Meaningful Use in 2014

Meaningful Use in 2014 Wednesday, June 4, 2014

Disclaimer: Nothing that we are sharing is intended as legally binding or prescrip7ve advice. This presenta7on is a synthesis of publically available informa7on and best prac7ces.

•  Set of standards defined by the Centers for Medicare & Medicaid Services (CMS)

•  Financial incen:ves for using cer:fied EHR technology (CEHRT): –  In a meaningful manner –  For electronic exchange of health informa:on –  Submit Clinical Quality Measures (CQM)

•  Three stages –  Crea:ng informa:on –  Exchanging informa:on –  Focusing on improved outcomes

Meaningful Use -‐ Overview

Meaningful Use Stages

Data capture and sharing

Advanced clinical processes

Improved outcomes

Stage 1

Stage 2

Stage 3

Meaningful Use Stages

*For Medicaid only

CMS Proposed Rule

•  File code CMS–0052–P •  Eligible Professionals (EPs) unable to fully implement 2014 Edi:on CEHRT

•  All providers are required to use 2014 Edi:on CEHRT for FY/CY 2015 and beyond

•  Extends MU2 by one year •  Modifies CEHRT defini:on to first day of FY/CY2015 as new required start dates for 2014 Edi:on

CMS Proposed Rule -‐ Con7nued

•  The edi:on of will dictate stage and version of the MU criteria –  2011 Edi:on only aYest for MU1 2013 criteria

•  CQMs from a set of 44 measures per MU1 criteria –  Combina:on of 2011 and 2014 Edi:on aYest on 2013 MU1 or

2014 MU1 or MU2 criteria. •  Provider aYesta:on required regarding delay •  CQMs per above if aYes:ng under 2013 criteria •  CQMs per 2014 criteria if not aYes:ng under 2013 criteria

–  Unable to fully implement all func:ons of 2014 Edi:on aYest for MU1 or MU2 2014 criteria. Provider aYesta:on required regarding delay. •  Provider aYesta:on required regarding delay •  CQMs per MU1 or MU2 2014 criteria

What Can You Do?

•  Public comment :me period –  60 days from May 23

•  How to submit –  Electronically: hYp://www.regula:ons.gov –  By regular mail:

Centers for Medicare & Medicaid Services, Department of Health and Human Services, AYen:on: CMS-‐0052-‐P, P.O. Box 8013, Bal:more, MD 21244-‐1850

What Can You Do? Con7nued

•  Public comment :me period – 60 days from May 23

•  How to submit – By express/overnight mail:

Centers for Medicare & Medicaid Services, Department of Health and Human Services, AYen:on: CMS-‐0052-‐P, Mail Stop C4-‐26-‐05, 7500 Security Boulevard, Bal:more, MD 21244-‐1850

What Can You Do? Con7nued

•  Public comment :me period – 60 days from May 23

•  How to submit – By hand/courier

Centers for Medicare & Medicaid Services, Department of Health and Human Services, Room 445-‐G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201

What’s the Rush?

•  Impact on HIT plans –  ICD10 – MU 2014 – What should you do?

•  Submit comment •  Move forward with MU2 effort to minimize risk •  Confirm with EHR vendor if hardship exemp:on will be possible

•  Run MU1/MU2 reports to assess readiness for aYesta:on •  Report for the Jul-‐Sep quarter •  Es:mate financial impact of aYesta:on

MU1 Criteria

•  Core Objec:ves – 13 measures (Hospitals/CAHs)/14 measures (EPs) – All must be met

•  Menu Objec:ves – 10 measures – 5 must be met

•  Clinical Quality Measures (CQMs) – 15 (Hospitals/CAHs) – 6 (EPs)

MU1 Core Objec:ves Measure Threshold

Computerized Provider Order Entry (CPOE)

30%

Drug-‐drug and drug-‐allergy checks Enabled

Maintain an up-‐to-‐date problem list of current and ac:ve diagnoses

80%


ePrescribing 40%

Maintain ac:ve medica:on list 80%

Maintain ac:ve medica:on allergy list 80%


Record demographics 50% (Preferred language, gender, race, ethnicity, date of birth)

Record and chart changes in vital signs 50%

Record smoking status for pa:ents 13 years or older

50%


Implement clinical decision support At least one

Provide pa:ents with an electronic copy of their health informa:on, upon request within 4 days

50%

Provide clinical summaries for pa:ents for each office visit within 3 days

50%


Protect electronic health informa:on 50%

MU1 Menu Objec:ves Menu Objec>ves Threshold

Drug formulary checks Enabled

Incorporate clinical lab-‐test results 40%

Generate lists of pa:ents by specific condi:ons

At least once


Send reminders to pa:ents for preven:ve/follow-‐up care

20%

Pa:ent-‐specific educa:on resources 10%

Medica:on reconcilia:on for transi:on of care

50%


Summary of care record for transi:ons of care

50%

Electronic access to health informa:on

Submit electronic data to immuniza:on registries; OR Submit electronic syndromic surveillance data to public health agencies

Performed at least one test

Clinical Quality Measures (CQMs)

•  No thresholds •  No calcula:ons •  Can vary for each provider •  6 or 9 measures –  6 of possible 44

•  3 required core, or 3 alternate core –  3 of 38 addi:onal measures

•  Repor:ng –  AYesta:on –  Electronic repor:ng pilots

•  PQRS (EPs) •  Quality Net (Hospitals/CAHs)

•  MU1 in 2013 not the same as MU1 in 2014 – Exclusions for menu objec:ves discon:nued

– CPOE alternate measure •  Number of unique pa:ents vs. total number of medica:ons

– ePrescribing •  Geography-‐based exclusion

– Record and chart changes in vital signs •  Age-‐ and prac:ce-‐based exclusions

What’s the Difference?

– Electronic exchange of key clinical informa:on •  Discon:nued for MU 1

– Report CQMs •  No longer a separate objec:ve

– Electronic copy and electronic access to health informa:on •  Availability within 4 business days

– Public Health Repor:ng •  At least one test of CEHRT capability

What’s the Difference? Con7nued

•  All EPs must meet MU1 – Two or three years

•  Focus on advanced clinical procedures – Rigorous health informa:on exchange – Enhanced ePrescribing and lab results requirements

– Con:nuity of care across mul:ple senngs –  Increased pa:ent and family engagement

•  Improved pa:ent care

Meaningful Use Stage 2


Computerized Provider Order Entry (CPOE)

60% of medica:on, 30% of laboratory, and 30% of radiology orders

ePrescribing (eRx) 50%

Record demographics 80%


Record vital signs 80%

Record smoking status for pa:ents 13 or older

80%

Use clinical decision support 5 clinical decision interven:ons related to at least 4 CQMs


Provide pa:ents ability to view online, download, and transmit their health informa:on

50% provided online access within 4 business days; 5% view, download, or transmit their health informa:on

Provide clinical summaries for pa:ents for each office visit

50%

Protect electronic health informa:on Security risk analysis


Incorporate clinical lab-‐test results into CEHRT

55%

Generate lists of pa:ents by special condi:ons

At least one

Iden:fy pa:ents who should receive reminders for preven:ve/follow up care

10% of unique pa:ents with at least 2 visits in the 24 months preceding repor:ng period


Iden:fy pa:ent-‐specific resources and provide to pa:ent

10%

Perform medica:on reconcilia:on 50%

Provide summary of care record for each transi:on of care or referrals

50%


Submit electronic data to immuniza:on registries

Successful ongoing submission

Use electronic messaging to communicate with pa:ents

5%


Submit syndromic surveillance data to public health agencies


Record electronic notes in pa:ent records

30%

Imaging results accessible through CEHRT

10%


Record pa:ent family health history 20%

Report cancer cases to a public health central cancer registry


Report specific cases to a specialized registry


•  9 of possible 64 –  Adult

•  Controlling High Blood Pressure •  Use of High-‐Risk Medica:ons in the Elderly •  Preven:ve Care and Screening: Tobacco Use: Screening and Cessa:on Interven:on

•  Use of Imaging Studies for Low Back Pain •  Preven:ve Care and Screening: Screening for Clinical Depression and Follow-‐Up Plan

•  Documenta:on of Current Medica:ons in the Medical Record •  Preven:ve Care and Screening: Body Mass Index (BMI) Screening and Follow-‐Up

•  Closing the referral loop: Receipt of specialist report •  Func:onal status assessment for complex chronic condi:ons

Selec:ng CQMs

–  Pediatric •  Appropriate Tes:ng for Children with Pharyngi:s •  Weight Assessment and Counseling for Nutri:on and Physical Ac:vity for Children and Adolescents

•  Chlamydia Screening for Women •  Use of Appropriate Medica:ons for Asthma •  Childhood Immuniza:on Status •  Appropriate Treatment for Children with Upper Respiratory Infec:on (URI)

•  ADHD: Follow-‐Up Care for Children Prescribed AYen:on-‐Deficit/Hyperac:vity Disorder (ADHD) Medica:on

•  Preven:ve Care and Screening: Screening for Clinical Depression and Follow-‐Up Plan

•  Children who have dental decay or cavi:es

Selec:ng CQMs -‐ Con7nued

Selec:ng CQMs -‐ Con7nued

Pa:ent and Family Engagement Popula:on and Public Health

Pa:ent Safety Efficient Use of Healthcare Resources

Care Coordina:on Clinical Processes/Effec:veness

Na>onal Quality Strategy Domains (NQSDs) •  Select from at least 3 domains

Q&A [email protected]

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Health & Medicine

Meaningful Use in 2014