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Medicare & Medicaid EHR Incentive Programs

Medicare & Medicaid EHR Incentive Programs. Robert Anthony Deputy Director, Health IT Initiatives Group Office of E-Health Standards and Services Centers for Medicare and Medicaid Services. Eligibility. Who is Eligible to Participate?. Eligibility was defined in statute

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Medicare & Medicaid EHR Incentive Programs

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  1. Medicare & Medicaid EHR Incentive Programs Robert Anthony Deputy Director, Health IT Initiatives Group Office of E-Health Standards and Services Centers for Medicare and Medicaid Services

  2. Eligibility

  3. Who is Eligible to Participate? • Eligibility was defined in statute • Hospital-based EPs are NOT eligible for incentives • DEFINITION: 90% or more of their covered professional services in either an inpatient (POS 21) or emergency room (POS 23) of a hospital • Incentives are based on the individual, not the practice

  4. Medicare-only Eligible Professionals Medicaid-only Eligible Professionals Could be eligible for both Medicare & Medicaid incentives

  5. Meaningful Use

  6. Conceptual Approach to Meaningful Use Stage 3 Stage 2 Stage 1

  7. What are the Requirements of Stage 1 Meaningful Use? 2 Years 2 Years And so on . . . Stage 3 – 1 Year Stage 3 – 1 Year Stage 2 – 1 Year Stage 2 – 1 Year Stage 1 – 1 Year Stage 1 – 90 Days

  8. What are the Requirements of Stage 1? Stage 1

  9. Stage 1 EP Core Objectives • 15 Core Objectives • Computerized physician order entry (CPOE) • E-Prescribing (eRx) • Report ambulatory clinical quality measures to CMS/States • Implement one clinical decision support rule • Provide patients with an electronic copy of their health information, upon request • Provide clinical summaries for patients for each office visit • Drug-drug and drug-allergy interaction checks • 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 or older • Capability to exchange key clinical information among providers of care and patient-authorized entities electronically • Protect electronic health information

  10. Stage 1 EP Menu Objectives • 5 of 10 Menu Objectives • Drug-formulary checks • Incorporate clinical lab test results as structured data • Generate lists of patients by specific conditions • Send reminders to patients per patient preference for preventive/follow up care • Provide patients with timely electronic access to their health information • Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate • Medication reconciliation • Summary of care record for each transition of care/referrals • Capability to submit electronic data to immunization registries/systems* • Capability to provide electronic syndromic surveillance data to public health agencies* * At least 1 public health menu objective + 4 others

  11. Stages of Meaningful Use Stage 3 Stage 2 Stage 1

  12. What are the Requirements of Stage 2 Meaningful Use? Stage 1 Stage 2

  13. Stage 1 Menu  Stage 2Core

  14. New for Stage 2

  15. Closer Look at Stage 2: Patient Engagement • Patient engagement – engagement is an important focus of Stage 2. • EXCLUSIONS–CMS is introducing exclusions based on broadband availability in the provider’s county. • Requirements for Patient Action: • More than 5% of patients must send secure messages to their EP • More than 5% of patients must access their health information online

  16. Closer Look at Stage 2: Electronic Exchange • Stage 2 focuses on actual use cases of electronic information exchange: • Stage 2 requires that a provider send a summary of care record for more than 50% of transitions of care and referrals. • The rule also requires that a provider electronically transmit a summary of care for more than 10% of transitions of care and referrals. • At least one summary of care document sent electronically to recipient with different EHR vendor or to CMS test EHR.

  17. Clinical QualityMeasures

  18. CQM Reporting in 2013 and 2014 • Reporting in 2014 and Beyond Reporting in 2013

  19. CQM Selection and HHS Priorities • All providers must select CQMs from at least 3 of the 6 HHS National Quality Strategy domains: • Patient and Family Engagement • Patient Safety • Care Coordination • Population and Public Health • Efficient Use of Healthcare Resources • Clinical Processes/Effectiveness

  20. http://www.cms.gov/EHRIncentivePrograms/For questions, please contact:Robert AnthonyOffice of E-Health Standards and ServicesCenters for Medicare & Medicaid Servicesrobert.anthony@cms.hhs.gov Stage 1 and Stage 2 Resources

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