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Meaningful Use Final Rule

Meaningful Use: Final Rule

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Dell Healthcare Services delivered this presentation on July 19, 2010 to highlight the recently issued "meaningful use" rule and its impact on providers. Both the Centers for Medicare & Medicare Services (CMS) and the Office of the National Coordinator (ONC) issued their final rule for the long-anticipated “meaningful use” criteria. The rule sets the standard that the healthcare industry must adhere to when implementing an electronic health record (EHR) system in order to receive part of the $27.3 billion in incentives authorized by the American Recovery and Reinvestment Act of 2009 (ARRA).

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Page 1: Meaningful Use: Final Rule

Meaningful Use Final Rule

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Agenda • Health Reform Update and

Highlights

• Meaningful Use

• Privacy and Security

• Provisions of the Rule

• Temporary Certification Rule

• Next Steps for Physicians and Hospitals

Send questions to

[email protected]

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Health Reform Update

$940 billion during the next decade, while reducing the deficit by $143 billion in the first ten years (2010-2019) and by $1.2 trillion in the second ten years. Note: the CBO released a report last week claiming the overall cost of the legislation would rise $115 billion.

Many states have filed lawsuits in federal court arguing that the federal government has no right to force their citizens to buy medical insurance

32 million Americans are estimated to gain health insurance coverage

President Obama

signed final bill

Cost

Reaction

Coverage

U.S. House Representatives passed Health

Reform

March 21

President Obama signed Health Reform

into law

March 23 Senate passed Health Reform

Bill March 24 March 30

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Global Marketing

Health Reform Highlights (Providers)

• 10% incentive payments for primary care physicians (2011–16)

• 10% incentive payments for general surgeons performing major surgery in health professional shortage areas (2011–16)

• 5% incentive payment for mental health services (2010)

• Medicare quality reporting incentive payments extended for participants of the Physician Quality Reporting Initiative

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• Increases Medicaid payments to Medicare levels for PCPs (internists, family physicians, and pediatricians) starting in 2013 and 2014

• 100% of federal funding to states for increased payments to Primary Care Physicians to increase rates to Medicare for 2013-2014

Medicare payment changes

Medicaid payment changes

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Health Reform Highlights (Payers)

32 million Americans are

estimated to gain health insurance coverage

$434 billion for expansion of Medicaid and Children's Health Insurance Plans enrollment

$36 billion in cuts to Medicare and Medicaid DSH payments

$60 billion in new fees on insurance companies (2014-2018)

Insurance companies can no longer exclude people from coverage due to

pre-existing conditions

Limits new or expanded

physician-owned hospitals

Payments to insurers offering Medicare Advantage services are

frozen at 2010 levels

Compact with states to allow cross-border policies by insurance policies.

Create state-based

American Health Benefit Exchanges through which individuals can purchase coverage

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Updated Definitions

• Hospital-based Eligible Professionals

Those who furnish substantially all their services in an inpatient or emergency room setting, such as a pathologist, anesthesiologist, or emergency physician, and who do so using the facility and equipment, including qualified electronic health care records, of the hospital.

• Place of Service for Hospital-based Eligible Professionals

A hospital-based eligible professional would be ineligible to receive an EHR incentive payment under either Medicare or Medicaid, regardless of the type of service provided, if more than 90% of his/her services are identified as being provided in an inpatient hospital and emergency room.

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www.healthcare.gov

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Clinical Criteria Objectives Relaxed

The proposed rule in January proposed criteria with 23 objectives for hospitals and 25 objectives for eligible professionals

There is a separate “menu” of 10 additional objectives for eligible providers and hospitals

Eligible providers and hospitals can choose five “menu” objectives to implement in the first two years; and the remainder can be deferred to stage two

The final regulation represents a smaller subset of 15 core objectives for eligible providers and 14 core objectives for hospitals

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Important Stage 1 Criteria Changes • Clinical Quality Measures

– Eligible professionals must meet 6 clinical quality measures while eligible hospitals and critical access hospitals must meet 15 measures (was 44)

• EHR Meaningful Use

– CPOE

› 30% of all orders for eligible professionals (was 80%)

› 30% of all orders (including in the emergency department) for eligible hospitals and critical access hospitals (was 10%)

– E-Prescribing: 40% of all permissible prescriptions (was 75%)

– Clinical Decision Support: 1 clinical decision support rule (was 5)

• Patient Information

– E-Copy of health information

› Must provide patients a copy of their health information within 72 hours (was 48 hours) for 50% (was 80%) of patients who request an electronic copy

– E-Copy of discharge summary

› Must provide 50% (was 80%) of patients at a eligible hospital or critical access hospital who request an electronic copy a version of their discharge summary

• Data Management

– 50% of patients must have demographics recorded as structured data (was 80%)

Source: HIMSS – Brief Facts on the Final Rule for the Medicare and Medicaid Electronic Health Record Incentive Programs

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Summary Overview of Meaningful Use Objectives* Objective Core Set †

Measure

Record patient demographics (sex, race, ethnicity, date of birth, preferred language, and in the case of hospitals, date and preliminary cause of death in the event of mortality)

More than 50% of patients’ demographic data recorded as structured data

Record vital signs and chart changes (height, weight, blood pressure, body-mass index, growth charts for children)

More than 50% of patients 2 years of age or older have height, weight, and blood pressure recorded as structured data

Maintain up-to-date problem list of current and active diagnoses More than 80% of patients have at least one entry recorded as structured data

Maintain active medication list More than 80% of patients have at least one entry recorded as structured data

Maintain active medication allergy list More than 80% of patients have at least one entry recorded as structured data

Record smoking status for patients 13 years of age or older More than 50% of patients 13 years of age or older have smoking status recorded as structured data

For individual professionals, provide patients with clinical summaries for each office visit; for hospitals, provide an electronic copy of hospital discharge instructions on request

For individual professionals, provide patients with clinical summaries for each office visit; for hospitals, provide an electronic copy of hospital discharge instructions on request

On request, provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies, and for hospitals, discharge summary and procedures)

More than 50% of requesting patients receive electronic copy within 3 business days

Generate and transmit permissible prescriptions electronically (does not apply to hospitals)

More than 40% are transmitted electronically using certified EHR technology

Computer provider order entry (CPOE) for medication orders More than 30% of patients with at least one medication in their medication list have at least one medication ordered through CPOE

* This overview is meant to provide a reference tool indicating the key elements of meaningful use of health information technology. It does not provide sufficient information for providers to document and demonstrate meaningful use in order to obtain financial incentives from the Centers for Medicare and Medicaid Services. The regulations and filing requirements that must be fulfilled to qualify for the Health IT financial incentive program are detailed at www.cms.gov. † These objectives are to be achieved by all eligible professionals, hospitals, and critical access hospitals in order to qualify for incentive payments. ‡ Eligible professionals, hospitals, and critical access hospitals may select any five choices from the menu set.

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Summary of Meaningful Use Objectives (cont.)*

Objective Core Set †

Measure

Implement drug–drug and drug–allergy interaction checks Functionality is enabled for these checks for the entire reporting period

Implement capability to electronically exchange key clinical information among providers and patient-authorized entities

Perform at least one test of EHR’s capacity to electronically exchange information

Implement one clinical decision support rule and ability to track compliance with the rule

One clinical decision support rule implemented

Implement systems to protect privacy and security of patient data in the EHR

Conduct or review a security risk analysis, implement security updates as necessary, and correct identified security deficiencies

Report clinical quality measures to CMS or states For 2011, provide aggregate numerator and denominator through attestation; for 2012, electronically submit measures

Objective Menu Set ‡

Measure

Implement drug formulary checks Drug formulary check system is implemented and has access to at least one internal or external drug formulary for the entire reporting period

Incorporate clinical laboratory test results into EHRs as structured data

More than 40% of clinical laboratory test results whose results are in positive/negative or numerical format are incorporated into EHRs as structured data

Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach

Generate at least one listing of patients with a specific condition

Use EHR technology to identify patient-specific education resources and provide those to the patient as appropriate

More than 10% of patients are provided patient-specific education resources

* This overview is meant to provide a reference tool indicating the key elements of meaningful use of health information technology. It does not provide sufficient information for providers to document and demonstrate meaningful use in order to obtain financial incentives from the Centers for Medicare and Medicaid Services. The regulations and filing requirements that must be fulfilled to qualify for the Health IT financial incentive program are detailed at www.cms.gov. † These objectives are to be achieved by all eligible professionals, hospitals, and critical access hospitals in order to qualify for incentive payments. ‡ Eligible professionals, hospitals, and critical access hospitals may select any five choices from the menu set.

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Objective Menu Set ‡

Measure

Perform medication reconciliation between care settings Medication reconciliation is performed for more than 50% of transitions of care

Provide summary of care record for patients referred or transitioned to another provider or setting

Summary of care record is provided for more than 50% of patient transitions or referrals

Submit electronic immunization data to immunization registries or immunization information systems

Perform at least one test of data submission and follow-up submission (where registries can accept electronic submissions)

Submit electronic syndromic surveillance data to public health agencies

Perform at least one test of data submission and follow-up submission (where public health agencies can accept electronic data)

Additional choices for hospitals and critical access hospitals

Record advance directives for patients 65 years of age or older More than 50% of patients 65 years of age or older have an indication of an advance directive status recorded

Submit of electronic data on reportable laboratory results to public health agencies

Perform at least one test of data submission and follow-up submission (where public health agencies can accept electronic data)

Additional choices for eligible professionals

Send reminders to patients (per patient preference) for preventive and follow-up care

More than 20% or patients 65 years of age or older or 5 years of age or younger are sent appropriate reminders

Provide patients with timely electronic access to their health information (including laboratory results, problem list, medication lists, medication allergies)

More than 10% of patients are provided electronic access to information within 4 days of its being updated in the EHR

* This overview is meant to provide a reference tool indicating the key elements of meaningful use of health information technology. It does not provide sufficient information for providers to document and demonstrate meaningful use in order to obtain financial incentives from the Centers for Medicare and Medicaid Services. The regulations and filing requirements that must be fulfilled to qualify for the Health IT financial incentive program are detailed at www.cms.gov. † These objectives are to be achieved by all eligible professionals, hospitals, and critical access hospitals in order to qualify for incentive payments. ‡ Eligible professionals, hospitals, and critical access hospitals may select any five choices from the menu set.

Summary of Meaningful Use Objectives (cont.)*

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Phase-In of Proposed Meaningful Use Definition

First Fiscal Year

Payment Year

2011 2012 2013 2014 2015

2011 Stage 1 Stage 1 Stage 2 Stage 2 TBD

2012 Stage 1 Stage 1 Stage 2 TBD

2013 Stage 1 Stage 1 TBD

2014 Stage 1 TBD

Progression of Meaningful Use Stages by Payment Year

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Privacy and Security – Provisions of the rule

Requires recipients of fundraising

communications with a clear and conspicuous opportunity to opt out of receiving future communications, making clear that opting out will not affect future treatment of the individual. Fundraising communications may not be sent to individuals who have not expressly opted

to receive them. Privacy notices must include a statement that an organization intends to send such communications and that an individual can opt out

Requiring business associates to

obtain “satisfactory assurances” from subcontractors that they will comply with applicable requirements of the privacy and security rules. Existing contracts between business associates and subcontractors can be grandfathered for up to one year beyond the rule's compliance date

Defines uses and disclosures of protected health information for which individual authorization is required, such as the sale of PHI. In the proposed rule, OCR asks for additional public comment on uses and disclosures of PHI for research purposes

Making requirements under the

privacy and security rules applicable to business associates in the same manner they presently apply to covered entities. Under the proposed rule, patient safety organizations now are defined as business associates

Restricting marketing activities by

redefining ”marketing“, which will limit health-related communications

that may be considered “health care operations”. The proposed rule would require covered entities receiving payment for making certain communications to obtain authorization from individuals before making the communications

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Privacy and Security – Provisions of the rule

Defines “reasonable cause”, “reasonable diligence”, and “willful neglect”, the definition of

which are the basis for setting monetary penalty amounts

Enables individuals to request

restriction of disclosures of PHI, unless otherwise required by law, if the restriction applies solely to a service fully paid out-of-pocket

Increases civil money penalties for violations of requirements to protect the privacy and security of protected health information, with

fines of up to $1.5 million in a single calendar year for violations of the same requirement

Requires notice of privacy practices to include a description of the uses and disclosures of protected health information that require an authorization

Strengthen the right of individuals to

obtain their electronic health records

Outlines the responsibilities of covered entities during complaint investigations and compliance reviews

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How to achieve temporary EHR technology certification

ONC will authorize organizations that meet criteria to become Authorized Testing and Certification Body (ATCB)

ONC-ATCBs are required to test and certify that EHR technology are compliant with the standards, implementation specifications, and certification criteria

National Coordinator began accepting applications July 1 for testing/certification bodies

The temporary certification program provides assurance that the EHR technology health care providers adopt is technically capable of supporting their efforts to achieve meaningful use.

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Next Steps for Physicians

• Determine Eligibility

– Are 90% of services provided within a traditional in-patient or out-patient hospital setting?

• Assess Medicare and Medicaid patient volumes

• Explore available resources and additional funding

– Regional Extension Center Program

– State Grant Programs

– Affiliated Physician Programs

• Start Now

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Next Steps for Hospitals

• Address key stakeholders:

– The Organization: Where are the gaps

and what aspects of the regulation can the hospital take advantage of?

– The Community: Are physicians averse

or receptive to HIE and EHR technology?

– The Greater Region: How advanced are

the surrounding hospitals? How are these relationships with your organization?

– The State: What are its HIT initiatives?

What can the organization align to immediately?

Design

(What is needed)

Optimize

(Build)

Prepare

(Test & Train)

Transform

(Implement)

Sustain

(Execution)

Assess

(Legislation)

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Medicare Payments for Hospitals

• Reimbursement structure (no up-front funds)

• Incentive payments starting in 2011

• Payments diminish over four-year period

• Penalties for late implementation (failure to implement by 2015)

• The market basket percentage increase is reduced starting 2015 and each subsequent year to a maximum of 75% by 2017

• Criteria for compliance – certified EHR system must facilitate:

• Clinical decision support

• CPOE

• Exchange of data

• Quality reporting

Medicare Phased Incentive Payments:

Year 1: 100% Year 3: 50% Year 2: 75% Year 4: 25%

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Initial Amount

Medicare Share

Transition Factor

Medicare Part A Medicare Part C

Total Inpatient Bed Days (Entire Hospital)

Hospital Charges

Hospital Charges

Charity [ ] Hospital Charges: Total Hospital Patient Revenue Charity: Total Uncompensated Care

Medicare Formula for Hospitals (High-Level View)

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Transition Factor Phase Down for Hospitals

Fiscal Year

Fiscal Year that Eligible Hospital First Receives the Incentive Payment

2011 2012 2013 2014 2015

2011 100% --- --- ---

2012 75% 100% --- --- ---

2013 50% 75% 100% --- ---

2014 25% 50% 75%

75% ---

2015 25%

50%

50% 50%

2016

25%

25%

25%

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Thank you