PYA Looks Beyond Meaningful Use at AHIMA

Beyond Meaningful Use: Connecting quality data requirements to business

operational improvements

Linda ClenDening, MS, CMPEPYA

Agenda

• Data and quality clinical outcomes

• Regulatory information highlights and audits

• Meaningful Use (MU) implications for – Staffing/Roles– Alliances/Referrals– Meaningful data

Quality Outcomes

Quality Data in the Exam Room

xx% of my patients over 18 who have their tonsils removed experience post-surgical hemorrhaging.

These outcomes are less than the national average of yy% of patients over 18.

Quality DataWhat’s the source of the data?

Communicating About QualityIf he’s using clinical outcomes statistics in the exam room, where else is he using them?

Doctor’s LoungeCommunicating with referring physicians?

Board Table

Quality contractual requirements between hospitals and physicians

– Employment arrangements– Clinical co-management– ACOs– Other partnerships

Negotiating Table

Once quality metrics are operationalized for one payor, the provider can build on that strength to discuss quality with other contracting payors.

WebsiteHow is he attracting patients to his practice based on quality outcomes?

Take Away #1

• What story are you telling about the physicians in your practice using the quality data collected in the MU process?

• Focus on a core measure metric or clinical quality metrics and develop the story.

MU Statistics as of June 2013

$-

$500,000,000

$1,000,000,000

$1,500,000,000

$2,000,000,000

$2,500,000,000

$3,000,000,000

2011 2012 2013 YTD

Medicare EP.s Medicaid EP.s

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/June_PaymentRegistration_Summary.pdf

Almost 6 billion

dollars to EP.s to-

date

Real World Impact of MU

• More than 458 million test results were entered into the EHR by 111,954 Eligible Providers (EP.s).

• Medication reconciliation was performed on over 40 million patient transitions of care by 83,035 EP.s.

• More than 4.3 million patient transitions of care summaries were generated by 24,827 EP.s.

By Robert Tagalicod, Director, Office of E-health Standards and Services http://www.cms.gov/eHealth/ListServ_RealWorldImpact_MeaningfulUse.html

Meaningful UseHeadlines• July 30, 2013 – AHA and AMA, as well as CHIME

(College of Healthcare Information Management Executives), request more time for Stage 2.

• July 30, 2013 –AHA report calls for a delay of Eligible Hospital Stage 2 deadline of October 1, 2013.

• September 24, 2013 – Senators call for one-year Stage 2 Meaningful Use extension.

As reported in HealthLeaders Media and EHRIntelligence.

Meaningful UseCurrent Details• Stage 2 Meaningful Use (MU) Attestation begins in calendar year

2014 for Eligible Providers (EP.s).– If a provider began MU in 2011, he/she will meet three consecutive

years of MU before beginning Stage 2 in 2014.– All other providers meet two years of MU before advancing to Stage 2

in their third reporting year.• For 2014 only, all providers – regardless of MU stage – are only

required to demonstrate MU for a 3 month reporting period.• Beginning in 2015, Medicare eligible professionals who do not

successfully demonstrate meaningful use will be subject to a payment adjustment.

Penalty ScenariosFirst Year of

MU

Requirement to Avoid Penalty

2015 2016 2017

2011 Achieve MU in 2013 (365 days)

Achieve MU in 2014 (One 3-month

quarter)Achieve MU in 2015

(365 days)

2012 Achieve MU in 2013 (365 days)

Achieve MU in 2014 (One 3-month

quarter)Achieve MU in 2015

(365 days)

2013Achieve MU in 2013

(Any 90-consecutive-day period)

Achieve MU in 2014 (One 3-month

quarter)Achieve MU in 2015

(365 days)

2014

Achieve MU in 2014 (Any 90-consecutive-day

period ending no later than 3 months before the

end of the reporting period)

Achieve MU in 2014 (One 3-month

quarter)Achieve MU in 2015

(365 days)

MU Role in New Care Model Development• Consolidation/M&A• ACOs• Clinically Integrated Networks• Private Payor Network

Development/Contracting• Others

MU & Consolidation

• Weathering the storm with a bigger ship:– From 2000 to 2010, hospital physician employment

rose 32%. – Hospitals directly employ about a quarter of all U.S.

physicians.– By 2013, two-thirds of physicians will work for

hospitals or large groups.• Strategic Consideration:

– Affiliate or merge with an organization without an MU plan or at risk of a penalty?

MU & Consolidation

• Transaction Due Diligence Consideration:– Meaningful Use due diligence now occurs in most

healthcare transactions. – Organizational readiness for Meaningful Use

Attestation requires detailed supporting documentation.

MU & ACOs

• Public Payor• Medicare• Medicaid

• Private Payor• Private Payors (Blue Cross, United, Cigna, Aetna)

• ACOs with private insurers in effect or development at four times the rate of Medicare ACOs

• Large Employers • Self-Insured Hospitals and Health Systems

MU & ACOs• ACO 33 Quality Measures include:

– Percent of PCPs who Successfully Qualify for MU Payment

– CQMs overlap with ACO measures

Clinical Quality Measure (CQM) Overlap with ACO and Other Programs

Stage 2 2014 CQM Measure Other CMS Program

Controlling High Blood Pressure Percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period.

ACO; EHR PQRS; Group Reporting PQRS

Use of High-Risk Medications in the Elderly PQRS

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

ACO; EHR PQRSGroup ReportingPQRS

Use of Imaging Studies for Low Back Pain

Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan

EHR PQRS; ACO; Group Reporting PQRS

Documentation of Current Medications in the Medical Record PQRS; EHR PQRS

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up

EHR PQRS; ACO; Group Reporting PQRS

2013 PQRS

• If you have EPs that meet MU, don’t leave money on the table:– 2013: 0.5% incentive– 2015: 1.5% penalty

• Assess crosswalk opportunities for quality reporting across programs.

MU & Private Payor Contracting

• A growing number of private payers have added the MU requirements to their P4P programs:– Aetna, United and WellPoint– Highmark modified "Quality Blue" program to include

MU:• Require copy of attestation• Incorporate CQM for physician practice best practice indicator

program

• Payors not setting up proprietary mini-MU programs– Rather use developed MU system– Similar to using DRGs as a reference price for rates

Take Away #2

• Incorporate MU into Compliance Program. – Compliance Officer involvement in attestation and annual

review.

• Ensure attestation documentation is consistent with CMS’s recommendations.

• Prepare for more oversight – not just from CMS.• Maximize MU attestation benefits with other payors

and alliances.

Operationalizing

to imperfect users.

Adapting a perfect program…

Much more about the people,

than the systems.

Operationalizing

Meaningful Use Progression

The systems need to carry the burden to prompt users to do the right

thing.

As Meaningful Use

requirements progress there

will be a higher volume

of data requirements

and more complexity.

We can only do so much.

MU Staffing Changes

Increased clerical staff

Increased clinical staff

No staffing changes made

Other

0% 10% 20% 30% 40% 50% 60%

Group 2Group 1

MU Staffing Changes?

• Increased data input demands on current staff.

• Hired dedicated quality manager.

• Shift in resources in IT department to focus on MU readiness.

• We used outside consultants for MU attestation.

MU Staffing Changes

Increased duties and responsibilities of

current staff, including Administrator/Director.

Use of consultants for MU implementation and attestation process.

New IT team members: Quality staff, EMR analysts, and EMR trainers

Yes

No

0% 20% 40% 60% 80%

Group 2Group 1

New IT Staff Positions

New IT Staff Positions for MU?

• Not yet, but we are discussing these.

• Hired a portal manager.

IT Staff Positions Added

Report/data specialist

Clinical data analyst

Training Other0%5%

10%15%20%25%30%35%40%45%50%

Group 1Group 2

IT Functional Roles Changing

Increase in support/

help desk

Increase in liaison/

networking support

Increase in leadership/

management

Other 0%

5%

10%

15%

20%

25%

30%

35%

40%

Group 1Group 2

Staffing Changes

Source: 7 Hottest IT Healthcare Skills http://www.cio.com/slideshow/detail/70112#slide1 www.CIO.com October 18, 2012

EMR Build Specialists

Healthcare Analytics

Project Management

Program Management

Application Development

Data Architecture

Quality Assurance

IT Functional Roles Changing

• Anticipate increased need of support for – New hardware– Networking– Remote access– Interoperability issues

2012 HIMSS Leadership Survey

Yes No Unknown0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Group 1Group 2

Strategic Partnerships based on Quality?

Referral partners asked about MU

Referral partners MU attested

MU not considered

Other (please specify)

0% 20% 40% 60% 80% 100%

Group 2Group 1

MU effect on Alliance Decisions

Take Away #3

• Re-assess staff skills and training for EHR usage.

• Determine possible staff duty changes.• Document process and workflow redesign for

EHR/MU implementation.• Update all affected policies and procedures.• Redesign monthly reports and dashboards to

include key MU metrics.

The Meaningful Use Goal

❝Language is the road map of a culture. It tells you where its people come from and where

they are going.❞‒Rita Mae Brown

Healthcare providers, executives, and staff are engaged in developing a new language.

Thank you!

Linda ClenDening, MS, CMPE

Manager

PYA

lclendening@pyapc.com

615-305-5218

865-684-2735