NY Medicaid. EHR Incentive Program

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NY Medicaid

EHR Incentive Program

Eligible Hospitals

Participation Year 2-3 (MU1) Webinar

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EHR Incentive Program Background

Original Legislation

The Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009 (ARRA).

The HITECH Act Established:

• Medicaid EHR Incentive Program • Medicare EHR Incentive Program

• Office of the National Coordinator for Health Information Technology (ONC) • Certified EHR Technology

Goals of the HITECH Act:

• Improve patient quality of care

• Promote the adoption and meaningful use of health information technology • Increase health information exchange

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Medicaid EHR Incentive Program

Provides incentive payments to:

• eligible professionals

• eligible hospitals

as providers:

• adopt,

• implement, or

• upgrade,

and subsequently:

• demonstrate meaningful use

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Eligible Hospitals

Acute Care Hospitals

• At least 10% Medicaid patient volume throughout all participation years. • An average patient length of stay of 25 days or fewer

• CMS Certification Number (CCN) that falls in the range 0001-0879 or 1300-1399

• May be eligible to receive both Medicaid and Medicare Incentive Payments

Children's Hospitals

• Hospital that is separately certified as a children's hospital • Predominantly treats individuals under the age of 21

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Meaningful Use Stage 1

 Introduction to Meaningful Use

 Meaningful Use Stage 1 Core Objectives

 Meaningful Use Stage 1 Menu Objectives

 Clinical Quality Measures

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What is Meaningful Use (MU)?

Meaningful Use means providers need to show they're using certified EHR

technology in ways that can be measured significantly in quality and in

quantity.

Achieving Meaningful Use

• Using certified EHR in a meaningful manner

• Using certified EHR technology for electronic exchange of health information to improve quality of health care

• Using certified EHR technology to submit clinical quality and other measures

Meaningful Use Stages

• Stage 1 sets the baseline for electronic data capture and information sharing • Stage 2 builds upon Stage 1 measures to grow the MU of CEHRT

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Participation Year 2-3 (MU1)

Meaningful Use Requirements

EHs must attest to having met 17 out of 22 Meaningful Use Stage 1 objectives and report on 15 Clinical Quality Measures:

 12 required core objectives and,  5 objectives out of a menu set of 10

 Based on Inpatient and Emergency Department (POS 21 or 23)

Participation Year 2-3 Attestation

• Reporting Period: Continuous 90 day / 1 quarter reporting period in the Federal Fiscal Year

• All Meaningful Use attestation should fall under the same reporting period • Attestation for participation year 2/3 (2014) ends on September 30, 2014

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AIU/Meaningful Use Reporting

Each participation year, hospitals must attest to Adoption/

Implementation/Upgrade (AIU) or Meaningful Use of certified EHR

technology.

• Medicaid (1

st

_{Participation Year): AIU}

• Medicaid (2

nd

_/3

rd

_{Participation Years): Meaningful Use}

• Medicare (All Participation Years): Meaningful Use

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EHR Reporting Periods in PY2013

Hospital Participating In:

Payment Year Medicaid Incentive Program Only

Medicaid 1st_{, then} Medicare in same FY

Medicaid 1st_{, then} Medicare in a later FY

Medicare and Medicaid Simultaneously / Medicare 1st_,

then Medicaid in a later FY

1st_payment

year AIU

AIU (Medicaid); MU, 90 Day Period (Medicare)

AIU MU, 90 Day Period

2nd_payment

year MU, 90 Day Period

MU, 1 quarter

reporting period MU, 90 Day Period

MU, 1 quarter reporting period 3rd_payment year MU, 1 quarter reporting period MU, 1 quarter reporting period MU, 1 quarter reporting period MU, 1 quarter reporting period

CMS Keyword: FAQ10826 (EH Reporting Period Table)

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Meaningful Use Stage 1

 Introduction to Meaningful Use

 Meaningful Use Stage 1 Core Objectives

 Meaningful Use Stage 1 Menu Objectives

 Clinical Quality Measures

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MU Stage 1 Core Set Objectives

Eligible Hospitals (EH) must attest to all 12 MU Stage 1 Core Set objectives.

MU Stage 1 Core Set Requirements

EHs must attest to all 12 core objectives:

 9 core threshold objectives  3 core activity objectives

 Participation Year 2: 90 day or one quarter reporting period in the Federal Fiscal Year

 Participation Year 3: One quarter (2014 Only) reporting period in the Federal Fiscal Year

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MU Stage 1 Core Set Objectives

Core Objective Measure (1-9) Min. Threshold 1 Use Computerized Provider Order Entry (CPOE) 30%

2 Implement drug interaction checks Enable EHR Functionality

3 Maintain problem list 80%

4 Maintain active medication list 80% 5 Maintain medication allergy list 80%

6 Record demographics 50%

7 Record vital signs 50%

8 Record smoking status 50%

MU Stage 1 Core Objectives 10-15 on next slide.

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MU Stage 1 Core Set Objectives (Cont’d)

Core Objective Measure (10-15) Min. Threshold 9 Implement clinical decision support rule Implement 1 Rule 10 Provide electronic copy of health information 50%

11 Provide electronic copy of discharge instructions 50%

12 Protect electronic health information Security Risk Analysis

For a full list of Meaningful Use objective details please consult the CMS Meaningful Use Website

2013 Change to MU Stage 1 Core Requirements

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Meaningful Use Stage 1

 Introduction to Meaningful Use

 Meaningful Use Stage 1 Core Objectives

 Meaningful Use Stage 1 Menu Objectives

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MU Stage 1 Menu Set Objectives

In addition to meeting all MU Stage 1 Core Objectives, EHs must also attest to an

addition subset of MU Stage 1 Menu Set Objectives.

MU Stage 1 Menu Set Requirements

EHs must attest to 5 out of 10 menu set requirements:

 Public Health Reporting (PHR) Requirement: Must select 1 of 3 PHR Objectives  Participation Year 2: 90 day or one quarter

 Participation Year 3: One quarter (2014 Only) reporting period in the Federal Fiscal Year

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MU Stage 1 Menu Set Objectives

Menu Objective Measure (1-10) Min. Threshold Public Health Rep. 1 Implement drug formulary checks Enable EHR functionality

2 Record advance directives 50% 3 Incorporate clinical lab test 40%

4 Generate patient lists Generate at least 1 report

5 Identify patient-specific education resources

10%

6 Perform medication reconciliation 50% 7 Provide summary care record 50%

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Meaningful Use Stage 1

 Introduction to Meaningful Use

 Meaningful Use Stage 1 Core Objectives

 Meaningful Use Stage 1 Menu Objectives

 Clinical Quality Measures

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Clinical Quality Measures (CQMs)

Clinical Quality Measures (CQMs) can be measures of processes, experiences

and/or outcomes of patient care, observations or treatment that relate to one or

more quality aims for health care such as effective, safe, efficient,

patient-centered, equitable, and timely care.

CQMs Requirements

EHs must report on all 15 clinical quality measure:



CMS CQM Specification Webpage

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CQM Measures

CQM Description NQF

ED-1 Median time from ED arrival to ED departure for admitted ED patients NQF 0495

ED-2 Admit decision time to ED departure time for admitted patients NQF 0497

Stroke-2 Discharged on anti-thrombotic therapy NQF 0435

Stroke-3 Anticoagulation therapy for atrial fibrillation/flutter NQF 0436

Stroke-4 Thrombolytic therapy NQF 0437

Stroke-5 Antithrombotic therapy by end of hospital day two NQF 0438

Stroke-6 Discharged on statin medication NQF 0439

Stroke-8 Stroke education NQF 0440

Stroke-10 Assessed for rehabilitation NQF 0441

.

For a full list of CQM details please consult the CMS Clinical Measures List

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CQM Measures (Cont’d)

CQM Description NQF

VTE-1 Venous Thromboembolism (VTE) prophylaxis NQF 0371

VTE-2 Intensive Care Unit (ICU) VTE prophylaxis NQF 0372

VTE-3 VTE Patients with overlap of anticoagulation therapy NQF 0373

VTE-4 VTE Patients receiving Unfractionated Heparin (UFH) dosages/platelet count monitoring by protocol (or nomogram)

NQF 0374

VTE-5 VTE discharge instructions NQF 0375

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Meaningful Use Stage 1

 Introduction to Meaningful Use

 Meaningful Use Stage 1 Core Objectives

 Meaningful Use Stage 1 Menu Objectives

 Clinical Quality Measures

 Public Health Reporting

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Public Health Reporting

CMS Meaningful Use Stage 1 Menu Set objectives require EHs to select one of

three Public Health Reporting (PHR) objectives.

– EH must perform at least one test of certified EHR technology's capacity to submit electronic data to the public health agency

– EH is then required to perform a follow-up submission if the test is successful

EHs must attest to 1 of 3 PHR objectives:

 Submit immunization registries data  Submit syndromic surveillance data  Submit lab results data

Frequently Asked Questions

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MU Stage 1 PH Matrix

Measure NY City Report To

NY State (outside of NY City) Report To

Immunizations (M) Citywide Immunization Registry (CIR)

NYC DOHMH

NYS Immunization Information System (NYSIIS)

NYSDOH

Syndromic Surveillance (M) NYC Department of Health and Mental Hygiene

NYC DOHMH

Electronic Clinical Laboratory Reporting System (ECLRS)

NYSDOH

Electronic Lab Reporting (M) Electronic Clinical Laboratory Reporting System (ECLRS)

NYSDOH

Electronic Clinical Laboratory Reporting System (ECLRS)

NYSDOH

Helpful Resources

• New PH Website: http://www.health.ny.gov/technology/meaningful_use_guidance/

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Meaningful Use Stage 1

 Introduction to Meaningful Use

 Meaningful Use Stage 1 Core Objectives

 Meaningful Use Stage 1 Menu Objectives

 Clinical Quality Measures

 Public Health Reporting

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Overviews and Walkthroughs

NY Medicaid EHR Incentive Program Website

Look for Participation Year 1 (A/I/U) Resources

• EH Participation Year 1 Webpage

• Interactive EP Participation Year 1 Walkthrough • EH Participation Year 1 Presentation

• Hospital Workbook

Look for Participation Year 2 and 3 (MU Stage 1) Resources

• EH Participation Year 2 webpage • EH Participation Year 3 webpage

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Details and Deadlines

• Dual Eligible Hospital MU Stage 1 attestations will be reported in the CMS Registration and Attestation System

• Hospitals must finish the attestation process in MEIPASS

• Providers must print, sign, and return (by mail) an attestation form before payment may be issued

• Medicaid Only Eligible Hospital (EH) MU Stage 1 attestations will be reported in MEIPASS

• All EH 2014 MU Stage 1 and Stage 2 reporting is based on a fiscal year quarter regardless of what participation year the EH is in.

• NY Medicaid will accept PY2 (MU1) attestations until December 29, 2014 • MU Stage 1 requirements have changed based on new CMS 2013 guidance

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Meaningful Use Resources

CMS Meaningful Use Stage 1 Resources

• Meaningful Use Website

• CMS Frequently Asked Questions

CMS Clinical Quality Measures (CQMs) Resources

• CMS CQM Specification Webpage

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State Resources

 Provider Information on eMedNY.org

https://www.emedny.org/meipass/  Hospital Webpage https://www.emedny.org/meipass/eh/index.aspx  MEIPASS: EH Login https://meipass.emedny.org/  eMedNY LISTSERV https://www.emedny.org/Listserv/eMedNY_Email_Alert_System.aspx Other Resources

 New York State Medicaid HIT Plan (NY-SMHP)

http://nyhealth.gov/regulations/arra/docs/medicaid_health_information_technology_plan.pdf

 CMS Website for the Medicare and Medicaid EHR Incentive Programs

http://www.cms.gov/ehrincentiveprograms/

 ONC Home Page

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