Medicare & Medicaid
EHR Incentive Program

Meaningful Use:
Stage 1 Changes
&
Stage 2 Quality Measures
June 6, 2013
Yvonne Sanchez, MPA
Program Manager
CentrEast Regional Extension Center
Presentation Overview

EHR Incentive Program Basics

Stage 1 Changes

Stage 2 of Meaningful Use
2
Medicare and Medicaid
EHR Incentive Program Basics
3
Choosing an Incentive Program:
Medicare or Medicaid
Medicare EHR Incentive Program
Medicaid EHR Incentive Program
Run by CMS
Each state runs it’s own program
Maximum incentive amount is
Maximum incentive amount is
$44,000 (across 5 years of program $63,750 (across 6 years of program
participation)
participation)
Payment reductions begin in 2015
for providers who are eligible but
choose not to participate
No Medicaid payment reductions if you
choose not to participate
In the first year and all remaining
years, providers have clinical
measures they must achieve to get
incentive payments.
In the first year, providers can receive
an incentive payment for adopting,
implementing, or upgrading (AIU) to a
certified EHR
.
In all remaining years, providers have
MU objectives to achieve
4
EHR Incentive Programs:
Who is Eligible
Medicare Eligible Providers:
Medicaid Eligible Providers:
 Doctor of Medicine or Osteopathy
 Doctor of Dental Surgery or Dental
Medicine
 Doctor of Podiatric Medicine
 Doctor of Optometry
 Chiropractor





Physicians
Nurse Practitioners
Certified Nurse-Midwives
Dentists
Physician Assistants (PAs) working in
Federally Qualified Health Center (FQHC)
or rural health clinic (RHC) that is so led
by a PA
Eligible Hospitals :
 Acute Care Hospitals including Critical Access Hospitals
 Eligible for Medicare and Medicaid
 Children’s Hospitals
5
Qualifying for an Incentive

Medicare EHR Incentive:
o
o
o

Be a Medicare Eligible Professional (EP)
Use certified electronic health record (EHR) technology
Show that you are “meaningfully using” your EHR by meeting
thresholds for meaningful use and clinical quality measures
Medicaid EHR Incentive:
o
o
o
o
o
Be a Medicaid EP
Meet a minimum of 30% patient volume or 20% if a Pediatrician
Use certified EHR technology
Show that you are “meaningfully using” your EHR by meeting
thresholds for meaningful use and clinical quality measures
If you work at an FQHC or RHC:
o
o
30% patient volume attributable to needy individuals
Practice predominantly: over 50% of the EP’s total encounters for 6 months
in the most recent calendar year.
6
CMS EHR Incentive Program
Registration and Attestation Portal
Medicare and Medicaid Incentive participants both register with CMS
https://ehrincentives.cms.gov/hitech/login.action
7
Texas Medicaid EHR Incentive
Program Attestation Portal
Medicaid participants continue their enrollment through HHSC/TMHP
http://www.tmhp.com/Pages/HealthIT/HIT_EHR_GettingStarted.aspx
8
Meaningful Use Timeline:
Medicare EP
The amount of your payment depends on when you begin, which is 75% of your
allowed charges up to a maximum annual cap.
Medicare EHR Incentive Program
Maximum
Payment by
Start Year
2011
2012
2013
2014
2015
2016
2011
1
1
1
2
2
3
$44,000
$18,000
$12,000
$8,000
$4,000
$2,000
2012
1
1
2
2
3
$44,000
$18,000
$12,000
$8,000
$4,000
$2,000
2013
1
1
2
2
$39,000
$15,000
$12,000
$8,000
$4,000
2014
1
1
2
$24,000
$12,000
$8,000
$4,000
Annual Incentive Payment by Stage of Meaningful Use
9
Meaningful Use Timeline:
Medicaid EP
Medicaid EHR Incentive Program
Calendar
Year
First CY in Which the Eligible Provider Receives an Incentive Payment
2011
2012
2013
2014
2015
2016
2011
$21,250
2012
$8,500
$21,250
2013
$8,500
$8,500
$21,250
2014
$8,500
$8,500
$8,500
$21,250
2015
$8.500
$8.500
$8,500
$8,500
$21,250
2016
$8,500
$8,500
$8.500
$8,500
$8,500
$21,250
$8,500
$8,500
$8.500
$8,500
$8,500
$8,500
$8,500
$8.500
$8,500
$8,500
$8,500
$8.500
$8,500
$8,500
2017
2018
2019
2020
2021
Total
$8,500
$63,750
63,750
$63,750
$63,750
$63,750
$63,750
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Meaningful Use Timeline
Eligible Hospitals
Medicare Hospitals: Payment calculations are hospital specific and depend on
Medicare and Medicaid share of patients
• Hospitals are eligible for both the Medicare and Medicaid incentive
Medicare EHR Incentive Program
First Year of
Participation
2011
2012
2013
2014
Stages of Meaningful Use for Eligible Hospitals (fiscal year)
2011
2012
2013
2014
2015
2016
1
1
1
2
2
3
1
1
2
2
3
1
1
2
2
1
1
2
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Changes to Stage 1
12
Changes to Stage 1 Measures in 2013
Measure
Change
CPOE (new alternate denominator)
The new, alternate measure is based on the total number of
medication orders created during the EHR reporting period
e-Prescribing (new exclusion)
Any EP who does not have a pharmacy within their
organization and there are no pharmacies that accept
electronic prescriptions within 10 miles of the EP's practice
location at the start of his/her EHR reporting period.
Vital Signs (measure and exclusion
change)
•
•
•
An EP must get height, weight, blood pressure, and BMI
for all patients over age 3.
EP who believes blood pressure is not relevant to their
scope of practice may claim an exclusion.
EP who believes that height and weight are not relevant
to their scope of practice may claim an exclusion
Test of electronic exchange of
information
Measure no longer required.
Clinical quality measures
No longer a core objective beginning in 2014, but all
providers are required to report on CQMs in order to
demonstrate meaningful use.
13
Policy Changes to Stage 1 in 2013
Policy
Change
Expanded definition of patient
encounter
Encounters will not include any service rendered on any
one day to an individual enrolled in a Medicaid program.
This may include certain “zero pay” or denied claims.
Patient volume look-back period
In calculation of Medicaid patient volume, the EP can
choose a 90 day period in the last 12 months immediately
preceding attestation.
FQHC/RHC “Practices
Predominantly” definition
EPs can use the most recent 12 months prior to attestation
to determine his/her “practices predominantly” status.
Hospital-based EP
If EPs can demonstrate that they fund the acquisition,
implementation, and maintenance of an EHR, including
supporting hardware and interfaces needed for MU without
reimbursement from an eligible hospital, in lieu of using
the hospital’s EHR — can be determined non-hospitalbased and potentially receive an incentive payment
14
Texas-specific Policy Changes



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Limited enrollment form is only for use by FQHC and RHC
providers – all others now required to complete full
enrollment application
Physician Assistants required to complete an attestation
form
FQHC and RHC providers are required to upload their
supporting documentation for patient volume
A board-certified pediatric dentist is allowed to use the
20% patient volume as part of their eligibility
15
Meaningful Use:
Changes from Stage 1 to Stage 2
Stage 1
Stage 2
Eligible Professionals:
Eligible Professionals:
15 core objectives
5 of 10 menu objectives
20 total objectives
17 core objectives
3 of 6 menu objectives
20 total objectives
Eligible Hospitals:
Eligible Hospitals:
14 core objectives
5 of 10 menu objectives
19 total objectives
16 core objectives
3 of 6 menu objectives
19 total objectives
16
Clinical Quality Measures:
Changes from Stage 1 to Stage 2
Prior o 2014
Beginning in 2014
Eligible Professionals:
Eligible Professionals:
Report 6 out of 44 CQMs
• 3 core or alternate core
• 3 menu
Report 9 out of 64 CQMs
• Selected CQMs must cover at
least 3 of the 6 NQS domains
• Recommended core CQMs”
• 9 for adult populations
• 9 for pediatric populations
Eligible Hospitals:
Eligible Hospitals:
Report 15 out of 15 CQMs
Report 16 out of 29 CQMs
• Selected CQMs must cover at
least 3 of the 6 NQS domains
17
HHH National Quality Strategy Domains
All providers must select CQMs from at least 3 of the 6 HHS
National Quality Strategy domains:

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Patient and Family Engagement
Patient Safety
Care Coordination
Population and Public Health
Efficient Use of Healthcare Resources
Clinical Processes/Effectiveness
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Meaningful Use:
Changes from Stage 1 to Stage 2
Changes
Menu Objective Exclusion:
While you can continue to claim
exclusions if applicable for menu
objectives, starting in 20124, these
exclusions will no longer count towards
the number of menu objectives
needed
No Changes
Half of Outpatient Encounters:
At least 50% of EP outpatient
encounters must occur at locations
equipped with certified EHR
technology
Denominators based on outpatient
locations equipped with certified
EHRs and include all such
encounters or only those for patients
whose records are in the EHR
depending on the measure.
19
2014 Specific 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

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 three-month
reporting period in 2014.
20
Batch Reporting
Medicare EPs:
 Stage 2 rule allows for batch reporting of meaningful use
measures -- 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
21
Overview of Stage 2
22
Stage 2 EP Core Objectives
EPs must meet all 17 core objectives:
Core Objectives
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. Clinical decision support
Implement 5 clinical decision support interventions plus
drug/drug and drug/allergy
7. Patient Access
Provide online access to health information for more than
50% with more than 5% actually accessing
8. Clinical Summaries
Provide clinical summaries within 1 business day for more
than 50% of office visits
9. Security Risk Assessment
Conduct or review security analysis and incorporate in risk
management process
23
Stage 2 EP Core Objective
Core Objectives
Measure
10. Clinical lab test results
Incorporate lab test results into the EHR as structured data
for more than 55% of all lab orders
11. Patient List
Generate patient list by specific condition
12. Preventative 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
13. Education Resources
Use EHR to identify and provide education material for
more than 10% of encounters
14. Medication Reconciliation
Reconcile medications for 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 more than 10% sent
electronically and at least one sent to a recipient with a
different EHR vendor or successful test with CMS test EHR
16. Immunization Data
Successful ongoing transmission of immunization data
17. Secure electronic messaging
An electronic message was sent by more than 5% of
unique patients seen by the EP
24
Stage 2 EP Menu Objectives
EPs must select 3 out of the 6:
Menu Objectives
Measure
1. Syndromic Surveillance
Successful ongoing transmission of syndromic
surveillance data
2. Progress Notes
Record at least 1 electronic progress note for
more than 30% of unique patients
3. Imaging Results
More than 10% of imaging results (image and any
explanation) are accessible through EHR
4. Family History
Record health history as structured data for more
than 20% of unique patients
5. Cancer registry
Successful ongoing transmission of cancer case
information from the EHR to the cancer registry
6. Specialized Registry
Successful ongoing transmission of specific case
information from the EHR to the cancer registry
25
Stage 2 Hospital Core Objectives
EPs must meet all 16 core objectives:
Core Objectives
Measure
1. CPOE
Use CPOE for more than 60% of medication, 30% of
laboratory, and 30% of radiology
2. Demographics
Record demographics for more than 80%
3. Vital signs
Record vital signs for more than 80%
4. Smoking status
Record smoking status for more than 80%
5. Clinical decision support
Implement 5 clinical decision support interventions plus
drug/drug and drug/allergy
6. Labs
Incorporate lab results for more than 55%
7. Patient List
Generate patient list by specific condition
8. Electronic Medication
Administration Record
(eMAR)
eMAR is implemented and used for more than 10% of
medication orders for tracking dosage data.
9. Patient Access
Provide online access to health information for more than
50% with more than 5% actually accessing
26
Stage 2 Hospital Core Objectives
Core Objectives
Measure
10. Education Resources
Use EHR to identify and provide education material for
more than 10% of patients
11. Medication Reconciliation
Reconcile medications for more than 50% of transitions of
care
12. Preventative 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
13. Immunization Data
Successful ongoing transmission of immunization data
14. Labs
Successful ongoing submission of reportable laboratory
results
15. Syndromic Surveillance
Successful ongoing submission of electronic syndromic
surveillance data
16. Security Analysis
Conduct or review security analysis and incorporate in
risk management process
27
Stage 2 Hospital Menu Objectives
Eligible hospitals must select 3 out of the 6:
Menu Objectives
Measure
1. Progress Notes
Record at least 1 electronic progress note for more than
30% of unique patients
2. e-Rx
More than 10% electronic prescribing (eRx) of discharge
medication orders
3. Imaging Results
More than 10% of imaging results (image and any
explanation) are accessible through EHR
4. Family History
Record family health history as structured data for more
than 20% of unique patients
5. Advanced Directives
Record advanced directives for more than 50% of patients
65 years or older
6. Labs
Provide structured electronic lab results to EPs for more
than 20%
28
Stage 2 MU Focus

Patient Engagement:
 More than 5% of patients must send secure messages to their
EP
 More than 5% of patients must access their health information
online

Electronic Information Exchange:
 Stage 2 requires that a provider send a summary of care record
for more than 50% of transitions of care and referrals.
 Requires that a provider electronically transmit a summary of
care for more than 10% of transitions of care and referrals
 At least one summary of care document sent electronically to
recipient with different EHR vendor or to CMS test EHR
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Things to Remember about CQMs




Your certified EHR does all the work—it calculates the
measures and gives you the numbers to report to
CMS
If your EHR reports zeros on one of the core CQMs,
replace it with one from the alternate core list
There are no minimum values that you must achieve
for CQMs; you only have to report on them, not
achieve a benchmark
Chose three measures from the additional list that
are relevant to your scope of practice.
30
EHR Incentive Program References

CMS EHR Incentive Program:
www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/index.html?redir
ect=/ehrincentiveprograms/

Texas Medicaid EHR Incentive Program:
www.tmhp.com/Pages/HealthIT/
HIT_EHR.aspx
31