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Listen. Learn. Implement. The Ins & Outs of Meaningful Use Stage 2

Webinar Q&A As a follow up to our recent webinar, Listen. Learn Implement. The Ins and Outs of Meaningful Use Stage 2, Elizabeth Woodcock and Kareo have answered the questions posed by participants.

Q: Can Meaningful Use only be done if you have EHR? A: Yes. It is a program specifically designed to provide incentives for meaningfully using an electronic health record (EHR). The incentives are intended to help offset the cost of purchasing and maintaining an EHR. Q: Do Stage 1 practices also have to submit within a fiscal quarter now? Or does this apply only to Stage 2? A: Starting on January 1, 2014, reporting for Medicare participants in the EHR Incentive Program is within the fiscal year quarters. Thus, there are four opportunities to report: January 1 through March 31, April 1 through June 30, July 1 through September 30 and October 1 through December 31. Previously, the program required any 90-day period for participants’ initial payment year.  Q: Do you have to 'register' for Stage 2 and if so how does one register? A: If you are enrolled as an eligible professional (EP) for Stage 1, you are already enrolled for Stage 2. If you still need to enroll for Stage 1, visit http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html. There are tools to assess eligibility and to enroll along with timelines and all the details of the program.

Q: I reported Stage 1 in 2012. Do I report for Stage 2 now for the full year or 90 days or do Stage 1 again? A: If you attested for Stage 1 in 2012 for 90 days then you would attest for Stage 1 again in 2013 but for a full 365 days. Stage 2 attestation doesn’t begin until 2014.

Q: If you did not meet criteria when you attested, do you still need to report full year or 90 days? A: If you were unsuccessful in your initial attempt to attest, then you would repeat your attestation. So, you would be trying to attest for a 90-day period, even if that period fell into the next year. Q: Does the MU program end after 2016 or will physicians continue to have to attest? A: The EHR Incentive Program is funded based on participants starting on or before 2016. (Please note that Medicaid participants may initiate in 2016.) It may end there, but the concept of being a meaningful user will probably continue. We do expect to see the details of Stage 3 released in 2014. In the meantime, we know that for the next few years, we will continue to have Meaningful Use incentives and, starting in 2015, penalties. Q: Related to the program ending—will the penalties continue after 2016? A: The penalties are scheduled to begin in 2015, and will be one percent per year for three years applied to Medicare payments. After that time, the Secretary of Health and Human Services has the option to increase the penalties an additional two percent, for a total of five percent. The additional increases of two percent are only applicable if an insufficient number of eligible professionals have implemented an EHR.

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Q: Will there be more eReporting procedures in the future? Will it include CQMs and Menu/Core requirements? A: Yes, for Stage 2, EPs will be able to send the reporting data electronically. For more details on this, see the Stage 2 tip sheet at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/ClinicalQualityMeasuresTipsheet.pdf. Q. If no CQMs are required but they recommended does that mean that 2014 CCHIT certification will require all EMRs to have ALL 64 CQMs available? A: There are still requirements for reporting CQMs; in fact, Stage Two requires nine of 64 approved clinical quality measures (CQMs) to incorporate at least three reporting domains. Q: Is the 30% requirement for lab/rad CPOE combined or 30% for each? A: No, 30 percent is required for laboratory and 30 percent for radiology in order to successfully attest to the computerized physician order entry (CPOE) criterion.

Q: What do you suggest to get more patients involved with the patient portal? 80% of our patients are elderly. They aren't really computer literate. A: You might be surprised how many people over 65 are using computers and the Internet now. In fact, according to the Pew Internet and American Life Project, 53% of adults over 65 use the Internet or email and other research suggests this is one of the fastest growing segments in social networking. The minimum thresholds are pretty low— you need to provide access to 50 percent of patients but only 5 percent of your patients need to access their record or send an electronic communication. To improve your chances, you might try to get your portal in place as soon as possible and promote it among your patients now so you can work on building up awareness and use before it is time to attest to Stage 2. Q: Regarding secure messaging, will appointment requests made through the portal count? A: Probably not. In the Federal Register that featured the release of the Final Rule regarding Stage Two, the Centers for Medicare & Medicaid Services (CMS) revealed that appointment requests or requests for general information will not count as “relevant health information” in order to meet the measure for the secure electronic messaging criterion. Q: For the 5% of patients using a patient portal and transmitting questions to the practice—is this 5 % of the 50% OR is this 5% of the patient base? A: There are a couple of different criteria here. To clarify, 50 percent or more of all unique patients must be provided with timely online access (within 4 business days) to their health information. Also, 5 percent or more of all unique patients must view, download, or transmit to a third party their health information. So, it is 5 percent of all unique patients, not 5 percent of the 50 percent. In addition, there is a separate criterion for electronic messaging, which requires 5 percent of the unique patients seen during that reporting period to send your practice a secure electronic message. Q: Do you know if responses to electronic messages sent by the practice count for patients sending an electronic message? A: The criterion counts only inbound messages, not secure electronic messages that you send to patients.   Q: Can you please talk a little about Transfer of Care. What constitutes a transfer of care? Specifically, as it relates to Medication Reconciliation and providing a summary of care record? A: CMS reveals the definition of “transfer of care” to be “the movement of a patient from one setting of care (hospital, ambulatory primary care practice, ambulatory, specialty care practice, long-term care, home health, rehabilitation facility) to another. At a minimum this includes all transitions of care and referrals that are ordered by the EP [eligible professional].” The summary of care record, which is the focus of this measure, does require the inclusion of an active/current medication list, which is defined as “a list of medications that a given patient is currently taking.” For more information, please see the tip sheet that CMS prepared for the measure entitled “Summary of Care.” You can download the tip sheet for this measure at the following link: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html.

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Q: Regarding 10% of unique patients receiving a reminder if they have had 2 office visits within a 24 month period. Is the 10% relative to the number of patients seen during the quarter you report? Is it only Medicare patients or all patients seen during that quarter? A: This requirement relates to all unique patients seen within the reporting period. It is not exclusive to Medicare patients. Q: Is the Kareo EHR ready for the for Stage 2 measures? A: Vendors received the final requirements for Stage 2 in September 2012. For specific information on certification and development plans and releases for Kareo EHR, visit http://www.kareo.com/ehr/roadmap... For more information, see https://www.cms.gov/EHRIncentivePrograms/

Small Practice & Billing Company Resources Please visit Kareo Resources at www.kareo.com/resources for helpful tools, webinars, whitepapers, and tips for how to help small practices become best practices. You can also view recorded webinars or register for our next event at www.kareo.com/resources. About Kareo Kareo is committed to providing education and insights to small medical practices. We work with in-the-trenches influencers, consultants, and Kareo customers to provide relevant tips on how to successfully manage medical practices and medical billing services. Find out more at www.kareo.com.