The 411 on Medicare Meaningful Use Incentives and the Attestation Process for Physician Practices

1. The 411 on Medicare Meaningful Use Incentives and the Attestation Process for Physician Practices

2. Speakers: . • Mary Zile, Director of Practice Consulting, Tri-State REC (moderator) • Michelle Emerson, Practice Consultant, Tri-State REC • Stefanie Strinko, Practice Consultant, KY REC • Dr. Mark Frazer, Summit Family Physicians • Leah Brunie, Certified Nurse Practitioner, Summit Family Physicians

3. Meaningful What? • I am Busy, Give Me the 10 Second Summary. • Who Thought Meaningful Use was a Good Idea? • What’s The Point? • Looks like Everyone Else has Started Without Me. • What if I Am the Only One Who Doesn’t Want to Do This? • Is it Getting Too Late to Start? • Am I in This Alone? • What’s in it for Me? .

4. I Am Busy, Give Me the 10 Second Summary • The Purpose of Meaningful Use • Process to incorporate “evidence-based practice, effective use of information technology, quality measurement and improvement, cost awareness, care coordination, leadership of interdisciplinary teams, and shared decision making” that needs to occur in parallel with the reshaping of US healthcare. • -Glenn Hackbarth • Recognition that Health IT is an Important Enabler of the new delivery models and payment structures that are Improving Health Care • Health Affairs, 3, 2012 31:3 pg 481 .

5. Who Thought Meaningful Use Was a Good Idea? • HITECH provisions of the ARRA of 2009 committed $14-$27 billion in incentives over ten years for providers and hospitals • American Association of Medical Colleges, 1998 • Howard Hughes Medical Institute and the American Association of Medical Colleges • American Board of Medical Specialties, October 2011 • American Medical Informatics Association • The National Board of Medical Examiners • Liaison Committee on Medical Education • The Accreditation Council for Graduate Medical Education .

6. What’s The Point? • Improve quality, safety (such as e-prescribing), efficiency, and reduce health disparities • Engage patients and families for patient centered care (such as providing health information to patient upon request) • Improve care coordination (electronically sending health information to other providers) • Improve population and public health • Ensure privacy and security protection for personal health information • Efforts for cost containment by improving efficiency, reducing redundancy, and providing information in real time .

7. Looks Like Everyone Else Has Started Without Me • Number of physicians reporting use of an EHR doubled since 2008, from 16.9% to 33.8%, with acceleration expected due to attainment of incentive program objectives. • Congressional Research Service anticipates that the HITECH incentives will increase EHR growth; by 2019 70% hospitals and 90% providers. • 90% of medical school students gave their student some access to EHRs as early as 2006. –Atul Grover, chief public policy officer, Association of American Medical Colleges, 12/20/ 2011). .

8. What if I am the Only One Who Doesn’t Want to Do This? • Physician licensure is state specific with precedent set. 2008 Massachusetts enacted legislation requiring that physicians adopt electronic health records by 2015 in order to obtain or renew licenses. • Recommendations for other states to follow, including recommendations to tie physician licensure to meaningful-use standards. • American Board of Medical Specialties has already taken steps to incorporate health IT training and skills assessment maintenance of board certification for primary care physicians, with ‘self-assessment’ modules related to Meaningful Use. • Regional and national health insurance payment methodologies being developed based on NCQA PCMH, MU, and public reporting. • Penalties start in 2015. .

9. Am I in This Alone? There Is Help • Tri-State Regional Extension Center • (REC) • WHAT IS IT? • New federally-funded collaboration led by HealthBridge • GOAL: Help eligible professionals • implement technology • achieve meaningful use and • qualify for incentives

11. Tri-State REC Partners

12. REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services . Eligibility for Incentives

13. REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services . Is it Getting Too Late to Start? Medicare

14. REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services . Is It Getting Too Late to Start? Medicaid

15. REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services . What’s in it for Me? Medicare

16. REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services . What’s in it for Me? Medicaid

17. Summit Family Physicians(513) 424-01221010 Summit Dr Middletown, OH 45042Discussion by Dr. Mark FrazerDr. Timothy Wourms, M.D.Dr. Kevin Strait, M.D.Lean Brunie C.N.P.

18. Milestone 1 Tri-State REC sign upPractice Management Implementation: 6/2011EHR Implementation: 9/20/2011Milestone 2 EHR Go-Live, Quality Reporting, e-Prescribing: 11/4/201190 day Attestation Period: 10/2011-12/2011Meaningful Use Attestation: 12/30/2011Meaningful Use Payment Received: 3/2/2012 Summit Family Physicians

19. What is Meaningful Use? Meaningful Use is a list of objectives that an eligible provider must meet in order to participate in the EHR Incentive Program.

20. Core Set • Use computerized order entry for medication orders. • Implement drug-drug, drug-allergy checks. • Generate and transmit permissible prescriptions electronically. • 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 old or older.

21. Core Set (cont.) • Implement one clinical decision support rule. • Report ambulatory quality measures to CMS or the States. • Provide patients with an electronic copy of their health information upon request. • Provide clinical summaries to patients for each office visit. • Capability to exchange key clinical information electronically among providers and patient authorized entities. • Protect electronic health information (privacy & security)

22. Core Measure 6: Allergies

23. Core Measure 7: Demographics

24. Core Measure 8: Vital Signs

25. Core Measure 9: Smoking Status

26. Core Measure 13: Clinical Summaries

27. Clinical Workflow Analysis

28. Clinical Workflow Analysis

29. How the EHR Implementation Affected: Processes Staff Communication WorkflowDiscussion by Lean Brunie C.N.P.

30. Privacy and Security Tools • Risk Assessment Questionnaire • Fact and Guidance Sheets • Business Impact/Disaster Recovery Template • Policy and Procedure Templates • Staff and Admin User Security Training Presentations • BAA and Confidentiality Agreement Templates • Privacy and Security Overview available at http://www.tristaterec.org/

31. Vendor Dashboard – e-MDs

32. Vendor Dashboard – eClinical Works

33. Medicaid Registration Guidance

34. CMS Registration Page

35. CMS EHR Incentive Home Page

36. Payment Assignment • Select SSN only if the Provider receives Medicare payments to his/her SSN • Select EIN if group receives payment (You will also need to select the Group Name.)

37. Attestation for Numerical Criteria

38. Attestation for Yes/No Criteria

39. Menu Measure 9: Immunization Registry • Kentucky Providers MUST connect to the Immunization Registry via the Kentucky Health Information Exchange. • Charlese Blair, KHIE Intake CoordinatorCharlese.Blair@ky.gov(502) 564-7992, Ext. 2656

40. Impact of EHR Implementation and Meaningful Use Discussion by Dr. Frazer

41. Lessons Learned • Involve entire team – get early buy-in • Identify a clinical champion and MU lead • Select Medicare/Medicaid incentive program • Register early • Create a plan • Discuss menu items early • Take advantage of REC and vendor tools and training • Monitor progress weekly/biweekly and report to staff • Have attestation reports printed and ready to go when attest • Remember this is an iterative process • Breathe! You can do this!

42. Questions?