Meaningful Use. Relevance. What is ARRA Meaningful Use? (American Recovery and Reinvestment Act of 2009)

Meaningful Use

First The What, Now The How

S. Hughes Melton, MD President, C-Health, P.C. hmelton@c-healthonline.com

Relevance

• Speedometer, Consumer Reports • Your Teenager

• Provider A and B

– Google: Rate your doctor – http://www ratemds com/

– http://www.ratemds.com/

– The Wall of Shame?

What is ARRA Meaningful Use?

(American Recovery and Reinvestment Act of 2009)

• Part of Federal Economic Stimulus & HITECH Acts – Began January 2011

– 3 stages • Stage 1 (2011)

F l t i ll t i h lth

– Focus on electronically capturing health information

• Stage 2 (2013)

– Disease management, improved communication • Stage 3 (2015)

– Decision support, increased quality measures

What is ARRA Meaningful Use?

(American Recovery and Reinvestment Act of 2009)

• Incentive period ends 2015

– Goal

• All eligible providers and hospitals at stage 3 by 2015

• Interoperability

• Penalties for those not meeting MU requirements (Medicare payment penalty)

Eligible Providers (EP’s)

– Must use Certified EMR product

– Doctors of medicine, osteopathy, dental surgery, dental medicine, podiatry, optometry and chiropractors optometry, and chiropractors

– Professionals who perform 90% or more of their services in the inpatient or emergency setting are considered ’hospital-based’ and are not eligible.

Payments to Eligible Providers

Year Maximum Benefit

per Provider Total Medicare Payment Reduction if not using an EHR

First Year $18,000 0% Second Year $12,000 0% Third Year $8 000 0% Third Year $8,000 0% Fourth Year $4,000 0% Fifth Year $2,000 2015:1% Sixth Year $0 2016:2% 2017 $0 2017: 3% Beyond 3% (up to 5% in 2019)

Significant reduction in payments occur if year one is not 2011 or 2012

Meaningful Use Goals

• Improve Quality and Safety, Efficiency and Reduce Health Disparities

• Engage patients and families in their health care

care

• Improve Care Coordination

• Improve Population and Public Health • Ensure adequate privacy and security

protections for personal health information

Meaningful Use

• Eligible Providers and hospitals must use a certified EMR

• Must report both Objectives and Quality Measures

Meaningful Use

• 3 Stage/Components

1. Use the EMR in a meaningful manner

– 2011- Attestation

– Future years attestation vs. electronic exchange

2 Electronic exchange of health information 2. Electronic exchange of health information 3. Submit clinical quality measures • Progressively harder to quality

• Must report for 90 consecutive days to qualify for year one. For years 2-5 must report for 365 days.

Asthma Assessment Colorectal Cancer Screening Childhood immunization Status Prenatal Care: Anti-D Immune Globulin Use of Appropriate Medications for Asthma Asthma Pharmacologic Therapy Cervical Cancer Screening Diabetes: LDL Management & Control Diabetes: HbA1c Poor Control Breast Cancer Screening Diabetes: Urine Screening Diabetes: Blood Pressure Management Controlling High Blood Pressure Low Back Pain: Use of Imaging Studies Diabetes: Eye Exam Adult Weight Screening and Follow-Up Diabetes: HbA1c Control (<8%) Chlamydia Screening for Women Diabetes: Foot Exam Appropriate Testing for Children with

Pharyngitis Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) Oncology Colon Cancer: Chemotherapy

for Stage III Colon Cancer Patients Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation Heart Failure (HF) : Warfarin Therapy Patients with Atrial Fibrillation Preventive Care and Screening Measure

Pair: b.Tobacco Cessation Intervention Preventive Care and Screening Measure Pair: a.Tobacco Use Assessment Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care W i ht A t d C li f P i V i ti St t f Old I h i V l Di (IVD) C l t Li id

Non-Core Quality Measures

Weight Assessment and Counseling for

Children and Adolescents Pneumonia Vaccination Status for Older Adults Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control Prenatal Care: Screening for Human

Immunodeficiency Virus (HIV) Preventive Care and Screening: Influenza Immunization for Patients ≥ 50 Years Old Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol Hypertension: Blood Pressure

Measurement Ischemic Vascular Disease (IVD): Use of Aspirin or another Antithrombotic Ischemic Vascular Disease (IVD): Blood Pressure Management Diabetic Retinopathy: Documentation of

Presence or Absence of Macular Edema and Level of Severity of Retinopathy

Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD

Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer Coronary Artery Disease (CAD):

Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: (a) Initiation, (b) Engagement

Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b) Effective Continuation Phase Treatment 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

Heart Failure (HF) : Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)

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

How Meaningful Use is

Roadmapped

Achieving Meaningful Use of Health Data

*From HIT Policy Comm. update

The Recovery Act specifies the following 3 components (Stages) of Meaningful Use:

1. Use in a meaningful manner (e.g., e-prescribing)

2. Use for electronic exchange of health information to improve quality of health information to improve quality of health care

3. Use to submit clinical quality measures (CQM) and other such measures selected by the Secretary

Why an the EHR in the First

Place?

• Complete a practice analysis to determine which ancillary services you need to implement

•E-Prescribing

•Portal

•Rule Manager

•CCD/CCR

•Lab Interface

Steps of The How

• Register

• Know, Assign and Attain Objectives • Self assess

• Attest

• Prepare for next year

How to register for the Medicare

EHR Incentive Program

• Started January 3, 2011

• National Level Repository (NLR):

www.cms.gov/EHRIncentiveProgramsand click on Registration and Attestation

click on Registration and Attestation • Office manager to watch video at

http://www.videocast.nih.gov/Summary.as p?File=16077

• This is per EP (Eligible Provider)- NP’s? • Virginia Medicaid EHR Incentive Program?

Know, Assign and Attain

Stage 1 Objectives and Measures Reporting • Objective Grid Handout

• Group composition

• Assign your “master MU”- Watch video,

t d h d t f b it

study handout, surf website

• Your Team, Your Software- Live demo of e-MD’s training module, will assign to the POC for that Objective

POC- Point of Contact

You have to divide the work and assign it to right person on your team. How does your teamwork?

• MD Provider • MD- Provider • RN- Nurses • FO- Front Office • BO- Back Office

Know, Assign and Attain

Stage 1 Objectives and Measures Reporting Eligible Professionals (and just EP’s) must

complete:

• 15 core set objectives

5 t f 10 t bj ti

• 5 out of 10 menu set objectives

• 6 total Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from additional set)

Meaningful Use

• Objectives

– How we use the EMR – Most have thresholds

Q lit M

• Quality Measures

– Clinical reporting

– No thresholds in year one

Meaningful Use

Objective Measures

Core Items Menu Items Total Eligible

Provider 15 5 20

Eligible

Hospital 14 5 19

There is almost 100% overlap in Core Measures, with the hospital not measured on e-prescribing because that is seen as an ambulatory activity.

Meaningful Use Goals

• Improve Quality and Safety, Efficiency and Reduce Health Disparities

• Engage patients and families in their health care

care

• Improve Care Coordination

• Improve Population and Public Health • Ensure adequate privacy and security

protections for personal health information

Objective Measures

Improve Quality and Safety, Efficiency and Reduce Health Disparities Objective Threshold Core

Use CPOE for medication orders 30%  Maintain an updated problem list 80%  Maintain an active medication list 80%  Maintain an active medication allergy list 80% 

Record Demographics 50% 

Record and Chart Vital Signs, BMI and growth charts 50% 

Record Smoking Status 50% 

Incorporate Clinical Lab Test Results 40% E-prescribing eligible prescriptions (Ambulatory) 40%  Send Reminders to Patients 20%

Advanced Directives 50%

Implement CDS 

Drug Formulary Checks

Drug/Drug interaction 

Generate Lists of Patients

Report on Quality Measures 

Objective Measures

Engage Patients and Families in their Health Care Objective Threshold Core

Electronic Copy of Health Information 50% 

Patient Education 10%

Clinical Summary 50% 

Electronic Access for Patients 10% Electronic Copy of Discharge Instructions 50% 

Objective Measures

Improve Care Coordination

Objective Threshold Core

Exchange Key Clinical Information Electronically  Medication Reconciliation 50%

Objective Measures

Improve Population and Public Health

Objective Threshold Core

Submit Data to Immunization Registries Send Syndromic Surveillance Data to Health Agencies Send Reportable Lab Results to Public Health Agencies

Objective Measures

Ensure Adequate Privacy and Security Protections for Personal Health Information

Objective Threshold Core

Protect Electronic Health Information 

Discussion of Core Set

Objectives

• Refer to your Objective Grid Handout • Which team member should do which? • BO- Easy (5, 7, 14, 15), Hard (3) • FO- Easy (8)

• MD- Easy (1, 2, 6)

• RN- Easy (9, 10, 11, 12, 13), Hard (4)

Know, Assign and Attain

Stage 1 Objectives and Measures Reporting Eligible Professionals (and just EP’s) must

complete:

• 15 core set objectives

5 t f 10 t bj ti

• 5 out of 10 menu set objectives

• 6 total Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from additional set)

Discussion of Menu Set

Objectives

• Refer to your Objective Grid Handout • Tougher so select the five that will be

easiest for you based on software functionality your interests etc functionality, your interests, etc… • BO- Easy (1,2,4,5,9)

• FO- Easy (8) • MD- Easy (6)

• RN- Easy (3), Hard (7)

Know, Assign and Attain

Stage 1 Objectives and Measures Reporting Eligible Professionals (and just EP’s) must

complete:

• 15 core set objectives

5 t f 10 t bj ti

• 5 out of 10 menu set objectives

• 6 total Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from additional set)

Meaningful Use: Clinical

Quality Measures

The measures used by CMS are drawn from National Quality Forum (NQF)

2011 – Eligible Professionals seeking to demonstrate Meaningful Use are required to submit aggregate CQM numerator denominator and exclusion data to 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. You have to PROVE it.

Details at:

https://www.cms.gov/QualityMeasures/03_ElectronicSpe

Hospital Quality Measures

• Must Report on all 15 • 3 Categories

– Stroke

V Th b b li

– Venous Thromboembolism

EH Quality Measures: Stroke

• Ischemic stroke: Discharge on anti-thrombotics • Ischemic stroke: Anticoagulation for A-fib/flutter • Ischemic stroke: Discharge on statins

• Ischemic stroke: Thrombolytic therapy for patients arriving within 2 hours of symptom onset

arriving within 2 hours of symptom onset

• Ischemic or hemorrhagic stroke: Stroke education • Ischemic or hemorrhagic stroke: Rehabilitation

assessment

• Ischemic or hemorrhagic stroke: Antithrombotic therapy by day 2

EH Quality Measures: VTE

• Prophylaxis within 24 hours of arrival • ICU prophylaxis

• Anticoagulation overlap therapy • Discharge instructions

• Incidence of potentially preventable VTE • Platelet monitoring on unfractionated

heparin

EH Quality Measures: ED

• Median time from ED arrival to ED departure for admitted patients

• Admission decision time to ED departure time for admitted patients

time for admitted patients

Eligible Provider Quality Measures

• Must report on 6 of 44 • 3 core or alternate core • 3 additional quality measures

Core Quality Measures

• Inquiry Regarding Tobacco Use • Blood pressure measurement

• Body Mass Index (BMI) Screening and

F ll U

Follow-Up

Alternate Core Measures

• Influenza Immunization for Patients ≥ 50 Years Old

• Childhood Immunization Status

B d M I d (BMI) 2 th h 18

• Body Mass Index (BMI) 2 through 18 years of age

Discussion of CQM (Clinical

Quality Measures)

• Woo Hoo! Clinical stuff.

• Refer to your Objective Grid- you can sort • We aren’t going to talk about each one • Are you collecting them properly so you

can “prove it” in 2012?

• Requires team approach- tougher • Fun Part- Is your work improving care?

Discussion of CQM (Clinical

Quality Measures)

• Pick the Core or Alternate Core set of 3 • Select 3 of the other 38 CQM’s

• Based on CMS CQM Detailed Explanation

h t D CMS NQF 0028

sheets- Demo CMS NQF 0028

• Software should have a CQM Reports Dictionary- Demo page 23

• You run a report that looks like “Sample Vitals Report”

Self Assess

• PDSA cycle

• www.ihi.org/IHI/Topics/Improvement/Impro vementMethods/HowToImprove/

2011 h t l t 3 th

• 2011 you have at least 3 months

• 2012 you needs to be up and going Jan 1st

How to attest for the Medicare

EHR Incentive Program

• Starts April 2011

• True reporting process is yet to be determined for 2012

A f 1/13/11 th i i f ti

• As of 1/13/11 there is no information on the attestation process! Answer ID: 9814. They are saying April 2011.

• Attest INDIVIDUALLY, not group average

Prepare for the Future

• Stage 2 and 3. What CMS is saying…. • Master MU follows development

– Twitter, visit CMS website

• All 10 on Menu Set Objectives?

– They are listed in same order as the Goals of MU

• More Clinical Quality Measures required? • I will see you next year!

Local CMS Contact

• CMS Region 3 Philadelphia, PA • PA, DE, WV, VA, DC, MD

• Public HITECH Inquiry Line: 215-861-4154 Email Address: ROPHICFM@cms.hhs.gov • Fax: 212-618-3176

• Lead HITECH Point of Contact: Patrick Hamilton • Regional Administrator: Nancy B. O’Connor • Chief Medical Officer: Barbara J. Connors, DO,

Status of Virginia Medicaid

Program

• http://dmasva.dmas.virginia.gov/Content_p gs/pr-arra.aspx

• Draft State Medicaid Health Information Technology Plan (SMHP) submitted 9/1/10 Technology Plan (SMHP) submitted 9/1/10 • DMAS expects to begin reviewing

applications in the second half of 2011 • Or the Medicaid EP practices predominantly in an

FQHC or RHC – 30%needy individual patient

volume threshold

Regional Extension Center

Contact