Meaningful Use – Eligible Professional Physician Office Breakfast April 13, 2011 Briggs Pille, HIMformatics Joe Cook, DO, Munson Family Practice Randi Terry, IS Director and Meaningful Use Coordinator for MHC
Agenda • Brief Meaningful Use Update and General Review - Briggs Pille • ePrescribing and Meaningful Use – Joseph Cook, DO • Medicaid Eligibility (how do you qualify, what insurance is listed under Medicaid, when will Michigan start paying) – Randi Terry • Registration and Certification - Dr. Cook and Randi Terry • Security Risk Analysis - Dr. Cook and Randi Terry • Interconnectivity and Munson‟s role Briggs Pille and Randi Terry • If you have an EMR, how do you look (a look at 4 Munson Hosted practices) – Briggs Pille • Quality Measures – Briggs Pille • Clinical Rules – Briggs Pille and Crystal Larson • Portal requirement – Briggs Pille – there is a notion out there that Portals are REQUIRED (you need to address this and what the regulations actually say). • MCEITA Update - Randi Terry, Lori Kissau, Kelly Bator • Stage 2 and 3 – Briggs Pille
Brief Meaningful Use Update and General Review Briggs Pille
Intent of the HITECH program The program emphasizes the meaningful use of an EHR to… 1. Improve quality, safety, efficiency, and reduce health disparities 2. Engage patients and families 3. Improve care coordination 4. Ensure adequate privacy and security protections for personal health information 5. Improve population and public health Oh yeah, reduce the cost of our healthcare system 4
Medicare Incentives for EPs • Maximum incentive amount is $44,000 over 5 years • Must begin participation by 2012 to receive maximum incentive • Incentives based on 75% of Medicare-Allowed Charges for that year • Starting in 2015 – Penalties (reduction in Medicare reimbursements) for EPs not demonstrating Meaningful Use 5
Medicaid Incentives for EPs • EPs may receive payments up to $63,750 over six years • Incentive based on up to 85% of state-calculated global average costs for EHR • Start no later than 2016 • Achievement of MU not required in first year • No payments made after 2021 • No Medicaid penalty for failure to demonstrate Meaningful Use
Maximum Incentives - EP 7
Incentive Program Progress • Over 60,000 Providers have enrolled with ONC REC (Regional Extension Centers - MCEITA in Michigan) programs nationwide • Over 45,000 Providers have requested Registration help from RECs (It‟s not simple) • Over 21,000 Providers have Registered for EHR incentive programs • MU Attestation capability will be available on April 28 th (90 days since the program began on 1/1/11) • CMS has paid more than $37.5M in EHR incentives in Jan/Feb. This was Medicaid AIU • Only $2.7M has been paid out to EP (Providers)
ePrescribing and Meaningful Use Joe Cook, DO
eRx Issues and Questions 1. Medicare eRx incentive/penalty process vs 2. MU eRx requirement
MU eRX Requirement • 40% of all Rxs • Narcotic Rxs excluded • eRx not e-fax • Exclusion • <100 Rx during reporting period
Medicare eRx Incentive or Penalty • 2011 Requirement 2010 2011 2012 2013 • G8553 • 25 reporting events Incentive 2% 1% 1% required • Avoid 2012 Penalty Process Penalty - 1% 1% 1.5% • If >10 claims with correct G codes • First 6 months of 2011
Relationship of eRx Incentives Medicare MU Medicaid MU eRx No Yes CMS clarification: Reporting eRx codes will not impede receiving MU incentives.
eRx Recommendation 1. Report >25 eRx G codes (8553) in the first 6 months of 2011 2. Maximize eRx utilization ASAP
Medicaid Eligibility What qualifies as a Medicaid encounter? If you qualify for Medicaid, do it now (AIU – Adopting, 1. Implementing and Upgrading) 2. State of Michigan administers this program over the course of 6 years, no money has been issues by the state to date 3. For example: 2011 (AIU), 2012 (Skip), 2013 (Attest for Meaningful Use for 90 days, this starts your year one of the program) 4. $$ differences that you are eligible to receive ($44,000 verses $63,750 maximum) Randi Terry
Who Qualifies? Eligible Professionals Medicare Medicaid • Doctor of medicine or • Physicians osteopathy • Dentists • Doctor of dental surgery or • Certified nurse midwives dental medicine • Nurse practitioners • Doctor of podiatric medicine • Physicians assistants (in rural • Doctor of optometry health clinic or FQHC led by a • Chiropractor physician assistant) Requires minimum 30% Medicaid patient Medicare EPs may not be hospital-based mix (20% for Pediatrics)
What is included in the 30 % (20% of Pediatrics) patient mix • Asked MCEITA for further clarification, per MCEITA, the definition of Medicaid is: – For the purpose of this program, Medicaid is defined as any program administered by the state authorized under Title 19 of the Social Security Act. – This includes both fee-for-service and managed care. – It does not include any other program or programs authorized under Title 21 for the Social Security Act, including the Children's Health Insurance Program (CHIP, known as MIChild in Michigan). • Medicaid Managed Care includes the following plans: – PHP of Mid Michigan Family Care, OMNICARE, Great Lakes Health Plan, Midwest Health Plan, CareSource MI, HealthPlus Partners, Upper Peninsula Health Plan, Molina Healthcare of MI, Health Plan of MI, Total Health Care, Priority Health Govt Programs, BlueCaid, McLaren Health Plan, Procare Health Plan
ALMB Additional Low Income Medicare Beneficiary BMP Beneficiary Monitoring Program CWP Children's Home and Community Based Services Waiver SED Children's Serious Emotional Disturbance Waiver Program Children‟s Serious Emotional Disturbance SED- DHS Waiver-DHS CMH Community Mental Health ESRD End Stage Renal Disease Family Planning Waiver Plan First MA Full Fee-for-Service Medicaid HSW Habilitation Supports Waiver Program Home and Community Based Waiver Here is a list of the Title 19 MI Choice Services Hospice Hospic programs in Michigan that can e Hospice Medicare Benefit Plan Hospic be included in Medicaid portion e-18 Incarceration - Emergency Services INCAR- ESO of the eligible patient volume Incarceration - MA INCAR- MA Incarceration - MA - Emergency Services INCAR- MA-E INCAR Incarceration - Other Intermediate Care Facility for Mental ICF/MR- DD Retarded - DD MA-MC Medicaid Managed Care Medical Assistance Emergency Services MA- ESO Medical Spend-down Spendo wn NH Nursing Home PIHP Prepaid Inpatient Health Plan PACE Program All-Inclusive Care for Elderly QDWI Qualified Disabled Working Individual QMB Qualified Medicare Beneficiary - All Inclusive SLMB Special Low Income Medicare Beneficiary SPF State Psychiatric Hospital SA Substance Abuse
Registration and Attestation • Registration • Medicaid AIU Submission • Attestation Randi Terry and Joe Cook, DO
Registration • Do it NOW (even the CMS says to register now, there is no downside other than you can only change from Medicaid to Medicare) • What is needed to register: – Active NPI number and NPPES Web User Account – Tax Identifier Number (SS #) – Medicare verse Medicaid – Address, email (doesn‟t have to be yours – Latest version of Internet Explorer • Resources available – https://ehrincentives.cms.gov – Helpdesk number (MCEITA (888-MICHEHR) and CMS (888-734- 6433) • April 18 th Proxy Rights (you can attest, Meaningful Users Jan, Feb and March)
Medicaid AIU Submission • You do not have to be a meaningful use, YET to submit for AIU • Must first register at the CMS site • Sent a letter to log into the state (Michigan Department of Community Health) with your NLR Registration Number. • Must have an approved CHAMPS number • www.michiganhealthit.org/EHR • Must have encounter and discharge data
Attestation • ONCE you have achieved Meaningful Use (with 90 consecutive days in the calendar year), you can attest • Must go to CHPL List and obtain an # (Certified HIT Product List) – http://onc-chpl.force.com/ehrcert. • Must go to Ambulatory Practice Type, select vendor name (add to cart), select “Get CMS E.H.R Certification ID” • If you use one vendor for all requirements, the number will be the same for everyone, but if you certify using different modular certification, your number will be unique
Security Risk Analysis Joe Cook, DO Randi Terry
MU Security Risk Analysis Requirement • “Conduct or review a security risk analysis in accordance with 45 CFR 164.308 (a) (1) and implement security updates as necessary and correct identified security deficiencies as part of it‟s risk management process”
45 CFR 164.308 (A) (1) “Implement policies and procedures to prevent, detect, contain, and correct security violations .”
45 CFR 164.308 (a) (1) 1. Risk Analysis 2. Risk Management 3. Sanction Policy 4. Information System Activity Review
45 CFR 164.308 (a) (1) RISK ANALYSIS “Conduct an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of electronic protected health information held by the covered entity”.
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