Meaningful Use: It’s Not Too Late For 2015!
Jeffrey D. Lehrman, DPM, FACFAS, FASPS, FAPWH
APMA Coding Committee
Expert Panelist, Codingline.com
Fellow, American Academy of Podiatric Practice Management
John Guiliana, DPM, MS
Managing Partner of Collaborative Practice Solutions
Fellow, American Academy of Podiatric Practice Management
• On October 7
th
, CMS released the
Medicare and Medicaid EHR Program
Final Rules for CY 2015
Need to know if you were
scheduled for Stage 1 or
Stage 2 in 2015 under old
Everyone was scheduled for
Stage 2 in 2015
First Year as a Meaningful User
Stage of Meaningful Use
2015 2016 2017 2018 2011 Modified Stage2 Modified Stage2 Modified Stage2 OrStage3 Stage3 2012 Modified Stage2 Modified Stage2 Modified Stage2 OrStage3 Stage3 2013 Modified Stage2 Modified Stage2 Modified Stage2 OrStage3 Stage3 2014 Modified Stage2* Modified Stage2 Modified Stage2 OrStage3 Stage3 2015 Modified Stage2* Modified Stage2 Modified Stage2 OrStage3 Stage3 2016 -NA- Modified Stage2 Modified Stage2 OrStage3 Stage3
STAGE OF MEANINGFUL USE
CRITERIA
Reporting
period
for
all
providers
in 2015
will
be any
90
consecutive
days.
* Reporting period in 2016 (other than first time providers)
will be the calendar year.
Reporting
period
if attesting
for the
first
time
in
2016
will
be
90
consecutive days.
Meaningful Use Stage 2
Attestation
• For an EHR reporting period in 2015, all Medicare
providers must attest by February 29, 2016.
Meaningful Use Stage 2
• All EP are required to attest to a single set of
objectives and measures
• There are
10
objectives, including one public
health measure
Meaningful Use Stage 2
Major Changes
• Patient Electronic Access: For 2015,
instead of the 5
Meaningful Use Stage 2
Major Changes
Conduct
or
review
a
security
risk
analysis
in
accordance
with
the
requirements
in
45
CFR
164.308(a)(1),
including
addressing
the
security
(to
include
encryption)
of
data
stored
in
Certified
EHR
Technology
in
accordancewith
requirements
in
45
CFR
164.312(a)(2)(iv)
and
45
CFR
164.306(d)(3),
and
implement
security
updates
as
necessary and correct identified security deficiencies as
part
of
the
eligible
provider
(EP)
risk
management
process.
Need….
• Documentation of:
• What they did
• What risks were identified
Implement five clinical decision support interventions related to four or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period.
Alternate Objective and Measure (For those scheduled for Stage 1) Implement ONE clinical decision support rule.
2.
Clinical
Decision
Support
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention (Population and Public Health)
Preventive Care and Screening: Influenza Immunization (Population and Public Health)
Pneumonia Vaccination Status for Older Adults (Clinical Processes/Effectiveness)
Diabetes: Eye Exam (Clinical Processes/Effectiveness) Diabetes: Foot Exam (Clinical Processes/Effectiveness)
Diabetes: Hemoglobin A1c Poor Control (Clinical Processes/Effectiveness) Hemoglobin A1c Test for Pediatric Patients (Clinical Processes/Effectiveness) Diabetes: Urine Protein Screening (Clinical Processes/Effectiveness)
Diabetes: Low Density Lipoprotein (LDL) Management (Clinical Processes/Effectiveness)
Falls: Screening for Future Fall Risk (Patient Safety)
Documentation of Current Medications in the Medical Record (Patient Safety)
Closing the referral loop: receipt of specialist report (Care Coordination)
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up (Population and Public Health)
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented (Population and Public Health)
3.
Computerized
Physician
Order
Entry
(CPOE)
Eligible provider must meet all three:
More than60 percentof medication orderscreated byEPare recorded using computerized provider orderentry.
More than30 percentof laboratory orderscreatedby EP are recorded using computerized provider order entry.
More than30 percentof radiology orderscreated byEPare recorded using computerized provider orderentry.
Alternate Measure 1 (Stage 1): More than 30 percent of medication orders created by the EP are recorded using computerized provider order entry.
Alternate Exclusion for Measure 2 (Stage 1): Provider may claim an exclusion for measure 2 (laboratory orders). Alternate Exclusion for Measure 3 (Stage 1): Provider may claim an exclusion for measure 3 (radiology orders).
More than 50 percent
of
all
permissible
prescriptions
written
by
the
EP
are
queried
for
a drug
formulary
and
transmitted
electronically
using Certified
EHR
Technology.
Alternate (Stage 1)
EP
Measure:
More
than
40
percent
of all
permissible prescriptions written by the EP are
transmitted electronically using Certified EHR
Technology.
4.
Electronic
Prescribing
Sate 2 Exclusions: EPs who: (1) write fewer than 100 permissible prescriptions during the EHR reporting period; or (2) do not have a pharmacy within their organization and there are no pharmacies that accept electronic
The EP that transitions or refers their patient to another setting of care or provider of care :
(1) uses CEHRT to create a summary of care record; and
(2) electronically transmits such summary to a receiving provider for
more than 10 percent of transitions of care and referrals.
Alternate Exclusion (Stage 1): Provider may claim an exclusion for the measure which requires the electronic transmission of a summary of care document
5.
Summary
of
Care
Summary of Care Document contains: .
5.
Summary
of
Care
• Patient name
• Provider’s name and office contact info • Current problem list • PMH
• Procedures
• Laboratory test results • Current medication list
and medication history
• Current medication allergy list and medication
allergy history
• Vital signs (height, weight, blood pressure, BMI,
growth charts)
• Smoking status
• Demographic information (preferred language, sex,
race, ethnicity, date of birth)
• Care plan field(s), including goals and instructions;
and any known care team members including the
Patient-specific education resources identified by Certified
EHR Technology are provided to patients for more than 10
percent
of
all
unique
patients.
Alternate Exclusion (Stage 1): Provider may claim an exclusion for
this measure
6.
Patient
Specific
Education
Stage 2 Exclusion: Any EP who was not the recipient of any transitions of care during the EHR reporting period.
The
EP
performs
medication reconciliation for
more
than
50
percent
of
transitions
of care
in
which
the
patient
is
transitioned
into
the
care
of
the EP.
Alternate Exclusion (Stage 1): Provider may claim an exclusion for
the measure
Measure 1: More than 50 percent of all unique patients seen by the EP
during the EHR reporting period are provided timely (within 4 business days after the information is availableto the EP) online access to their health
information* subject to the EP's discretion to withhold certain information. Measure 2: At least one patient seen by the EP during the EHR reporting
period (or their authorized representatives) views,downloads, or transmits
his or her health information to a third party.
Alternate Exclusion Measure 2 (Stage 1): Provider may claim an exclusion for the
second measure
8.
Patient
Electronic
Access
Stage 2 Exclusions: Any EP who—(a) Neither orders nor creates any of the information listed for inclusion as part of the measures; or (b) Conducts 50 percent or more of his or her patient encounters in a county that does not have 50
• Current medication allergy list and medication
allergy history
• Vital signs (height, weight, blood pressure, BMI,
growth charts)
• Smoking status
• Demographic information (preferred language, sex,
race, ethnicity, date of birth)
• Care plan field(s), including goals and instructions;
and any known care team members including the
primary care provider of record.
Health
Information to be Provided
• Patient name
• Provider’s name and office contact info • Current problem list • PMH
• Procedures
• Laboratory test results • Current medication list
Measure:
During the EHR reporting period, the capability
for patients to send and receive a secure electronic
message with the provider was fully enabled.
Alternate Exclusion (Stage 1): An EP may claim an exclusion for the
measure
9.
Secure
Electronic
Messaging
Objective #10
Public Health Reporting
Stage 2
Measure Option 1 – Immunization Registry Reporting: The EP is in active
engagement with a public health agency to submit immunization data.
Exclusions: Any EP meeting one or more of the following criteria may be excluded
from the immunization registry reporting measure if the EP--
• Does not administer any immunizations to any of the populations for which data is collected by its jurisdiction's immunization registry or immunization
information system during the EHR reporting period;
• Operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or
Objective #10
Public Health Reporting
Stage 2
Measure Option 2 – Syndromic Surveillance Reporting: The EP is in active
engagement with a public health agency to submit syndromic surveillance data.
Exclusion for EPs: Any EP meeting one or more of the following criteria may be
excluded from the syndromic surveillance reporting measure if the EP:
• Is not in a category of providers from which ambulatory syndromic surveillance data is collected by their jurisdiction's syndromic surveillance system;
• Operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data from EPs in the specific
standards required to meet the CEHRT definition at the start of the EHR reporting period; or
Objective #10
Public Health Reporting
Stage 2
Measure Option 3 – Specialized Registry Reporting: The EP is in active engagement
to submit data to a specialized registry.
Exclusions: Any EP meeting at least one of the following criteria may be excluded
from the specialized registry reporting measure if the EP--
• Does not diagnose or treat any disease or condition associated with, or collect relevant data that is collected by, a specialized registry in their jurisdiction during the EHR reporting period;
• Operates in a jurisdiction for which no specialized registry is capable of accepting electronic registry transactions in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or
• Operates in a jurisdiction where no specialized registry for which the EP is eligible has declared readiness to receive electronic registry transactions at the
