Meaningful Use Stage 2 Changes for Eligible Professionals

Michelle Brunsen, Senior HIT Advisor

2

Today’s Objectives

Stage 2 Meaningful Use Clinical Quality Measures New Clinical Quality Measures Reporting Mechanisms Payment Adjustments and Hardships Medicaid Program Specific Changes

3

EPs Paid By Medicare or Medicaid

Payments to Eligible Professionals

3,365 Medicaid Eligible Professionals have been paid (27.8%) 8,737 Medicare Eligible Professionals have been paid (72.2%) Total Medicare and Medicaid payments to Michigan of $572M

4

Michigan Payments as of October 2013

STAGE 2 MEANINGFUL USE

5

What Stage 2 Means to You

Starting in 2014, providers participating in the EHR Incentive Programs who have met Stage 1 for two or three years will need to meet meaningful use Stage 2 criteria

Improving Patient Care – Stage 2 includes new objectives to improve patient care through better clinical decision support, care coordination and patient engagement

Saving Money, Time, Lives – With this next stage, EHRs will further save our health care system money, save time for doctors and hospitals and save lives

6

New Criteria

Stages of Meaningful Use

7

Stage 2: Advanced Clinical Processes

Stage 1

Stage 2Stage 3

Data Capturing

and Sharing

Improved OutcomesAdvanced

Clinical Processes

What is Your Meaningful Use Path?

8

Starting in 2014

EHRs Meeting ONC 2014 Standards – Starting in 2014, all EHR Incentive Program participants will have to adopt certified EHR technology that meets ONC’s Standards & Certification Criteria 2014 Final Rule

9

Changes

10

What does this mean for EPs?

Pay your annual maintenance/support with your EHR vendor Speak with a representative from your EHR vendor to get in

the queue to receive the 2014 upgrade Install the 2014 EHR version as soon as possible Start educating your patients about the patient portal,

collecting email addresses

11

2014 Reporting Period

To allow providers time to adopt 2014 certified EHR technology and prepare for Stage 2

Regardless of Meaningful Use stage or year

Reporting Period Reduced to Three Months

12

What does this mean for Michigan EPs?

All participants will have one calendar quarter reporting period in 2014

Medicare and Medicaid = 1 quarter Jan – Mar, Apr – June, July – Sep, Oct – Dec Stage 1 Year 1 attesting for first time – MUST attest NO LATER

THAN 10/1/14 to avoid a disincentive and use reporting period of Q1, Q2 or Q3

Stage 2 EP Core Objectives

13

EPs Must Meet all 17 Core Objectives

Stage 2 EP Core Objectives

14

EPs Must Meet all 17 Core Objectives

Stage 2 EP Menu Objectives

15

Eligible Professionals Must Select 3 out of the 6

Closer Look at Stage 2

Patient Engagement is an important focus of Stage 2 Requirements for patient action

– More than five percent of patients must send secure messages to their EP

– More than five percent of patients must access their health information online

Exclusions– CMS is introducing exclusions based on broadband availability in the

provider’s county

16

Patient Engagement

Closer Look at Stage 2

Stage 2 requires that a provider send a summary of care record for more than 50 percent of transitions of care and referrals

The rule also requires that a provider electronically transmit a summary of care for more than 10 percent of transitions of care and referrals

At least one summary of care document sent electronically to recipient with different EHR vendor or to CMS test EHR

17

Electronic Exchange: Stage 2 focuses on actual use cases of electronic information exchange

CLINICAL QUALITY MEASURES

18

How Do CQMs Relate to the CMS Incentive Programs?

Although reporting CQMs is no longer a core objective of the EHR Incentive Programs, all providers are required to report on CQMs in order to demonstrate meaningful use

In 2014 and beyond, reporting programs (i.e., PQRS, eRx reporting) will be streamlined in order to reduce provider burden

19

CQM Alignment with HHS Priorities

Patient and Family Engagement Patient Safety Care Coordination Population and Public Health Efficient Use of Healthcare Resources Clinical Processes/Effectiveness

20

All Providers Must Select CQMs from at least 3 of the 6 HHS National Quality Strategy domains

CQMs in 2014 and Beyond

A complete list of 2014 CQMs and their associated National Quality Strategy domains is posted on the CMS EHR Incentive Programs website

CMS has posted a recommended core set of CQMs for EPs that focus on high priority health conditions

21

www.cms.gov/EHRIncentivePrograms

CQMs in 2014 and Beyond

22

CQMs change in 2014

*Regardless of the stage of meaningful use, all providers will complete this number of CQMs in 2014

23

CQMs in 2014 and Beyond

Controlling High Blood Pressure Use of High-Risk Medications in the Elderly Preventive Care and Screening: Tobacco Use: Screening and

Cessation Intervention Use of Imaging Studies for Low Back Pain Preventive Care and Screening: Screening for Clinical Depression

and Follow-Up Plan Documentation of Current Medications in the Medical Record Preventive Care and Screening: Body Mass Index (BMI) Screening

and Follow Up Closing the Referral Loop: Receipt of Specialist Report Functional Status Assessment for Complex Chronic Conditions

Adult Recommended Core Measures

24

CQMs in 2014 and Beyond

Appropriate Testing for Children with Pharyngitis Weight Assessment and Counseling for Nutrition and Physical Activity

for Children and Adolescents Chlamydia Screening for Women Use of Appropriate Medications for Asthma Childhood Immunization Status Appropriate Treatment for Children with Upper Respiratory Infection

(URI) ADHD: Follow-Up Care for Children Prescribed ADHD Medication Preventive Care and Screening: Screening for Clinical Depression

and Follow-Up Plan Children Who Have Dental Decay or Cavities

Pediatric Recommended Core Measures

NEW CLINICAL QUALITY MEASURES REPORTING MECHANISMS

25

Reporting CQMs in 2014 and Beyond

Beginning in 2014, all Medicare-eligible providers in their second year and beyond of demonstrating meaningful use must electronically report their CQM data to CMS

Medicaid providers will electronically report their CQM data to their state

26

EP CQM Reporting in 2014

27

EPs Reporting for the Medicare EHR Incentive Program

PAYMENT ADJUSTMENTS AND HARDSHIP EXEMPTIONS (MEDICARE ONLY)

28

EP Payment Adjustments

2015 2016 2017 2018 2019 2020+EP is not subject to the payment adjustment for eRx in 2014

99% 98% 97% 96% 95% 95%

EP is subject to the payment adjustment for eRx in 2014

98% 98% 97% 96% 95% 95%

2015 2016 2017 2018 2019 2020+

EP is not subject to the payment adjustment for eRx in 2014

99% 98% 97% 97% 97% 97%

EP is subject to the payment adjustment for eRx in 2014

98% 98% 97% 97% 97% 97%

% adjustment below assumes less than 75% of EPs are meaningful users by CY 2018+

% adjustment below assumes more than 75% of EPs are meaningful users by CY 2018+

29

Payment adjustments are based on prior years' reporting periods The length of the reporting period depends upon the first year of

participation To avoid payment adjustments:

– EPs MUST continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years

*Special three month reporting period

Payment Adjustment Year 2015 2016 2017 2018 2019 2020Based on full year EHR reporting period

2013 2014* 2015 2016 2017 2018

For an EP who has demonstrated meaningful use in 2011 or 2012

EP EHR Reporting Period

30

*Special three month reporting period

Payment Adjustment Year 2015 2016 2017 2018 2019 2020

Based on 90 day EHR reporting period

2013

Based on full year EHR reporting period

2014* 2015 2016 2017 2018

For an EP who demonstrates meaningful use in 2013 for the first time

To avoid payment adjustments:EPs MUST continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years

EP EHR Reporting Period

31

Payment Adjustment Year 2015 2016 2017 2018 2019 2020

Based on 90 day EHR reporting period

2014* 2014

Based on full year EHR reporting period

2015 2016 2017 2018

EP who demonstrates meaningful use in 2014 for the first time:

* In order to avoid the 2015 payment adjustment, the EP must attest no later than 10/1/14, which means they must begin their 90-day reporting period no later than 7/1/14

EP EHR Reporting Period

32

Payment Adjustments for Providers Eligible for Both Programs

If you are eligible to participate in both the Medicaid and Medicare EHR Incentive Programs, you MUST demonstrate Meaningful Use according to the timelines in the previous slides to avoid the payment adjustments

You may demonstrate meaningful use under either program– NOTE: Congress mandated that an EP must be a meaningful user in order to avoid a

payment adjustment; therefore receiving a Medicaid EHR Incentive Payment for adopting, implementing or upgrading your certified EHR Technology would not exempt you from the payment adjustments

33

EPs can apply for hardship exceptions in the following categories:

1. Infrastructure EPs must demonstrate they are in an area without sufficient internet access or face insurmountable barriers to obtaining infrastructure.

2. New EPs Newly practicing EPs who would not have time to become a meaningful user can apply for a 2-year limited exception to payment adjustments.

3. Unforeseen circumstances

Natural disaster or other unforeseeable barrier.

4. EPs must demonstrate the criteria

1. Lack of face-to-face or telemedicine interaction with patients.

2. Lack of need for follow up with patients.

5. EPs who practice in multiple locations must demonstrate

Lack of control of availability of CEHRT for more than 50% of patient encounters.

EP Hardship Exceptions

34

Applying: EPs/EHs must apply for hardship exceptions to avoid payment adjustments

Granting Exceptions: CMS will grant hardship exceptions only if they determine that providers have demonstrated that those circumstances pose a significant barrier to them achieving meaningful use

Deadlines: Applications need to be submitted no later than July 1 for EPs of the year before the payment adjustment year, but CMS recommends earlier submission

For More Information: Details on how to apply will be available in the future at www.cms.gov/EHRIncentivePrograms

Applying for Hardship Exceptions

35

MEDICAID PROGRAM SPECIFIC CHANGES

36

Medicaid Eligibility Expansion

Definition of patient encounter has changed The rule includes encounters for anyone enrolled in the

Medicaid program, including Medicaid expansion encounters (except stand-alone Title 21) and those with zero-pay claims

The rule adds flexibility in the look-back period for overall patient volume

37

Patient Encounters

Provider Eligibility: Patient Volume Calculation

Previously under Stage 1 rule:– Service rendered on any one day where Medicaid paid for all or part of

the service or Medicaid paid the co-pays, cost-sharing or premiums Changes in Stage 2 rule (applicable to all stages):

– Service rendered on any one day to a Medicaid-enrolled individual, regardless of payment liability

– Includes zero-pay claims and encounters with patients in Title-21 funded Medicaid expansions (but not separate CHIPs)

38

Medicaid Encounters

Provider Eligibility: Patient Volume Calculation

Under Stage 1 rule, Medicaid patient volume for providers calculated across 90-day period in last calendar year

Under Stage 2 rule (applicable to all stages), States also have the option to allow providers to calculate Medicaid patient volume across 90-day period in last 12 months preceding provider’s attestation

Also applies to needy individual patient volume Applies to patient panel methodology:

– With at least one Medicaid encounter taking place in the last 24 months prior to the 90-day period (expanded from 12 months prior)

39

90 Day Period for Medicaid Patient Volume Calculation

STAGE 2 RESOURCES

40

Stage 2 Resources

http://www.cms.gov/Regulations-and Guidance/Legislation/EHRIncentivePrograms/Stage_2.html

Links to the Federal Register Tip Sheets:

– Stage 2 Overview – 2014 Clinical Quality Measures – Payment Adjustments & Hardship Exceptions (EPs & Hospitals) – Stage 1 Changes – Stage 1 vs. Stage 2 Tables (EPs & Hospitals)

41

CMS Website

Michelle BrunsenSr. Health IT Advisor

mbrunsen@telligen.org(515) 453-8180

www.telligenhitrec.org@TelligenHITREC

Contact Us

42

In Partnership with: The Office of the National Coordinator for Health Information Technology (ONC) U.S. Department of Health and Human Services grant 90RC0004/01. IA-HITREC-05/13-794