NPRM Meaningful Use Stage 2 What’s new, what’s the same?

1. NPRM Meaningful Use Stage 2 What’s new, what’s the same? May 5, 2012 - HIMSS Renee’ Rowell, MS, RHIA, CCS, CPHIT This document was developed by CIMRO of Nebraska through funding from the United States Office of the National Coordinator, Department of Health and Human Services, grant number 90RC0018/01. Form No. 0227-0512

3. Meaningful Use – Stage 2 NPRMs • Notice of Proposed Rule Making: –Medicare and Medicaid Programs Electronic Health Record Incentive Programs – 77FR13698 – March 7, 2012 – Comments due: May 7, 2012 • Health Information Technology Standards, Implementation Specifications, and Certification Criteria for EHR Technology, 2014 Edition… – Office of the National Coordinator for HIT (ONC) – 77FR13832 – March 7, 2012 – Comments due: May 7, 2012

4. Stage 2 NPRMs • Proposed Rules – not final rules, already changes • Most will be in 2014 • Comments due by close of business (5:00 pm ET) May 7, 2012 – various media • Final Rules? – Could be modified by comments – Separate rules for Incentive Program vs. EHR Certification – December 2012?

5. Objectives and Measures • Requirements for core and menu sets continue • More focus on transition of care • Several Stage 1 measures are combined • Measurement thresholds are increased • Expanded definition of Medicaid patient • “Minor” delay of S2, delayed until FY/CY 2014 • Clarify providers demonstrating MU first time, EHR reporting period = 90 days regardless of payment year • Clinical quality reporting becomes part of the definition of a “meaningful user”

6. Modifications Cont’d… • Intent for Stage 3 proposed rules out in early 2014 • Exclusions no longer count to meet MU objectives • All denominators move to all patient encounters at OP locations with CEHRT • “Meaningful User” = 50% of encounters in EHR reporting period must be seen in practice(s)/location(s) equipped with a Certified EHR Technology (Same as Stage 1)

7. CAH Concepts • Requirements for core and menu sets continue • More focus on transition of care • Several stage 1 measures are combined • Measurement thresholds are increased • Reporting on CQMs will: - Be aligned with other CMS quality reporting requirement - Be submitted electronically – CMS is looking for comment on this process

8. Meaningful Use Stage 1 to Stage 2

27. Meaningful Use Stage 2 Clinical quality measures (cqms)

29. Meaningful Use Stage 2 - CQMs • Most Stage 2 CQMs are endorsed by National Quality Forum • CHANGE: CQMs no longer objectives, CMS is proposing integrated directly into MU EHR user definition • Goal – 2014 CQMs align with existing programs • Physician Quality Reporting System (PQRS) • CMS Shared Savings Program (ACO) • Hospital Inpatient Quality Reporting (HIQR) • Joint Commission

35. Payment Adjustments

36. Payment Adjustments and Exceptions • Medicare payment adjustment begin 2015 • Adjustments can be avoided if: - Provider qualifies as a meaningful user in 2013, or - Provider qualifies for the 90-day period within 2014 depending on FY or CY year • Exceptions (demonstrated): - Lack of available Internet access or barrier to IT infrastructure - Newly practicing EPs or new hospitals – time limited - Unforeseen circumstances - (Possible?) Combination of clinical features limiting a provider’s interaction with patients

42. Registration, Attestation and Payment • Providers register at the CMS website • Download Registration User’s Guide from https://ehrincentive.cms.gov • Hospitals sign up as dually eligible • Attestation electronically • Verification • Payment • Audit and Appeal

43. Questions/Comments • Send comments/questions to either rrowell@widerivertec.org or contact your Wide River TEC Project Lead • Or visit widerivertec.org/splash and post your comments in the Meaningful Use Café

44. Contact Information Wide River Technology Extension Center 1230 O Street, Suite 120 Lincoln, Nebraska 68508 P: 402.476.1700 F: 402.476.1707 W: www.widerivertec.org Blog: widerivertec.wordpress.com