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Meaningful Use for Specialists. September 28, 2012 Paul Forlenza , VP Policy and Special Projects Priscilla Phelps , Implementation Specialist Larry Gilbert , Director of Outreach and Business Development. Objectives. To provide: General Meaningful Use information
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Meaningful Use for Specialists September 28, 2012 Paul Forlenza, VP Policy and Special Projects Priscilla Phelps, Implementation Specialist Larry Gilbert, Director of Outreach and Business Development
Objectives • To provide: • General Meaningful Use information • Information on specific criteria • Exclusions • Requirements • Potential concerns • Insights on Clinical Quality Measures (CQMs) • Examples from one specialist • Tools to assist
Medicare EHR Incentive Payments to Eligible Professionals Nationwide Source: CMS August 2012 report
Medicare EHR Incentive Payments to Eligible Hospitals Nationwide Source: CMS August 2012 report
Medicare EHR Incentive Payments to Vermont Eligible Professionals by County Compiled from CMS August 2012 report
Medicaid EHR Incentive Payments to Vermont Eligible Professionals Source: DVHA Sept. 2012
Medicaid EHR Incentive Payments to Vermont Eligible Hospitals Source: DVHA Sept. 2012
Medicaid EHR Incentive Payments to Vermont Eligible Professionals by County Compiled from DVHA Sept. 2012 Report
Items to Ponder • Specialists ARE meeting the Meaningful Use criteria and receiving incentive money • Percentage indicated is not enough • “More than” 50% really means at least 51% (rounded) • Both Core and Menu criteria have exclusions on several items • Exclusions count as criteria being “met”
Specific Core Criteria • Use of Computerized Provider Order Entry for Medications (C1) • Generate and transmit permissible prescriptions electronically (C4) • Exclusion for providers who write fewer than 100 prescriptions in reporting period • Maintain up-to-date problem list for current/active diagnoses (C3) • Maintain active medication list (C5) • Maintain and active medication allergy list (C6) • No exclusions, but • Have at least ONE entry or an indication of “none” or “no known”
More Core • Record and chart changes in vital signs (C8) • Exclusion if height, weight and blood pressure have no relevance to scope of practice • Provide patients with an electronic copy of their health information (C12) • Exclusion if no patients or their agents request an electronic copy
Security Risk Assessments • Protect electronic health information (C15) • Security Risk Assessment (SRA) • Requirements in 45 CFR 164.308 (a)(1) list more than a quick review of your EHR security • One SRA for all providers in same office using the same EHR • VITL Implementation Specialists conduct SRAs to allow EPs to meet this measure • Take roughly 5-6 hours to complete, including on-site visit and analysis returned to practice
Menu Set Criteria • Implement drug formulary checks (M1) • Exclusion for providers who write fewer than 100 prescriptions in reporting period • Incorporate clinical lab test results into an EHR as structured data (M2) • Requires a lab interface or data entry of results • Exclusion if no labs with results as a numerical or negative/positive format are ordered • Medication reconciliation at a transfer IN from another setting of care (M7) • Summary of Care for patients transitioned TO another setting (M8) • Exclusions: • Not the recipient of a transitioned patient during the reporting period(M7) • No patients are transferred out or referred to another provider (M8)
Public Health Measures (PHM) • MUST select one PHM in Menu criteria • Capability to submit data to an immunization registry (M9) • In Vermont, you should select this measure • At this time, take exclusion #2 during attestation – “where no immunization registry has the capacity to receive…” • May also be able to take exclusion #1, if zero immunizations are administered during the reporting period • Immunization registry is under construction • Capability to provide syndromic surveillance data (M10) • In Vermont, this is not a viable option at this time
Clinical Quality Measures (10a,b,c) • Must report • Three (3) core or • Core and alternate core to total three (3) • AND • Three (3) from the list of 38 measures • To total six (6) • Current list does not fit many specialties • Select any that are relevant • Then look for those with potential relevance • Or ease of recording • Zeros are acceptable in both the numerator and denominator • No percentages to meet!
Real Life Example • Pain management practice, single provider • Live with EHR in February 2011 • Attested to Meaningful Use for 90-day period ending 12/31/11 • Took exclusions for • CPOE (C1), E-prescribing (C4), Providing electronic copies (C12) • Drug formulary checks (M1), Immunization registry (M9) • Clinical Quality Measures: • Reported two core • One alternate core with zeros, as none applied • Low back pain: Use of Imaging studies • Diabetic: foot exams • Pneumonia vaccines for older patients
Stage 1 Changes • Most voluntary in 2013 – required in 2014 • Change CPOE denominator: # of medication orders • Vital Signs: exclusion and age requirement revised • Test exchange key clinical information removed • Add view, download or transmit patient data
Stage 1 Changes • E-prescribing exclusion added (2013) • Menu set exclusion limited (2014) • EP must create record directly in CEHRT (2013)