Meaningful Use – Eligible Provider

1. Overview Meaningful Use – Eligible Provider

2. Introductions & Objectives • Office of Clinical Effectiveness – Ambulatory Team • Report up through Karen Cox, PhD. and Kristin Hahn-Cover, M.D. • Ambulatory Team • Lori J. Johnson (Coordinator, Quality Improvement) JohnsonLJ@health.missouri.edu or 882-2665 • Somosree Dutt (Methods and Procedures Analyst) DuttS@health.missouri.edu or 882-2682 • Jennifer Evans (Office Support Staff) EvansJP@health.missouri.edu or 884-2409 • Objectives of today’s presentation are to provide you with: • an overview of Meaningful Use of the EMR incentive program for Eligible Professionals (EP’s). • what you need to know/do in order to be a “Meaningful User” to gain incentives/avoid payment adjustments.

3. Meaningful Use Eligible Professional Basics • The EHR Incentive Program provides incentive payments for certain healthcare providers to use EHR technology in ways that can positively impact patient care. (taken from http://www.cms.gov/EHRIncentivePrograms/Downloads/Beginners_Guide.pdf) • There are 2 EHR Meaningful Use incentive programs ; 1 for hospitals and 1 for eligible professionals. Focus today = eligible professional. • EHR Incentive Program is a CMS program but is separate from CMS PQRS and e-Rx programs. • There are 3 stages of Meaningful Use – we are in stage 1. • Incentive programs are available for Medicare and Medicaid Eligible Professionals (can only participate in Medicaid or Medicare, not both in same year). • EHR (Meaningful Use) Incentive Program is provider specific (i.e. not location or group specific).

4. 3 Stages Chart copied from: An Introduction to the Medicare EHR Incentive Program for Eligible Professionals - http://www.cms.gov/EHRIncentivePrograms/Downloads/Beginners_Guide.pdf Stage 2 to begin in 2014. Proposed rule for stage 2 published, comment period ended 5/7/12, awaiting final rule. If not delayed, stage 3 to begin in 2015. Guidelines not yet available for stage 3.

5. Medicare Versus Medicaid EHR Incentive Program Chart copied from: http://www.cms.gov/EHRIncentivePrograms/Downloads/Beginners_Guide.pdf Screen clipping taken: 11/28/2011, 8:59 AM • Note: • Incentives are per eligible provider. • Medicaid $’s are a fixed amount/year. • Medicare - The incentive payment is 75% of Medicare allowed charges up to a maximum annual cap. • Medicare eligible professionals who do not meet the requirements for meaningful use by 2015 and in each subsequent year are subject to payment adjustments to their Medicare reimbursements that start at 1% per year, up to a maximum 5% annual adjustment.

6. Eligible Professionals Medicare Medicaid Physician Dentist Certified nurse-midwife Nurse practitioner Physician assistant practicing in a FQHC or RHC led by a physician assistant • Doctor of medicine or osteopathy • Doctor of oral surgery or dental medicine • Doctor of podiatric medicine • Doctor of optometry • Chiropractor • Note: • Provider is not eligible for either program if 90% or more of services are provided in an inpatient hospital or emergency room setting. • Eligible for Medicaid if at least 30% (20% for peds) of services furnished are to Medicaid patients in an outpatient setting.

7. Meaningful Use Stage 1 Requirements Each provider must report: • 15 Core Functional Measures (some have minimum performance thresholds) • 5 of 10 Menu Functional Measures • 3-6 Core Clinical Quality Measures • 3 Menu Clinical Quality Measures

9. Must report 5 of 10 for Stage 1 • Working with Cerner to meet as many as possible for Stage 1; will choose menu measures as an institution rather than each individual.

10. Keys to meeting Meaningful Use (slide 1 of 2)

11. Keys to meeting Meaningful Use (slide 2 of 2) • Clinical Quality Measures (CQM’s): • Currently just expected to measure them with certified EHR (no performance thresholds) • Working with each department on selection of menu CQM’s • Will work with departments on performance improvement once baselines established

12. Clinical Quality Core Measures • 3 required core measures: • Hypertension: Blood pressure measurement (NQF 0013) • Tobacco use assessment & tobacco cessation intervention (NQF 0028) • Adult weight screening and follow up (NQF 0421) • 3 alternate core measures (must report if the denominator of 1 or more of the required core measures is zero, then EPs are required to report results for up to 3 alternate core measures) • Weight assessment and counseling for children and adolescents (NQF 0024) • Influenza immunization for patients 50 years old or older (NQF 0041) • Childhood immunization status (NQF 0038)

13. Additional Clinical Quality Measures • 38 additional clinical quality measures. Each EP must report 3 of the 38. • Each department and/or division is choosing the 3 (instead of each provider) • Choosing based on patient population and overlap with other quality reporting programs (e.g. PQRS/GPRO, pay P4P programs) • It is acceptable to have a '0' denominator provided the EP does not have an applicable population. • If the EP reports zero values for these three additional, menu-set clinical quality measures, then the EP will have to attest that all the other menu-set quality measures calculated by the certified EHR technology have a value of zero in the denominator.

14. Next Steps – Providers and Clinic Staff • Now: • Start (or continue) meaningful using • Don’t hesitate to ask questions • 2/27 – 5/26 –90 day attestation period for primary care. • May – early June – review 90 day meaningful use results and approve OCE to use data to attest on your behalf. • After Attestation – CONTINUE TO MEANINGFUL USE – Required to attest annually (for entire calendar year) to receive incentive and avoid future payment adjustments. • Use monthly dashboards to monitor and adjust performance.

15. What to expect from us • Clinic education • Provider, clinic, and department level dashboards – monthly • Clinic and department communications regarding 90 day attestation period • Summary of your 90 day Meaningful Use results for your signature • Submission of your results/attestation to CMS

16. Dashboards – Provider SummaryExample 15 Core Functional Measures Note – Above was generated with test data. Is not actual provider performance.

17. Dashboards – Department and Clinic Level Summaries Note – Above was generated with test data. Is not actual department performance.

18. Dashboards – Department & Clinic Detail

19. Resources • CMS EHR Incentive Site - https://www.cms.gov/EHRIncentivePrograms/01_Overview.asp#TopOfPage • An Introduction to the Medicare EHR Incentive Program for Eligible Professionals - http://www.cms.gov/EHRIncentivePrograms/Downloads/Beginners_Guide.pdf • MO Medicaid EHR Incentive Site - http://mo.arraincentive.com/default.aspx • University Physician – Office of Clinical Effectiveness, Ambulatory: • Lori J. Johnson (Coordinator, Quality Improvement) JohnsonLJ@health.missouri.edu or 882-0492 • Somosree Dutt (Methods and Procedures Analyst) DuttS@health.missouri.edu or 882-2682 • Jennifer Evans (Office Support Staff) EvansJP@health.missouri.edu or 884-2409

20. Incentives • Note: • Medicaid $’s are a fixed amount/year. • Medicare - The incentive payment is 75% of your Medicare allowed charges up to a maximum annual cap. • Medicare eligible professionals who do not meet the requirements for meaningful use by 2015 and in each subsequent year are subject to payment adjustments to their Medicare reimbursements that start at 1% per year, up to a maximum 5% annual adjustment.