorganizations(MAO)fortheiraffiliated EPswhoaremeaningfulusersofcertifiedEHRtechnology.SpecificallyanMA EPmusteither: i.Furnish, on average, at least 20 hours/week of patient-care services andbeemployedbythequalifyingMAO,or ii.Beemployedby,orbeapartnerof,anentitythatthroughcontractwith thequalifyingMAOfurnishesatleast80percentoftheentity’sMedicarepatientcareservicestoenrolleesofthequalifyingMAO 5.IfanEPprovidesservicesinmorethanonepracticeorlocation,50%ormoreofthe EP’spatientencountersmustbeinapractice(s)orlocation(s)equippedwithcertified EHRtechnology. Example: If an EP works in 3 practices/locations and 2 of the 3 have certified EHR technology,50%ormoreoftheEP’spatientencountersmustoccuratthe2locations thathavecertifiedEHRtechnology. 6.EPswhoseepatientsinbothinpatient/ERandoutpatientsettingsandcertifiedEHR technologyisavailableateachlocation,theEPsmustbasetheirmeaningfulusecalculationsonpatientsinonlytheoutpatientsetting(s). ahsrcm.com | 908-279-8120 4 2013 EHR Incentive Program Manual COMPARISONS OF MEDICARE & MEDICAID EHR PROGRAMS NOTABLE DIFFERENCES BETWEEN THE MEDICARE & MEDICAID EHR PROGRAMS MEDICARE MEDICAID Run by CMS Run by Your State Medicaid Agency $44,000 Maximum Incentive Payment per EP - Payments over 5 consecutive years (2011 & 2012), reduced payments over less years for 2013 - 2016 $63,750 Incentive Payment per EP - Payments over 6 years, does not have to be consecutive Payment adjustments will begin in 2015 for providers who are eligible but decide not to participate No Medicaid payment adjustments Providers must demonstrate meaningful use every year to receive incentive payments. In the first year providers can receive an incentive payment for adopting, implementing, or upgrading EHR technology. Providers must demonstrate meaningful use in the remaining years to receive incentive payments Last year EP can initiate program is 2014 Last year EP can initiate program is 2016 Last payment year in program is 2016 Last payment year in program is 2021 Payment adjustments begin in 2015 No Payment adjustments Only Physicians 5 Types of EPs LIMITATIONS OF PARTICIPATION IN MULTIPLE INCENTIVE PROGRAMS PARTICIPATION IN HITECH AND OTHER MEDICARE INCENTIVE PROGRAMS OTHER EHR MEDICARE INCENTIVE PROGRAM ELIGIBLE FOR HITECH? PQRS Yes, EPs can participate in both if eligible eRx (E-prescribe) No - if the EP chooses to participate in the MEDICARE EHR Incentive Program, they cannot participate in the eRx program simultaneously eRx (E-prescribe) Yes - If the EP chooses to participate in the MEDICAID EHR Incentive program THE MEDICARE EHR INCENTIVE PLAN NOTE:AsmostofourclientswillnotparticipateintheMedicaidIncentiveProgram,theremainderofthismanualwillfocusonlyontheMedicareIncentiveProgram.Thoseinterestedinthe Medicaid Incentive Program should visit CMS’ EHR Incentive Program website and review the EHR BasicsandMedicaid State Informationsubcategories. 5 ahsrcm.com | 908-279-8120 2013 EHR Incentive Program Manual ToqualifyforMedicareincentivepayments,theEPmustmeaningfullyusecertifiedEHRtechnologyforthedurationoftheEHRreportingperiodoftherelevantpaymentyear.Thereporting periodmaybeanycontinuous90-dayperiodormorewithinthefirstpaymentyear,andtheentire calendaryearforallsubsequentyears.Example:IftheEPwantedtoreportfortheyear2013,the lastreportingperiodfor2013wouldbeginonOctober1,2013. Intheoriginalfinalrule,CMShadestablishedatimelinethatrequiredproviderstoprogressto Stage2criteriaaftertwoprogramyearsundertheStage1criteria.Thisoriginaltimelinewould haverequiredMedicareproviders who first demonstrated meaningful use in 2011 to meet the Stage2criteriain2013. UndertherecentStage2FinalRule,CMSdelayedtheonsetofStage2criteriaforEPsuntilfiscal year2014.ThisallowsproviderswhofirstdemonstratedMUin2011tohavethreeconsecutive yearsofMUundertheStage1criteriabeforeadvancingtoStage2criteria.Allotherproviders wouldmeettwoyearsofmeaningfuluseundertheStage1criteriabeforeadvancingtotheStage 2criteriaintheirthirdyear. •FirstYearofparticipation–providersmustdemonstrateMUfora90-DayEHRreportingperiod. •Subsequentyears-fullyearreportingperiod(entirecalendaryear),exceptfor2014 In the Stage 2 ruling, CMS made an exception for the year 2014 requiring only a three-month reportingperiodforthatyearinorderforEPstomakethenecessarychangestotheirsystems, regardlessoftheirstageofMU.Thethree-monthEHRreportingperiodisfixedtocalendaryear quartersinordertoalignwithexistingCMSqualitymeasurementprogramssuchasPQRS.2014is theonlytimeCMSwillpermitthisthree-monthreportingperiod.Thefollowingtableillustratesthe progressionofMUstagesfromwhenaMedicareproviderbeginsparticipationwiththeprogram. STAGE OF MEANINGFUL USE BY FIRST MEDICARE PAYMENT YEAR 1st Year 2011 2012 STAGE OF MEANINGFUL USE BY FIRST MEDICARE PAYMENT YEAR 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2013 1 1 1 2 2 3 3 TBD TBD TBD TBD 1 1 2 2 3 3 TBD TBD TBD TBD 1 1 2 2 3 3 TBD TBD TBD 1 1 2 2 3 3 TBD TBD 1 1 2 2 3 3 TBD 1 1 2 2 3 3 1 1 2 2 3 2013 2014 2015 2016 2017 ahsrcm.com | 908-279-8120 6 2013 EHR Incentive Program Manual PAYMENT & ADJUSTMENT PROVISIONS OF THE EHR INCENTIVE PLAN MEDICARE PAYMENT INCENTIVES Paymentprovisionsforqualifiedprovidersareasfollows: •Providersmayearnincentivepaymentequalto75%oftheirMedicareallowedcharges forcoveredservicesfurnishedbytheproviderinayear,subjecttothemaximumpaymentasstatedinthefollowingchart. •ThoseEPswhoattestandsuccessfullyadoptMUin2011and2012aretheonlyEPswho willreapthehighestincentiveof$44,000perEP.ProvidershaduntilOctober1,2012to demonstrate90daysofMUwiththeirEHRtoqualifyforthefull$44,000per-provider Medicarebonus. •Thosewhobegintheprocessin2013canearnamaximumof$39,000andin2014,$24,000. •TherewillbenoincentivepaymentstoEPswhofirstbecomemeaningfulEHRusersin 2015orthereafter. MEDICARE & MAO FIRST CALENDAR YEAR IN WHICH EP RECEIVES INCENTIVE PAYMENT CALENDAR YEAR 2011 2011 $18,000 2012 $12,000 $18,000 2013 $8,000 $12,000 $15,000 2014 $4,000 $8,000 $12,000 $12,000 2015 $2,000 $4,000 $8,000 $8,000 $0 $2,000 $4,000 $4,000 $0 $44,000 $39,000 $24,000 $0 2016 TOTAL $44,000 2012 2013 2014 2015 & later Additional incentives are made for Medicare EPs practicing in HPSAs. (Health Professional ShortageArea) MEDICARE PAYMENT ADJUSTMENTS (PENALTIES) For2015andlater,MedicareEPswhoarenotmeaningfulusersofCertifiedEHRtechnologyby 2014willfaceMedicarepaymentreductionsin2015.(unlesstheEPissuccessfullyparticipating intheMedicaidEHRIncentiveProgram) EPswhofirstdemonstratedMUin2011or2012mustdemonstrateMUforafullyearin2013to avoidpaymentadjustmentsin2015andmustcontinuetodemonstrateMUeveryyeartoavoid 7 ahsrcm.com | 908-279-8120 2013 EHR Incentive Program Manual paymentadjustmentsinsubsequentyears. ThepaymentadjustmentswillbeappliedtotheMedicarephysicianfeeschedule(PFS)amount forcoveredprofessionalservicesfurnishedbytheEPduringtheyear.Thepaymentadjustment is1%peryearandiscumulativeforeveryyearanEPisnotameaningfuluser.For2018and thereafter,ifitisfoundthattheproportionofproviderswhoareMedicareEHRusersislessthan 75%,thenreductionswillincreaseby1%eachyearbutnotbymorethan5%overall.Payment adjustmentswillbeasfollows: •1%in2015, •2%in2016, •3%in2017, •4%in2018,and •between3-5%insubsequentyears. HARDSHIP EXEMPTIONS Inthe“proposed“Stage2period,inadditiontothoseEPswhopetitionedCMSandONCtonot penalizeEPsinunusualcircumstances,manyspecialtyorganizationspetitionedCMSandONC, torefocustheEHRobjectivesorexemptthemfromtheprogramastheprogram’sobjectives favoredprimarycareanddidnotmatchtheirspecialties’environment.TheresultofbothrequestswasthecreationoffourhardshipexemptionsinthefinalStage2ruling.Thesehardship exemptionswillbegrantedonlyunderspecificcircumstancesandonlyifCMSdeterminesthat providershavedemonstratedthatthosecircumstancesposeasignificantbarriertotheirachievingMU.Thefourexemptionsare: • Infrastructure: Clinicians must prove that they practice in an area with inadequate internetaccessor“insurmountablebarriers”toobtainingit • New Practitioners:Clinicianswhobeginpracticingin2015wouldbeexemptfromthe MUpenaltyin2015and2016,butwouldhavetodemonstrateMUin2016toavoidthe penaltyin2017. • Unforeseen Circumstances:NaturaldisasterorsomeotherunforeseeableeventthatpreventsmeetingEHRMUcriteria.CMSwillconsiderthisexceptiononacase-by-casebasis. • Scope of Practice: EPswhodonotseepatientsface-to-faceorwhopracticeinmultiple locationswheretheyhavenocontrolovertheavailabilityofEHRtechnology. >The face-to-face exemption is directed towards Anesthesiologists, Pathologists,andRadiologistsandtheseEPsmustberegisteredinMedicare’sPro- ahsrcm.com | 908-279-8120 8 2013 EHR Incentive Program Manual viderEnrollmentChainandOwnershipSystem(PECOS)withaprimaryspecialtyofanesthesiology,pathologyorradiology. >ThemultiplelocationsexemptioncoversEPswhoseepatientsinmultiplelocationssuchasASCsornursinghomeswheretheEPhasnointerestorsay inwhetherthefacilitiesinstallcertifiedEHRsystemsfortheiruse.Asthese facilities are not required under the EHR Programs to be EHR certified, the EPswouldbeartheentireimpactofanypaymentadjustment. >TherulingstatesthattheScopeofPracticeexemptionsmaynotbeawarded formorethan5years.CMSwillregularlyassessmeaningfulusecompliance levelsandtheoverallstateofhealthinformationexchangeandmaymakeregulatory changes or develop new guidance that would eliminate the need for thisexception.Newlegislationmustbepassedinordertomakethisexemptionpermanent. Thedeadlinetoapplyfortheexemptionfromthe2015paymentadjustmentisJuly1,2014.However,CMShasnotyetpublishedtheapplicationprocess. THE REQUIREMENTS FOR REPORTING MEANINGFUL USE EHR SYSTEMS MUST BE CERTIFIED FOR CMS REGULATIONS EPsmustuseEHRsystemsthathavebeencertifiedtomeettheCMSregulationsinordertoreceiveincentivemoney.CMShasapproved6organizationstoperformCompleteEHRand/orEHR Moduletestingandcertification.TheseONC-AuthorizedTestingandCertificationBodies(ATCBs) arerequiredtotestandcertifyEHRstotheapplicablecertificationcriteriaadoptedbytheSecretaryundersubpartCofPart170PartIIandPartIIIasstipulatedintheStandards and Certification Criteria Final Rule ThefollowingorganizationshavebeenselectedasONC-(ATCBs): • Surescripts LLC-Arlington,VA Dateofauthorization:December23,2010. Scopeofauthorization:EHRModules:E-Prescribing,PrivacyandSecurity. • ICSA Labs-Mechanicsburg,PA Dateofauthorization:December10,2010. Scopeofauthorization:CompleteEHRandEHRModules. • SLI Global Solutions-Denver,CO Dateofauthorization:December10,2010. Scopeofauthorization:CompleteEHRandEHRModules. • InfoGard Laboratories, Inc.–SanLuisObispo,CA 9 ahsrcm.com | 908-279-8120 2013 EHR Incentive Program Manual Dateofauthorization:September24,2010. Scopeofauthorization:CompleteEHRandEHRModules. •Certification Commission for Health Information Technology (CCHIT)-Chicago,IL Dateofauthorization:September3,2010. Scopeofauthorization:CompleteEHRandEHRModules. •Drummond Group, Inc. (DGI)-Austin,TX Dateofauthorization:September3,2010. Scopeofauthorization:CompleteEHRandEHRModules. TheCertified Health IT Product ListlistsallEHRsystemsthathavebeencertifiedfortheEHR IncentiveProgram.Thisonlinelistofcertifiedelectronichealthrecordtechnologyisupdatedas ONC-ATCBscertifynewproducts. 2013 REQUIREMENTS FOR STAGE 1 OF MEANINGFUL USE 1.Thereareatotalof25meaningfuluseobjectives(CoreandMenu-set)forEPs.Theseobjectives werecreatedtoshowhowwellaproviderisusingEHRbyensuringbasicpatientinformation iscapturedinthemedicalrecordandenteredintotheEHRsystem.Toqualifyforanincentive payment,20ofthese25objectivesmustbemet. 2.EPsmustalsoreportonatotalof6quality measures:3requiredcoremeasures(substituting alternatecoremeasureswherenecessary)and3additionalmeasures.Amaximumof9measureswouldbereportediftheEPneededtoattesttothe3requiredcore,the3alternatecore andthe3additionalmeasures CORE & MENU-SET OBJECTIVES InordertobeameaningfuluserinStage1,anEPmustreportboththerequired15“coreset”and 5“menuset”objectives(outof10)thatarespecifictoeligibleprofessionals(EPs).TheStage2 RulingmadesomechangestothecurrentStage1objectiveswhichwillbecomeeffective January 1, 2013. Thechangesarelistednexttotheapplicableobjective. CORE OBJECTIVES - EPS ARE REQUIRED TO REPORT THE FOLLOWING 15 EHR OBJECTIVES 1.ComputerizedProviderorderentry(CPOE)-CMSisaddinganoptionalalternatemeasure.The currentmeasureisbasedonthenumberofuniquepatientswithamedicationintheirmedicationlistthatwasenteredusingCPOE.ThenewmeasureisbasedonthetotalnumberofmedicationorderscreatedduringtheEHRreportingperiods. 2.Drug-druganddrug-allergyinteractionchecks ahsrcm.com | 908-279-8120 10 2013 EHR Incentive Program Manual 3.Maintainanup-to-dateproblemlistofcurrentandactivediagnoses 4.Electonic-prescribing-CMSisaddinganadditionalexclusionforproviderswhoarenotwithin a10mileradiusofapharmacythatacceptselectronicprescriptions. 5.Maintainactivemedicationlist 6.Maintainactivemedicationallergylist 7.Recorddemographics 8.Recordandchartchangesinvitalsigns(optional in 2013) -Thecurrentmeasurespecifiesthat vitalsignsmustberecordedformorethan50percentofalluniquepatientsages2andover.The newmeasureamendsthatagelimittorecordingbloodpressureforpatientsages3andover andheightandweightforpatientsofallages.Theexclusionsarealsochanging. 9.Recordsmokingstatusforpatients13yearsandolder 10.ReportambulatoryclinicalqualitymeasurestoCMS/States- Therewillnolongerbeasepa- rate objective for reporting ambulatory CQMs as part of MU. The objective is incorporated directlyintothedefinitionofameaningfulEHRuser. 11.Implementoneclinicaldecisionsupportrule 12.Providepatientswithanelectroniccopyoftheirhealthinformation,uponrequest 13.Provideclinicalsummariesforpatientsforeachofficevisit 14.Capabilitytoexchangekeyclinicalinformationamongprovidersofcareandpatient-authorized entitieselectronically-TheobjectivewillnolongerberequiredforStage1. 15.Protectelectronichealthinformation MENU-SET OBJECTIVES - Providers must choose 5 EHR objectives from the following menu: 1.Drug-formularychecks 2.Incorporateclinicallabtestresultsasstructureddata 3.Generallistsofpatientsbyspecificconditions 4.Sendreminderstopatientsperpatientpreferenceforpreventive/followupcare 5.Providepatientswithtimelyelectronicaccesstotheirhealthinformation 6.Use certified EHR technology to identify patient-specific education resources and provide to patient,ifappropriate 7.Medicarereconciliation 8.Summaryofcarerecordforeachtransitionofcare/referrals 9.Capabilitytosubmitelectronicdatatoimmunizationregistries/systems* 10.Capabilitytoprovideelectronicsyndromicsurveillancedatatopublichealthagencies* *AlloftheStage1publichealthobjectiveswillrequirethatprovidersperformatleastonetestof theircertifiedEHRTechnology’scapabilitytosenddatatopublichealthagencies,exceptwhere prohibited. 11 ahsrcm.com | 908-279-8120 2013 EHR Incentive Program Manual Core and Menu Set Exclusions IfanEPcannotmeetaspecificMUobjectivebecauseitisoutsidethescopeoftheirpracticethey maypossiblybeallowedtoexemptthatobjective.Forthe13ofthe25criteriathathaveexclusions, CMSdesignatesnarrowwindowsforphysicianstoreportthattheobjectiveormeasuredoesnot applytothembecausetheyhavenopatients,ornoorinsufficientnumberofactionsthatwould allowcalculationofthemeaningfulusemeasure.Twoexamplesare •Aphysicianwhohasnopatientsage65orolderorage5oryoungerwouldnothaveto meettherequirementtosendanappropriatereminderto20percentormoreofallpatientsinthoseagegroupsduringtheEHRreportingperiod. •AnEPmustwriteatleast100prescriptionstobeeligibleforthee-prescribingobjective. IfanEPdoesnotwrite100prescriptions,he/shecanbeexemptfromthatobjective. Notall objectivescanbeexcludedbutifanobjectiveisexempt,itcancountthesameasifthat objectivewasmet.Intheaforementionedexamples,theEPmaygivetheobjectivea“0”andthen reportontheremaining19objectives. Detaileddescriptionsofallthecoreandmenu-setobjectivesincludingthenumerators,denominators,thresholdsandexclusionscanbefoundatEHRIncentivePrograms.Attestationrequirementsarealsolisted. CLINICAL QUALITY MEASURES (CQMs) SimilartoPQRS,aspartofthecriteriaforsatisfyingmeaningfuluse,clinicalqualitymeasures resultsmustalsobereportedtoCMSinadditiontotheCoreandMenuobjectives.. InordertoreportqualitymeasuresfromanEHR,electronicspecificationsweredevelopedthat includethedataelements,logic,anddefinitionsforthatmeasureinaformatthatcanbecaptured orstoredintheEHRsothatthedatacanbesentorsharedelectronicallywithotherentitiesina structured,standardized,andunalteredformat. Eachelectronicspecificationcontainsthefollowing4maincomponents •MeasureOverview/Description–Measuretitle,description,number,measurementperiod,measuresteward,andotherrelevantinformationtothemeasure. •MeasureLogic–populationcriteriaandmeasurelogicforthenumerator,denominator andexclusioncategoriesandthealgorithmusedtocalculateperformance •MeasureCodelists •QDS(QualityDataSets)Elements–listsanddescribeseachQualityDataSet(QDS)data elementassociatewiththemeasure. ahsrcm.com | 908-279-8120 12 2013 EHR Incentive Program Manual TheGuide for Reading EP measures andeachmeasureanditscomponentscanbeviewedinthe downloadsectionofthe Quality Measure Specifications site.Bothofthefollowingtwodocuments shouldbeviewedtounderstandtheelectronicmeasuresapplicabletoyourpractice.(Thexxxbelowisthemeasurenumber) 1. NQF_HQMF_HumanReadable_xxx.pdf-ThisfilecontainstheeMeasurespecifications includingmeasurebackgroundinformation,requireddataelements,measurelogicand measurecalculationinstructions. 2. NQF_Retooled_Measure_xxx.xls–Thisfilecontainsallofthecodelists(asynonymfor valuesets)referencedbyallQDSdataelementsintheeMeasures. Reporting Quality Measures EPsmustreporton3requiredCoreQualityMeasures(CQMs),andifthedenominatorofoneor moreoftherequiredcoremeasuresis0,thentheEPsarerequiredtoreportresultsforupto3 alternatecoremeasures(ACMs). Inaddition,EPsmustalsoselect3additionalCQMsfromasetof38CQMs(excludingthecore/ alternatecoremeasures.)Itisacceptabletohave‘0’denominatorsprovidedtheEPdoesnothave anapplicablepopulation. Core Quality Measures-NQF(NationalQualityForum)MeasureNumber&PQRSImplementationNumber/ClinicalMeasureTitle) 1.NQF0013-HypertensionBloodPressureMeasurement 2.NQF0028–PreventiveCareandScreeningMeasurePair a.TobaccoUseAsessment b. TobaccoCessationIntervention 3.NQF0421,PQRS128–AdultWeightScreeningandFollow-up Alternate Core Quality Measures - (NQF Measure Number & PQRS Implementation Number/ ClinicalMeasureTitle) 1. NQF0024–WeightAsssessmentandCounselingforChildrenandAdolescents 2.NQF0041–PQRI110–PreventiveCare&Screening;InfluenzaImmunizationforPatients50Yearsoldandolder 3. NQF0038–ChildhoodImmunizationStatus CLINICAL QUALITY MEASURES – EPS MUST COMPLETE 3 OF THE 38 MEASURES 13 1.Diabetes:HemoglobinA1cPoorControl ahsrcm.com | 908-279-8120 2013 EHR Incentive Program Manual 2.Diabetes:LowDensityLipoprotein(LDL)ManagementandControl 3.Diabetes:BloodPressureManagement 4.HeartFailure(HF):Angiotensin-ConvertingEnzyme(ACE)InhibitororAngiotensinReceptorBlocker(ARB)TherapyforLeftVentricularSystolicDysfunction(LVSD) 5.CoronaryArteryDisease(CAD):Beta-BlockerTherapyforCADPatientswithPriorMyocardialInfarction(MI) 6.PneumoniaVaccinationStatusforOlderAdults 7.BreastCancerScreening 8.ColorectalCancerScreening 9.CoronaryArteryDisease(CAD):OralAntiplateletTherapyPrescribedforPatientswithCAD 10.HeartFailure(HF):Beta-BlockerTherapyforLeftVentricularSystolicDysfunction 11.Anti-depressantmedicationmanagement: (a)EffectiveAcutePhaseTreatment, (b)EffectiveContinuationPhaseTreatment 12.PrimaryOpenAngleGlaucoma(POAG):OpticNerveEvaluation 13.DiabeticRetinopathy:DocumentationofPresenceorAbsenceofMacularEdemaand LevelofSeverityofRetinopathy 14.DiabeticRetinopathy:CommunicationwiththePhysicianManagingOngoingDiabetesCare 15.AsthmaPharmacologicTherapy 16.AsthmaAssessment 17.AppropriateTestingforChildrenwithPharyngitis 18.OncologyBreastCancer:HormonalTherapyforStageIC-IIICEstrogenReceptor/ProgesteroneReceptor(ER/PR)PositiveBreastCancer 19.OncologyColonCancer:ChemotherapyforStageIIIColonCancerPatients 20.SmokingandTobaccoUseCessation,MedicalAssistance: a)AdvisingSmokersandTobaccoUserstoQuit, b)DiscussingSmokingandTobaccoUseCessationMedications, c)DiscussingSmokingandTobaccoUseCessationStrategies 21.Diabetes:EyeExam 22.Diabetes:UrineScreening 24.Diabetes:FootExam 25.CoronaryArteryDisease(CAD):DrugTherapyforLoweringLDL-Cholesterol 26.HeartFailure(HF):WarfarinTherapyPatientswithAtriaFibrillation 27.IschemicVascularDisease(IVD):BloodPressureManagement 28.IschemicVascularDisease(IVD):UseofAspirinorAnotherAntithrombotic 29.InitiationandEngagementofAlcoholandOtherDrugDependenceTreatment: a)Initiation, b)Engagement ahsrcm.com | 908-279-8120 14 2013 EHR Incentive Program Manual 30.PrenatalCare:ScreeningforHumanImmunodeficiencyVirus(HIV) 31.PrenatalCare:Anti-DImmuneGlobulin 32.ControllingHighBloodPressure 33.CervicalCancerScreening 34.ChlamydiaScreeningforWomen 35.UseofAppropriateMedicationsforAsthma 36.LowBackPain:UseofImagingStudies 37.IschemicVascularDisease(IVD):CompleteLipidPanelandLDLControl 38.Diabetes:HemoglobinA1cControl(<8.0%) Clinical Quality Measures Exclusions Iftherequiredcore,alternatecore,orothermeasuresdonotencompassthetypeofpatientsthat anEPtypicallysees,theEPmayassignazerovalue.CMS’guidancestates:“Aneligibleprofessional(EP)isnotexcludedfromreportingcoreclinicalqualitymeasures.However,zeroisanacceptablevaluetoreportforthedenominatorofaclinicalqualitymeasureifthereisnopatientpopulationwithintheEHRtowhomthatclinicalqualitymeasureapplies.Intheeventthatnoneofthe 44clinicalqualitymeasuresappliestoanEP’spatientpopulation,theEPisstillrequiredtoreport azeroforthedenominatorsforallsixofthecoreandalternatecoreclinicalqualitymeasures.”.. REGISTRATION & ATTESTATION FOR THE MEDICARE EHR PROGRAM REGISTRATION CMSstatesallEPsshouldregisterfortheprogrameveniftheyarenotyetonanEHRsystem.An EPmustberegisteredinPECOSbeforeregisteringfortheEHRIncentiveProgram. ToregisterforEHR,thefollowinginformationisneededforeachEP •NationalProviderIdentifier(NPI). •NationalPlanandProviderEnumerationSystem(NPPES)UserIDandPassword. •PayeeTaxIdentificationNumber(ifyouarereassigningyourbenefits). •PayeeNationalProviderIdentifier(NPI)(ifyouarereassigningyourbenefits). Ifyouhavenotyetregistered,seetheRegistration User Guide for Medicare Eligible Professionals forstep-by-stepregistrationinstructions. 15 ahsrcm.com | 908-279-8120 2013 EHR Incentive Program Manual ATTESTATION & eREPORTING TherearetworeportingmethodsavailableforreportingtheStage1measures;Attestationand eReportingPilots. Attestation - EPs must be registered and have decided which objectives and quality measures theywillperformbeforecanattestthattheyareusingacertifiedEHRproduct.AttestationrequirescompletingtheAttestationandPaymentform.CMSwillallowanEPtodesignateathird partytoregisterandattestonhisorherbehalf. ThiswillrequiretheappointedpartytohaveanIdentityandAccessManagementSystem(I&A) webuseraccount(UserID/Password),andbeassociatedtotheEP’sNationalProviderIdentifier (NPI).IftheappointedpersondoesnothaveanI&Awebuseraccount,visitthefollowingwebsite tohaveonecreated. https://nppes.cms.hhs.gov/NPPES/IASecurityCheck.do CMSoffersthefollowingguidebooksofferingstep-by-stepinstructionstoassistEPstoregister andattesttotheEHRIncentiveProgram. Attestation User Guide for Medicare Eligible Professionals For more information on webinar tutorials, attestation worksheets and calculators, visit CMS’ Registration & Attestation site. eReporting Pilots–ParticipationintheeReportingPilotisvoluntaryandenablesEPstoreport EHRMUandPQRSqualitymeasurestogetherandwouldsatisfyrequirementsofboththeMUand PQRSprograms.ThekeydifferencesbetweenthepilotandreportingMUandPQRSseparately: •Reportingperiodistheentireyear •DataissubmittedonMedicareBpatientsonly •ReportthequalitymeasuresrequiredforMU ProvidersmustindicatetheirintenttoparticipateviatheMUattestationpage. Tolearnmoreaboutthisreportingfeatures,clickbelow: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/ downloads/2012PQRS_MedicareEHR-IncentPilot_Final508_1-13-2012.pdf ahsrcm.com | 908-279-8120 16 2013 EHR Incentive Program Manual STAGE 2 – JANUARY 1, 2014 Stage1criteriafocusesonelectronicallycapturinghealthinformationinacodedformatandusingthatinformationtotrackkeyclinicalconditionswhilecommunicatingthatinformationforcare coordinationpurposes.Stage2expandsuponStage1toencouragetheuseofhealthITforcontinuous quality improvement at the point of care and the exchange of information in the most structuredformatpossible. Toaccomplishthis,Stage2willstillrequiremeeting20objectives.Theseobjectiveswillmake mandatorysomeEHRmeasuresthatareoptionalforStage1aswellasupgradeStage1measurestohigherthresholds. Thenumberofrequiredcoresetmeasuresisincreasedto17from15,withEPsreporting3outof 6additionalmenusetmeasures. COREOBJECTIVES •9ofthecurrentStageOne15CoreObjectivesremain •7ofthe10currentmenuobjectiveswillbecomeCoreobjectives •1newcoreobjectivewillbeadded •6ofthecurrentCoreObjectiveswereeitherdeletedorincorporatedintootherobjectives MENUOBJECTIVES •1ofthecurrentmenuobjectiveswillremain •5newobjectiveswillbeadded Inaddition,EPsmustreporton9outof64totalclinicalqualitymeasures(CQMs),selectingthem fromatleast3ofthe6keyhealthcarepolicydomains. Formoreinformation,seethe Stage 1 vs. Stage 2 ComparisonchartofferedbyCMSandseethe Stage2CoreandMenuObjectivesinAddendum1. CLINICALQUALITYMEASURES(CQMs) •In2014,EPsmustreporton9outof64totalclinicalqualitymeasures(CQMs),selecting themfromatleast3ofthe6keyhealthcarepolicydomains.SeeAddendum2forthe 2014CQMs. Other Stage 2 Changes 17 • Electronically reporting CQMs-Beginningin2014,allMedicareEPsbeyondtheirfirst ahsrcm.com | 908-279-8120 2013 EHR Incentive Program Manual yearofdemonstratingMUmustelectronicallyreporttheirCQMdatatoCMS. • Definition Change of Hospital-Based EP–EPswhocandemonstratethattheyfundthe acquisition,implementation,andmaintenanceofCEHRT(certifiedelectronichealthrecordtechnology),includingsupportinghardwareandinterfacesneededformeaningful usewithoutreimbursementfromaneligiblehospitalorCAH,inlieuofusingthehospital’sCEHRT,canbedeterminednon-hospital-basedandpotentiallyreceiveanincentive payment. • Adoption of 2014 Technology Criteria - All EHR Incentive Programs participants will havetoadoptcertifiedEHRtechnologythatmeetsONC’sStandards&CertificationCriteria2014FinalRule • Reporting Period Reduced to Three Months–toallowproviderstimetoadopt2014certifiedEHRtechnologyandprepareforStage2,allparticipantswillhaveathreemonth reportingperiodin2014.Thiswillonlyoccurin2014. • Menu Objective Exclusions–WhileEPsmaycontinuetoclaimexclusionsifapplicable formenuobjectives,startingin2014,theseexclusionswillnolongercounttowardsthe numberofmenuobjectivesneededifthereareothermenuobjectiveswhichtheycan select.EPswillnotbepenalizedforselectingamenuobjectiveandclaimingtheexclusioniftheywouldalsoqualityfortheexclusionsforalltheremainingmenuobjectives. • Batch Reporting-Startingin2014,groupswillbeallowedtosubmitattestationinformationforalloftheirindividualEPsinonefileforuploadtotheAttestationSystem,rather thanhavingeachEPindividuallyenterdata. ADDENDUM 1 - STAGE 2 EHR INCENTIVE PROGRAM 17 CORE OBJECTIVES (EPs must report on all) Current Core Objectives Remaining in Stage 2 1.ComputerizedProviderOrderEntry(CPOE)(Morethan60%ofmedication,30%oflabs, 30%ofradiology) 2.E-prescribing(morethan50%ofprescriptions) 3.Recordpatientdemographicinformation(>80%uniquepatients(UP)) 4.Recordandchartchangesinvitalsigns(>80%UP) 5.Recordsmokingstatusforpatients13yearsorolder(>80%UP) 6.Useclinicaldecisionsupport(5interventions&drug/drug,drug/allergy) 7.PatientElectronicAccesstotheirhealthinformation(>75%UPwith>5%accessing) 8.Provideclinicalsummariesforpatientsforeachofficevisit(>50%ofvisits) 9.Protectelectronichealthinformation ahsrcm.com | 908-279-8120 18 2013 EHR Incentive Program Manual Current Menu Objectives Upgraded to Core Objectives 10.IncorporateclinicallabtestresultsintoEHR(>55%) 11.Generatelistsofpatientsbyspecificconditions 12.Sendreminderstopatientsperpatientpreferenceforpreventive/followupcare(10% w/2ormorevisits) 13.UsecertifiedEHRtechnologytoidentifypatient-specificeducationresources(>10%) 14.Medicationreconciliation(>50%) 15.Summaryofcarerecordforeachtransitionofcare/referral 16.Capabilitytosubmitelectronicdatatoimmunizationregistries/systems* New Objective 17.Use Secure electronic messaging to communicate with patients on relevant health information(>5%) 6 MENU OBJECTIVES (EPs must report on 3 of these objectives) Current Menu Objective Remaining in Stage 2 1.Submitelectronicsyndromicsurveillancedatatopublichealthagencies New Menu Objectives 2.Recordelectronicnotesinpatientrecords(>30%UP) 3.ImagingresultsaccessiblethroughCEHRT(>10%imagingresults) 4.Recordpatientfamilyhealthhistory(>20%UP) 5.IdentifyandreportcancercasestoaStatecancerregistry 6.Identifyandreportspecificcasestoaspecializedregistry(otherthanacancerregistry) DELETED OBJECTIVES: Thefollowingcurrentcoreobjectiveswereeitherdeletedorincorporatedintootherobjectives forStage2. 1.Drug-druganddrug-allergyinteraction(IncorporatedintoCoreObjective#6) 2.Maintainanup-to-dateproblemlistofcurrentandactivediagnoses(Incorporatedinto Stage2objective#15) 3.Maintainactivemedicationlist(IncorporatedintoCoreObjective#15) 4.Maintainanactivemedicationallergylist(incorporatedintoCoreObjective#15) 5.Report ambulatory clinical quality measures (CQMs) to CMS/States (Removed as an objectivebutismandatedasageneralpartofEHR) 19 6.Capability to exchange key clinical information among providers of care and patientahsrcm.com | 908-279-8120 2013 EHR Incentive Program Manual authorizedentitieselectronically(EliminatedinbothStage1&2) 7.Implementdrug-formularychecks(Menu)–(IncorporatedintoCoreObjective2) 8.Providepatientswithtimelyelectronicaccesstotheirhealthinformationwithin4businessdaysofinformationbeingavailabletoEP(Menu)(EliminatedfromStage1in2014 andnolongeranobjectiveforStage2) CLINICAL QUALITY MEASURES (CQMs) FOR 2014 The64final2014qualitymeasuresarelistedinAddendum2. HEALTH CARE POLICY DOMAINS Stage2willoffer64clinicalqualitymeasuresofwhichEPsmustreportonatleast9.The9measuresmustbeselectedfromatleast3ofthefollowing6healthcarepolicydomains. 1.PatientandFamilyEngagement 2.PatientSafety 3.CareCoordination 4.PopulationandPublicHealth 5.EfficientUseofHealthcareResources 6.ClinicalProcesses/Effectiveness ahsrcm.com | 908-279-8120 20 2013 EHR Incentive Program Manual ADDENDUM 2 – 2014 CLINICAL QUALITY MEASURES (CQMs) Italicizes measures were either available or very similar to the measures introduced in Stage 1. The 4-digit number is the NQF (National Quality Forum) clinical measure number. Detailed information such as the measure description, numerator and denominator statements, and the measure steward may be found on the CMS website. 1.0002AppropriateTestingforChildrenwithPharyngitis 2.0004InitiationandEngagementofAlcoholandOtherDrugDependenceTreatment 3.0018ControllingHighBloodPressure 4.0022UseofHigh-RiskMedicationsintheElderly 5.0024WeightAssessmentandCounselingforNutritionandPhysicalActivityforChildrenandAdolescents 6.0028PreventiveCareandScreening:TobaccoUse:ScreeningandCessationIntervention 7.0031BreastCancerScreening 8.0032CervicalCancerScreening 9.0033ChlamydiaScreeningforWomen 10.0034ColorectalCancerScreening 11.0036UseofAppropriateMedicationsforAsthma 12.0038ChildhoodImmunizationStatus 13.0041PreventiveCareandScreening:InfluenzaImmunization 14.0043PneumoniaVaccinationStatusforOlderAdults 15.0052UseofImagingStudiesforLowBackPain 16.0055Diabetes:EyeExam 17.0056Diabetes:FootExam 18.0059Diabetes:HemoglobinA1cPoorControl 19.0060HemoglobinA1cTestforPediatricPatients 20.0062Diabetes:UrineProteinScreening 21.0064Diabetes:LowDensityLipoprotein(LDL)Management 22.0068IschemicVascularDisease(IVD):UseofAspirinorAnotherAntithrombotic 23.0069AppropriateTreatmentforChildrenwithUpperRespiratoryInfection(URI) 24.0070CoronaryArteryDisease(CAD):Beta-BlockerTherapy—PriorMyocardialInfarc- tion(MI)orLeftVentricularSystolicDysfunction(LVEF<40%) 25.0075IschemicVascularDisease(IVD):CompleteLipidPanelandLDLControl 26.0081HeartFailure(HF):Angiotensin-ConvertingEnzyme(ACE)InhibitororAngio- tensinReceptorBlocker(ARB)TherapyforLeftVentricularSystolicDysfunction(LVSD) 21 ahsrcm.com | 908-279-8120 2013 EHR Incentive Program Manual 27.0083HeartFailure(HF):BetaBlockerTherapyforLeftVentricularSystolicDysfunc- tion(LVSD) 28.0086PrimaryOpenAngleGlaucoma(POAG):OpticNerveEvaluation 29.0088DiabeticRetinopathy:DocumentationofPresenceorAbsenceofMacularEdema andLevelofSeverityofRetinopathy 30.0089Diabetic Retinopathy: Communication with the Physician Managing Ongoing DiabetesCare 31.0101Falls:ScreeningforFutureFallRisk 32.0104MajorDepressiveDisorder(MDD):SuicideRiskAssessment 33.0105Anti-depressantMedicationManagement 34.0108A DHD: Follow-Up Care for Children Prescribed Attention Deficit/Hyperactivity Disorder(ADHD)Medication 35.0110BipolarDisorderandMajorDepression:Appraisalforalcoholorchemicalsubstanceuse 36.0384Oncology:MedicalandRadiation–PainIntensityQuantified 37.0385ColonCancer:ChemotherapyforAJCCStageIIIColonCancerPatients 38.0387BreastCancer:HormonalTherapyforStageIC-IIICEstrogenReceptor/Pro- gesteroneReceptor(ER/PR)PositiveBreastCancer 39.0389ProstateCancer:AvoidanceofOveruseofBoneScanforStagingLowRiskProstateCancerPatients 40.0403HIV/AIDS:MedicalVisit 41.0405HIV/AIDS:Pneumocystisjirovecipneumonia(PCP)Prophylaxis 42.0418PreventiveCareandScreening:ScreeningforClinicalDepressionandFollow-UpPlan 43.0419DocumentationofCurrentMedicationsintheMedicalRecord 44.0421PreventiveCareandScreening:BodyMassIndex(BMI)ScreeningandFollow-Up 45.0564C ataracts:Complicationswithin30DaysFollowingCataractSurgeryRequiring AdditionalSurgicalProcedures 46.0565Cataracts:20/40orBetterVisualAcuitywithin90DaysFollowingCataractSurgery 47.0608PregnantwomenthathadHBsAgtesting 48.0710DepressionRemissionatTwelveMonths 49.0712DepressionUtilizationofthePHQ-9Tool 50.TBDChildrenwhohavedentaldecayorcavities 51.1365ChildandAdolescentMajorDepressiveDisorder:SuicideRiskAssessment 52.1401Maternaldepressionscreening 53.1401Maternaldepressionscreening 54.TBDPrimaryCariesPreventionInterventionasOfferedbyPrimaryCareProviders, includingDentists 55.TBDPreventiveCareandScreening:Cholesterol–FastingLowDensityLipoprotein ahsrcm.com | 908-279-8120 22 2013 EHR Incentive Program Manual (LDL-C)TestPerformed 56.TBDPreventiveCareandScreening:Risk-StratifiedCholesterol–FastingLowDensityLipoprotein(LDL-C) 57.TBDDementia:CognitiveAssessment 58.TBDHypertension:Improvementinbloodpressure 59.TBDClosingthereferralloop:receiptofspecialistreport 60.TBDFunctionalstatusassessmentforkneereplacement 61.TBDFunctionalstatusassessmentforhipreplacement 62.TBDFunctionalstatusassessmentforcomplexchronicconditions 63.TBDADEPreventionandMonitoring:WarfarinTimeinTherapeuticRange 64.TBDPreventiveCareandScreening:ScreeningforHighBloodPressureandFollowUpDocumented 23 ahsrcm.com | 908-279-8120
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