American Academy of Pediatrics
Ohio Section
Cathy Costello, JD
OHIP
Manager, REC Services
May 13, 2011
3/16/2016
1
Who is the Ohio Health
Information Partnership?
3/16/2016
2
The Ohio Health Information Partnership
 Nonprofit partnership
 State-designated Regional Extension Center and
Health Information Exchange
 Federal funding through Office of National Coordinator
of HIT, Department of Health & Human Services
 Board members have vested interest in its success
3/16/2016
3
OHIP’s Founders
3/16/2016
4
How can we help achieve the
State’s health transformation
objectives?
3/16/2016
5
Addressing the Hot Spots
• Regional Extension Center
Services
– Helps providers adopt EHRs
and achieve meaningful use
– Available at no cost to
pediatricians regardless of
physician’s eligibility for
Medicaid incentives
• Health Information Exchange
– Connects providers so they
can electronically exchange
data to better coordinate care
3/16/2016
6
Regional Extension Center Services
Care Summaries
3/16/2016
e-Prescribing
7
Regional Extension Center Physician
Sign-ups
Over 60,000 physicians have signed up
nationally to receive REC services
3/16/2016
8
Preferred EHR Vendors
3/16/2016
9
ProOhio Vendor Program
IT Support
Document Imaging
Human Resources
Billing & Coding
Security Controls
Change
Management
Data Management
3/16/2016
10
Loan Program
3/16/2016
11
HEALTH INFORMATION EXCHANGE
3/16/2016
12
What is a
Health Information Exchange?
An HIE moves patient
information electronically
among physician offices,
hospitals and other
health professionals
directly involved in a
patient’s care, such as
pharmacies and labs.
3/16/2016
13
What is OHIP’s Vision?
Create a secure, sustainable Health Information Exchange
To protect ALL patient records;
Enable providers to access necessary, patientauthorized health information; and
Improve the overall level of health care provided
throughout the state of Ohio.
3/16/2016
14
Phasing of HIE Services
• 20 Hospitals
• 200 Offices
• 20 Hospitals
• 200 Offices
• 10 Hospitals
• 100 Offices
3/16/2016
15
Confidential, For Internal Discussion Only
Community Model
Prioritize coordination of care;
Everyone pays a little;
No one pays a lot; and
Everyone helps enroll/implement physicians.
3/16/2016
16
More Information on REC Services
and HIE Development
www.OHIPonline.org
3/16/2016
17
Priorities for Meaningful Use
Structured Lab
Results
3/16/2016
Care Summaries
e-Prescribing
18
Medicaid
Adopt
Implement
Upgrade
3/16/2016
19
Notable Differences Between the
Medicare & Medicaid Incentives
20
Medicare
Medicaid
Reimbursement for eligible
professionals
Based on Medicare Part B allowed
charges
Based on patient mix (EHR cost
assumed)
Types of eligible
professionals
Physicians, dentists, podiatrists,
optometrists, chiropractor
Physicians, dentists, nurse midwife,
nurse practitioner and some PAs
First payment year
Demonstrate meaningful use over
a continuous 90 days in the
calendar year
Can be for adopt, implement or
upgrade only
Subsequent payment years
Must be consecutive
Needn’t be consecutive for EPs
Payments
No payments for years after 2016
Payments can start as late as 2016
and no payments after 2021
Penalties if not a MUser
Yes
No
Consistent across nation
Yes
States choose to implement
Medicaid: 1st Payment Year For “Adopt,
Implement, Upgrade”
 Eligible professionals can receive incentives for adoption,
implementation and upgrade of certified EHR technology in their
first year of participation
 “Adopt, implement, or upgrade” means:
– Install or commence utilization of certified EHR technology
capable of meeting meaningful use requirements; or
– Expand the functionality of certified EHR technology capable of
meeting meaningful use requirements at the practice site,
including staffing, maintenance, and training.
– Upgrade from existing EHR technology to certified EHR
technology per the ONC EHR certification criteria.
21
Medicaid: 1st Payment Year For “Adopt,
Implement, Upgrade”
 All eligible Medicaid providers will be “deemed” to have met the
cost-base of the Medicaid EHR incentives—need only to
demonstrate that the EHR system is CMS certified under the ATCB
certification program.
 A practitioner can demonstrate that an EHR system is certified and
the practitioner has Adopted/Implemented/Upgraded the system
by uploading a copy of a: 1) Purchase order; 2) Contract; or 3) EHR
software license to the Medicaid incentive program website during
registration for the incentives.
3/16/2016
22
Medicaid Eligible Professional Incentive
 The Medicaid EHR incentive program reimbursement for eligible
professionals is paid out over a six-year period. Professionals that
meet Medicaid eligibility criteria will be paid the maximum
incentive regardless of the cost of the certified EHR system that the
professional is using.
 Pediatricians that meet the Medicaid 20% patient volume threshold
will be paid $14,160 for the first year with a total EHR incentive of
$42,500. Pediatricians that meet the Medicaid 30% patient volume
threshold will be paid $21,250 for the first year with a total EHR
incentive of $63,750.
 Pediatricians that fall between 20% and 30% Medicaid patient
volume will be paid at the 20% threshold (i.e., $14,160 for the first
year with a total incentive of $42,500).
3/16/2016
23
Meaningful Use Timeline
Medicaid Incentives
First Registration for the
Incentive Program:
Medicaid: June 2011
Demonstrate Eligibility: 20% Medicaid
Patient Volume—Pediatricians
30% Medicaid Patient Volume—All Other
Eligible Professionals
Adopt, Implement or Use
a Certified EHR System
July 2011
First Payments Issued for
Medicaid EHR Incentives:
Maximum 1st Year: $21,250 per
Physician or Eligible Professional that
Qualifies;
No cost-based Reimbursement
3/16/2016
24
What is MPIP?
Ohio’s EHR program is the Medicaid Provider Incentive Program
(MPIP)
– Who is eligible?
Eligible Hospitals: (acute care, cancer, children’s)
Eligible Professionals: (physician, dentist, certified nurse
midwives, nurse practitioners, Physician Assistants when
practicing at an FQHC/RHC so led by a PA)
– The MPIP will be available through CY 2021, but participation in
the program is for 6 years, which can be non-consecutive years.
25
Notes on Medicaid Incentive Program
 Pediatricians (including subspecialists) that meet the eligibility
requirements in Ohio will be eligible for Medicaid incentives at the
20% patient volume level. Must have pediatric board certification.
All other physicians eligible at the Medicaid 30% patient volume
level.
 Patient volume will be calculated based on the Medicaid services
rendered on any one day to an individual where Medicaid paid for
part or all of the service.
3/16/2016
26
Notes on Medicaid Incentive Program
 Medicaid eligibility will be determined by a practitioner’s Medicaid
patient volume over a 90 day period in the preceding calendar
year. The practice can choose the 90 day period for eligibility, but it
must be for 3 consecutive months (e.g., January 1 – March 31, 2010
Medicaid patient volume to draw down 2011 EHR incentives).
 Medicaid will use an online attestation form that automatically
calculates the eligibility based on patient volume totals entered by
practitioner. There will be a slight adjustment to totals based on
SCHIP population figures in the provider’s county.
3/16/2016
27
MPIP will be open in June 2011
– In March, first milestone of the MPIP system build was the
completion of testing of the interface between the federal
system (the National Level Repository) and MPIP.
– In April, Ohio’s State Medicaid Health Information Technology
Plan (SMHP) was approved by CMS.
– In May, ODJFS will be putting the finishing touches on the
customized build of the MPIP system:
Ohio now appears in the state drop down box on CMS’
website, allowing Ohio providers to begin registration for
Ohio’s program.
In June, the launch of MPIP will occur, allowing providers to
complete enrollment at Ohio’s MPIP site and upon approval,
be eligible to receive their 1st payment.
28
What is needed to register federally
for either Medicare or Medicaid?
 Confirmed National Provider Identifier and NPPES account and
password
https://nppes.cms.hhs.gov/NPPES/
 CMS/National Level Repository registration
www.cms.gov/EHRIncentivePrograms/
 PECOS (for dual hospitals)
29
National Provider Identifier
30
CMS Registration
31
What is needed to enroll in MPIP?
Once finished at the national registration website, providers will be
sent to the Ohio site to begin MPIP enrollment. They will need:
• An active Medicaid provider agreement.
– Providers without one will be directed to:
http://jfs.ohio.gov/OHP/provider.stm
• MPIP uses only Electronic Funds Transfer (EFT). So providers
who get paper warrants will have to go to Ohio Shared
Services to sign up for EFT.
32
First-time User Registration
First-time users will
receive a link to begin
Registration
33
First-time User Registration
Enter NPI, TIN, CMS Confirmation Number
Enter the NPI, TIN and
CMS Confirmation
Number and click
Register
34
First-time User Registration
Establish Password
Enter CMS Confirmation
Number. Enter and confirm
Password. Click Save to
Continue.
35
Welcome Page
After logging into
MPIP the first
time, the user will
see the Welcome
page
Press Continue to
proceed with the MPIP
enrollment process
36
Adopt, Implement, Upgrade
(AIU)
Select AIU
Designation
Select Supporting
Documentation and
Upload
Enter the CMS EHR
Certification Number
Upload AIU
Documents
37
MPIP Registration
38
Stay in touch with Medicaid
 Visit the ODJFS MPIP Website at:
http://jfs.ohio.gov/OHP/HIT%20Program.stm
 Send an email at MPIP@jfs.ohio.gov
39
Why Is This Work Important?
MOVING TO
MEANINGFUL USE
3/16/2016
40
Meaningful Use Timeline
Medicare Incentives
First Registration for the
Incentive Program:
Medicare: January 2011
90 Days Meaningful Use
April 18 2011
First Day of Attestation
For Meaningful Use
May 2011 First
Payments Issued for
Medicare EHR Incentives
Maximum 1st Year: $18,000 per
Physician or Eligible Professional
3/16/2016
41
Meaningful Use Tips
 Use Meaningful Use Attestation Calculator before going to
actually register: http://www.cms.gov/apps/ehr/
 Print out calculator’s summary page to see how close you are
to meeting meaningful use
 Use the calculator as a guide for explaining the MU core and
menu items and the exclusions
3/16/2016
42
Core and Menu Criteria
• Professionals must complete each of the core criteria unless
unable to, due to scope of practice, population served or
number in the denominator. For example:
– Chiropractor and e-prescribing
– CAH and no patients have requested electronic access
• Professionals may defer up to 5 of the menu criteria until
stage 2
43
Core Criteria (15):
All Patients:
• Record demographics
• Maintain an up-to-date problem list
• Maintain active medication list
• Maintain active medication allergy list
EHR Patients:
• CPOE
• E-Prescribing
• Record and chart changes in vital signs
• Record smoking status
• Provide patients with an electronic copy of their health information
• Provide clinical summaries for patients for each office visit
Implemented (Yes or No):
• Report Clinical Quality Measures
• Drug (D-A, D-D) Interactions
• Implement one clinical decision support rule
• Electronically exchange key clinical information
• Protect electronic health information created or maintained by certified EHR
44
Menu Criteria
• Professionals and hospitals may defer up to 5 of the
menu criteria until stage 2
• At least one of the criteria from population and public
health must be included in order to qualify as a
meaningful user
45
Menu Criteria (5 of 10):
All Patients:
• Provide patients timely electronic access to their health information.
• Provide patient-specific education resources through the use of certified EHR technology.
EHR Patients:
• Lab test results are stored as structured data
• Send appropriate reminders for preventive/follow up care
• Perform medication reconciliation on > 50% of transitions of care or relevant encounters.
• Provide a summary of care record for transitions of care and referrals.
Implemented (Yes or No):
• Implement drug -formulary checks
• Generate at least one report of patients by specific condition
• Perform at least one test of submission of electronic data to immunization registries/systems. *
• Perform at least one test of providing electronic syndromic surveillance data to public health
agencies. *
* At least 1 public health objective must be selected
46
Reporting of Clinical Quality Measures
• EPs would be required to provide clinical data on 2 measure groups:
– A core set of 3 measures (or alternates) (3 of 6)
– 3 additional measures selected from among 38 others (3 of 38)
• EHR must be certified for these measures (ONC ‘CHPL’ website for
confirmation)
http://onc-chpl.force.com/ehrcert
47
Core Quality Measures for EPs
Measure Number
Clinical Quality Measure Title
NQF 0013
Blood pressure
measurement
Percentage of patient visits for patients
aged 18 years and older with a diagnosis of hypertension who
have been seen for at least 2 office visits, with blood pressure
(BP) recorded.
NQF 0028
1. Percentage of patients aged 18 years and older who have
Tobacco use assessment and
been seen for at least 2 office visits who were queried
intervention
about tobacco use one or more times within 24 months
2. Percentage of patients aged 18 years and older identified
as tobacco users within the past 24 months and have
been seen for at least 2 office visits, who received
cessation intervention.
NQF 0421
PQRI 128
Adult Weight Screening and
Follow-up
48
1. Percentage of patients aged 18 years and older with a
calculated BMI in the past six months or during the
current visit documented in the medical record AND
2. if the most recent BMI is outside parameters, a follow-up
plan is documented.
Alternate Core Quality Measures for EPs
49
Measure Number
Clinical Quality Measure Title
NQF 0024
Weight Assessment and
Counseling for Children and
Adolescents
Percentage of patients 2 -17 years of age who had an
outpatient visit with a Primary Care Physician (PCP) or
OB/GYN and who had evidence of BMI percentile
documentation, counseling for nutrition and counseling for
physical activity during the measurement year.
NQF 0041, PQRI 110
Influenza Immunization for
Patients ≥ 50 Years Old
Percentage of patients aged 50 years and older who received
an influenza immunization during the flu season (September
through February).
NQF 0038
Childhood Immunization
Status
Percentage of children 2 years of age who had four
diphtheria, tetanus and acellular pertussis (DTaP); three
polio(IPV), one measles,mumps and rubella (MMR); two H
influenza type B (HiB); three hepatitis B (Hep B); one chicken
pox (VZV); four pneumococcal conjugate (PCV); two hepatitis
A (Hep A); two or three rotavirus (RV); and two influenza (flu)
vaccines by their second birthday. The measure calculates a
rate for each vaccine and nine separate combination rates.
Menu Quality Measures
• 38 other measures addressing:
– Diabetes
– Cardiovascular disease
– Prevention
– Asthma
– Appropriate use of teste
– Smoking and Tobacco use
– Alcohol and Drug dependence
– Oncology
– Depression management
– Others
50
Resources
• “Meaningful Use” information on the Health and
Human Services web site:
– http://healthit.hhs.gov/meaningfuluse/
• “Meaningful Use” on the CMS web site:
– https://www.cms.gov/EHRIncentivePrograms/
• Testing criteria for each of the EHR modules:
– http://healthcare.nist.gov/use_testing/effective_requirem
ents.html
• Quality Measure Specifications on the CMS web site:
– http://www.cms.gov/QualityMeasures/03_ElectronicSpeci
fications.asp
51
Questions?
Cathy Costello, JD
ccostello@OHIPonline.org
614.664.2607
3/16/2016
52