2013 Crossroads Conference Texas RECS Update Meaningful Use and EHR Incentive Program Basics

1. 2013 Crossroads Conference Texas RECS Update Meaningful Use and EHR Incentive Program Basics Presentation - Carson Scott June 6, 2013

2. Meaningful Use Basics

3. Meaningful Use Core Measures (15) (1) Use CPOE for medication orders directly entered by any licensed healthcare professional. (2) Implement drug-drug and drug-allergyinteraction checks. (3) Maintain an up-to-date problem list of current and active diagnoses. (4) Generate and transmit permissible prescriptions electronically (eRx). (5) Maintain active medication list. (6) Maintain active medication allergy list. (7) Record all of the following demographics: • Preferred language, Gender, Race, Ethnicity, Date of birth (8) Record and chart changes in the following vital signs: • Height, Weight, Blood pressure, Calculate BMI, Plot and display growth charts for children 2–20 years, including BMI. (9) Record smoking status for patients 13 years old or older.

4. Meaningful Use Core Measures (15) (10) Report ambulatory clinical quality measures to CMS or, in the case of Medicaid EPs, the States. (11) Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule. (12) Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, medication allergies) upon request. (13) Provide clinical summaries for patients for each office visit. (14) Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically. (Removed for 2013) (15) Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. Security & Risk Analysis.

5. Meaningful Use Menu Set Measures (5) (1) Implement drug formulary checks. (2) Incorporate clinical lab-test results into EHR as structured data. (3) Generate lists of patientsby specific conditions to use for quality improvement, reduction of disparities, research, or outreach. (4) Send patient remindersper patient preference for preventive/follow-up care. (5) Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP. (6) Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. (7) The EP who receives a patient from another setting of care or provider of care should perform medication reconciliation. (8) The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care recordfor each transition of care or referral.

6. Meaningful Use Public Health Measures (9) Capability to submit electronic data to immunization registries or immunization information systemsand actual submission according to applicable law and practice. OR (10) Capability to submit electronic syndromic surveillance datato public health agencies and actual submission according to applicable law and practice.

7. Changes to Stage 1 for 2013 https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1ChangesTipsheet.pdf Optional alternate measure added for CPOE Exclusion added for Electronic Prescribing Optional changes for Blood Pressure age limit Optional new exclusions for EPs Electronic exchange of key clinical information not required in Stage 1 for 2013 No longer a separate objective for reporting CQM Public Health Reporting

8. Meaningful Use Stage 2 Summary Final Rule Released, August, 2012 Stage 2 begins in 2014 Most of the Stage 1 Menu Set Objectives have been moved to Stage 2 Core Set Objectives Most of the thresholds have been increased Inclusion of patient portals and electronic access to health information

9. Stage 2 Requirements Eligible Professionals 15 core objectives 5 of 10 menu objectives 20 total objectives Eligible Professional 17 core objectives 3 of 6 menu objectives 20 total objectives Eligible Hospitals & CAHs 14 core objectives 5 of 10 menu objectives 19 total objectives Eligible Hospitals & CAHs 16 core objectives 3 of 6 menu objectives 19 total objectives http://www.cms.gov/EHRIncentivePrograms/

10. Medicare and Medicaid EHR Incentive Program Basics

11. Eligible Provider (EP): Medicaid Basics • Must be one of 5 types of EPs • Physicians (primarily doctors of medicine and doctors of osteopathy) • Nurse practitioner • Certified nurse-midwife • Dentist • Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant. Must either: • Have ≥ 30% Medicaid patient volume (≥ 20% for pediatricians only); or • Practice predominantly in an FQHC or RHC with ≥30% needy individual patient volume • Licensed, credentialed • No OIG exclusions (http://exclusions.oig.hhs.gov/), • Must not be hospital-based

12. EP Eligibility: Medicare Basics • Eligible professionals under the Medicare EHR Incentive Program include: • Doctor of medicine or osteopathy • Doctor of dental surgery or dental medicine • Doctor of podiatry • Doctor of optometry • Chiropractor • Must have Part B Medicare allowed charges • Must not be hospital-based • Must be enrolled in PECOS

13. Hospital Eligibility • What is an Eligible Hospital under the Medicaid EHR Incentive Program? • Acute care hospitals (including CAHs and cancer hospitals) with at least 10% Medicaid patient volume • Children's hospitals (no Medicaid patient volume requirements) • What is an Eligible Hospital under the Medicare EHR Incentive Program? • "Subsection (d) hospitals" in the 50 states or DC that are paid under the Inpatient Prospective Payment System (IPPS) • Critical Access Hospitals (CAHs) • Medicare Advantage (MA-Affiliated) Hospitals

14. Medicaid Incentive Program

15. Medicare Incentive Payment

16. Potential Fines/Reductions/Audits • Medicare reimbursement (-1% for 2015, -2% for 2016, -3% thereafter) • Medicare e-Prescribing reimbursement (-1.5% on 2013 claims, -2% on 2014 claims) • Sequestration • Medicare Payments for Hospitals and EPs • Incentive payments will be reduced by 2% • Will be applied to any Medicare EHR incentive payment for a reporting period that ends on or after April 1, 2013. • Medicaid Payments for Hospitals and EPs • Reduction does not apply • CMS Incentive Program Audits • Pre-payment and Post-payment

17. Number and Characteristics of Providers Awarded Medicare Incentive Payments for 2011 ReportGAO-12-778R, Jul 26, 2012 “Professionals who had signed an agreement to receive technical assistance from a Regional Extension Center were more than twice as likely to have been awarded an incentive payment.”

18. Questions? 806-743-7467 carson.scott@ttuhsc.edu www.wtxhitrec.org