CMS Incentive Programs for
Eligible Professionals
David Nilasena MD
CMS Region VI
NM HFMA/HIMA
April 13, 2012
Medicare EHR Incentive
Program
Overview of the Program for
Eligible Professionals
Who is Eligible to
Participate?
• Medicare Eligible Professionals include:
•
•
•
•
•
Doctors of medicine or osteopathy
Doctors of dental surgery or dental medicine
Doctors of podiatric medicine
Doctors of optometry
Chiropractors
• Specialties are eligible if meet one of above
criteria
• EPs may not be hospital-based
Who is Eligible to
Participate?
• Eligibility determined in law
• Hospital-based EPs are NOT eligible for
incentives
• DEFINITION: 90% or more of their covered
professional services in either an inpatient (POS 21)
or emergency room (POS 23) of a hospital
• Definition of hospital-based determined in law
• Incentives are based on the individual, not the
practice
How Much Are the
Incentives?
• Medicare Incentive Payments Detail
• Columns = first calendar year EP receives a payment
• Rows = Amount of payment each year if continue to meet requirements
CY 2011
CY 2012
CY 2013
CY2014
CY 2015
and later
CY 2011
$18,000
CY 2012
$12,000
$18,000
CY 2013
$8,000
$12,000
$15,000
CY 2014
$4,000
$8,000
$12,000
$12,000
CY 2015
$2,000
$4,000
$8,000
$8,000
$0
$2,000
$4,000
$4,000
$0
$44,000
$39,000
$24,000
$0
CY 2016
TOTAL
$44,000
In order to get a payment
Medicare
• Meaningfully use of certified EHR technology
• Attest to all program requirements, Meaningful Use requirements
• Get EHR certification number from Office of National Coordinator
of Health IT technology’s CHPL website
Medicaid
• Meaningful use* of certified EHR technology
• Attest to all program eligibility requirements
• Attest to meaningful use* requirements
• Get EHR certification number from Office of National Coordinator
of Health IT technology’s CHPL website
*Medicaid eligible hospitals may adopt, implement, upgrade, or meaningfully
use certified EHR technology in the first participation year.
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Register for the EHR Incentive
Program
• Visit the CMS EHR Incentive Program website
• Click on the Registration tab
• Complete your registration
https://www.cms.gov/EHRIncentivePrograms/
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What are the Requirements/
Meaningful Use?
• Meaningful Use is using certified EHR
technology to
• Improve quality, safety, efficiency, and reduce health
disparities
• Engage patients and families in their health care
• Improve care coordination
• Improve population and public health
• All the while maintaining privacy and security
• Meaningful Use mandated in law to receive
incentives
What are the Requirements/
Meaningful Use?
• Established 3 stages of meaningful use: 2011,
2013 and 2015
Data
capture
and sharing
Advanced
clinical
processes
Improved
outcomes
What are the Requirements/
Meaningful Use?
• Basic Overview of Stage 1 Meaningful Use:
• Stage 1
• Reporting period is 90 days for first year and 1 year
subsequently
• Reporting through attestation
• Objectives and Clinical Quality Measures
• Reporting may be yes/no or numerator/denominator
attestation
• To meet certain objectives/measures, 80% of patients
must have records in the certified EHR technology
What are the Requirements/
Meaningful Use?
• Stage 1 Objectives and Measures Reporting
• Must complete:
• 15 core objectives
• 5 objectives out of 10 from menu set
• 6 total Clinical Quality Measures
(3 core or alternate core, and
3 out of 38 from menu set)
What are the Requirements/
Meaningful Use?
• A Medicare Eligible Professional who does NOT
demonstrate meaningful use by 2015 will be
subject to payment reductions in their Medicare
reimbursement schedule
• Medicaid-only EPs are not subject to payment
reductions
• Payment reductions may apply for any EP who
accepts Medicare, even if you only participate in
the Medicaid EHR incentive program
What You Need to Participate
• All providers must:
• Register via the EHR Incentive Program website:
https://ehrincentives.cms.gov/
• Be enrolled in Medicare FFS, MA, or Medicaid (FFS
or managed care)
• Have a National Provider Identifier (NPI)
• Use certified EHR technology
• Medicaid providers may adopt, implement, or upgrade in their
first year
• All Medicare providers and Medicaid eligible
hospitals must be enrolled in PECOS
What You Need to Participate
•
Certified EHR Technology:
•
Required in order to achieve meaningful use
•
Standards and certification criteria announced on July 13, 2010.
See http://healthit.hhs.gov/standardsandcertification for more
information
•
ONC has authorized 6 “testing and certification bodies” (ATCBs)
for temporary certification program as of December 2010
•
Certified products are available. (~800 complete EHRs)
•
List of certified EHRs and EHR modules are posted on ONC web
site: http://onc-chpl.force.com/ehrcert
•
Visit http://healthit.hhs.gov/certification for more information
•
Email ONC.Certification@hhs.gov with questions
Proposed Rule
Everything discussed in this presentation is part of
a notice of proposed rulemaking (NPRM).
We encourage anyone interested in Stage 2 of
meaningful use to review the NPRM for Stage 2
of meaningful use and the NPRM for the 2014
certification of EHR technology at
CMS Rule: http://www.gpo.gov/fdsys/pkg/FR-2012-03-07/pdf/2012-4443.pdf
ONC Rule: http://www.gpo.gov/fdsys/pkg/FR-2012-03-07/pdf/2012-4430.pdf
Comments can be made starting March 7 through
May 7 at www.regulations.gov
What is in the Proposed
Rule
•
•
•
•
•
•
•
•
Minor changes to Stage 1 of meaningful use
Stage 2 of meaningful use
New clinical quality measures
New clinical quality measure reporting
mechanisms
Appeals
Details on the Medicare payment adjustments
Minor Medicare Advantage program changes
Minor Medicaid program changes
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Stages of Meaningful Use
Stage of Meaningful Use
1st
Year
2011
2012
2013
2014
2015
2016
2017
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
1
1
1
2
2
3
3
TBD
TBD
TBD
TBD
1
1
2
2
3
3
TBD
TBD
TBD
TBD
1
1
2
2
3
3
TBD
TBD
TBD
1
1
2
2
3
3
TBD
TBD
1
1
2
2
3
3
TBD
1
1
2
2
3
3
1
1
2
2
3
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Payment Adjustments
• The HITECH Act stipulates that for Medicare EP,
subsection (d) hospitals and CAHs a payment
adjustment applies if they are not a meaningful EHR
user.
• An EP, subsection (d) hospital or CAH becomes a
meaningful EHR user when they successfully attest
to meaningful use under either the Medicare or
Medicaid EHR incentive program
• As adopt, implement and upgrade does not
constitute meaningful use, a provider receiving a
Medicaid incentive for AIU would still be subject to
the Medicare payment adjustment.
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EP Payment Adjustments
% ADJUSTMENT ASSUMING LESS THAN 75 PERCENT OF EPs ARE MEANINGFUL EHR
USERS FOR CY 2018 AND SUBSEQUENT YEARS
2015 2016 2017 2018 2019 2020+
EP is not subject to the payment
adjustment for e-Rx in 2014
EP is subject to the payment
adjustment for e-Rx in 2014
99%
98%
97%
96%
95%
95%
98%
98%
97%
96%
95%
95%
% ADJUSTMENT ASSUMING MORE THAN 75 PERCENT OF EPs ARE MEANINGFUL EHR
USERS FOR CY 2018 AND SUBSEQUENT YEARS
2015 2016 2017 2018 2019 2020+
EP is not subject to the payment
adjustment for e-Rx in 2014
EP is subject to the payment
adjustment for e-Rx in 2014
99%
98%
97%
97%
97%
97%
98%
98%
97%
97%
97%
97%
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EP EHR Reporting Period
EP who has demonstrated meaningful use in 2011
or 2012
Payment Adjustment Year
2015 2016 2017 2018 2019
2020
Full Year EHR Reporting Period
2013 2014 2015 2016 2017
2019
EP who demonstrates meaningful use in 2013 for the
first time
Payment Adjustment Year
90 day EHR Reporting Period
Full Year EHR Reporting Period
2015 2016 2017 2018 2019
2020
2013
2014 2015 2016 2017
2019
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EP EHR Reporting Period
EP who demonstrates meaningful use in 2014 for
the first time
Payment Adjustment Year
90 day EHR Reporting Period
Full Year EHR Reporting Period
2015 2016 2017 2018 2019
2020
2014* 2014
2015 2016 2017
2019
*In order to avoid the 2015 payment adjustment the EP
must attest no later than Oct 1, 2014 which means
they must begin their 90 day EHR reporting period
no later than July 2, 2014
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EP Hardship Exemption
Proposed Exemptions on an application basis
• Insufficient internet access two years prior to the
payment adjustment year
• Newly practicing EPs for two years
• Extreme circumstances such as unexpected
closures, natural disaster, EHR vendor going out
of business, etc.
Applications need to be submitted no later than
July 1 of year before the payment adjustment
year; however, we encourage earlier submission
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Resources to Get Help and
Learn More
• Get information, tip sheets and more at CMS’
official website for the EHR incentive programs:
www.cms.gov/EHRIncentivePrograms
• Learn about certification and certified EHRs, as
well as other ONC programs designed to
support providers as they make the transition:
http://healthit.hhs.gov
Durable Medical Equipment, Prosthetics, Orthotics and
Supplies (DMEPOS) Competitive Bidding Program
Medicare covers Part B medical equipment and supplies
Examples: walkers, power wheelchairs, hospital beds, CPAPs, enteral nutrition and various other
medical supplies and accessories.
New competitive bidding program
Initially, became effective 1/1/11 in 9 areas around the country
Medicare beneficiaries must use contract supplier
In certain areas (based on zip codes)
For certain products
Or, it won’t be covered by Medicare
• Applies to beneficiaries who have Original Medicare
That reside in a Competitive Bidding Area (CBA) and/or
Must obtain a competitive bid item while visiting a CBA
To see if ZIP Code is in a Competitive Bidding Area
Call 1-800-MEDICARE
Visit www.medicare.gov
Medicare Advantage enrollees will not participate in this program and must use their plan suppliers
What’s Coming? Round 2!!!
The Competitive Bidding Program expands in 2013 to:
91 Metropolitan Statistical Areas
For New Mexico
– Albuquerque will be the CBA
Round 2 product categories include:
1.
2.
3.
4.
5.
6.
7.
8.
Oxygen, oxygen equipment, and supplies
Standard (power and manual) wheelchairs, scooters, and related accessories
Enteral nutrients, equipment, and supplies
Continuous Positive Airway Pressure (CPAP) devices and Respiratory Assist Devices (RADs) and
related supplies and accessories
Hospital beds and related accessories
Walkers and related accessories
Negative Pressure Wound Therapy pumps and related supplies and accessories
Support Surfaces (Group 2 mattresses and overlays)
There will also be a National Mail Order Diabetic Supplies Contract
Anyone receiving their diabetic supplies via a national or local mail carrier must obtain them from
the national mail order diabetic supplies contractor in order for Medicare to pay for the product or
service.
For more info, please visit www.cms.gov/DMEPOSCompetitiveBid/
Medicare Shared Savings Program
The Shared Savings Program is a new
approach to the delivery of health care
aimed at reducing fragmentation,
improving population health, and
lowering overall growth in expenditures
by:
Promoting accountability for the care of
Medicare fee-for-service beneficiaries
Requiring coordinated care for all
services provided under Medicare Parts
A and B
Encouraging investment in
infrastructure and redesigned care
processes
http://www.cms.gov/sharedsavingsprogram
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http://www.cms.gov/sharedsavingsprogram
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Questions?
David Nilasena MD
Chief Medical Officer, CMS Region VI
(214)-767-4449
david.nilasena@cms.hhs.gov