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__________________________________________ Help has arrived. Medicare & Medicaid Meaningful Use Incentives Program Specifics May 2011 SUCCOR CONSULTING GROUP Copyright 2011 © Succor Consulting Group, Inc

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Page 1: SCG's Meaningful Use White Paper

__________________________________________

Help has arrived.

Medicare & Medicaid Meaningful Use

Incentives Program Specifics

May 2011

SUCCOR CONSULTING GROUP

Copyright 2011 © Succor Consulting Group, Inc

Page 2: SCG's Meaningful Use White Paper

TABLE OF CONTENTS

EHR INCENTIVE PROGRAM - OVERVIEW 1

MEDICARE/MEDICAID ELIGIBLE PROFESSIONALS (EPs) 3

ELIGIBILITY REQUIREMENTS FOR PHYSICIANS 4

MEDICAID INCENTIVES OVERVIEW 6

ELIGIBLE PROFESSIONAL SHORTAGE BONUSES 7

PROFESSIONALS ELIGIBLE FOR BOTH PROGRAMS 8

MEDICARE VS MEDICAID 9

PENDING EXPANDED MEDICARE & MEDICAID ELIGIBLE PROFESSIONALS & FACILITIES 10

MEDICARE EHR INCENTIVES BASICS OVERVIEW FOR ELIGIBLE PROFESSIONALS 11

MEDICAID EHR INCENTIVES BASICS OVERVIEW FOR ELIGIBLE PROFESSIONALS 12

MEDICARE ADVANTAGE ELIGIBLE PROFESSIONALS 13

MEDICARE ELIGIBLE HOSPITALS 14

MEDICAID ELIGIBLE HOSPITALS 19

MEDICARE & MEDICAID DUALLY ELIGIBLE HOSPITALS 22

E-PRESCRIBING INCENTIVES PROGRAM OVERVIEW 23

E-PRESCRIPTION – ELIGIBLE PROFESSIONALS 26

E-PRESCRIBING INCENTIVES PAYMENT DETAILS 28

WHAT IS MEANINGFUL USE (MU)? 29

BASIC OVERVIEW OF STAGE 1 MU OBJECTIVES AND MEASURES REPORTING 32

ELIGIBLE PROFESSIONALS 15 CORE/10 MENU OBJECTIVES 33

ELIGIBLE PROFESSIONALS & MEANINGFUL USE 34

WHAT ARE CLINICAL QUALITY MEASURES? 35

WHAT ARE QUALITY MEASURES? 35

EP REQUIREMENTS FOR CLINICAL QUALITY MEASURES 36

EP REQUIREMENTS FOR CLINICAL QUALITY MEASURES REPORTING 36

EP REPORTING PERIOD 37

CLINICAL QUALITY MEASURES CORE SET 38

ALTERNATE CORE SET 38

ADDITIONAL SET CQM 39

REGISTRATION REQUIREMENTS 41

PROGRAM TIMELINE 42

ACRONYMS 43

Page 3: SCG's Meaningful Use White Paper

EHR INCENTIVES PROGRAM OVERVIEW

EHR Incentive Programs were established by law through the American

Recovery & Reinvestment Act (ARRA) of 2009.

The Medicare and Medicaid EHR Incentive Programs will provide incentive

payments to eligible professionals (EPs), eligible hospitals and critical access

hospitals (CAHs), Integrated Delivery Networks (IDNs) and other Medical

Establishments as they adopt, implement, upgrade or demonstrate Meaningful

Use (MU) of CCHIT certified EHR technology.

We have been preparing to cross this threshold for many decades. The

potential for information technology to support and improve health care was

recognized early. Government and private support for development and

assessment of health informatics began in the 1960s. Yet, even as computers

transformed almost every other sector of the economy, health care remained

mostly paper-based.

In 2009, Congress and President Obama took a definitive new step when they

enacted the Health Information Technology Economic and Clinical Heath Act

(HITECH), part of ARRA. HITECH authorized up to $27 billion in incentive

payments for providers and $2 billion to build a national infrastructure for the

adoption of EHRs. Most importantly, HITECH established the goal of the

meaningful use of electronic health records. However cryptic this term may

have seemed at first, it holds the key to unlocking the power of information to

transform health care for the better.

Put plainly, “meaningful use” is a shorthand for three things:

An incentive program, rewarding not only deployment of EHRs, but also their

effective use for patient benefit;

A new national infrastructure to support deployment and beneficial use of

EHRs; and

A vision for the evolving, dynamic and optimal uses of information to support

health and health care improvement – the tip of the spear for an information-

powered leap in the quality, safety and effectiveness (including cost

effectiveness) of our health care system.

1

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As an incentive program, meaningful use went live January 1, 2011. That was

when registration opened for eligible providers and hospitals to take part in the

Medicare and Medicaid incentive payments programs. Surveys in the latter part

of 2010 by the American Hospital Association (AHA) and CDC’s National Center

for Health Statistics indicated that 81 percent of hospitals and 41 percent of

office-based physicians were already planning to achieve meaningful use and

qualify for incentive payments. In January alone, 21,300 providers initiated the

registration process.

Page 5: SCG's Meaningful Use White Paper

MEDICARE ELIGIBLE PROFESSIONALS

Eligible professionals under the Medicare EHR Incentive Program include:

• Doctor of medicine or osteopathy

• Doctor of dental surgery or dental medicine

• Doctor of podiatry

• Doctor of optometry

• Chiropractor

EPs may not be hospital-based.

MEDICAID ELIGIBLE PROFESSIONALS

Eligible professionals under the Medicaid EHR Incentive Program include:

• Physicians (primarily doctors of medicine and doctors of osteopathy)

• Nurse practitioner

• Certified nurse-midwife

• Dentist

• Physician assistant who furnishes services in a

Federally Qualified Health Center or Rural Health

Clinic that is led by a physician assistant.

EPs may not be hospital-based.

To qualify for an incentive payment under the Medicaid EHR Incentive Program,

an eligible professional must meet one of the following criteria:

1. Have a minimum of 30% Medicaid patient volume*

2. Have a minimum of 20% Medicaid patient volume and is a pediatrician*

3. Practice predominantly in a Federally Qualified Health Center or Rural Health

Center and have a minimum of 30% patient volume attributable to needy

individuals

*Note - Children's Health Insurance Program (CHIP) patients do not count toward the

Medicaid patient volume criteria.

3

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• Incentive payments for eligible professionals are based on individual

practitioners.

• If you are part of a practice, each eligible professional may qualify for an

incentive payment if each eligible professional successfully demonstrates

meaningful use of certified EHR technology.

• Each eligible professional is only eligible for one incentive payment per year,

regardless of how many practices or locations at which he or she provides

services.

Hospital-based eligible professionals are not eligible for incentive

payments. An eligible professional is considered hospital-based if 90% or more

of his or her services are performed in a hospital inpatient (Place Of Service

code 21) or emergency room (Place Of Service code 23) setting.

ELIGIBILITY REQUIREMENTS FOR PROFESSIONALS

4

Page 7: SCG's Meaningful Use White Paper

Medicare EP Incentive Payments amounts are based on:

• Fee-for-Service (FFS) allowable charges

• Maximum incentives are $44,000 over 5 years

• Incentives decrease if starting after 2012

• Must begin by 2014 to receive incentive payments

• Last payment year is 2016

• Extra bonus amount available for practicing predominantly in a

Health Professional Shortage Area

• Receive one (1) incentive payment per year

5

Payment First Year you First Year you First Year you First Year you

Amount for Qualify to Qualify to Qualify to Qualify to

Year: Receive Payment Receive Payment Receive Payment Receive Payment

2011 2012 2013 2014

TOTAL Possible

Incentive

Payments

2011

2016

2015

2014

2013

2012

-

-

-

$12,000

$8,000

$4,000$4,000

$18,000

-

-

$15,000

$12,000$8,000

$12,000

-

$8,000

$2,000

$4,000

-

$2,000

$4,000

$8,000

$12,000

$18,000

$44,000 $24,000$39,000$44,000

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Medicaid Incentives Payments Overview

• Maximum incentives are $63,750 over six years

• Incentives are the same regardless of start year

• The first year payment is $21,250

• Must begin by 2016 to receive incentive payments

• Incentives are available through 2021

• Pays one (1) incentive payment per year

*NOTE: No extra bonus for health professional shortage area

6

Payment First Year you First Year you First Year you First Year you First Year you First Year you

Amount for Qualify to Qualify to Qualify to Qualify to Qualify to Qualify to

Year: Receive Payment Receive Payment Receive Payment Receive Payment Receive Payment Receive Payment

2011 2012 2013 2014 2015 2016

TOTAL Possible

Incentive

Payments

2011

2017

2016

2015

2014

2013

2012

-

2021

2020

2019

2018

$21,250

$8,500

$8,500

$8,500

$8,500

$8,500

$8,500

$8,500

$8,500

-

-

-

-

-

-

-

-

-

-

-

-

-

$21,250

$8,500

$8,500

--

-

-

-

$21,250

$8,500

$8,500

$8,500

$8,500

$8,500

$8,500

$8,500

$8,500

-

-

-

$21,250

-

-

$21,250

$8,500$8,500

$8,500

-

$8,500

-

$8,500

$8,500

$8,500

-

-

-

-

$8,500

-

-

-

-

-

-

$8,500

$8,500

$8,500

$8,500

$21,250

$63,750 $63,750$63,750$63,750$63,750$63,750

Page 9: SCG's Meaningful Use White Paper

ELIGIBLE PROFESSIONAL SHORTAGE BONUSES

7

You may qualify for more!

Practices with 30% or more of their patient population paying with Medicaid

(20% for pediatricians) are eligible for stimulus incentive payments of up to

$65,000.

Practices operating in a "health provider shortage area" (HPSA) can qualify

for bonus incentives, e-prescribing, Medicare's physician quality reporting

initiative (PQRI) and Medicare Care Manage Performance (MCMP) can also

increase your bonuses.

Medicare HITECH

Incentive

Medicare Plus

HSPA

Medicaid HITECH

Incentive

Bonus

E-Prescribe

Medicare PQRI

Medicare MCMP

-

-

2% bonus

$12,500 per provider

2% bonus

$12,500 per provider

2% bonus

$44,000 per provider

$48,400 per provider

$65,000 per provider

$44,000 per provider

$48,400 per provider

$65,000 per provider

2% bonus

Private Practice FQHC ClinicsNon-FQHC Safety NetClinics

$44,000 per provider

$48,400 per provider

-

2% bonus

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PROFESSIONALS ELIGIBLE FOR BOTH PROGRAMS

EPs eligible for both the Medicare and Medicaid EHR Incentive Programs

must choose which incentive program they wish to participate in when they

register.

Before 2015, an EP may switch programs only once after the first incentive

payment is initiated. Medicare EPs who also qualify as a Medicaid EP must

choose between the Medicare and Medicaid incentive programs when they

register.

Medicaid EPs and providers who are not eligible to participate in the Medicare

and Medicaid EHR Incentive Programs will not be subject to payment

adjustments. However, Medicaid EPs who also treat Medicare patients will

have a payment adjustment to Medicare reimbursements, starting in 2015 if

they do not successfully demonstrate meaningful use.

*Most eligible professionals will maximize their incentive payments by

participating in the Medicaid EHR Incentive Program.

Doctors or Medicine

Doctors of Osteopathy

Doctors of Dental Medicine or Surgery

Nurse Practitioners

Certified Nurse-Midwives

Physician Assistants

(when working at an FQHC or RHA that is led by a PA)

Doctors of Optometry

Doctors of Podiatric Medicine

Chiropractor

Eligible for both

Medicare only Medicaid only

Page 11: SCG's Meaningful Use White Paper

MEDICARE VS MEDICAID

9

Medicare Medicaid

Federal Government will implement Voluntary for States to implement -

starting January 2011 Most expected to start late summer 2011

Payment reductions begin in 2015 for No Medicaid payment reductions

providers that do not demonstrate MU

Must demonstrate MU in Year 1 A/I/U option for 1st participation year

Maximum incentive is $44,000 for EPs Maximum incentive is $63,750 for EPs

(bonus for Eps in HPSAs)

MU definition is common for Medicare States can adopt certain additional

requirements for MU

Last year a provider may initiate program Last year a provider may register for &

is 2014; Last year to register is 2016; initiate program is 2016; Last payment

Payment adjustments begin in 2015 year is 2021

Only physicians, subsection (d) 5 types of EPs, acute care hospitals

hospitals and CAHs (including CAHs) & children's hospitals

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PENDING EXPANDED MEDICARE & MEDICAID ELIGIBLE

PROFESSIONALS & FACILITIES

Legislation introduced in the U.S. Senate would extend eligibility for electronic

health records meaningful use incentive payments to:

• Behavioral health professionals and facilities

• Mental health professionals and facilities

• Substance abuse professionals and facilities

Sen. Sheldon Whitehouse (D-RI) introduced S. 539, which has been referred to

the Finance Committee. Facilities eligible under the bill include:

• Community mental health centers

• Psychiatric hospitals

• Residential mental health treatment facilities

• Outpatient mental health treatment facilities

• Substance abuse treatment facilities

• Including facilities operated by counties

The legislation also would make these professionals and facilities eligible for

services from health information technology extension centers. Text of S. 529 is

available at congress.gov. Please check back for updates.

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MEDICARE EHR INCENTIVES BASICS OVERVIEW FOR

ELIGIBLE PROFESSIONALS

The Medicare EHR Incentive Program for EPs starts in 2011 and will continue

through 2016. Depending on the first year they participate, EPs can participate

for up to 5 years throughout the duration of the program. The last year to begin

participation in the Medicare EHR Incentive Program is 2014.

• To qualify for Medicare EHR incentive payments, Medicare EPs must

successfully demonstrate meaningful use for each year of participation in

the program.

• Incentive payments are made based on the calendar year. The reporting

period for the first year is any 90 continuous days during the calendar year. The

reporting period for all subsequent years is the entire calendar year.

• For calendar years 2011–2016, EPs who demonstrate meaningful use of

certified EHR technology can receive up to $44,000 over 5 years under the

Medicare EHR Incentive Program.

To receive the maximum EHR incentive payment, Medicare EPs must begin

participation by 2012.

Important! For 2015 and later, Medicare EPs who do not successfully

demonstrate meaningful use will have a payment adjustment to their Medicare

reimbursement. The payment reduction starts at 1% and increases each year

that a Medicare EP does not demonstrate meaningful use, to a maximum of 5%.

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MEDICAID EHR INCENTIVES BASICS OVERVIEW FOR

ELIGIBLE PROFESSIONALS

The Medicaid EHR Incentive Program is offered and administered voluntarily by

states and territories. States can start offering their program to EPs as early as

2011. The program continues through 2021. EPs can participate for 6 years

throughout the duration of the program. The last year to begin participation

in the Medicaid EHR Incentive Program is 2016.

• To qualify for Medicaid incentive payments, Medicaid EPs must adopt,

implement, upgrade or demonstrate meaningful use of certified EHR technology

in the first year of participation and successfully demonstrate meaningful use in

subsequent participation years.

• For calendar years 2011–2021, participants can receive up to $63,750 over 6

years under the Medicaid EHR incentive program. EHR incentive payments are

made by the state based on the calendar year.

• Medicaid EPs who also qualify as Medicare EPs must choose between the

Medicare and Medicaid EHR Incentive Programs when they register.

• Medicaid EPs and providers who are not eligible to participate in the Medicare

and Medicaid EHR Incentive Programs will not be subject to payment

adjustments. However, Medicaid EPs who also treat Medicare patients will have

a payment adjustment to Medicare reimbursements starting in 2015 if they do

not successfully demonstrate meaningful use.

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MEDICARE ADVANTAGE ELIGIBLE PROFESSIONALS?

Medicare Advantage (MA) EPs are physicians that are either:

• Employed by the Medicare Advantage organization

OR

• Employed by, or partner of, an entity through a contract with the Medicare

Advantage organization, that furnishes at least 80% of that entity's Medicare

patient care services to enrollees of the MA organization.

Also, Medicare Advantage EPs must furnish at least 80% of their Medicare-

related professional services to enrollees of the MA organization and must

furnish, on average, at least 20 hours per week of patient care services.

Medicare Advantage (MA) organizations may also qualify to receive EHR

incentive payments. Under the Medicare Advantage EHR Incentive Program,

payments are made only to Medicare Advantage organizations that are licensed

as HMOs, or in the same manner as HMOs, by a State. These Medicare

Advantage organizations may receive incentive payments by way of Medicare

Advantage affiliated hospitals (MA-affiliated hospitals) and Medicare Advantage

EPs.

What is a Medicare Advantage affiliated hospital?

Medicare Advantage affiliated hospitals are hospitals that:

• Are under a common corporate governance with the Medicare Advantage

organization

AND

• Serve individuals enrolled under Medicare Advantage plans offered by the

Medicare Advantage organization, where less than one-third are Medicare

individuals covered under Medicare Part A.

*For additional information regarding the Medicare Advantage EHR incentive payment,

please review section 4101(c) of subtitle D of the HITECH ACT.

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MEDICARE ELIGIBLE HOSPITALS

Eligible hospitals and Critical Access Hospitals (CAHs) will qualify for incentive

payments under the Medicare EHR Incentive Program if they successfully

demonstrate meaningful use of certified EHR technology.

What is an Eligible Hospital under the Medicare EHR Incentive Program?

• "Subsection (d) hospitals" in the 50 states or DC that are paid under the

Inpatient Prospective Payment System (IPPS)

• Critical Access Hospitals (CAHs)

• Medicare Advantage (MA-Affiliated) Hospitals

• Eligible hospitals and CAHs that adopt and successfully demonstrate

meaningful use of certified EHR technology can begin receiving incentive

payments for any year from federal fiscal year (FY) 2011 to FY 2015.

• Incentive payments to eligible hospitals and CAHs may begin as early as

2011 and are based on a number of factors, beginning with a $2 million base

payment.

• The law defines a payment year for eligible hospitals and CAHs in terms of

federal fiscal year (FY) beginning with FY 2011. However, a hospital does not

have to begin receiving incentive payments in FY 2011.

• Hospitals can begin receiving EHR incentive payments in any year from FY

2011 to FY 2015, but payments will decrease for hospitals that start receiving

payments in 2014 and later.

• Hospitals that do not successfully demonstrate meaningful use of certified

EHR technology beginning in FY 2015 will be subject to payment adjustments.

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Eligible acute care inpatient hospitals are defined as “subsection (d) hospitals”

in section 1886(d)(1)(B) of the Act—which are hospitals that are paid under the

hospital inpatient prospective payment system (IPPS) and are located in one of

the 50 states or the District of Columbia. Section 1853(m)(2) of the Act also

specifies that qualifying Medicare Advantage (MA) organizations will be eligible

for incentive payments by way of their MA-affiliated eligible hospitals. An MA-

affiliated eligible hospital is a “subsection (d)” hospital that operates under

common corporate governance with a qualifying MA organization and serves

primarily individuals enrolled under MA plans offered by such organizations.

Medicare hospitals and MA-affiliated eligible hospitals that adopt a certified

EHR system and are meaningful users can begin receiving incentive payments

in any year from FY 2011 to FY 2015.

Medicare Incentive Payment Calculation

Regardless of the payment year, the Medicare incentive payment is the product

of three factors:

1. An Initial Amount

2. The Medicare Share

3. A Transition Factor applicable to the payment year This payment

methodology will be utilized to calculate Medicare hospital-based EHR incentive

payments for eligible hospitals participating under both the Medicare fee for

service and MA incentive programs.

Initial Amount = a base amount of $2,000,000 + discharge-related amount

The Initial Amount is the sum of a base amount and a discharge-related

amount. The base amount is $2,000,000, and the discharge-related amount

provides an additional $200 for each acute care hospital discharge during a

payment year, beginning with a hospital’s 1,150th discharge of the year and

ending with a hospital’s 23,000th discharge of the year. No additional payment

is made for discharges prior to the 1,150th discharge or for those discharges

after the 23,000th discharge.

Data on acute care hospital discharges from the hospital’s most recently filed

12-month cost report at the time of the calculation will be used as the basis for

making preliminary incentive payments. Final payments will be determined at

the time of settling the first 12-month cost report for the hospital FY that begins

after the beginning of the payment year and settled on the basis of the hospital

discharge data from that cost reporting period.

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For example, for an eligible hospital with a cost reporting period running from

July 1, 2010 through June 30, 2011, CMS would employ the relevant data from

the hospital’s most recently filed 12-month cost report at the time of the

calculation (most likely the June 30, 2010 cost report) to determine the

preliminary incentive payment for the hospital during FY 2011. However, the

final incentive payment would probably be based on hospital discharge data

from the cost report beginning July 1, 2011 (fiscal year ending June 30, 2012)

and determined at the time of settlement for that cost reporting period. If that

cost report is not filed for a 12-month period, the next full 12-month cost report

would be employed.

For purposes of determining the Initial Amount, three (3) classes of hospitals

are distinguished on the basis of the number of discharges as shown in Table 1.

Table 1: Initial Amount Calculation

Type of Hospital with 1,149 or fewer with at least 1,150 but no with 23,001 or more

discharges during the more than 23,000 discharges during

payment year discharges during payment payment year

year

Discharge $0 $200 x (n-1,149) $200 x (23,001-

Related Amount (n=number of discharges 1,149)

during the payment year)

Base Amount $2,000,000 $2,000,000 $2,000,000

Total Initial $2,000,000 Between $2M & $6,370,400 Limited by law to

Amount depending on number of $6,370,400

Discharges

Medicare Share Calculation is as follows:

# of IP Part A Bed Days + # of IP Part C Days________________________

Total IP Bed Days x Total Charges - Charges Attributable to Charity Care

IP=inpatient Total Charges

The second step in determining the hospital payment for a meaningful user of

certified EHR technology is to calculate the Medicare Share.

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As in calculating the Initial Amount, the time period used to determine the

Medicare Share fraction is based on data from the latest filed 12-month cost

report at the time the calculation is made and that is later update when the first

12-month cost report for the hospital fiscal year that begins after the beginning of

the payment year is settled.

The numerator of the Medicare Share is the sum of:

• The estimated number of acute care inpatient-bed-days attributable to

individuals for whom payment may be made under Part A; and

• The estimated number of acute care inpatient-bed-days attributable to

individuals who are enrolled with a Medicare Advantage organization under Part

C.

The denominator of the Medicare Share is the product of:

• The estimated total number of acute care inpatient-bed-days for the eligible

hospital during such a period; and

• The estimated total amount of the eligible hospital’s charges during such

period, not including any charges that are attributable to charity care, divided by

the estimated total amount of the hospitals charges during such period.

Note: The removal of charges attributable to charity care in the formula, in effect,

increases the Medicare Share resulting in higher incentive payments for

hospitals that provide a greater proportion of charity care. The amount comes

from the Medicare Cost Report, Worksheet S-10.

Transition Factor

The third (3rd) factor in the formula to determine the incentive payment to an

eligible hospital for a payment year is the Transition Factor. As seen in Table 2 on

the following page, this element phases down the incentive payments over time.

Hospitals that demonstrate that they are meaningful users of certified EHR

technology in FYs 2011, 2012 or 2013, could receive up to four (4) years of

financial incentive payments. Hospitals that begin receiving incentive payments

later than FY 2013 will receive no more than three (3) years of incentive

payments. Specifically, if a hospital were to begin to demonstrate meaningful use

of certified EHR technology in FY 2014, it would receive incentive payments for

FY 2014, FY 2015, and FY 2016.

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Similarly, if a hospital were to begin meaningful use of certified EHR

technology in FY 2015, it would receive incentive payments for FYs 2015 and

2016. Table 2 shows the possible years an eligible hospital could receive an

incentive payment and the Transition Factor applicable to each year.

Table 2: Fiscal Year That Eligible Hospital First Receives the Incentive

Payment

Fiscal

Year

2011 2012 2013 2014 2015

2011

2012

2013

2014

2015

2016

1.00

0.75

0.50

0.25

1.00

1.00 0.75

0.75 0.75 0.50

0.50 0.50 0.50 0.25

0.25 0.25 0.25

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MEDICAID ELIGIBLE HOSPITALS

Eligible hospitals will qualify for incentive payments if they adopt, implement,

upgrade or demonstrate meaningful use of certified EHR technology during

the first participation year or successfully demonstrate meaningful use of

certified EHR technology in subsequent participation years.

What is an Eligible Hospital under the Medicaid EHR Incentive

Program?

• Acute care hospitals (including CAHs and cancer hospitals) with at least

10% Medicaid patient volume Children's hospitals (no Medicaid patient

volume requirements)

• Medicaid hospitals that qualify for EHR incentive payments may begin

receiving incentive payments in any year from fiscal year (FY) 2011 to FY

2016.

• While the law defines a payment year in terms of a FY beginning with FY

2011, a hospital does not have to begin receiving incentive payments

in FY 2011.

An eligible acute care inpatient hospital is defined as a health care facility

with an average length of patient stay of 25 days or fewer and with a Claim

Control Number that has the last four digits in the series 0001-0879 or 1300-

1399. This includes the 11 cancer hospitals and all Critical Access Hospitals

(CAHs) in the United States. In addition, to be eligible to receive a Medicaid

EHR incentive payment, acute care hospitals must also meet a 10 percent

(10%) Medicaid patient volume threshold. There is no Medicaid patient

volume requirement for children’s hospitals.

The method for estimating Medicaid patient volume will be designated by the

State Medicaid Agency and approved by CMS, but CMS provided States with

acceptable alternatives for making such estimates in the final rule.

Provided the state where the hospital is located is ready and participating in

the Medicaid EHR Incentive Program, acute care and children’s hospitals that

adopt a certified EHR system and are meaningful users can begin receiving

incentive payments in any year from fiscal year (FY) 2011 to FY 2016.

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While the law defines a payment year in terms of a federal fiscal year, a hospital

does not have to begin receiving incentive payments in FY 2011. Hospitals can

begin receiving payments in any year from FY 2011 to FY 2016; however, the last

year a hospital can first receive a Medicaid incentive program payment is 2016.

Acute care hospitals may receive EHR Incentive Program payments from both

Medicare and Medicaid if eligible for both programs.

Medicaid Incentive Payment Calculation States may pay children’s hospitals and

acute care hospitals up to 100 percent (100%) of an aggregate EHR hospital

incentive amount provided over a minimum of a three-year period and a

maximum of a six-year period. The aggregate EHR incentive amount is the total

amount the hospital could receive in Medicaid payments over a theoretical four

(4) years of the program. It is the product of two factors:

1. The overall EHR amount.

2. The Medicaid Share.

The overall EHR amount is based upon the sum over a theoretical four years of

payment where the amount for each year is the product of three (3) factors:

1. An Initial Amount

2. The Medicare Share

3. A Transition Factor applicable to each of a theoretical four (4) years.

Initial Amount

Initial Amount = a base amount of $2,000,000 + a discharge-related amount

The Initial Amount is the sum of a base amount and a discharge-related amount.

The base amount is $2,000,000, and the discharge-related amount provides an

additional $200 for estimated discharges between 1,150 and 23,000 discharges.

No payment is made for discharges prior to the 1,150th discharge or for

discharges after the 23,000th discharge.

For the first payment year, data on hospital discharges from the hospital fiscal

year that ends during the federal fiscal year prior to the hospital fiscal year that

serves as the first payment year will be used as the basis for determining the

discharge-related amount. To determine the discharge-related amount for the

three subsequent payment years that are included in determining the overall

EHR amount, the number of discharges will be based on the average annual

growth rate for the hospital over the most recent three years of available data.

Note: If a hospital’s average annual rate of growth is negative over the three-year

period, the rate should be applied as such.

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This factor in the formula determines the Medicaid incentive payment to an

eligible hospital. For each of the four (4) years of theoretical payment, a different

transition factor applies, as demonstrated in Table 1. Note that for the Medicaid

Program, an aggregate EHR amount is calculated only once, and this amount is

then spread over all years of a hospital’s payments. Therefore, the transition

factors in Table 1 are used to calculate the aggregate EHR amount but do not

indicate that the hospital’s payment will be calculated anew on a yearly basis.

The second step in determining the aggregate EHR amount for a meaningful

user of certified EHR technology is to calculate the Medicaid Share. The

Medicaid Share is essentially the percentage of a hospital’s inpatient, non-charity

care days that are attributable to Medicaid inpatients.

Year 1

Year 2

Year 3

Year 4

TRANSITION FACTOR

1.00

0.75

0.50

0.25

Table 1: Transition Factor by Year

The Medicaid Share

The numerator of the Medicaid Share is the sum of:

1. The estimated number of Medicaid inpatient-bed-days

2. The estimated number of Medicaid managed care inpatient-bed-days

The denominator of the Medicaid Share is the product of:

1. The estimated total number of inpatient-bed-days for the eligible hospital

during that period

2. The estimated total amount of the eligible hospital’s charges during that period,

not including any charges that are attributable to charity care divided by the

estimated total amount of the hospital’s charges during that period. The hospital’s

final payments would be based on the State Health Information Technology plan

for incentive payments.

Note: The removal of charges attributable to charity care in the formula, in effect, increases the

Medicaid Share resulting in higher incentive payments for hospitals that provide a greater proportion

of charity care.

Page 24: SCG's Meaningful Use White Paper

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MEDICARE & MEDICAID DUALLY ELIGIBLE HOSPITALS

Some hospitals may receive incentive payments from both Medicare and

Medicaid if they meet all eligibility criteria.

Hospitals that are eligible for EHR incentive payments under both Medicare and

Medicaid should select "Both Medicare and Medicaid" during the

registration process, even if they plan to apply ONLY for a Medicaid EHR

incentive payment by adopting, implementing or upgrading certified EHR

technology.

Dually-eligible hospitals can then attest through CMS for their Medicare EHR

incentive payment at a later date, if they so desire. It is important for a dually-

eligible hospital to select "Both Medicare and Medicaid" from the start of

registration in order to maintain this option.

Hospitals that register only for the Medicaid program (or only the Medicare

program) will not be able to manually change their registration (i.e., change to

"Both Medicare and Medicaid" or from one program to the other) after a

payment is initiated and this may cause significant delays in receiving a

Medicare EHR incentive payment.

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Eligible Professionals who participate in the eRx Incentive Program by

reporting on their adoption and use of a qualified eRx system that has the

functionalities required by CMS may qualify for an incentive payment.

E-prescribing is the transmission of prescription or prescription-related

information through electronic media. The Medicare Improvements for Patients

and Providers Act of 2008 (known as MIPPA) authorized the Medicare

Electronic Prescribing Incentive Program to promote adoption and use of

electronic-prescribing systems.

With eRx, health care professionals can electronically transmit both new

prescriptions and responses to renewal requests to a pharmacy without having

to write or fax the prescription.

The eRx incentive payment is similar to the Physician Quality Reporting

Initiative, or PQRI incentive in that it is based on the Medicare Part B

Physician Fee Schedule (PFS) covered professional services furnished by the

EPs during a reporting period. To be eligible for the incentive, you must meet

the criteria for being a successful electronic prescriber. The criteria used to

determine whether an EP is a successful electronic prescriber are established

for each program year through rulemaking.

Beginning 2012, CMS will apply payment adjustments to EPs who are not

successful electronic prescribers under the eRx Incentive Program. To become

successful e-prescribers for purposes of avoiding the 2012 eRx payment

adjustment, EPs must report the electronic prescribing measure for a required

minimum number of unique electronic prescribing events via claims between

January 1, 2011 and June 30, 2011

EPs may begin reporting the eRx measure at any time throughout the 2011

program year of January 1-December 31, 2011 to be incentive eligible, but

must do so prior to June 30, 2011 to be exempt from the 2012 eRx payment

adjustment.

E-PRESCRIBING INCENTIVES PROGRAM OVERVIEW

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EPs must have adopted a "qualified" e-prescribing system in order to be able to

report the e-prescribing measure. There are two (2) types of systems.

1) a system for eRx only (stand-alone).

2) an EHR system with eRx functionality.

Regardless of the type of system used, to be considered "qualified" it must be

based on ALL of the following capabilities:

• Generating a complete active medication list incorporating electronic data

received from applicable pharmacies and pharmacy benefit managers (PBMs) if

available.

• Selecting medications, printing prescriptions, electronically transmitting

prescriptions and conducting all alerts.

• Providing information related to lower cost, therapeutically appropriate

alternatives (if any). (The availability of an eRx system to receive tiered formulary

information, if available, would meet this requirement for 2011)

• Providing information on formulary or tiered formulary medications, patient

eligibility and authorization requirements received electronically from the patient's

drug plan, if available.

EPs can begin by reporting e-prescribing data for January 1-December 31, 2011.

Beginning in 2012, EPs who are not successful e-prescribers may be subject to

a payment adjustment. Section 132 of the Medicare Improvements for Patients

and Providers Act of 2008 (MIPPA) authorizes CMS to apply this payment

adjustment whether or not the EP is planning to participate in the eRx Incentive

Program.

The payment adjustment in 2012, with regard to all of the EP’s Part B-covered

professional services, will result in the EP’s or group practice receiving 99% of

the Physician Fee Schedule (PFS) amount that would otherwise apply to such

services. In 2013, the EPs will receive 98.5% of their covered Part B-eligible

charges if they aren’t a successful e-prescriber. In 2014, the penalty for not being

a successful e-prescriber is 2% resulting in EPs receiving 98% of their covered

Part B charges.

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For purposes of determining which EPs or group practices are subject to the

payment adjustment in 2012, CMS will analyze claims data from January 1,

2011- June 30, 2011 to determine if the EP has submitted at least ten (10)

electronic prescriptions during the first six months of calendar year 2011. Group

practices reporting as a GPRO I or GPRO II in 2011must report all of their

required e-prescribing events in the first six months of 2011 to avoid the

payment adjustment in 2012.

If an EP or selected group practice wishes to request an exemption to the eRx

Incentive Program and the payment adjustment, there are two “hardship codes”

that can be reported via claims should one of the following situations apply:

• G8642 - The EP practices in a rural area without sufficient high speed internet

access and requests a hardship exemption from the application of the payment

adjustment under section 1848(a)(5)(A) of the Social Security Act.

• G8643 - The eligible professional practices in an area without sufficient

available pharmacies for electronic prescribing and requests a hardship

exemption from the application of the payment adjustment under section

1848(a)(5)(A) of the Social Security Act

Additionally, there will be a G code which can be used by EPs to indicate that

they do not have prescribing privileges. Reporting this G code will prevent the

EP from being subjected to a payment adjustment in 2012.

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EPRESCRIPTION – ELIGIBLE PROFESSIONALS

Eligible professionals do not need to participate in the Physician Quality

Reporting System to participate in the Electronic Prescribing (eRx) Incentive

Program.

Under the eRx Incentive Program, covered professional services are those paid

under the Medicare Physician Fee Schedule (PFS). To the extent that eligible

professionals are providing services which are paid under the PFS, those

services are eligible for eRx Incentive Program.

Eligible and Able to Participate The following professionals are eligible to participate in eRx Incentive Program:

Eligible professionals must have prescribing authority in order to participate in

this program.

1. Medicare physicians

• Doctor of Medicine

• Doctor of Osteopathy

• Doctor of Podiatric Medicine

• Doctor of Optometry

• Doctor of Oral Surgery

• Doctor of Dental Medicine

• Doctor of Chiropractic

2. Practitioners

• Physician Assistant

• Nurse Practitioner

• Clinical Nurse Specialist

• Certified Registered Nurse Anesthetist (and Anesthesiologist Assistant)

• Certified Nurse Midwife

• Clinical Social Worker

• Clinical Psychologist

• Registered Dietician

• Nutrition Professional

• Audiologists

3. Therapists

• Physical Therapist

• Occupational Therapist

• Qualified Speech-Language Therapist

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Eligible But Not Able to Participate

The following professionals are eligible to participate but are not able to

participate for one or more reasons:

1. Professionals paid under or based upon the PFS billing Medicare Carriers/

Medicare Administrative Contractors (MACs) who do not bill directly.

2. Professionals paid under the PFS billing Medicare fiscal intermediaries

(FIs) or MACs. The FI/MAC claims processing systems currently cannot

accommodate billing at the individual physician or practitioner level:

• Critical access hospital (CAH), method II payment, where the physician or

practitioner has reassigned his or her benefits to the CAH. In this situation,

the CAH bills the regular FI for the professional services provided by the

physician or practitioner.

• All institutional providers that bill for outpatient therapy provided by physical

and occupational therapists and speech language pathologists (for example,

hospital, skilled nursing facility Part B, home health agency, comprehensive

outpatient rehabilitation facility, or outpatient rehabilitation facility). This does

not apply to skilled nursing facilities under Part A.

Services payable under fee schedules or methodologies other than the PFS

are not included in Physician Quality Reporting (for example, services

provided in federally qualified health centers, independent diagnostic testing

facilities, independent laboratories, hospitals [including method I critical

access hospitals], rural health clinics, ambulance providers, and ambulatory

surgery center facilities).

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EPRESCRIBING INCENTIVES PAYMENT DETAILS

Beginning 2012, Section 132 of the Medicare Improvements for Patients and

Providers Act of 2008 (P.L.110-275) (MIPPA) requires CMS to subject eligible

professionals who are not successful electronic prescribers under the eRx

Incentive Program to a payment adjustment.

This payment adjustment applies to all of the eligible professional's Part B-

covered professional services under the Medicare Physician Fee Schedule

(MPFS). From 2012 through 2014, the payment adjustment will increase with

each new reporting period. Accordingly, for 2012, eligible professionals

receiving a payment adjustment will be paid 1.0% less than the MPFS

amount for that service. In 2013 and 2014, the payment adjustment increases

to 1.5% and 2.0% respectively.

Significant Hardship Exception: Eligible professionals may be exempt from

the application of the payment adjustment if CMS determines that compliance

with the requirement for being a successful electronic prescriber would result

in a significant hardship. This hardship exception is subject to annual

renewal.

Page 31: SCG's Meaningful Use White Paper

WHAT IS MEANINGFUL USE (MU)?

29

The Medicare and Medicaid EHR Incentive Programs provide a financial

incentive for the "meaningful use" (MU) of certified EHR technology to

achieve health and efficiency goals. By putting into action and meaningfully

using an EHR system, providers will reap benefits beyond financial

incentives–such as reduction in errors, availability of records and data,

reminders and alerts, clinical decision support, and e-prescribing/refill

automation.

The American Recovery and Reinvestment Act (ARRA) specifies three (3)

main components of Meaningful Use:

1. The use of a certified EHR in a meaningful manner, such as e-Prescribing.

2. The use of certified EHR technology for electronic exchange of health

information to improve quality of health care.

3. The use of certified EHR technology to submit clinical quality and other

measures.

Simply put, "meaningful use" means providers need to show they are using

certified EHR technology in ways that can be measured significantly in quality

and in quantity.

Meaningful Use is using certified EHR technology to:

• Improve quality, safety, efficiency and reduce health disparities

• Engage patients and families in their health care

• Improve care coordination

• Improve population and public health

• Maintaining privacy and security

The criteria for meaningful use will be staged in three (3) steps over the

course of the next five (5) years.

Page 32: SCG's Meaningful Use White Paper

Stage 1 (2011 and 2012) sets the baseline for electronic data capture and

information sharing.

Stage 2 (expected to be implemented in 2013)

Stage 3 (expected to be implemented in 2015) and will continue to expand

on this baseline and be developed through future rule making.

30

To qualify for incentive payments, meaningful use requirements must be met in

the following ways:

Medicare EHR Incentive Program—Eligible professionals, eligible hospitals,

and critical access hospitals (CAHs) must successfully demonstrate meaningful

use of certified electronic health record technology every year they participate in

the program.

Medicaid EHR Incentive Program—Eligible professionals and eligible

hospitals may qualify for incentive payments if they adopt, implement, upgrade

or demonstrate meaningful use in their first year of participation. They must

successfully demonstrate meaningful use for subsequent participation years.

Adopted: Acquired and installed certified EHR technology. (For example, can

show evidence of installation.)

Implemented: Began using certified EHR technology. (For example, provide

staff training or data entry of patient demographic information into EHR.)

Upgraded: Expanded existing technology to meet certification requirements.

(For example, upgrade to certified EHR technology or add new functionality to

meet the definition of certified EHR technology.)

What are the requirements for Stage 1 of Meaningful Use (2011 and 2012)?

Meaningful use includes both a core set and a menu set of objectives that are

specific to eligible professionals or eligible hospitals and CAHs.

• For eligible professionals, there are a total of 25 meaningful use objectives.

To qualify for an incentive payment, 20 of these 25 objectives must be met.

-There are 15 required core objectives.

-The remaining 5 objectives may be chosen from the list of 10 menu set

objectives.

Page 33: SCG's Meaningful Use White Paper

• For eligible hospitals and CAHs, there are a total of 24 meaningful use

objectives. To qualify for an incentive payment, 19 of these 24 objectives must

be met.

-There are 14 required core objectives.

-The remaining 5 objectives may be chosen from the list of 10 menu set

objectives.

31

How do I meet the Requirements?

To qualify for incentive payments, meaningful use requirements must be met in the

following ways:

Medicare EHR Incentive Program—Eligible professionals, eligible hospitals and

critical access hospitals (CAHs) must successfully demonstrate meaningful use of

certified electronic health record technology every year they participate in the

program.

Medicaid EHR Incentive Program—Eligible professionals and eligible hospitals

may qualify for incentive payments if they adopt, implement, upgrade or

demonstrate meaningful use in their first year of participation. They must

successfully demonstrate meaningful use for subsequent participation years.

Adopted: Acquired and installed certified EHR technology. (For example, can

show evidence of installation.)

Implemented: Began using certified EHR technology. (For example, provide staff

training or data entry of patient demographic information into EHR.)

Upgraded: Expanded existing technology to meet certification requirements. (For

example, upgrade to certified EHR technology or add new functionality to meet the

definition of certified EHR technology.)

Page 34: SCG's Meaningful Use White Paper

BASIC OVERVIEW OF STAGE 1 MEANINGFUL USE

• Reporting period is 90 days for first year and one (1) year subsequently

• Reporting through “attestation”

• Objectives and Clinical Quality Measures

• Reporting may be yes/no or numerator/denominator attestation

• To meet certain objectives/measures, 80% of patients must have records in

the certified EHR technology

32

*SCG assists with the registration and Attestation Processes – see related white

paper

Eligible Professionals must complete:

• 15 core objectives

• 5 objectives out of 10 from menu set

• 6 total Clinical Quality Measures (3 core or alternate core, and 3 out of

38 from menu set)

STAGE 1 OBJECTIVES AND MEASURES REPORTING

NOTE: Some MU objectives are not applicable to every provider’s clinical

practice, thus they would not have any eligible patients or actions for the

measure denominator. Exclusions do not count against the five (5) deferred

measures. In these cases, the eligible professional would be excluded from

having to meet that measure.

IE: Dentists who do not perform immunizations; Chiropractors do not e-Prescribe

There are two types of percentage-based measures for denominator:

1. All patients seen during EHR reporting period

2. Patients or actions taken for patients who’s records are kept in the

certified EHR technology

Page 35: SCG's Meaningful Use White Paper

ELIGIBLE PROFESSIONALS 15 CORE OBJECTIVES

1. Computerized physician order entry (CPOE)

2. E-Prescribing (eRx)

3. Report ambulatory clinical quality measures to CMS/States

4. Implement one clinical decision support rule

5. Provide patients with an electronic copy of their health information, upon

request

6. Provide clinical summaries for patients for each office visit

7. Drug-drug and drug-allergy interaction checks

8. Record demographics

9. Maintain an up-to-date problem list of current and active diagnoses

10. Maintain active medication list

11. Maintain active medication allergy list

12. Record and chart changes in vital signs

13. Record smoking status for patients 13 years or older

14. Capability to exchange key clinical information among providers of care and

patient-authorized entities electronically

15. Protect electronic health information

33

ELIGIBLE PROFESSIONALS 10 MENU OBJECTIVES

EPs must complete 5 of 10, listed below

1. Drug-formulary checks

2. Incorporate clinical lab test results as structured data

3. Generate lists of patients by specific conditions

4. Send reminders to patients per patient preference for preventive/follow up

care

5. Provide patients with timely electronic access to their health information

6. Use certified EHR technology to identify patient- specific education

resources and provide to patient, if appropriate

7. Medication reconciliation

8. Summary of care record for each transition of care/referrals

9. Capability to submit electronic data to immunization registries/systems*

10.Capability to provide electronic syndromic surveillance data to public

health agencies*

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ELIGIBLE PROFESSIONALS & MEANINGFUL USE

An Eligible Professional who works at multiple locations, but does not have

certified EHR technology available at all of them would:

• Have to have 50% of their total patient encounters at locations where

certified EHR technology is available

• Would base all meaningful use measures only on encounters that occurred

at locations where certified EHR technology is available

A Medicare Eligible Professional who does NOT demonstrate meaningful use

by 2015 will be subject to payment adjustments in their Medicare

reimbursement schedule.

• Medicaid-only EPs are not subject to payment adjustments

• Payment adjustments may apply for any EP who accepts Medicare and

does not demonstrate meaningful use in 2015

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WHAT ARE CLINICAL QUALITY MEASURES?

35

Quality health care is a high priority for the President, the Department of Health

and Human Services (HHS) and the Centers for Medicare & Medicaid Services

(CMS). CMS implements quality initiatives to assure quality health care for

Medicare Beneficiaries through accountability and public disclosure. CMS uses

quality measures in its various quality initiatives that include quality

improvement, pay for reporting, and public reporting.

WHAT ARE QUALITY MEASURES?

Quality measures are tools that help us measure or quantify healthcare

processes, outcomes, patient perceptions, and organizational structure and/or

systems that are associated with the ability to provide high-quality health care

and/or that relate to one or more quality goals for health care. These goals

include: effective, safe, efficient, patient-centered, equitable and timely care.

To demonstrate meaningful use successfully, eligible professionals, eligible

hospitals and CAHs are required also to report clinical quality measures

specific to eligible professionals or eligible hospitals and CAHs.

Eligible professionals must report on six (6) total clinical quality measures:

Three (3) required core measures (substituting alternate core measures

where necessary) and three (3) additional measures (selected from a set of 38

clinical quality measures).

Eligible hospitals and CAHs must report on all 15 of their clinical quality

measures.

Page 38: SCG's Meaningful Use White Paper

ELIGIBLE PROFESSIONALS REQUIREMENTS FOR

CLINICAL QUALITY MEASURES

36

Details of Clinical Quality Measures

2011 –Eligible Professionals seeking to demonstrate Meaningful Use are

required to submit aggregate CQM numerator, denominator, and exclusion

data to CMS or the States by “ATTESTATION”.

2012 –Eligible Professionals seeking to demonstrate Meaningful Use are

required to electronically submit aggregate CQM numerator, denominator, and

exclusion data to CMS or the States.

ELIGIBLE PROFESSIONALS REQUIREMENTS FOR

CLINICAL QUALITY MEASURES REPORTING

EHR Incentive Program Electronic Specifications Introduction:

In order to report quality measures from an EHR, electronic specifications

must be developed that include the data elements, logic and definitions for

that measure in a format that can be captured or stored in the EHR so that

the data can be sent or shared electronically with other entities in a

structured, standardized format and unaltered.

These electronic specifications are derived from certified EHRs. As part of the

criteria for satisfying meaningful use, clinical quality measures results

(numerators, denominators, and exclusions) must be reported to CMS.

Page 39: SCG's Meaningful Use White Paper

ELIGIBLE PROFESSIONALS REPORTING PERIOD

37

The reporting period for the EHR Incentive program using a certified EHR is

any continuous 90 day period during the first payment year. Please note

that although the measure specifications assume a full calendar year, you

should only calculate the denominator and numerator from the first day of the

90 day reporting period to the last day of the 90 day reporting period.

Eligible professionals must report from the table of 44 clinical quality measures

which includes, 3 Core, 3 Alternate Core, and 38 additional CQMs.

• Core CQMs - EPs must report on 3 required core CQMs, and if the

denominator of 1 or more of the required core measures is 0, then EPs are

required to report results for up to 3 alternate core measures.

• EPs must also select 3 additional CQMs from a set of 38 CQMs (excluding

the core/alternate core measures). It is acceptable to have a '0' denominator,

provided the EP does not have an applicable population.

In sum, EPs must report on six (6) total measures: 3 required core measures

(substituting alternate core measures where necessary) and 3 additional

measures. A maximum of 9 measures would be reported if the EP needed to

attest to the 3 required core, the three alternate core and the 3 additional

measures.

Page 40: SCG's Meaningful Use White Paper

CLINICAL QUALITY MEASURES CORE SET

38

NQF Measure Number & PQRI Clinical Quality Measure Title

Implementation Number

NQF 0013 Hypertension: Blood Pressure

Measurement

NQF 0028 Preventive Care & Screening Measure

Pair: a) Tobacco Use Assessment,

b) Tobacco Cessation Intervention

NQF 0421 Adult Weight Screening & Follow-up

PQRI 128

ALTERNATE CORE SET

NQF Measure Number & PQRI Clinical Quality Measure Title

Implementation Number

NQF 0024 Weight Assessment & Counseling for

Children & Adolescents

NQF 0041 Preventive Care & Screening:

PQRI 110 Influenza Immunization for Patients

50 Years Old or Older

NQF 0038 Childhood Immunization Status

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ADDITIONAL SET CQM

39

1. Diabetes: Hemoglobin A1c Poor Control

2. Diabetes: Low Density Lipoprotein (LDL) Management and Control

3. Diabetes: Blood Pressure Management

4. Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or

Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic

Dysfunction (LVSD)

5. Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients

with Prior Myocardial Infarction (MI)

6. Pneumonia Vaccination Status for Older Adults

7. Breast Cancer Screening

8. Colorectal Cancer Screening

9. Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for

Patients with CAD

10. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic

11. Dysfunction (LVSD) Anti-depressant medication management: (a)

Effective Acute Phase Treatment, (b)Effective Continuation Phase

Treatment

12. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation

13. Diabetic Retinopathy: Documentation of Presence or Absence of Macular

Edema and Level of Severity of Retinopathy

14. Diabetic Retinopathy: Communication with the

15. Physician Managing Ongoing Diabetes Care

16. Asthma Pharmacologic Therapy

17. Asthma Assessment

18. Appropriate Testing for Children with Pharyngitis Oncology Breast Cancer:

Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone

Receptor (ER/PR) Positive Breast Cancer

19. Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients

20. Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk

Prostate Cancer Patients

21.Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising

Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco

Use Cessation Medications, c) Discussing Smoking and Tobacco Use

Cessation Strategies

Must Complete 3 of 38

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22. Diabetes: Eye Exam

23. Diabetes: Urine Screening

24. Diabetes: Foot Exam

25. Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-

Cholesterol

26. Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation

27. Ischemic Vascular Disease (IVD): Blood Pressure Management

28. Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic

29. Initiation and Engagement of Alcohol and Other Drug Dependence

Treatment: a) Initiation, b) Engagement

30. Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)

31. Prenatal Care: Anti-D Immune Globulin

32. Controlling High Blood Pressure

33. Cervical Cancer Screening

34. Chlamydia Screening for Women

35. Use of Appropriate Medications for Asthma

36. Low Back Pain: Use of Imaging Studies

37. Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control

38. Diabetes: Hemoglobin A1c Control (<8.0%)

• Clinical Quality Measures align with Physicians Clinical Quality reporting

(PQRI)

• Alignment between 4 HITECH CQM and the CHIPRA initial core set that

providers report to States

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REGISTRATION REQUIREMENTS INCLUDE:

41

• Name of the eligible professional

• National Provider Identifier (NPI)

• Business address and business phone

• Taxpayer Identification Number (TIN) to which the provider would like their

incentive payment made

• Medicare or Medicaid program selection (may only switch once after

receiving an incentive payment before 2015) for EPs

• State selection for Medicaid providers

Page 44: SCG's Meaningful Use White Paper

PROGRAM TIMELINE

42

January 2011 –Registration for the EHR Incentive

Programs begins

January 2011 –For Medicaid providers. States may

launch their programs if they choose

April 2011 –Attestation for the Medicare EHR Incentive

Program begins

May 2011 –Medicare EHR incentive payments begin

February 29, 2012 –Last day for EPs to register and

attest to receive an incentive payment for CY 2011

2015–Medicare payment adjustments begin for EPs and eligible hospitals that

are not meaningful users of EHR technology

2016–Last year to receive a Medicare EHR incentive payment; Last year to

initiate participation in Medicaid EHR Incentive Program

2021–Last year to receive Medicaid EHR incentive payment

**for details on how SCG assists with the registration & MU process, see our

“procedure for assistance” white paper.

Page 45: SCG's Meaningful Use White Paper

ACRONYMS

43

ACA –Patient Protection and Affordable Care Act

A/I/U –Adopt, implement, or upgrade

CAH –Critical Access Hospital

CCN –CMS Certification Number

CHIPRA –Children's Health Insurance Program Reauthorization Act of 2009

CMS –Centers for Medicare & Medicaid Services

CNM –Certified Nurse Midwife

CPOE –Computerized Physician Order Entry

CQM –Clinical Quality Measures

CY –Calendar Year

EHR –Electronic Health Record

EP –Eligible Professional

eRx–E-Prescribing

FFS –Fee-for-service

FQHC –Federally Qualified Health Center

FFY –Federal Fiscal Year

HHS –U.S. Department of Health and Human Services

HIT –Health Information Technology

HITECH –Health Information Technology for Economic and Clinical Health Act

HITPC –Health Information Technology Policy Committee

HPSA –Health Professional Shortage Area

MA –Medicare Advantage

MCMP –Medicare Care Management Performance Demonstration

MU –Meaningful Use

NCVHS –National Committee on Vital and Health Statistics

NP –Nurse Practitioner

NPI –National Provider Identifier

NPRM –Notice of Proposed Rulemaking

OMB –Office of Management and Budget

ONC –Office of the National Coordinator of Health Information Technology

ATCB –Authorized Testing and Certification Body

CCHIT –Certification Commission for Health Information Technology

EMR –Electronic Medical Records

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HIPAA –Health Insurance Portability and Accountability Act of 1996

PA –Physician Assistant

PECOS –Provider Enrollment, Chain, and Ownership System

PPS –Prospective Payment System (Part A)

PQRI –Medicare Physician Quality Reporting Initiative

ARRA –American Reinvestment & Recovery Act of 2009

RHC –Rural Health Clinic

RHQDAPU –Reporting Hospital Quality Data for Annual Payment Update

TIN –Taxpayer Identification Number

Page 47: SCG's Meaningful Use White Paper

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