Presenter
James S. Dunnick, SESEDN LLC.
Credentials:
MD. FACC.
CHCQM.
CPC.
Contact Information:
SESEDN@gmail.com
jdmd62@gmail.com
SESEDN LLC
Disclaimer:
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Do NOT assume I am correct, I make mistakes.
Read and self educate.
CPT books, government manuals, online resources.
Obtain teaching, from more than one source.
Auditors opinions will vary. States will vary.
Rules change.
This is meant as general and initial information only.
Always the responsibility of the client to verify the accuracy of information.
Meaningful Use Stage 1 and 2
Stage 1
2011-2012
Data capture and sharing
Stage 2
2014
Advance clinical processes
Stage 3
2016
Improved outcomes
Meaningful Use Delay?
On May 20, the Centers for Medicare and Medicaid Services
(CMS) and the Office of the National Coordinator for
Health Information Technology (ONC) issued a proposed
rule that may delay implementation of 2014 edition
Certified Electronic Health Record Technology (CEHRT).
LA Healthcare Quality Forum. June 2014
Meaningful Use Delay?
“If it is finalized, it could mean that some EPs will be able to
attest to Meaningful Use this year using 2011 CEHRT or a
mix of 2011 and 2014 technology,” she said. “It may also
allow some EPs to attest this year by meeting the 2013 or
2014 Stage 1 measures even if those providers were
scheduled to start Stage 2 this year.”
Nadine Robin, Health IT Program Manager for the Louisiana Health Information
Technology (LHIT) Resource Center.
Meaningful Use Delay?
• The proposal, if approved, would be valid only for the
2014 reporting year. In 2015, all EPs will still be required
to report using the 2014 Edition CERHT.
Meaningful Use Delay?
• CMS admitted problems with EHR technology and
implementation and late Tuesday……………
Meaningful Use Delay?
• CMS admitted problems with EHR technology and
implementation and late Tuesday formalized its
decision to extend Stage 2 of the program for an
additional year--through 2016--and to put off the start of
Stage 3 until 2017
Meaningful Use Delay?
• CMS MAKES IT OFFICIAL: MU DEADLINES PUSHED
BACK TO 2016, 2017:
Meaningful Use Delay?
• The proposal, if (now) approved, would be valid only for
the 2014 reporting year. In 2015, all EPs will still be
required to report using the 2014 Edition CERHT.
For 2014 only
“For Medicaid providers only eligible to receive Medicaid
EHR incentives, the 3-month reporting period is not
fixed, where providers do not have the same alignment
needs.”
For 2014 only
For Medicare providers, this 3-month reporting period is
fixed to the quarter of either the fiscal (for eligible
hospitals and CAHs) or calendar (for EPs) year in order to
align with existing CMS quality measurement programs,
such as the Physician Quality Reporting System (PQRS)
and Hospital Inpatient Quality Reporting (IQR).
Meaningful Use
Eligible Professionals (EP)
Eligible Hospitals (EH)
Eligible Critical Access Hospitals (CAH)
Meaningful Use
• Eligible Professionals (EP)
• Eligible Hospitals (EH)
• Eligible Critical Access Hospitals (CAH)
• Stage 1 and Stage 2
• Definitions 2013 or 2014
• CERHT 2011 or 2014
Meaningful Use
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Eligible Professionals (EP)
Eligible Hospitals (EH)
Eligible Critical Access Hospitals (CAH)
Stage 1 and Stage 2
Definitions 2013 or 2014
CERHT 2011 or 2014
Core objectives
Menu objectives
Clinical quality measures
National quality strategy domains
2013 EP Stage 1
Eligible professionals must meet:
• 13 required core objectives
• 5 menu objectives from a list of 10
• Total of 18 objectives
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CMShttp://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/2013Definition_Stage1_MeaningfulUse.html
Meaningful use EP Stage 1
Although some Stage 1 objectives were either combined
or eliminated, most of the Stage 1 objectives are now
core objectives under the Stage 2 criteria
Meaningful Use
For many of these Stage 2 objectives:
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The threshold has been raised
The expectation is higher
“We expect that providers…. will be able to demonstrate
meaningful use…. for an even larger portion of their
patient populations.”
Meaningful Use
Group Practices Can Now Register for Group Practice
Reporting Option for 2014 PQRS Participation
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Eligible professionals (EPs) who wish to participate in the
2014 PQRS program as a group practice can now
register for the group practice reporting option (GPRO).
When your group is ready to register, you can access the PVPQRS Registration System at https://portal.cms.gov.
EHR Reporting Options for
Eligible Professionals in 2014
Include:
Eligible Professionals in 2014 Include:
• Options that only apply for the EHR Incentive Program
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Option 1: Attest to CQMs through the EHR Registration &
Attestation System
Option 2: eReport CQMs through Physician Quality Reporting
System (PQRS) Portal
EHR Reporting Options for
Eligible Professionals in 2014
Include:
• Options that Align with Other Quality Programs
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Option 3: Report individual eligible professionals’ CQMs through
PQRS Portal
Option 4: Report group’s CQMs through PQRS Portal
Option 5: Report group’s CQMs through Pioneer ACO
participation or Comprehensive Primary Care Initiative
participation
Stage 2 Core and Menu Objectives
Eligible Professionals
Eligible professionals must meet:
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17 core objectives
3 menu objectives that they select from a total list of 6
Total of 20
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html
2014 Clinical Quality Measures
• Eligible professionals who demonstrate 2014 clinical
quality measures (CQMs) will need to report 9
measures, and eligible hospitals will need to report 16.
CQMs may be reported electronically, or via attestation.
http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/2014_ClinicalQualityMeasures.html
Stage 2 Core and Menu Objectives
Eligible Professionals
Eligible professionals must meet:
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17 core objectives
3 menu objectives that they select from a total list of 6
Eligible professionals who demonstrate 2014 clinical quality
measures (CQMs) will need to report 9 measures
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html
National Quality Strategy
Domains
• There is also a new requirement in 2014 that the quality
measures selected must cover at least 3 of the 6
available National Quality Strategy (NQS) domains,
which represent the Department of Health and
Human Services’ NQS priorities for health care quality
improvement.
Clinical Quality Measures
• The 6 NQS domains are:
1. Patient and Family Engagement
2. Patient Safety
3. Care Coordination
4. Population/Public Health
5. Efficient Use of Healthcare Resources
6. Clinical Process/Effectiveness
Stage 2 Core and Menu Objectives
Eligible Professionals
Total 20?
Eligible professionals must meet:
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17 core objectives
3 menu objectives that they select from a total list of 6
Eligible professionals who demonstrate 2014 clinical quality measures (CQMs)
will need to report 9 measures. Which must cover 3 of 6 NQS domains.
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html
Stage 2 Core and Menu Objectives
Eligible Professionals
• 17 core objectives
• 3 of 6 menu objectives
• 9 CQMs (to include 3 of 6 NQS domains)
Total: 17 + 3 + 9 = 29
Stage 2 Core and Menu Objectives
Eligible Professionals
• 17 core objectives
• 3 of 6 menu objectives
• 9 CQMs (to include 3 of 6 NQS domains)
Total: 17 + 3 + 9 = 29*
Report on all 17 Core Objectives:
1. Use computerized provider order entry (CPOE) for
medication, laboratory and radiology orders
2. Generate and transmit permissible prescriptions
electronically (eRx)
3. Record demographic information
4. Record and chart changes in vital signs
5. Record smoking status for patients 13 years old or older
Report on all 17 Core Objectives:
6. Use clinical decision support to improve performance on
high-priority health condition
7. Provide patients the ability to view online, download and
transmit their health information
8. Provide clinical summaries for patients for each office visit
9.Protect electronic health information created or maintained
by the Certified EHR Technology
10. Incorporate clinical lab-test results into Certified EHR
Technology
Report on all 17 Core Objectives:
11. Generate lists of patients by specific conditions to use
for quality improvement, reduction of disparities,
research, or outreach
12. Use clinically relevant information to identify patients
who should receive reminders for preventive/follow-up
care
13. Use certified EHR technology to identify patient-specific
education resources
Report on all 17 Core Objectives:
14. Perform medication reconciliation
15. Provide summary of care record for each transition of
care or referral
16. Submit electronic data to immunization registries
17. Use secure electronic messaging to communicate with
patients on relevant health information
Report on 3 of 6 Menu Objectives:
1. Submit electronic syndromic surveillance data to public health
agencies
2. Record electronic notes in patient records
3. Imaging results accessible through CEHRT
4. Record patient family health history
5. Identify and report cancer cases to a State cancer registry
6. Identify and report specific cases to a specialized registry
(other than a cancer registry)
Final Rule
II. Summary of Errors.
A. Summary of Errors in the Preamble
On page 54,041 in our response…..
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https://www.federalregister.gov/articles/2012/10/23/2012-25975/medicare-and-medicaid-programs-electronichealth-record-incentive-program-stage-2-corrections
Final Rule
• ACTION: Final Rule; Correction.
• SUMMARY: This document corrects technical errors and
typographical errors in the final rule entitled “Medicare
and Medicaid Programs; Electronic Health Record
Incentive Program—Stage 2”
Meaningful Use EP Stage 2, 2014
1. Wow
2. Build a team
Providers - MD/DO/NPP
Ancillary staff
Administration - hospital and office
IT
3. Consultants help - state help
Stage 2 EP 2014 Meaningful Use
SESEDN LLC:
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James S. Dunnick, MD. FACC. CHCQM. CPC.
Hometown Health University:
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Kathy Whitmire, Managing Director
Mark Renfro, HomeTown Health HIT Director
Reimbursement Solutions Group
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Jesus F. Ruiz, CPA
Presenter
James S. Dunnick, SESEDN LLC.
Credentials:
MD. FACC.
CHCQM.
CPC.
Contact Information:
SESEDN@gmail.com
jdmd62@gmail.com