Vermont Information Technology Leaders, Inc.

1. Vermont Information Technology Leaders, Inc. Meaningful Use Stage 2 For Eligible Professionals Carol Kulczyk October 10, 2012 ckulczyk@vitl.net 802-839-1957

2. Vermont Information Technology Leaders (VITL) • Non-profit organization funded by the Federal Office of the National Coordinator for Health Information Technology within HHS to provide direct assistance to primary care providers in Vermont • Manages the Vermont Health Information Exchange with funding from the State of Vermont • Offices in Montpelier and Burlington

3. Stage 2 Final Rule • Defines Stage 2 and Changes to Stage 1 • Clarification on timing of Stages • New Clinical Quality Measures and reporting mechanism • Medicaid program changes • Payment adjustments and hardship exemptions • Hints for Stage 3 • Patient engagement focus

4. Summary of Stage 2 • Retains Core/Menu Measures structure • Most stage 1 Menu Measures become Stage 2 Core Measures • Some Stage 1 Measures eliminated/combined • Most patient thresholds raised • New Measures: Core (1), Menu (6) • List of Clinical Quality Measures expanded • New method for electronic submission of patient information

5. Stage 2 Measures

6. Clinical Quality Measures as of 2014 • Clinical Quality Measures (“CQMs”) • No longer tied to a specific stage • Whether a first-time Stage 1 meaningful user or a Stage 2 meaningful user, EPs must complete 9 of 64 available CQMs • EP/EH will need to upgrade to a 2014 CEHRT • 90 day reporting period whether EP is in Stage 1 or 2 (Calendar year 2014 only)

7. Timing for Medicare EP

8. Timing for Medicaid EP

9. For 2014 Only • Eligible Professionals (EPs) required to demonstrate MU for 3 month period (allows for time to upgrade to 2014 CEHRT) • Medicare: reporting period aligned to calendar year quarters (Jan.- Mar., Apr.- Jun., Jul.- Sept., Oct.- Dec.) • Medicaid:any consecutive 90 day reporting period

10. Clinical Quality Measures • CQMs aligned with National Quality Strategy (NQS) policy domains • Patient and Family Engagement • Patient Safety • Care Coordination • Population and Public Health • Efficient use of healthcare resources • Clinical processes/effectiveness • CQM list to be posted in future

11. CQM Changes

12. Transformed Measures Stage 1 Provide patients with an e-copy of their health information Provide online access Stage 1 Test of exchange of key clinical information Stage 1 (in 2013) and Stage 2: Provide transition of care record to another setting of care Stage 2: Provide patients with timely online access to their health information

13. Stage 2: Transitions of Care • Provider must send summary of care for > 50% of transitions of care and referrals to another setting of care • More than 10% must be electronic, using CEHRT • At least 1 summary of care document sent electronically to recipient with either different EHR vendor or CMS test EHR • Exclusion: less than 100 transitions/referrals during EHR reporting period

14. Stage 2: Patient Access • Provide 50% of unique patients seen by EP with timely online access to their health information • within 4 business days after data available to EP • EP’s discretion to withhold information • For > 5% of unique patients seen by EP • must view online, download or transmit to 3rd party their health information • Patient portal acceptable if certified by ONC

15. Stage 2: Patient Communication • More than 5% of unique patients seen by EP must send secure messages to their EP using CEHRT • Email • Personal Health Record function • Online portal • Exclusion - based on lack of 3Mbps broadband availability in county (determined by FCC)

16. CQMs Aligned with Other Programs • Starting 2014, CMS will align • Hospital Inpatient Quality Reporting (IQR) Program • Physician Quality Reporting System (PQRS) • Children's Health Insurance Program Reauthorization Act (CHIRPA) • Accountable Care Organizations (ACO) • Meaningful Use CQMs • Alignment includes: • Choosing same measures for different programs • Identifying ways to minimize multiple submissions

17. 2014 - Reporting Mechanism for CQMs • EPs submit group CQM data using one file for all participating EPs • File will be uploaded to CMS system

18. Medicaid EP Eligibility Determination • Encounter defined as “any service rendered on any one day to an individual enrolled in a Medicaid program…” • the encounter counts even if Medicaid did not pay for the service • excludes stand-alone Title 21 patients

19. Payment Adjustments * CMS only requiring 90 days of MU in 2014. For full description of payment adjustments, see CMSPayment Adjustments & Hardship Exceptions Tip Sheet for EPs

20. Payment Adjustments * EPs must attest to meaningful use for 90 days no later than Oct. 1, 2014

21. Payment Adjustment Hardship Exceptions • Lack of Infrastructure • New Eligible Professional • Unforeseen Circumstances • Scope of Practice (ex. - anesthesiology, radiology, pathology) • Lack of interactions with patients • Lack of follow-up needed with patients • EP in multiple locations: lack of control over availability of CEHRT at practice location

22. Stage 1 Changes • Most voluntary in 2013 but required in 2014 • CPOE denominator: alternative measure • Vital Signs: exclusion/age requirement revised • Removed test exchange key clinical information • Added view,download, and transmit patient data • E-prescribing exclusion added (no pharmacy accepting e-Rx within 10 miles)

23. Stage 1 Changes • Enter at least (1) electronic progress note, edited, and signed by EP for >30 % of unique patients • Electronic progress notes must be text-searchable • Non-searchable notes do not qualify, but not all content has to be character text I’m sorry, I don’t understand this • Drawings and other content can be included with searchable text notes • Menu set exclusion limited (2014)

24. Stage 3 • CMS will finalize criteria early 2014 to start in 2016 and will focus on: • Promoting improvements in quality, safety and efficiency leading to improved health outcomes • Decision support for national high priority conditions • Patient access to self-management tools • Access to comprehensive patient data through robust, secure, patient-centered HIE • Improving population health

25. Next set of slides has detailed information • Clarification about non-hospital based EP • Patient information required online • Stage 2 Core Measures • Stage 2 Menu Measures • Additional resources and contacts

26. Requirements for EPs seeking to reverse a hospital-based determination • Beginning in payment year 2013, EP who meets the definition of hospital-based EP but who can demonstrate to CMS that EP funds the acquisition, implementation, and maintenance of CEHRT, including supporting hardware and interfaces needed for meaningful use without reimbursement from an eligible hospital or CAH, and uses such CEHRT in the inpatient or emergency department of a hospital (instead of the hospital’s Certified EHR Technology), may be determined by CMS to be a non-hospital-based EP.

27. Process for determining a non-hospital-based EP • When an EP registers for a given payment year they should receive a determination of whether they have been determined "hospital-based." • An EP determined "hospital-based," but who wishes to be determined non-hospital-based, may use an administrative process to provide documentation and seek a non-hospital-based determination. • Such administrative process will be available throughout the incentive payment year and including the 2 months following the incentive payment year in which the EP may attest to being a meaningful EHR user.

28. Online Access Information Required • Patient name, provider’s name, and office contact information • Current and past problem list • Procedures and laboratory test results • Current medication list and medication history • Current medication allergy list and medication allergy history • Vital signs (height, weight, blood pressure, BMI, growth charts) • Smoking status • Demographics (language, sex, race, ethnicity, date of birth) • Care plan field(s), including goals and instructions • Any known care team members including the Primary Care Provider

29. Stage 2 Core EP * Must be recorded as structured data

30. Stage 2 Core EP * Must be recorded as structured data

31. Stage 2 Core EP

32. Stage 2 Core EP

33. Stage 2 Core EP

34. Stage 2 Core EP

35. Stage 2 EP Menu Objectives

36. Resources and Contacts • CMS resources for stage 2 http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html • VITL resources at http://www.vitl.net/resources • Contacts at VITL • If you would like to use VITL services, please contact Larry Gilbert lgilbert@vitl.net 802-839-1943 • If you are already a VITL customer, please contact Carol Kulczyk ckulczyk@vitl.net 802-839-1957

37. Discussion ……. Questions?