MU 3 Session Series

1. Meaningful Use Measures SeriesObjectives related to drugs, medications, and eRx for Eligible Professionals

2. MU 3 Session Series Physician Meaningful Use 3 Session Series • Sept. 20 - Session #1  Drug, Medication, eRx related • Oct. 18 - Session #2  Recording Patient Data • Nov. 15 - Session #3  Interoperability, Exchanging Data Outside the Clinic Other Than to Patients TAKEAWAY: Use Your resources – GA-HITREC & HomeTown Health

3. PHYSICIAN Incentive Programs • Medicaid and Medicare Incentive Programs • Medicare Physician Quality Reporting Initiative (PQRI) • Electronic Prescribing (eRx) Incentive Program • If the EP chooses to participate in the Medicare EHR Incentive Program, they cannot participate in the Medicare eRx Incentive Program simultaneously in the same program year. • If the EP chooses to participate in the Medicaid EHR Incentive Program, they can participate in the Medicare eRx Incentive Program simultaneously.

4. PHYSICIAN Incentive Programs The Physician Quality Reporting Program (PQRI) will provide a 1 percent payment incentive for 2011, 0.5 percent incentive payment from 2012 through 2104, • Penalties for non-participation in PQRI of 1.5 percent in 2015 and 2 percent in 2015.

5. PHYSICIAN Incentive Programs

6. PHYSICIAN Incentive Programs Medicare Incentive • Can receive up to $44,000.00 in incentives, and up to $48,400.00 if practicing in a Health Provider Shortage Area (HPSA) • Required to demonstrate meaningful use of certified EHR technology every year to qualify for payment and participate by 2nd year - 2012 to receive the maximum incentive payment Medicaid Incentive • Can receive up to $63,750.00 in incentives • Can qualify for payment for adopting, implementing, upgrading or demonstrating meaningful use of certified EHR technology in first participation year. Required to demonstrate meaningful use in each subsequent year to qualify for payment • Must participate by 2016 to receive the maximum incentive payment

7. E-Prescribing (eRx) Incentive Program eRx BACKGROUND • Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes a separate incentive program for eligible professionals who are successful electronic prescribers as defined by MIPPA. This is a separate incentive and is in addition to the Physician Quality Reporting System (Physician Quality Reporting) program. Eligible professionals do not have to be reporting in the Physician Quality Reporting program to participate in the eRx Incentive program. • For 2011, a 1 percent incentive payment can be paid to eligible professionals who successfully prescribe (as defined by the statute) their patient’s medications via a qualified eRx system.

8. E-Prescribing (eRx) Incentive Program eRx Definition • eRx is a prescriber’s ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point-of-care and is an important element in improving the quality of patient care.

9. E-Prescribing (eRx) Incentive Program eRx Changes Effective July 2011 • eRx is no longer included in the Physician Quality Reporting Measures List. • The eRx incentive is 1 percent of the Physician Fee Schedule (PFS) allowed amount. • The incentive is only available to authorized prescribers under their state laws. • Georgia is an approved state

10. E-Prescribing (eRx) Incentive Program eRx Overview • eRx does not require the provider to participate in the Physician Quality Reporting program. • Eligible professionals may participate in either or both incentive programs and could potentially receive two incentive payments. • eRx has no sign-up or registration to participate in the program. • Eligible professionals must have a qualified system to participate.

11. E-Prescribing (eRx) Incentive Program eRx Overview • eRx can be reported: • On Medicare Part B claims. • To a qualified registry. • Through a qualified Electronic Health Record (EHR) product. • Ten percent of a successful electronic prescriber’s Medicare Part B covered services must be made up of codes that appear in the eRx measure. • eRx does not require the provider to participate in the Physician Quality Reporting program.

12. E-Prescribing (eRx) Incentive Program eRx Overview • Medicare Advantage plans are not eligible for this incentive; only Medicare Part B qualifies. • Beginning in 2012, eligible providers who are not successful electronic providers may be subject to payment adjustments (payment reductions). Those not successful will see a reduction in the PFS amount of 1 percent. • FEEDBACK REPORT • http://www.cms.gov/ERXIncentive/downloads/2009eRxFeedbackReportUserGuide_10-12-2010.pdf

13. E-Prescribing (eRx) Incentive Program Hardship Codes • CMS has introduced new codes, referred to as hardship codes, which should be reported at least one time on a denominator-eligible claim during the 2012 payment adjustment reporting period (if applicable). The payment adjustment period for 2011 is considered January 1, 2011, through June 30, 2011. During this time period, if eligible providers do not report eRx services, those providers will receive a 1 percent physician fee schedule adjustment (fee schedule reductions) in the year 2012. • These codes should be used when an eligible professional wishes to request a significant hardship exemption from the application of the 2012 payment adjustment because the provider is unable to submit electronic prescriptions due to some type of system hardship.

14. E-Prescribing (eRx) Incentive Program • Examples of system hardship: • Rural area without Internet access. • Limited pharmacies accepting eRx. • Does not have prescribing privileges.

15. E-Prescribing (eRx) Incentive Program Hardship Codes • G8642 The eligible professional practices in a rural area without sufficient high-speed Internet access and requests a hardship exemption from the application of the payment adjustment under Section 1848(a)(5)(A) of the Social Security Act. • G8643 The eligible professional practices in an area without sufficient available pharmacies for eRx and requests a hardship exemption from the application of payment adjustment under Section 1848(a)(5)(A) of the Social Security Act. • G8644 may be used when an eligible professional does not have prescribing privileges. • If these codes are used, the eligible professional may not be considered for a payment adjustment.

16. E-Prescribing (eRx) Incentive Program Hardship Codes

17. E-Prescribing (eRx) Incentive Program POLL QUESTION

18. 25 Objectives in 5 Priority Outcomes • Improving quality, safety, efficiency and reducing health disparities • Engage patients and families in their health care • Ensure adequate privacy and security protections for personal health information • Improve care coordination • Improving population and public health

19. 25 Objectives in 5 Priority Outcomes Stage I Meaningful Use for 2011 • – Eligible Professionals must complete: • 15 core objectives (e.g., maintain active medication list, etc.) • 5 objectives out of 10 from menu set (e.g., implement drug formulary checks, etc.) • 6 total Clinical Quality Measures(CQM) (3 core or alternate core, and 3 out of 38 from additional set)

20. Objective Requirements 15 Core Set Objectives • Eligible Professionals must meet all Core Objectives to qualify for incentive payments

21. Objective Requirements 10 Menu Set Objectives • Eligible Professionals will defer 5 Menu Objectives One of the remaining objectives must be from Improving population and public health priority

22. Measures Attestation

23. Exclusions

24. Defining Terms

25. Defining Terms

26. Defining Terms

27. Defining Terms

28. E-Prescribing (eRx) Incentive Program POLL QUESTION

29. Selected Objectives Related to:

30. Core Objective–Use CPOE Objective

31. Attestation Requirements – CPOE The resulting percentage (Numerator ÷Denominator) must be more than 30 percent in order for an EP to meet this measure.

32. Additional Information – CPOE • Provider is permitted, but not required, to limit the measure of this objective to those patients whose records are maintained using certified EHR technology. • Any licensed health care professionals can enter orders into the medical record for purposes of including the order in the numerator for the objective of CPOE if they can enter the order per state, local and professional guidelines. • Order must be entered by someone who can exercise clinical judgment in the case that the entry generates any alerts about possible interactions or other clinical decision support aides. This necessitates that the CPOE occurs when the order first becomes part of the patient’s medical record and before any action can be taken on the order. • Electronic transmittal of the medication order to the pharmacy, laboratory, or diagnostic imaging center is not a requirement for meeting the measure of this objective. However, a separate objective addresses the electronic transmittal of prescriptions and is a requirement for EPs to meet MU.

33. Core Objective – Interaction checks

34. Attestation Requirements – Interaction Check

35. Core Objective – eRx

36. Attestation Requirements – eRx The resulting percentage (Numerator ÷Denominator) must be more than 40 percent in order for an EP to meet this measure.

37. Additional Information – eRx • The provider is permitted, but not required, to limit the measure of this objective to those patients whose records are maintained using certified EHR technology. • Authorizations for items such as durable medical equipment, or other items and services that may require EP authorization before the patient could receive them, are not included in the definition of prescriptions. These are excluded from the numerator and the denominator of the measure. • Instances where patients specifically request a paper prescription may not be excluded from the denominator of this measure. The denominator includes all prescriptions written by the EP during the EHR reporting period. • The guidelines of the recent Dept of Justice IFR allows e-prescribing of controlled substances could not be incorporated into the EHR Incentive Programs. "Permissible prescriptions" will be based on guidelines for prescribing Schedule II-V controlled substances in effect on or before 1/13/10.

38. Additional Information – eRx • EPs cannot receive incentive payments for e-prescribing under both the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) and the Medicare EHR Incentive Program for the same year. However, EPs can receive payments from both the MIPPA E-Prescribing Incentive Program and the Medicaid EHR Incentive program for the same year. • Providers can use intermediary networks that convert information from the certified EHR into a computer-based fax in order to meet this measure as long as the EP generates an electronic Rx and transmits it electronically using the standards of certified EHR technology to the intermediary network, and this results in the Rx being filled without the need for the provider to communicate the Rx in an alternative manner.

39. Additional Information – eRx • Rxs transmitted electronically within the same legal entity don't need to use the NCPDP standards. EHRs must be Certified EHR Technology and meet all applicable certification criteria and be certified as having the capability of meeting the external transmission requirements of §170.304(b). • EPs should include in the numerator and denominator both types of electronic transmissions (those within and outside the organization) for the measure of this objective.

40. Core Objective – Medication List

41. Attestation Requirements – Med. List The resulting percentage (Numerator ÷Denominator) must be more than 80 percent in order for an EP to meet this measure.

42. Additional Information – Med. List • For patients with no active medications, an entry must still be made to the active medication list indicating that there are no active medications. • An EP is not required to update this list at every contact with the patient. The EP can then use his or her clinical judgment to decide when additional updating is required.

43. Core Objective – Allergy List

44. Attestation Requirements – Allergy The resulting percentage (Numerator ÷Denominator) must be more than 80 percent in order for an EP to meet this measure.

45. Additional Information – Allergy List • For patients with no active medication allergies, an entry must still be made to the active medication allergy list indicating that there are no active medication allergies. • An EP is not required to update this list at every contact with the patient. The measure ensures that the EP has not ignored having a medication allergy list for patients seen during the EHR reporting period and that at least one piece of information on medication allergies is presented to the EP. The EP can then use their judgment in deciding what further probing or updating may be required given the clinical circumstances at hand.

46. Menu Objective – Drug Formulary Checks

47. Attestation Requirements – Drug Checks

48. Additional Information – Drug Checks • At a minimum an EP must have at least one formulary that can be queried. This may be an internally developed formulary or an external formulary. The formularies should be relevant for patient care during the prescribing process.

49. Menu Objective–Medication Reconciliation

50. Attestation Requirements – Med. Reconciliation The resulting percentage (Numerator ÷Denominator) must be more than 50 percent in order for an EP to meet this measure.