S1MU Part 1:
An Overview of Core
Requirements and Big
Changes Ahead
Moderator:
Mary Zile, BSN, MHSA
Presenters:
Nathan Diller, MBA, MHSA
Marty Larson, MS
Stefanie Strinko, MBA, CPHIMS
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the Office of the National Coordinator for HIT, US Dept. of Health and
Coordinator for HIT, US Dept. of Health and Human
Human Services
Services
Agenda
• Overview of Meaningful Use
• Contrasting Stage 1 Meaningful Use (S1MU) to Stage
2 Meaningful Use (S2MU)
• Deep Dive: S2MU Core Measures
• Question & Answers
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2
Overview of Meaningful Use
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3
HITECH: Policy Framework
Better care for individuals, better health for populations, and lower per-capita costs.
IHI-Triple Aim Initiative
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Pillars of Meaningful Use
Improve quality, safety, efficiency, and reduce health disparities
•
•
•
•
Provide access to comprehensive patient health data for patient’s health care
team
Use evidence-based order sets and CPOE
Apply clinical decision support at the point of care
Generate lists of patients who need care and use them to reach out to patients
Engage patients and families
•
Provide patients and families with timely access to data, knowledge, and tools to
make informed decisions and to manage their health
Improve care coordination
•
Exchange meaningful clinical information among professional health care team
Improve population and public health
•
Submit immunization, syndromic surveillance and reportable disease data to
public health agencies
Ensure privacy and security protection for personal health information
•
•
Protect confidential information through operating policies, procedures, and
technologies
Provide transparency of data sharing to patient
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Definition of Meaningful Use
• Use of ONC-HIT Certified Electronic Health
Records (EHR)
• Electronic Exchange of Health Information
• Quality Reporting
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6
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7
Why S2MU Matters
• Stage 2 Meaningful Use serves as a foundation for
other health care innovation initiatives
• S2MU is a glide path to:
• Accountable care organizations
• Medical home
• Payment reform initiatives
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8
Stages of Meaningful Use
http://www.cms.gov/EHRIncentivePrograms
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10
For Medicare Hospitals:
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11
Meaningful Use – Potential
Penalties
• Penalties apply to Medicare only
• You must begin your first 90-day reporting period no
later than July 3, 2014
• EPs must attest to Meaningful Use no later than
October 1, 2014
• AIU for year one Medicaid does not count as
attestation
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12
The Penalty
•
Adjustments will be applied as a percentage of Medicare Part B
Professional Fee Schedule Charges
•
Penalties scheduled to begin in Jan 1, 2015, and continue as
follows:
•
•
•
•
•
2015: 1%
2016: 2%
2017: 3%
2018-2019: may increase 1% per year at discretion of HHS Secretary
You cannot wait until 2015 to be Meaningful User if you are
concerned about penalties
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13
Medicare Payment Adjustments
EPs who first demonstrated meaningful use in
2011 or 2012 must demonstrate meaningful use
for a full year in 2013 to avoid payment
adjustments in 2015. They must continue to
demonstrate meaningful use every year to avoid
payment adjustments in subsequent years.
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14
Hardship Exceptions for Medicare
EPs
EPs can apply for hardship exceptions in the following
categories:
• Infrastructure
• New EPs
• Unforeseen circumstances
• By specialist/provider type
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15
Contrasting S1MU
to S2MU
An Overview
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Meaningful Use – Who is eligible for incentives?
Eligible Providers in
Medicare
Eligible Providers in
Medicaid
Eligible Professionals (EPs)
Doctor of Medicine or
Osteopathy
Doctor of Dental Surgery or
Dental Medicine
Doctor of Podiatric Medicine
Doctor of Optometry
Chiropractor
Eligible Professionals (EPs)
Physicians (Pediatricians have
special eligibility & payment rules)
Nurse Practitioners (NPs)
Eligible Hospitals
Acute Care Hospitals
Critical Access Hospitals (CAHs)
Eligible Hospitals
Acute Care Hospitals
Children’s Hospitals
Certified Nurse-Midwives (CNMs)
Dentists
Physician Assistants (PAs) who
practice in a Federally Qualified
Health Center (FQHC) or rural
health clinic (RHC) that is led by a
PA
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No Changes
from Stage 1
Meaningful
Use
Stage 2 Meaningful Use Overview
Stage 2 Meaningful Use (S2MU) Final Rule
was published on August 23, 2012.
Beginning in 2014, providers participating in
the EHR Incentive Programs who have met
Stage 1 for 2 or 3 years will need to meet
S2MU criteria.
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What is in the Rule
•
•
•
•
•
Changes to Stage 1 of Meaningful Use
Stage 2 of Meaningful Use
New clinical quality measures (CQMs)
New CQM reporting mechanisms
Medicaid program changes
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S2MU Change in Total Objectives
Required
Stage 1 MU – Eligible Professionals
Stage 2 MU – Eligible Providers
15 core objectives
17 core objectives
5 of 10 menu objectives
3 of 6 menu objectives
20 total objectives
20 total objectives
Stage 1 MU – Eligible Hospitals &
CAHs
Stage 2 MU – Eligible Hospitals &
CAHs
14 core objectives
16 core objectives
5 of 10 menu objectives
3 of 6 menu objectives
19 total objectives
19 total objectives
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20
How to Get to S2MU
17 Core
Objectives
3 of 6 Menu
Objectives
9 Clinical
Quality
Measures
Meaningful Use
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Key Changes to Stage 1 Meaningful
Use
Menu Objective Exclusion– While you can
continue to claim exclusions if applicable for menu
objectives, starting in 2014 these exclusions will no
longer count towards the number of menu objectives
needed.
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Medicaid Eligibility Changes
The definition of what constitutes a Medicaid patient
encounter has changed.
A Medicaid encounter now includes anyone enrolled in a
Medicaid program, including:
• Medicaid expansion encounters (excluding stand alone Title
21)
• Zero-pay claims
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23
Medicaid Eligibility Changes
States have the option to allow providers to calculate
Medicaid patient volume across 90-day period in last
12 months preceding a provider’s attestation.
This also applies to needy patient volume and patient
panel methodology with at least one Medicaid
encounter taking place in the 24 months prior to the
90-day period.
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2014 Changes
EHRs Meeting ONC 2014 Standards – starting
in 2014, all EHR Incentive Programs participants
will have to adopt certified EHR technology that
meets ONC’s Standards & Certification Criteria
2014 Final Rule
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2014 Changes
Reporting Period Reduced to Three Months – to allow
providers time to adopt 2014 certified EHR technology
and prepare for Stage 2, all participants will have a threemonth reporting period in 2014.
All providers regardless of their stage of meaningful
use are only required to demonstrate meaningful use
for a three-month EHR reporting period.
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2014 Changes
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).
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2014 Changes
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. CMS is permitting this onetime three-month reporting period in 2014 only so that
all providers who must upgrade to 2014 Certified EHR
Technology will have adequate time to implement their
new Certified EHR systems.
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Stage 2: Batch Reporting
Stage 2 MU rules allows for batch reporting:
Starting in 2014, groups will be allowed to submit
attestation information for all of their individual EPs
in one file for upload to the Attestation System, rather
than having each EP individually enter data.
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How do CQMs relate to the CMS
Incentive Programs?
Although reporting CQMs is no longer a core objective
of the EHR Incentive Programs, all providers are
required to report on CQMs in order to demonstrate
Meaningful Use.
In 2014 and beyond, reporting programs (i.e., PQRS,
eRx reporting) will be streamlined in order to reduce
provider burden.
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Reporting CQMs in 2014 and Beyond
Beginning in 2014, all Medicare-eligible providers in their
second year and beyond of demonstrating meaningful
use must electronically report their CQM data to CMS.
Medicaid providers will electronically report their CQM
data to their state.
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Clinical Quality Measures
Provider
Prior to 2014
Complete 6 out of 44:
EPs
3 core or 3 alt. core
+
3 menu
Eligible Hospitals
Complete 15 out of 15
and CAHs
2014 and Beyond*
Complete 9 out of 64
Choose at least 1 measure in 3 NQS
domains
Recommended core CQMs include:
9 CQMs for the adult population
9 CQMs for the pediatric population
Prioritize NQS domains
Complete 16 out of 29
Choose at least 1 measure in 3 NQS
domains
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Deep Dive: S2MU Core Measures
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33
Stage 2 MU EP Core Objectives
Core
Objective
Measure
1. CPOE
Use CPOE for more than 60% of medication, 30% of laboratory, and 30%
of radiology
2. E-Rx
E-Rx for more than 50%
3. Demographics
Record demographics for more than 80%
4. Vital Signs
Record vital signs for more than 80%
5. Smoking Status Record smoking status for more than 80%
6. Interventions
Implement 5 clinical decision support interventions + drug/drug and
drug/allergy
7. Labs
Incorporate lab results for more than 55%
8. Patient List
Generate patient list by specific condition
9. Preventive
Reminders
Use EHR to identify and provide reminders for preventive/follow-up care
for more than 10% of patients with two or more office visits in the last 2
years
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Stage 2 MU EP Core Objectives
Core Objective
Measure
10. Patient Access
Provide online access to health information for more than 50% with
more than 5% actually accessing
11. Visit Summaries
Provide office visit summaries for more than 50% of office visits
12. Education
Resources
Use EHR to identify and provide education resources more than 10%
13. Secure Messages
More than 5% of patients send secure messages to their EP
14. Rx Reconciliation
Medication reconciliation at more than 50% of transitions of care
15. Summary of Care
Provide summary of care document for more than 50% of
transitions of care and referrals with 10% sent electronically and at
least one sent to a recipient with a different EHR vendor or
successfully testing with CMS test EHR
16. Immunizations
Successful ongoing transmission of immunization data
17. Security Analysis
Conduct or review security analysis and incorporate in risk management
process
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EP Core Requirements
Objective
Use of
computerized
provider order
entry
Stage 1 MU
Stage 2 MU
More than 30% of
unique patients
with at least one
medication in their
medication list seen
by the EP have at
least one
medication order
entered using
CPOE.
More than 60% of
medication, 30% of
laboratory and 30% of
radiology orders
created by the EP
during the reporting
period are recorded
using CPOE.
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Summary of
Change
Revised
Threshold
Revised
Requirement
36
EP Core Requirements
Objective
Generate
and transmit
permissible
prescriptions
electronically
(eRx)
Stage 1 MU
Stage 2 MU
More than 40% of
all prescriptions
written are
transmitted
electronically
using certified
EHR technology
(CEHRT).
More than 50%
of all
permissible
prescriptions or
all prescriptions
written by the
EP and queried
for a drug
formulary and
transmitted
electronically
using CEHRT.
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Summary of
Change
Increased
Threshold
Revised
Requirement
37
EP Core Requirements
Objective
Record the
following
demographic
s:
•
•
•
•
•
Preferred
language
Gender
Race
Enthnicity
Date of
birth
Stage 1 MU
Stage 2 MU
More than 50% of
all unique patients
seen by the EP
have
demographics
recorded as
structured data.
More than 80%
of all unique
patients seen by
the EP during
the EHR
reporting period
have
demographics
recorded as
structured data.
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Summary of
Change
Increased
Threshold
38
EP Core Requirements
Objective
Stage 1 MU
Stage 2 MU
More than 50% of
all unique patients’
age 2 and over
seen by the EP
height, weight and
blood pressure are
recorded as
structured data.
More than 80% of
all unique patients
seen by the EP
during the EHR
reporting period
have blood
pressure (for
patients age 3 and
over only) and
height/length and
weight (for all ages)
recorded as
structured data.
Record and chart
changes in the
following vital
signs:
•
•
•
•
Height/length
and weight
Blood pressure
Calculate and
display BMI
Plot and
display growth
charts for
patients 0-20
years (incl.
BMI)
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Summary of
Change
Increased
Threshold
Revised
Requirement
39
EP Core Requirements
Objective
Stage 1 MU
Stage 2 MU
Record smoking
status for patients
13 years old or
older
More than 50% of
all unique patients
13 years old or
older seen by the
EP have smoking
status recorded as
structured data.
More than 80% of
all unique patients
13 years old or
older seen by the
EP have smoking
status recorded as
structured data.
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Summary of
Change
Increased
Threshold
40
EP Core Requirements
Objective
Use clinical
decision
support to
improve
performance
on high
priority health
conditions
Stage 1 MU
Implement one
clinical decision
support rule
relevant to
specialty or high
clinical priority
along with the
ability to track
compliance with
that rule.
Stage 2 MU
Implement five clinical
decision support
interventions related to
four or more clinical
quality measures at a
relevant point in patient
care for the entire EHR
reporting period.
The EP has enabled and
implemented the
functionality for drug-drug
and drug-allergy
interaction checks for the
entire EHR reporting
period.
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Summary of
Change
Revised
Requirement
Increased
Threshold
41
EP Core Requirements
Objective
Incorporate
clinical labtest results
into CEHRT
as structured
data
Stage 1 MU
More than 40% of
all clinical lab tests
results ordered by
the EP during the
EHR reporting
period whose
results are either in
a positive/negative
or numerical format
are incorporated in
certified EHR
technology as
structured data.
Stage 2 MU
More than 55% of all
clinical lab tests ordered
by the EP during the EHR
reporting period whose
results are either in a
positive/negative or
numerical format are
incorporated in a CEHRT
as structured data.
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Summary of
Change
Menu to Core
Increased
Threshold
42
EP Core Requirements
Objective
Generate lists
of patients by
specific
conditions to
use for quality
improvement,
reduction of
disparities,
research or
outreach
Stage 1 MU
Stage 2 MU
Generate at least
one report listing
patients of the EP
with a specific
condition.
Generate at least one
report listing patients of
the EP with a specific
condition.
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Summary of
Change
Menu to Core
43
EP Core Requirements
Objective
Use clinically
relevant
information to
identify patients
who should
receive reminders
for
preventive/followup care and send
these patients the
reminder, per
patient preference
Stage 1 MU
Stage 2 MU
More than 20%
of all unique
More than 10% of all
patients 65
unique patients who have
years or older
had two or more office
or 5 years old
visits with the EP within
or younger
the 24 months before the
were sent an
beginning of the EHR
appropriate
reporting period were
reminder
sent a reminder, per
during the EHR
patient preference when
reporting
available.
period.
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Summary of
Change
Menu to Core
Decreased
Threshold
44
EP Core Requirements
Objective
Provide patients
the ability to view
online, download
and transmit their
health information
within 4 business
days of the
information being
available to the
EP
Stage 1 MU
More than 10% of
all unique
patients seen by
the EP are
provided timely
electronic access
to their health
information.
Stage 2 MU
More than 50% of all unique
patients seen by the EP are
provided timely electronic
access to their health
information.
More than 5% of all unique
patients seen by the EP
during the EHR reporting
period (or their authorized
representatives) view,
download or transmit to a
third party their health
information.
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Summary of
Change
Menu to Core
Revised
Requirement
45
EP Core Requirements
Objective
Provide clinical
summaries for
patients for each
office visit
Stage 1 MU
Clinical
summaries
provided to
patients for
more than 50%
of all office
visits within 3
business days.
Stage 2 MU
Summary of
Change
Clinical summaries
provided to patients within
1 business day for more
than 50% of office visits.
Revised
Requirement
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EP Core Requirements
Objective
Use CEHRT to
identify patientspecific education
resources and
provide those
resources to the
patient
Stage 1 MU
More than 10% of
all unique patients
seen by the EP
during the EHR
reporting period
are provided
patient-specific
education
resources.
Stage 2 MU
Summary of
Change
Patient-specific
education resources
identified by CEHRT are
provided to patients for
more than 10% of all
office visits by the EP.
Menu to Core
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Revised
Requirement
47
EP Core Requirements
Objective
Use secure
electronic
messaging to
communicate with
patients on relevant
health information
Stage 1 MU
N/A
Stage 2 MU
A secure message was
sent using the electronic
messaging function of
CEHRT by more than 5%
of unique patients seen by
the EP during the EHR
reporting period.
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Summary of
Change
New
Requirement
48
EP Core Requirements
Objective
Stage 1 MU
Stage 2 MU
The EP who
receives a patient
from another
setting of care or
provider of care or
believes an
encounter is
relevant should
perform medication
reconciliation
The EP performs
medication
reconciliation for
more than 50% of
transitions of care
in which the
patient is
transitioned into
the care of the
EP.
The EP performs
medication reconciliation
for more than 65% of
transitions of care in
which the patient is
transitioned into the care
of the EP.
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Summary of
Change
Increased
Threshold
Menu to Core
49
EP Core Requirements
Objective
The EP who
transitions their
patient to another
setting of care or
provider of care or
refers their patient
to another provider
of care provides a
summary care
record for each
transition of care
or referral
Stage 1 MU
The EP who
transitions their
patient to another
setting of care or
provider of care
provides a
summary of care
record for more
than 50% of
transitions of care
and referrals.
Stage 2 MU
The EP who transitions their
patient to another setting of care
or provider of care provides a
summary of care record for
more than 50% of transitions of
care and referrals.
10% of such transitions or
referrals are electronically
transmitted.
Summary of
Change
Menu to Core
Revised
Requirement
One or more successful
exchanges of a summary of
care document with a recipient
on a different EHR technology.
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50
EP Core Requirements
Objective
Capability to
submit electronic
data to
immunization
registries or
immunization
information
systems except
where prohibited,
and in
accordance with
applicable law
and practice
Stage 1 MU
Performed at least one
test of certified EHR
technology’s capacity to
submit electronic data
to immunization
registries and follow up
submission if the test is
successful (unless the
immunization registries
do not have the
capacity to receive the
information
electronically).
Stage 2 MU
Successful ongoing
submission of
electronic
immunization data
from CEHRT to an
immunization registry
or immunization
information system for
the entire EHR
reporting period.
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Summary of
Change
Revised
Requirement
Menu to Core
51
EP Core Requirements
Objective
Stage 1 MU
Stage 2 MU
Protect
electronic
health
information
created or
maintained
by the
CEHRT
through the
implementati
on of
appropriate
technical
capabilities
Conduct or review
a security risk
analysis per 45
CFR 164.308
(a)(1) and
implement security
updates as
necessary and
correct identified
security
deficiencies as
part of its risk
management.
Conduct or review a security risk
analysis in accordance with the
requirements under 45 CFR
164.308(a)(1), including
addressing the encryption/security
of data stored in CEHRT in
accordance with requirements
under 45 CFR 164.312 (a)(2)(iv)
and 45 CFR 164.306(d)(3), and
implement security updates as
necessary and correct identified
security deficiencies as part of the
provider’s risk management
process.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
Revised
Requirement
52
Stage 2 MU EP Menu Objectives
Menu Objective
Measure
1. Imaging Results
More than 20% of imaging results are accessible through
Certified EHR Technology
2. Family History
Record family health history for more than 20% of unique
patients
3. Syndromic
Surveillance
Successful ongoing transmission of syndromic surveillance data
4. Cancer
Successful ongoing transmission of cancer case information
5. Specialized
Registry
Successful ongoing transmission of data to a specialized
registry
6. Progress Notes
Enter an electronic progress note for more than 30% of unique
patients
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Q&A Session
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
54
Additional MU Information
Tri-State Regional Extension Center
www.tristaterec.org/S2MU
CMS EHR Incentive Program Home Page
http://www.cms.gov/EHRIncentivePrograms/
Office of National Coordinator for Health IT
http://healthit.gov/
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
55