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Meaningful Use - Stage 2

Meaningful Use - Stage 2. Prepared by: Health Technology Services Regional Extension Center A division of Mountain-Pacific Quality Health . Outline. MU Overview MU Stage 2 Final Rule Core/Menu Objectives Clinical Quality Measures Payment Adjustments. MU Overview. Rules.

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Meaningful Use - Stage 2

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  1. Meaningful Use - Stage 2

    Prepared by: Health Technology Services Regional Extension Center A division of Mountain-Pacific Quality Health
  2. Outline MU Overview MU Stage 2 Final Rule Core/Menu Objectives Clinical Quality Measures Payment Adjustments
  3. MU Overview
  4. Rules CMS Rule: http://www.ofr.gov/(X(1)S(uzclbwrx5fwqm2w2mipkysrh))/OFRUpload/OFRData/2012-21050_PI.pdf ONC Rule: http://www.ofr.gov/(X(1)S(uzclbwrx5fwqm2w2mipkysrh))/OFRUpload/OFRData/2012-20982_PI.pdf
  5. Meaningful Use - Goals Vision Enable significant and measurable improvements in population health through a transformed health care delivery system Goals: Improving quality, safety, efficiency, and reducing health disparities Engage patients and families in their health care. Improve care coordination Improve population and public health Ensure adequate privacy and security protections for personal health information Goals Adapted from National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America’s Healthcare. Washington, DC: National Quality Forum; 2008.
  6. Meaningful Use - Definition Congress established three fundamental criteria: Use of a certified Electronic Health Record (EHR) that meets guidelines Electronic Exchange of health information Reportingon Clinical Quality and other Measures
  7. MU Stage 2 Final Rule
  8. Stage 2 Timeline
  9. Stages of Meaningful Use
  10. Stage 1 to Stage 2 Eligible Professionals -17 core objectives -3 of 6 menu objectives -20 total objectives Eligible Professionals -15 core objectives -5 of 10 menu objectives -20 total objectives Eligible Hospitals -16 core objectives -3 of 6 menu objectives -19 total objectives Eligible Hospitals -14 core objectives -5 of 10 menu objectives -19 total objectives
  11. Meaningful Use - Concepts Changed Exclusions no longer count to meeting one of the menu objectives Not Changed No change in 50% of EP outpatient encounters must occur at locations equipped with certified EHR technology Measure compliance = objective compliance PAs still ineligible, unless lead at RHC/FQHC Denominators based on outpatient locations equipped with CEHRT and include all such encounters or only those for patients whose records are in CEHRT depending on the measure.
  12. MU Stage 2 EP Core / Menu Objectives
  13. Stage 2 EP Core Objectives EPs must meet all 17 core objectives: Challenges! Core #2 requires the availability of pharmacies in your area to accept eRx.
  14. Stage 2 EP Core Objectives EPs must meet all 17 core objectives: Challenges! Core #6 CDSI rules must be useful to the provider at the point of care.
  15. Stage 2 EP Core Objectives EPs must meet all 17 core objectives: Challenges! Core #10 requires patient engagement to meet MU.
  16. Stage 2 EP Core Objectives EPs must meet all 17 core objectives: Challenges! Core #11 has been one of the most challenging measures for EPs. Core #12 education materials is often limited in the EHR. Core #13 requires patient engagement to meet MU.
  17. Stage 2 EP Core Objectives EPs must meet all 17 core objectives: Challenges! Core #15 requires a method to send summary information out side of your own vendor networks.
  18. Stage 2 EP Menu Objectives EPs must select 3 out of 6 menu objectives:
  19. Stage 2 EP Menu Objectives EPs must select 3 out of 6 menu objectives:
  20. MU Stage 2 Hospital Core/Menu Objectives
  21. Stage 2 Hospital Core Objectives Hospitals must meet all 16 core objectives:
  22. Stage 2 Hospital Core Objectives Hospitals EPs must meet all 16 core objectives: Challenges! Core #5 CDSI rules must be useful to the provider at the point of care.
  23. Stage 2 Hospital Core Objectives Hospitals must meet all 16 core objectives: Challenges! Core #9 requires patient engagement to meet MU.
  24. Stage 2 Hospital Core Objectives Hospitals must meet all 16 core objectives: Challenges! Core #12 requires a method to send summary information out side of your own vendor networks.
  25. Stage 2 Hospital Core Objectives Hospitals must meet all 16 core objectives:
  26. Stage 2 Hospital Menu Objectives Hospitalsmust select 3 out of 6 menu objectives:
  27. Stage 2 Hospital Menu Objectives Hospitalsmust select 3 out of 6 menu objectives:
  28. Changes to Stage 1
  29. Changes to Stage 1 CPOE -Optional in 2013 and beyond Denominator: Unique Patient with at least one medication in their med list Denominator: Number of Orders during the EHR Reporting Period Vital Signs - Optional in 2013 Required in 2014+ Age Limits: Age 3 for Blood Pressure, No age limit for Height/Weight Age Limits: Age 2 for Blood Pressure & Height/Weight
  30. Changes to Stage 1 Vital Signs -Optional in 2013 Required in 2014+ Exclusion: All three elements not relevant to scope of practice Exclusion: Allows BP to be separated from height/weight Test of HIE– Effective 2013 Requirement removed effective 2013 One test of electronic transmission of key clinical information
  31. Changes to Stage 1 E-Copy and Online Access -Required in 2014+ Objective: Provide patients with e-copy of health information upon request Objective: Provide electronic access to health information Replacement Objective: Provide patients the ability to view online, download and transmit their health information Public Health Objectives – Effective 2013 Addition of “except where prohibited” to all three Immunizations Reportable Labs Syndromic Surveillance
  32. Clinical Quality Measures
  33. Clinical Quality Measures CQMs are no longer a meaningful use core objective, but reporting CQMs is still a requirement for meaningful use.
  34. CQM - Domains 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
  35. CQM – Changes 2014 and Beyond
  36. Core CQMs for EPs CMS selected the CQMs for the proposed core set based on analysis of several factors: Conditions that contribute to the morbidity and mortality of the most Medicare and Medicaid beneficiaries Conditions that represent national public/ population health priorities Conditions that are common to health disparities
  37. Core CQMs for EPs (cont’d) Conditions that disproportionately drive healthcare costs and could improve with better quality measurement Measures that would enable CMS, States, and the provider community to measure quality of care in new dimensions, with a stronger focus on parsimonious measurement Measures that include patient and/or caregiver engagement
  38. Payment Adjustments (Penalties)
  39. Payment Adjustments The HITECH Act stipulates that for Medicare EPs a payment adjustment applies if they are not a meaningful EHR user. An EP/Hospital becomes a meaningful EHR user when they successfully attest to meaningful use under either the Medicare or Medicaid EHR incentive program Adopt, implement and upgrade (AIU) does not constitute meaningful use. A provider receiving a Medicaid incentive for AIU would still be subject to the Medicare payment adjustment.
  40. EP Payment Adjustments % Adjustment Assuming less than 75% of EPs are meaningful EHR users for CY 2018 and subsequent years % Adjustment Assuming more than 75% of EPs are meaningful EHR users for CY 2018 and subsequent years
  41. EP EHR Reporting Period EP who has demonstrated meaningful use in 2011 or 2012 EP who demonstrates meaningful use in 2013 for the first time
  42. EP EHR Reporting Period EP who demonstrates meaningful use in 2014 for the first time
  43. EP Payment Adjustments In order to avoid the 2015 payment adjustment the EP must attest no later than Oct 1, 2014 which means they must begin their 90 day EHR reporting period no later than July 1, 2014. To Avoid Payment Adjustments: EPs must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years.
  44. Subsection (d) Hospital Payment Adjustments % Decrease in the Percentage Increase to the IPPS Payment Rate that the hospital would otherwise receive for that year:
  45. Subsection (d) Hospital EHR Reporting Period For a hospital that has demonstrated meaningful use in 2011 or 2012 (fiscal years): For a hospital that demonstrates meaningful use in 2013 for the first time:
  46. Subsection (d) Hospital EHR Reporting Period For a hospital that demonstrates meaningful use in 2014 for the first time:
  47. Subsection (d) Hospital Payment Adjustments In order to avoid the 2015 payment adjustment the hospital must attest no later than July 1, 2014 which means they must begin their 90 day EHR reporting period no later than April 1, 2014 To Avoid Payment Adjustments: Hospitals must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years.
  48. Critical Access Hospital (CAH) Payment Adjustments Applicable % of reasonable costs reimbursement which absent payment adjustments is 101%: :
  49. CAH EHR Reporting Period For a CAH who has demonstrated meaningful use prior to 2015 (fiscal years): For a CAH who demonstrates meaningful use in 2015 for the first time:
  50. CAH Payment Adjustments To Avoid Payment Adjustments: CAHs must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years.
  51. Questions?
  52. Contact Information Rick Yearry Health Technology Services | Regional Extension Center ryearry@mpqhf.org 406-457-5819 www.htsrec.com
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