Using AUtomAtion to AttAin
meAningfUl Use stAge 2
PreventAtive CAre
reminder objeCtives
DECEMBER 2014
1
EXECUTIVE SUMMARY
In order to qualify for an incentive payment through the
Medicare Incentive Program and to avoid facing penalties
beginning in 2015, eligible professionals must adopt
and successfully demonstrate meaningful use (MU)
of certified electronic health record (EHR) technology.
Adoption appears to be slow, with less than 1,000
eligible professionals successfully attesting to stage 2
as of July 2014. Conflicting information about timelines,
changing requirements and the additional burdens these
requirements place on medical practices all seem to
contribute to slow adoption.
In this white paper, we will address one specific Stage 2
core objective – the preventative care reminder objective –
and clarify the timelines, briefly outline the technical,
attestation and security requirements, discuss the
challenges faced by medical practices, provide resources
for addressing these challenges and conclude with tips
on what functional features to look for in an effective
automation tool to attain this core objective.
4
MEANINGFUL USE TIMELINES
Conflicting or incorrect reports by several media outlets has created some confusion over the timelines for implementation. According to the ONC start of stage 2 has NOT been delayed. In August 2014, CMS released a final rule that grants flexibility to providers who are unable to fully implement 2014 Edition CEHRT for an EHR reporting period in 2014 due to delays in the availability of certified technology.5 On October 7, CMS announced their intention to reopen
the submission period for hardship exceptions applications (due to delays in 2014 certifications) to avoid the 2015 penalty.
Here are the facts:
• Everyone starts in Stage 1 regardless of the year in which they start. All EPs must complete at least two years at Stage 1.
• No one can start Stage 2 before 2014. In 2014, all EPs regardless of their stage of meaningful use are only required to demonstrate meaningful use for a three-month reporting period.
• Start of stage 3 COULD begin in 2016, if the ONC proposal is adopted • Regardless of stage, EPs must continue to attest successfully each year
to receive incentives and avoid payment penalties
REQUIREMENTS FOR PREVENTATIVE CARE REMINDERS
Attestation Requirements
For reporting purposes, the data required for attestation are pretty simple.
DENOMINATOR* Number of unique patients who have had two or more office visits with the
EP in the 24 months prior to the beginning of the EHR reporting period. *The data for the denominator must be pulled from data stored within the CEHRT.
NUMERATOR Number of patients in the denominator who were sent a reminder per
patient preference when available during the EHR reporting period.
THRESHOLD The resulting percentage must be more than 10 percent in order for an
EP to meet this measure.
EXCLUSION Any EP who has had no office visits in the 24 months before the EHR
reporting period.
If the medical practice uses separate preventative care reminder solutions to provide additional communication options to patients, then that preventative care reminder solution must provide the data for the numerator.
PROTECTING PATIENT HEALTH INFORMATION:
online resoUrCes
security and risk Analysis tipsheet: Protecting Patients’ Health information
DOWNLOAD HERE
guide to Privacy and security of Health information
DOWNLOAD HERE
RESOURCE FOR EPs:
my eHr Participation timeline, at Cms.gov helps determine which year ePs will demonstrate stage 1, stage 2 and stage 3 of meaningful use; provides the length of time ePs are required to demonstrate meaningful use at each stage and the maximum incentive payment for each year of participation.
VISIT CMS.GOV HERE
5
6 Federalregister.gov, 2014 Edition Release 2 EHR Certification Criteria Final Rule (11 September 2014), page 17-18. http://www.gpo.gov/fdsys/pkg/FR-2014-09-11/pdf/2014-21633.pdf, accessed November 2014.
According to the final rule for certification to the 2014 Edition EHR certification criteria, the EHR “does not need to be certified to the ‘automated numerator recording,’ nor the ‘automated measure calculation’ certification criterion.”6 So, currently, the CEHRT does not have to record the numerator
and it does not have to make the calculations for the percentage-based measure, it merely has to be the source of the patient lists, thereby providing the denominator.
Communication Options
EPs must also meet the objective to communicate per patient preference, so medical practices must offer enough options to satisfy patient preference – which may be by traditional mail, email, voicemail or text.
Some medical practices may already use patient portals to share lab results and health information and hope to use it to communicate preventative care reminders, but portals alone may not provide enough options to meet this objective. Typically, patient portals provide an email only option and are further limited by the fact that they are one-way communication tools.
Some medical practices may have started using appointment reminder systems to satisfy Stage 1 criteria. Under Stage 2 criteria, appointment reminder systems alone will not be enough to satisfy the preventative care reminder requirement. Although it is a simple way to deliver these messages to patients, medical practices will not meet the Stage 2 objective and measure (see figure 2). The guidelines state preventative care reminders must use clinically relevant information to identify patients who should receive reminders for preventative/follow-up care and send patients reminders, per patient preference. In addition, to count for the measure, reminders must be for care the patient isn’t already scheduled to receive.
Because ONC now allows a combination of an EHR system with third-party modules that better accommodate the practice’s process or workflow, there is an opportunity to use the strengths of different systems to meet MU requirements. For example, use the CEHRT to identify patients, use an appointment reminder or patient recall system to deliver preventative care reminders according to patient preference and provide a link to or information about the patient portal for the patient to access more information prior to their appointment.
Adding New Challenges to Medical Practices
Medical practice managers or operations leads already face enough challenges: cumbersome manual processes, staffing and resourcing issues, seasonal pressures on the schedule, or technology that may no longer meet the needs of the practice.
Add to that the additional challenges created by adopting meaningful use and it’s no wonder only 1,000 EPs so far have successfully attested to Stage 2.
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The “Right” Technology
Selecting and implementing the right technology to meet MU measures and attestation requirements can prove challenging. The chief operations officer, practice manager, or IT lead doesn’t want to risk making a decision that will result in noncompliance or waste money, resources or effort. Without suitable technology, processes can become more burdensome and disruptive to the daily patient workload.
Change Management
Whether the medical practice must convert from one system to another or add new modules or software, it often results in developing a new workflow and training the staff on the new software, systems and workflow. It will initially create additional burden on the staff during the transition and managing this change can become a delicate balance. The National Learning Consortium has a number of resources, training and tools to help medical practices implement EHR systems at
healthit.gov.
Medical practices also have to consider the impact this will have on their patients. You’ll be asking them to change their behavior and communication patterns. How will this new technology impact your patients? Will they adapt to the changes or not? How will this impact their perception of your medical practice during and after the transition? Done correctly, many studies show that the use of electronic communication helps patients change their behavior and increase patient engagement—they’re more likely to take an active role in learning about, complying with treatment and managing their own health.
MEETING THE ULTIMATE CHALLENGE
The ultimate challenge for medical practices, of course, is to achieve high-quality patient care as cost-effectively as possible. Meaningful Use can serve as a catalyst for creating more efficiencies in the workflow and easing the workload when practices select and use effective technologies. Practices can move beyond just the attestation data required for the incentive program and collect additional data that will be helpful in determining the effectiveness and cost efficiencies of differing communication methods. By analyzing and using this data, medical practices can improve processes and workflow, resulting in increased revenue, process and quality improvements and increased patient satisfaction.
Preventative Care Reminders
CEHRT systems are good for identifying the patients and sending out email communications. However, in order to offer enough options to satisfy patient communication preferences, a separate preventative care reminder system provides additional communication channels. The added value of a separate third-party system is that it may also serve as a comprehensive workflow management tool. Each method of communication provides specific benefits for patients which are described in Figure 4 and there are special considerations medical practices will want to keep in mind.
7
7 Susannah Fox and Maeve Duggan. “Mobile Health 2012.” Pew Research Center, Washington, D.C. (November 2012). pewinternet.org/2012/11/08/mobile-health-2012/, accessed October 2014.
8 Michael Essany. “SMS Marketing Wallops Email with 98% Open Rate and Only 1% Spam.” (6 August 2014). mobilemarketingwatch.com/sms-marketing-wallops-email-with-98-open- rate-and-only-1-spam-43866/, accessed November 2014.
Direct Mail
Traditional mail (letters and/or postcards) may still be a preferred communication option for patients. Generating the preventative care reminder is one thing. What systems are in place to ensure they’re delivered, received and followed up? To make this a truly effective system, the practice will want to design a follow-up workflow and assign resources to make sure a patient is contacted for an appointment, is confirmed and the information is logged back into the system for reporting purposes.
Electronic Communications
Compared to traditional mail, automated electronic communications offer a distinct advantage to a medical practice. See Figure 5, Automated Electronic Communications Help Decrease Operating
Costs and Increase Appointments.
Each method of communi-cation, whether direct mail or electronic, offers advantages to the patient and can be used separately or in combination to achieve meaningful use objectives or meet the goals of the practice. See Figure 4.
Preventative Care Reminder Solutions: Top Five Features
Ultimately, meaningful use objectives are designed to help improve clinical outcomes and population health outcomes, increase transparency and efficiency, empower individuals and provide more research data on health systems. For medical practices selecting the appropriate technologies, their objectives are to meet MU
measures while providing quality care, increasing patient satisfaction and decreasing operating costs. Currently, it’s almost impossible to find a CEHRT that fits the needs of the practice and at the same time offers enough options to satisfy the range of patient communication preferences, so an EHR system combined with a preventative care reminder solution that provides auditable attestation data is the most viable option.
FIGURE 4: PREVENTATIVE CARE REMINDERS AND COMMUNICATION METHODS:
PATIENT ADVANTAGES
MAILED COMMUNICATION – More information can be included
– Patients can read and re-read information at their own convenience – Easy to provide supplementary information, links
Considerations for the practice: No record of delivery, need follow-up workflow and documentation process.
INTERACTIVE VOICE RESPONSE (IVR)
– Patient can connect to appointment scheduler immediately
– Patient can connect to the appropriate department or person if there are questions EMAIL
– Less disruptive, patient can read it at their convenience – Self-documenting
– More information can be included
– Patients can read and re-read information at their own convenience – Easy to provide supplementary information, links
Considerations for the practice: Email preventative care reminders must be generated and sent through a certified EHR system.
SHORT MESSAGE SERVICE (SMS)
According to the Pew Research Center, 80% of U.S. adults own a cell phone and 80% of them say they send and receive text messages.7 In addition, text messages have open rates as high as 98%.8
– Patients can read and re-read information at their own convenience – Instant opt-out
– Reliable connection
8
When selecting a preventative care reminder solution, here are the top five functional features to consider to ensure your medical practice has the most robust technology available to meet MU measures and practice objectives.
1. Offers enough options in electronic communication channels to
accommodate patient communication preferences – email, SMS, IVR.
2. Integrates with the practice’s medical management software or
electronic health system so patient communications can be triggered by patient-related data or events.
3. Flexibly accommodates the practice workflow and creates efficiencies.
The ideal solution will allow you to:
• Easily personalize and customize your messages for each specific patient without creating additional work for your staff.
• Generate communications at every stage of a patient’s care – pre-visit, post-visit, preventative/ongoing care.
• Control the schedule and frequency that reminder calls, text messages and emails are sent.
• Automatically and properly document the contact for reporting (attestation) purposes.
4. Helps drive patients to take an action—to make an appointment, confirm or cancel an
appointment, visit patient portal, etc. It’s important to provide a two-way communication system that connects with a patient and elicits a response.
5. Adheres to security and compliance requirements, protect patient health information while
meeting MU requirements.
An even more unique time-saving feature to look for is one that manages inbound calls for patients who may call back without listening to their voicemail. With this functionality, the system will recognize the patient’s telephone number, play the original message for them and give them the menu prompts to connect them to the right department or person. this alleviates the burden on staff to triage the call.
FIGURE 5: AUTOMATED ELECTRONIC COMMUNICATIONS HELP DECREASE OPERATING COSTS AND INCREASE APPOINTMENTS
*Depends on Specialty
TRADITIONAL COMMUNICATIONS & MANUAL PROCESS ELECTRONIC COMMUNICATIONS & AUTOMATED TECHNOLOGY
Automated Messages Delivered Labor = $0 Automated Appointment Confirmation Labor = $0 Make Appointments Labor @ 2 min= $.50 Contact Automatically Documented Labor = $0 Identify Patients Using EHR Labor = $0
Automated Preventative Care Reminders Total Savings per 1,000 Patients: $3,465 Additional Appointments per 1,000 Patients: 20
Cost per Patient: $ .50 Cost per 1,000 Patients: $500 Typical % Appointments Scheduled: 20%* Appointments per 1,000 patients:120 Address Postcard, add Postage and Send
Labor @ 2 min= $.50 Printing & Postage = $1.34 Manual Appointment
Confirmation Labor @ 2 min = $.50
Follow-up with Patients Labor @ 2.5 min = $.625 (avg 2.5x to reach patient) Manuallly Documant the Contact Labor @ 2 min = $.50 Identify Patients Using EHR Labor = $0 Make Appointments Labor @ 2 min = $.50
Cost per Patient:
$ 3.965 Cost per 1,000 Patients: $3,965 Typical % Appointments Scheduled: 10%* Appointments per 1,000 Patients: 100
