It's Not Too Late! Getting Meaningful Use Dollars for Your Program. June 20, 2013

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It's Not Too Late!

Getting Meaningful Use Dollars

for Your Program

(2)

Julie Hook, MPH

(3)

John Jessop, MHA

Planned Parenthood of Southern New England

&

Susan Lane, BA

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Intended Audiences

Title X grantees and sub-recipient leadership

interested in pursuing Meaningful Use Medicaid

Electronic Health Record (EHR) Incentive

Program funds

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Learning Objectives

• Define Meaningful Use and the requirements for

data collection within each stage

• Describe the benefits of achieving Meaningful Use

• Describe an effective process that was used to

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Why Should Family Planning Programs

Care about Meaningful Use?

• Helps you meet the standards of future partners,

payers, and stakeholders

Medicaid EHR Incentive Program

• o

Maximum incentive amount is $63,750 per eligible

professional

Medicaid expansion through Affordable Care Act

o

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About the Medicaid EHR Incentive

Program

• Voluntarily offered by 47 individual states and

territories; CMS expects full adoption in the future

Eligible providers include physicians, certified

nurse-midwives, or nurse practitioners

For more information, go to:

https://www.cms.gov/apps/files/statecontacts.pdf

•

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Meaningful Use: Main Ingredients

• Using Certified EHR Technology (CEHRT)

Electronically exchanging health

information to improve quality

Using technology to report clinical quality

and other measures

•

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Data Reporting in All Stages of MU

Source:

www.cms.gov

Core

Measures

Clinical

Quality

Measures

Meaningful

Use

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Stage 1 Meaningful Use:

15 Core Objectives

1. Computerized provider order entry

(CPOE)

Drug-drug and drug-allergy checks

Maintain an up-to-date problem list of

current/active diagnoses

E-prescribing

Maintain active medication list

Maintain active medication allergy list

Record demographics

Record and chart changes in vital signs

2.

3.

4.

5.

6.

7.

8.

9. Record smoking status for patients 13

years and older

Report ambulatory clinical quality

measures

Implement clinical decision support

Provide patients with an electronic copy

of the health information, upon request

Provide clinical summaries for patients

for each office visit

Capability to exchange clinical

information

Protect electronic health information

10.

11.

12.

13.

14.

15. Source:

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Stage 1 Meaningful Use:

10 Menu Objectives

At least one of the 5 you report on must be a Public Health objective:

o

Submit electronic data to immunization registries OR

o

Submit electronic syndromic surveillance data to public health agencies

Other Stage 1 Menu Objectives

Drug formulary checks

Patient-specific education resources

Incorporate clinical lab-test results

Electronic access to health information for patients

Generate lists of patients by specific conditions

Medication reconciliation

Send reminders to patients for preventive/follow-

Summary of care record for transitions of care

up care

Source:

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Attestation of EHR

In your first year of participation you can:

• Adopt a certified EHR

• Implement a certified EHR

• Upgrade to a certified EHR

In the second year and beyond, you will need to

demonstrate and attest to Meaningful Use

You’ll need documentation proving A/I/U of a

certified EHR

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Stages of Meaningful Use

**Stage 1 (2011-2012*)**

**Stage 2 (2014*)**

Data capture and

**Stage 3 (2016*)**

sharing

_{Advance clinical}

15 CORE + 5 MENU processes

_{Improve outcomes}

17 CORE + 3 MENU

+ CLINICAL QUALITY MEASURES

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Getting Help on EHRs and Meaningful Use:

62 Regional Extension Centers (RECs)

• Located in every region of the U.S.

Fee-based, on-the-ground assistance for providers

Funding model is shifting to self-sustaining

Find your REC:

http://www.healthit.gov/providers-professionals/regional-extension-centers-recs

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Core Measure Most Relevant to Family

Planning Settings

• Preferred language

Gender

Race/Ethnicity

Date of birth

•

• Patient

Demographics

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Clinical Quality Measures Most

Relevant to Family Planning Settings

• % of patients aged 18 years and older who

were screened for tobacco use one or more

times within 24 months AND who received

cessation counseling intervention if

identified as a tobacco user

Tobacco

• % of patients aged 18-85 years of age with

a diagnosis of hypertension whose blood

pressure improved during the

measurement period

Blood Pressure

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Clinical Quality Measures Most

Relevant to Family Planning Settings

• % of patients 3-17 years and 18+ of age

who had an outpatient visit with a PCP or

OB/GN and who had BMI, nutrition

counseling, and physical activity

Body Mass

Index

• % of women 21-64 years of age, who

received one or more Pap tests to screen

for cervical cancer during measurement

year or 2 years prior

Cervical Cancer

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Clinical Quality Measures Most

Relevant to Family Planning Settings

• % of patients, regardless of age, with a

diagnosis of HIV/AIDS with at least two

medical visits during the measurement

year with a minimum of 90 days between

each visit

HIV/AIDS

• % of women 16-24 years of age who were

identified as sexually active and who had

at least one test for chlamydia during the

measurement period

Chlamydia

Screening

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Clinical Quality Measures Most

Relevant to Family Planning Settings

• % of women 40-69 years of age who had a

mammogram to screen for breast cancer

during the measurement year or the year

prior

Breast Cancer

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The PPSNE Experience:

Why We Pursued Meaningful Use

• Financial incentives

Competition in the marketplace

Changes in payer demands

Outcomes-driven payments

Quality of care improvements

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Financial Incentives

• EHRs are EXPENSIVE!

Approximate cost to PPSNE for EHR - $3.1M

o

Software, hardware, interfaces, custom templates, network

improvements, custom application development

A/I/U Payment - $950K

Estimated total payments for Years 2-6 - $1.75M

Estimated total MU incentive - $2.7M

So EHR only cost $400K!

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Initial Meaningful Use Considerations

• Change management

Data analysis

Capabilities of EHR templates

Education of key stakeholders, staff &

clinicians

General systems to support MU

requirements

•

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Change Management

• Underpins all aspects of the MU process

Requires education of key stakeholders (clinical, finance,

management)

Needs to link MU to quality of care

Focus on:

o

How MU is integrated with the use of the EHR

o

Potential to increase agency revenue

•

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Data Analysis

• Capturing data needed for MU measures

o

Extracting the data from the EHR

o

Time

o

Person responsible

What systems can help?

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Capabilities of EHR Templates

• MU data capture

through its templates

Where/How is it

being captured?

Optimizing workflow

•

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Key Stakeholders, Staff & Clinicians

• Need education

Generally supported concept once understood

Staff & clinicians:

o

Didn’t understand why they had to do something that

seemed unrelated to our core mission

o

Hated workflow disruption caused by new requirements and

initially inefficient template design

o

Had to overcome individual practice patterns and personal

habits based on 10+, 20+ years of experience working in a

center

•

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MU Systems and Related Capabilities

• Data extraction – Is it possible? How? Who can do it?

o

Internal skillsets (reporting software, programming

languages)

o

Turnaround time

o

Frequency

Data validation of “canned” reports

o

Are the reports accurate?

o

Do they capture data from customized templates or from

non-standard workflows?

Are the reports easy to execute and aggregate?

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MU First Step: A/I/U

• Easiest of all MU steps to meet

Very lucrative / “found money”

Easy to establish a baseline of Medicaid patients

Our A/I/U effort primarily involved two staff

However, this step still requires preparation and planning

o

Waivers with cover letters

o

Data analysis

o

Registration

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Preparation & Planning for A/I/U

• Prepared for A/I/U by reading about requirements

o

Learned how to attest at federal and state levels

o

Learned how to do bulk data uploads

o

Learned about waiver letter requirement

Defined MU team (helped with communication to

clinicians)

Determined how to do a baseline analysis for A/I/U

Reviewed new procedures/data collection activities

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CMS Registration

• Attestation – CMS Registration

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MU Core Team

Also known as

“EHR Core Team”

Recommend that

the Project Lead be

in charge of your

clinical staff

Project Lead Clinical Application Manager (IT) Clinical Application Specialist (IT) Regional Manager (Clinical) Regional Manager, Special Projects (Clinical) Director of Quality Assurance and Improvement (Clinical) Director of Medical Services (Clinical)

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A/I/U Work

•

• Assessed patient & payer population

Determined # of Eligible Providers

Identified measurement period (any 90-day

period)

Saved all data for submission validation

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Preparation & Planning for MU

• Attestation – State Registration

o

The following information will be required:

1. License number/NPI

2. Information on provider practice if in multiple states

3. Office location (was location-specific in CT)

4. Medicaid or needy encounter data

5. Total encounter data

6. Specialty (taxonomy)

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Medicaid Population Calculations

• Determined Medicaid population

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Collecting Waivers from Clinicians

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Preparation & Planning for Stage 1

• Determined requirements for Stage 1

Identified target Menu Measures and additional Clinical

Quality Measures

Reviewed new procedures/data collection activities

Acquired and implemented a MU dashboard

Evaluated EHR template changes

Conducted staff education and training

•

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Identified Target Measures from Menu

• Identified 5 of 10 Menu Measures

• Identified 6 of 38 additional CQMs

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New Procedures/Data Collection

Activities

• Looked at EHR templates to see how the data was

captured

Determined where the reports are coming from

Determined who would run reports and when

Identified how much time and attention was required to

run the reports and to aggregate the data

Determined that it was too much for us to do manually!

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Staff & Clinician Preparation

• Additional clinical effort required to achieve Stage 1

Learning sessions via conference calls

Communications from CEO about steps toward MU

Clinician conferences for clinical services

Site visits

Repeated and ongoing communication

Answered questions about quality of care

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Where We Are Today and What’s

Ahead

• In Stage 1 (90-day reporting period)

• Planning on Stage 1 for the full year (Stage 1, 2

nd

_year)

o

Some measures requirements change

• Working on connectivity requirements

o

RI ConnectCare

o

CT DPH Lab

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Lessons Learned

Change management is TOUGH!

Understanding market trends and appreciating increased

competition can help secure buy-in for MU

Planning and preparation are critical to the transition

Education of ALL stakeholders is critical to success

Data analysis resources are critical to demonstrating MU

EHR templates & MU data capture don’t necessarily go

hand-in-hand

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National Training Center for Management and

Systems Improvement

www.fpntc.org

Reesa Webb

[email protected]

Ann Loeffler

[email protected]

Tara Melinkovich

[email protected]

Caitlin Hungate

[email protected]

Jen Spezeski

[email protected]

Adrienne Christy

[email protected]

Paul Rohde

[email protected]

303-262-4300

www.jsi.com