Meaningful Use Update Eligible Professionals December 2011 - PowerPoint PPT Presentation

Meaningful Use Update – Eligible Professionals December 2011

Discussion Topics • Welcome, HITECH Program Update • Topics for Clarification (Stage 1) – CPOE – Quality Measures – PQRI e-prescribing verses Meaningful Use e-prescribing – Clinical Decision Support – Public Health Reporting (Immunization and Syndrome Surveillance) – Security Audit – Data Exchange Requirement – Audits and Documentation suggestion • How to register, obtain vendor number, attest • Stage 2 Update and Closing 2

HITECH PROGRAM UPDATE 3

National Numbers (By Program) As of 10/31 • The Medicare EHR Incentive Program has made payments of more than $527 million ( actual MU achievement ) • Over $711 million has been paid in Medicaid EHR incentives since the program began in January ( AIU and Achievement ) • There are 138,570 active registrations of eligible professionals and eligible hospitals for the Medicare and Medicaid programs 4

National Numbers (By State) MI 5

Michigan Numbers http://www.michiganhit.org/ 6

TOPICS FOR CLARIFICATION (STAGE 1) 7

CPOE Requirements “medications directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines” • Requirement: >30% of patients • Denominator: Unique patients during the reporting period • Numerator: At least one medication entered by “licensed healthcare professional” • Rationale: Relationship to action on clinical alerts • Drug-allergy, drug-drug, drug-condition • FAQ response • Exclusion: <100 Rxs during reporting period 8

PFR & PFP MU Quality Measures, PQRP, and eRx • Similarities , differences, and cross-overs

MU and Medicare Incentives Meaningful use Core Medicare incentives Measures • Use eRx for 40% of non- • eRx narcotic Rxs • PQRP • Report on 6 Quality Measures

MU and Medicare Incentives Medicare MU $ Medicaid MU $ eRx $ No Yes PQRP $ Yes Yes

MU and other incentives Medicare MU $ Medicaid MU $ eRx $ No Yes PQRP $ Yes Yes CMS clarification: Reporting eRx codes will not impede receiving MU incentives.

eRx 1. Goal: ↑ eRx usage 2. Fax and eFax does not count 3. Only “eligible Rxs ” (not narcotics) 4. MU eRx core requirement 40% 1. numerator and denominator 2. exclusion <100 Rxs 5. eRx Incentive/Penalty 1. Registry or claims based reporting to claim incentive 2. Claims based reporting to avoid penalty

Medicare eRx Incentive or Penalty 2010 2011 2012 2013 2014 Incentive 2% 1% 1% Penalty - 1% 1.5% 2.0% • 2011 Requirement • G8553 • 25 reporting events required • Avoid 2012 Penalty Process • If >10 claims with correct G codes • First 6 months of 2011 • Penalty exemptions

eRx Recommendation A. Optimize eRx utilization ASAP B. eRx $ or MU $ in 2011 eRx Incentive/Penalty MU 1. Report >50 eRx G 1. Monitor provider % codes (G8553) in 2. > 40 % goal 2011 2. Review exemption criteria 3. Review 2012 Criteria

MU and other incentives Medicare MU $ Medicaid MU $ eRx $ No Yes PQRP $ Yes Yes

PFR Quality Measures MU PQRP Report on 6 measures Report on any 3 measures • 3 core/alternative • Claims or Registry core • 3 additional • Attestation 2011 • Web based 2012

MU Quality Measures • 3 Core or alternative Core, and 3 Additional • 38 NQF measures • 2011 Attestation – Numerator and denominator • 2012 Web based

Quality Measures Measures EP1 - PC EP2 - PC EP3 - Spec EP4 - Spec 3 Core 20/200 20/200 20/200 0/0 17/150 17/150 0/185 0/0 1/150 0/0 0/0 0/0 3 Alt 32/200 16/150 0/0 0/0 Must Have 0/0 3 Above & Menu 1 - 32/275 11 – 16/175 23 – 10/150 19 – 16/45 Below 11 - 2/250 12 - 21/225 30 – 6/100 27 – 0/50 (38) 12 - 8/250 26 - 12/200 32 – 5/125 30 – 6/40 • Must report 3 measures above the line and three below • “0” in the numerator is not the same as “0” in the denominator • Menu items limited by Measures Certified by EMR vendor 19

MU Core and Alternative Quality Measures Core • NQF 0013 BP measurement in hypertensives • NQF 0028 Tobacco assessment and cessation • NQF 0421 Adult weight and follow up Alternative Core • NQF 0024 Pediatric weight and follow up • NQF 0041 Flu vacc > 50 years old • NQF 0038 Pediatric immunization status

MU Additional Quality Measures • 38 Additional Measures • Limited number of specialty specific measures • Need to report on 3

Stage 1 Menu Quality Measures Detailed list provided on CD

PQRP 2011 • Most are also NQF measures – Some identical to MU CQM • Claims based reporting – >80% eligible encounters for 3 measures • Registry based reporting – Report on three measures • No quality threshold • 1% 2011 Medicare MAC

Quality Measures Recommendations A. Identify measures for your practice B. PQRP $ and/or MU $ in 2011 MU PQRP Incentive/Penalty 1. Identify 3 1. Identify >3 measures core/alternative core 2. Choose claims or 2. Identify =>3 registry method additional – Find a registry ! 3. Practice measurements

Clinical Decision Support Requirement “Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance to that rule” • Must enable and configure Decision Support engine within the certified EMR • Select a standard rule or define/configure a custom rule (appropriate for your practice) • Demonstrate ability to track compliance – How many times was the rule triggered? – If possible, what action was taken or not taken • Examples – Next Slide 25

Rule Examples 1. For diabetic patients, an alert which allows the physician to order a hemoglobin A1c test if there is no hemoglobin A1c result in the past six months 2. For a patient with a history of ischemic vascular disease without contraindications for aspirin use, and who does not have aspirin on his medication list, an alert which asks the provider if the patient is currently taking aspirin and if not, allows the provider to order it 3. For women age 40-69 with no mammogram in the past year, an alert and/or an order set to facilitate ordering of this diagnostic study 4. For patients 18 and older – alert if have NOT received smoking cessation counseling 26

Public Health Reporting Requirements EPs must include 1 Public Health Reporting Objective in the chosen Menu Items Submission to Immunization Registries - Capability to • submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice. Submission of Syndromic Surveillance Data - Capability to • submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice. 27

Immunization Registry Perform 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 • Michigan Care Improvement Registry (MCIR) is the approach most MI EHs and EPs are using for Public Health Reporting • MDCH has determined MCIR has the capacity to receive immunization data in accordance with the established meaningful use vocabulary and content exchange standards. Therefore, all eligible professions and hospitals administering immunizations in Michigan do not qualify for exclusion • The old EXT MCIR Transfer format is not eligible for the MU incentive • The Michigan Department of Community Health (MDCH) has developed a testing process • Testing to certify for meaningful use will be conducted in a test environment using the version 2.5 or 2.3.1 HL7 VXU message – The Medicare program is already active; A Medicaid program is schedule to begin in Jan. 2012 – Get more information at http://mcir.org/meaningfuluse.html 28

Syndromic Surveillance Data Performed at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP submits such information have the capacity to receive the information electronically.) • More complicated and advanced public health requirement • "the systematic process of data collection and analysis for the purposes of detecting and characterizing outbreaks of disease in humans and animals in a timely manner" • The CDC contracted with International Society for Disease Surveillance (ISDS) to develop business and infrastructure requirements for syndromic surveillance using clinical data from health information exchanges • The “PHIN Messaging Guide for Syndromic Surveillance: Emergency Department and Urgent Care Data Version 1.0” (HL7 v2.5.1 (v2.3.1 Compatible)) was released on 10/18/11 and includes minimum syndromic surveillance data standards • This standards are intended to help local, state, and federal public health agencies get information to detect and respond to more outbreaks and health events more quickly 29