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A Beginner’s Guide to Meaningful Use
Stage 1 for Doctors of Optometry
2Meaningful Use and EHRs
There’s been a lot of talk about implementing EHRs and meaningful use in eyecare practices. But there is also a lot of confusion surrounding meaningful use. In fact, you might have heard good and bad things about the program. That’s why we’ve teamed up with VitalHealthSoftware to sort it all out and tell you everything you need to know about getting started.
Some concerns about meaningful use and EHRs that you’ve heard may sound like this:
Productivity is bound to drop because the entire practice has to get used to the new system, when everything works just fine as is!
I want to spend time seeing more patients, not more time entering large amounts of data!
Getting an EHR isn’t worth it! I will never be able to recover the implementation cost.
3Meaningful Use and EHRs
Despite the risks and disadvantages you may have heard, meaningful use is meant to benefit your practice and your patients.
The Meaningful Use Program was introduced in 2009 as part of the HITECH Act to promote the use of electronic health records (EHRs) in an effort to make healthcare more consistent, transparent, and allow for the measurement of quality of care.
Electronic Health Records allow healthcare providers to record patient information electronically instead of using paper records. It also allows records to be shared across care providers. But the real key to EHRs is the ability to analyze data using the processing power of computers. This is even more powerful when performed in the cloud.
Purchasing an EHR? Find out why you should choose a
cloud-based solution!
4Meaningful Use and EHRs
Early adopters of the Meaningful Use Program qualify for incentive payments. 2014 will be the last year that a doctor can register for payments. And 2015 will be the first year of payment adjustments, which means lower reimbursements to your practice for care provided to Medicare patients.
As of February 2013, $96 million has been given out to optometrists and $74 million to ophthalmologists who participated in the program.
The incentive program is a great way to offset the cost of your initial EHR investment, but beyond that, meaningful use is all about increasing patient care and efficiency. So why not embrace a change for the better?
More than 11,000 ODs have registered for the program. And *85% of doctors who have adopted an EHR reported satisfaction with the system. Now is the best time to start!
* http://www.healthit.gov/providers-professionals/healthcare-providers-and-health-information-technology-infographic
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Table of Contents
Meaningful Use At Your Practice …….. 6
Financial Incentives ……………………... 12
Stage 1 ………………………………………. 16
Attestation …………………………………. 22
Being Audited ……………………………... 26
Planning for Meaningful Use …………. 30
Resources …………………………………… 35
Meaningful Use At Your Practice • Benefits of EHRs• Eligibility • How Meaningful Use Works
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Patients expect their eyecare provider to have high-tech equipment in their practice, and they want to know that their records are safe and accurate. Show your patients that you are up-to-date. Become a thorough, more sophisticated eye care provider. You’ll be able to enhance patient care, get work done easier and faster, and make more money in the long run!
Meaningful Use At Your Practice
Before we get started, it is important to note that the Meaningful Use Program is a project that your entire practice needs to be committed to. On top of completing the stages, you need to make sure that you follow best practices even after receiving your incentive payments. It will affect every aspect of your practice, and is essentially a change management tool.
Think of it as a weight loss challenge. It’s not just about losing the weight, but also keeping it off, which means making a lifestyle change.
We understand that change can be hard, especially when it involves getting the entire practice on board. But we assure you that the benefits outweigh the risks, and it isn’t as hard as you think!
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Improve communications between various systems and provide convenience for patients visiting multiple doctors.
If you are meaningfully using an EHR at your practice, you can look forward to providing better patient care as well as experiencing the following benefits:
Benefits of EHRs
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Remember, meaningful use is not about purchasing or replacing an EHR. It’s not enough for your practice to just own a certified EHR or simply move paper records to the computer. You have to show that you are using it in ways that can positively affect the care of your patients by meeting all of the objectives established by the Center for Medicare and Medicaid Services (CMS).
Getting Started
The CMS defines the minimum functional requirements that EHRs must meet in order to demonstrate “Meaningful Use” of the technology. The CMS also oversees the providers attestation and distribution of incentives.
So you think you’re ready to take on meaningful use?
Let’s get started!
10Meaningful Use Eligibility
There are two different EHR incentive programs that you could participate in: The Medicare Incentive Program and Medicaid Incentive Program. Optometrists and ophthalmologists qualify as eligible professionals. Check your eligibility.
Most eye doctors will only be eligible for the Medicare Incentive Program, but if you are eligible for both, you must choose the plan you would like to participate in when you register. Switching from Medicare to Medicaid and vice versa is allowed only once after the first incentive payment is initiated.
We will be focusing more on the Medicare Incentive Program, but more information about the Medicaid Incentive Program can be found in the Resources page at the end of the eBook.
Program Differences Eligibility
Medicare Incentive Program
• Max incentive: $44,000• Last year to receive
incentives: 2014
Doctors of Optometry
• Ophthalmologist• Optometrist
Medicaid Incentive Program
• Max incentive: $63,750• Last year to receive
incentives: 2016
Ophthalmologist and optometrist, but only if:
• 30% or more of your patients are Medicaid patients• Your practice is in either of these states: AL, IL, KY, OH,
LA, MD, MI, NJ, SC, VA
Meaningful Use: How Does it Work?
There are 6 basic steps to how meaningful use works:
1. The government defines the program and criteria
• Medicare EHR Incentive Program: Run by CMS • Medicaid EHR Incentive Program: Run by the state’s program
2. EHR vendors implement required criteria in EHR systems
3. Third party authorized testing and certification bodies verify that EHR vendor products indeed meet the MU criteria
4. Care providers adopt a certified EHR
5. Care providers then attest to meaningful use by submitting usage reports
6. Upon successful attestation, providers receive incentive payments
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The EHR Incentive Program currently consists of 4 stages.
Each stage will have its own set of requirements to meet in order to demonstrate meaningful use. Stage 1, 2, and 3 have been fully defined.
Financial Incentives • Medicare Payment• Penalties
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Meaningful Use Financial Incentives
Do the math!• As you will see in the table on the next page, the maximum
amount you can receive in your first year is $18,000. Based on the 75% cap, you can receive:
• A maximum of $18,000 if you made $24,000 or more • 75% of what you made, if you make less than $24,000
You can receive up to $44,000 over five consecutive years under the Medicare EHR Incentive Program. The incentive payment is 75% of your Medicare allowed charges up to a maximum annual cap.
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The Meaningful Use Program provides participating professionals with financial incentives to stimulate adoption.
Incentive payments are only made to the participating optometrist and ophthalmologist. Eyecare practices cannotparticipate in incentive programs. You can designate a practice to receive the incentive funds on your behalf, but the practice cannot claim the money even if the EHR belongs to the practice.
Meaningful Use Medicare Payment
Starting Year of Participation
2011 2012 2013 2014 2015 and later
Year
to R
ece
ive i
nce
nti
ves 2011 $18,000 - - - -
2012 $12,000 $18,000 - - -
2013 $8,000 $12,000 $18,000 - -
2014 $4,000 $8,000 $12,000 $12,000 -
2015 $2,000 $4,000 $8,000 $8,000 $0
2016 - $2,000 $4,000 $4,000 $0
Total $44,000 $44,000 $39,000 $24,000 $0
* To get the maximum incentive payment you must have begun participation in 2012. If you do not start by 2014, you will not be eligible to receive any incentive payments.
The amount of your incentive payment for both Medicare and Medicaid depends on when you begin participating. The table shows the incentive amounts broken down by the year you start participating in the program.
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Meaningful Use Penalties
What If I Don’t Participate?
If you are eligible and choose not to participate by 2015, your practice will be penalized through lower reimbursements for care provided to Medicare patients.
Medicare eligible professionals who participate in the program but do not meet the requirements for meaningful use by 2015 (or in each subsequent year) are subject to payment adjustments to their Medicare reimbursements that start at 1% per year, up to a maximum 5% annual adjustment.
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Stage 1 Meaningful Use• Requirements• Core Objectives• Menu Objectives• Clinical Quality Measures
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Meaningful Use Stage 1: Requirements
You have to meet the following measures in Stage 1 in order to receive a payment:
15 Core Objectives
Everyone who participates in the program must meet these objectives.
5 Menu Objectives
You only have to report on 5 out of 10 menu objectives. You can choose objectives that is the most relevant to the workflow of your practice.
6 Clinical Quality Measures (CQM)
These are based on calculated data. Most certified EHRs will produce a report with CQM data. All you have to do is enter the data exactly as your EHR produced it. But you will have to report on:
• 3 core CQMs• 3 out of 38
additional CQMsThere are also exclusions specific to each objective. If the objective does not apply to you, it still counts as having met the objective.
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Every objective has an associated measure which shows the minimum requirement needed to achieve each objective.
Meaningful Use Stage 1: Core Objectives
Core Objectives: Must Report on All 15
4. E-Prescribing (eRx) 5. Maintain active medication list 6. Maintain active medication allergy list 7. Record demographics 8. Record and chart changes in vital signs 9. Record smoking status for patients 13 years or older 10. Report ambulatory clinical quality measures to CMS11. Implement clinical decision support 12. Provide patients with an electronic copy of their
health information, upon request 13. Provide clinical summaries for patients for each office
visit 14. Capability to exchange key clinical information 15. Protect electronic health information
1. Computerized Provider Order Entry (CPOE) 2. Drug-drug and drug-allergy checks 3. Maintain an up-to-date problem list of current and
active diagnoses
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Things to look for on CMS site:
• Measures• Exclusions• Way to attest: Yes/No or
percentage calculations
Meaningful Use Stage 1: Menu Objectives
Menu Objectives: Report on Only 5 out of 10 Objectives
ALERT! One of the 5
objectives must be 9 or 10
4. Send patient reminders per patient preference for preventive/follow-up care
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5. Provide patients with timely electronic access to their health information
6. Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate
7. Perform medication reconciliation8. Provide summary care record for each transition of care or referral 9. Capability to submit electronic data to immunization registries or
immunization information systems and actual submission10. Capability to submit electronic syndromic surveillance data to
public health agencies and actual submission
1. Implement drug formulary checks 2. Incorporate clinical lab-test results into EHR as structured data3. Generate lists of patients by specific conditions to use for
quality improvement, reduction of disparities, research, or outreach
Meaningful Use
CQMs: Report on 6 (3 Core and 3 Additional)
There are 3 core requirements to report:
1. Hypertension: Blood Pressure Measurement2. Preventive Care and Screening Measure Pair:
a) Tobacco Use Assessmentb) Tobacco Cessation Intervention
3. Adult Weight Screening and Follow-up
If the data produced by your EHR or your calculations indicates a zero for one or more of the core CQMs, then you must choose one or more alternate core CQMs from this list:
1. Weight Assessment and Counseling for Children and Adolescents
2. Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or Older
3. Childhood Immunization Status
20Clinical Quality Measures
Meaningful Use
Clinical Quality Measures: Report on 6
There are 3 additional requirements to report that you choose from a list of 38. But these 5 measures are the most relevant to eyecare:
1. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation
2. Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
3. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
4. Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quitb) Discussing Smoking and Tobacco Use Cessation
Medications
5. Diabetes: Eye Exam
21Clinical Quality Measures
View Full List of 38 Additional CQMs
Attestation • Attesting for Stage 1• Reporting CQMs
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Meaningful Use Attestation for Medicare
Stage 1 attestation is a legal statement that shows that you have met all of the requirements of the Medicare EHR Incentive Program. Note that you will have to meet requirements for 90 days in year 1 and a full year in year 2. (View details on Page 31)
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Practice With the Attestation Calculator
If you would like some practice before attesting, this calculator allows you to enter your core and menu objective information to see if you have met all of the requirements for the program.
The process of attestation happens through the same system where you initially registered. (https://ehrincentives.cms.gov)
During the attestation process, you will answer yes/no questions and report the percentages met on the core objectives, menu objectives, and clinical quality measures.
Meaningful Use Attestation for Medicare
As soon as you submit your attestation you will immediately find out whether or not you have successfully met the core and menu objectives of the program.
If you are successful, the CMS will perform a number of internal checks to be sure you are eligible for payment. You should then receive your EHR incentive payment in approximately 4-8 weeks following attestation.
If you are not successful, you can edit any information that was entered incorrectly and resubmit your attestation. Or you can resubmit for a different 90-day reporting period with new information.
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Meaningful Use Reporting on CQMs
2014
Beginning in 2014, you will be required to report CQMs using the new 2014 criteria regardless of whether you are participating in Stage 1 or Stage 2 of the EHR Incentive Program.
To successfully report CQMs electronically for 2014, the CMS is providing a set of electronic specifications for Clinical Quality Measures (eCQMs) for electronic reporting. These electronic specifications contain multiple parts which allow certified EHR technology systems to be programmed to accurately capture, calculate, and report CQMs.
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2013
There are 2 options for CQM reporting if you are currently in the process: • Attestation (As mentioned on page 23)• Electronic Reporting Pilots through PQRS
(Physician Quality Reporting System)• Check your eligibility for PRQS.
Reporting on CQMs during attestation are done differently depending on which year you begin reporting.
Being Audited • Auditors• How To Prepare• Best Practices
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Meaningful Use Being Audited
There is no need to panic when being audited. Here are some things about auditors you should be aware of:
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• Many audits are triggered automatically and are not necessarily the result of suspicious activity (CMS will audit between 5% to 10% of the attestation documents it receives)
• Auditors are not usually experts in eyecare, so make sure you defend yourself well and are able to provide sufficient records
• Auditor’s conclusions are often incorrect and should be challenged
• Assistance is available from state associations, and you should seek legal advice if necessary
As we all know, receiving money from the government is never easy. If you’re waiting for your payment check, you might be surprised to receive a letter saying you are being audited instead! We understand that you are no expert in meaningful use and you may have entered some errors unintentionally. But if you ever receive that dreaded letter or phone call, stay calm and be prepared.
There are two kinds of audits: pre and post payment audits. Pre payment audits start before you receive your payment, and post payment audits might involve repayments.
Meaningful Use How To Prepare 28
You must be able to defend yourself when being audited, even when you believe the auditor has made a mistake.
Here are some ways you can be prepared:
• Document everything! Especially the reason you answered yes/no during the attestation process. You should also keep all documentation for at least 5 years after attestation
• Send all records requested as soon as possible; do not delay compliance
• Do not alter any records that you send in
• Contact the auditor and maintain contact so you are clear of expectations they have. The vendor of your certified EHR can also provide support
• Audits will remain in your records and increase your chances of being audited in the next stages. It also increases the chances of other ODs who work in the same practice of being audited. So if you are being audited, notify your practice immediately
Meaningful Use Best Practices
• Conduct internal audits of each doctor at your practice every 6-12 months.
• Commit all doctors and staff to focus on compliance. Keeping good records should not only be done in fear of being audited. It ultimately enhances patient care by facilitating communication between patients and staff, and assisting you in remembering what you did if the patient returns or has more questions.
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If you did not get audited in Stage 1, don’t assume that you won’t be in the next stages. You should still be prepared in case it happens. These are some best practices to implement:
Planning for Meaningful Use• Plan for Completion • Registration
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Meaningful Use Getting Started 31
Stage 1
Reporting Time
Meet the requirements and report data for a continuous 90 day period in Year 1 and a full year in Year 2
Reporting Period
Meet the requirements and report data for a full year in Year 2: From January 1 to December 31
Submission Period
Anytime immediately following the end of the 90-day reporting period, but no later than February 28 of the following calendar year.
A popular option is to start on October 1 and attest in the following full calendar year after the 90 day reporting time.
Plan for Completion
Timeline: The table below shows when you can expect to complete all stages of meaningful use depending on when you started.
StartYear
Stage of Meaningful Use
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
2011 1 1 1 2 2 3 3 TBD TBD TBD TBD
2012 1 1 2 2 3 3 TBD TBD TRB TBD
2013 1 1 2 2 3 3 TBD TBD TBD
2014 1 1 2 2 3 3 TBD TBD
2015 1 1 2 2 3 3 TBD
2016 1 1 2 2 3 3
2017 1 1 2 2 3
* TBD: Stage 4 has not been fully defined.
Participation Timeline Use this timeline to determine which year you will demonstrate Stage 1, 2, and 3 of meaningful use. It will also provide the length of time you are required to demonstrate meaningful use at each stage and the maximum incentive payment for each year you participate.
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Medicare: Starting Stage 1 in 2014 is the last year to receive payment ($24,000) and you‘ll complete the program by 2019.
Table Explained
StartYear
Stage of Meaningful Use
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
2011 1 1 1 2 2 3 3 TBD TBD TBD TBD
2012 1 1 2 2 3 3 TBD TBD TRB TBD
2013 1 1 2 2 3 3 TBD TBD TBD
2014 1 1 2 2 3 3 TBD TBD
2015 1 1 2 2 3 3 TBD
2016 1 1 2 2 3 3
2017 1 1 2 2 3
It will take 5 to 6 years to complete all three stages for both the Medicare and Medicaid Incentive Program. But under Medicare, the program has to be completed consecutively.
Stage 2 will only begin in 2014. So even if you have completed Stage 1 in 2011, your status will still fall under Stage 1 in 2013.
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Stage 1Registration
Ready to Get Started on Meaningful Use?
Start by getting registered at https://ehrincentives.cms.gov
• Registering does not mean that you have to participate. You can cancel your registration at any time.
• By registering, you will be able to check your eligibility and other issues that could interfere with, or delay, your participation.
• You are allowed to let a 3rd party, such as an office manager, to register on your behalf.
You will need:
National Provider Identifier Number National Plan and Provider Enumeration System (NPPES) account Active PECOS account: PECOS is a database of physicians who have enrolled
or re-enrolled in Medicare. You must be listed or active in PECOS to participate in the EHR Incentive Program.
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Resources• Stage 1 CMS Resources • Stage 2 Meaningful Use - Summary• What VisionWeb Can Do For You
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Stage 1Stage 1 CMS Resources
The following are resources about Meaningful Use from the CMS site.
(Links on the PDF do not open in a new tab if viewed on a browser. We recommend that you download the PDF before accessing the links.)
Sta
ge 1
EHR Incentive Programs Overview http://go.cms.gov/ZC40Ex
Eligibility Chart: Choosing a Program http://go.cms.gov/13j4zpq
Comprehensive Guide to Medicare EHR Incentive Program http://go.cms.gov/OWhNS1
Stage 1 Overview http://go.cms.gov/HKhaMb
Core and Menu Set Objectives http://go.cms.gov/JGavjk
Core CQM Requirements http://go.cms.gov/TD6IF4
Additional CQM Requirements http://bit.ly/ZO5M4p
Reporting CQMs: PQRS Eligibility (2013) http://go.cms.gov/YwOBaZ
2013 and 2014 CQM Tipsheet http://go.cms.gov/OpyQdZ
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Stage 1Stage 1 CMS Resources – Continued
The following are resources about Meaningful Use from the CMS site.
(Links on the PDF do not open in a new tab if viewed on a browser. We recommend that you download the PDF before accessing the links.)
Sta
ge 1
Registration Guide http://go.cms.gov/107geb6
PECOS http://go.cms.gov/ZNazrn
Attestation Guide http://go.cms.gov/ZLUAJZ
Attestation Calculator http://go.cms.gov/eaMQn6
Reporting CQMs through PQRS http://go.cms.gov/15ABDOO
Electronic Specifications for Clinical Quality Measures http://go.cms.gov/TWIshF
Participation Timeline: Planning for Completion http://go.cms.gov/18SsRYy
Difference between Medicare and Medicaid Program http://go.cms.gov/131j0MY
Comprehensive Guide to Medicaid EHR Incentive Program http://go.cms.gov/15lm91c
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Meaningful Use Stage 2 Meaningful Use
Here is a quick summary of Stage 2 requirements:
• 17 Core Objectives• 3 Menu Objectives• 12 Clinical Quality Measures (CQM)
• 9 out of 64 clinical quality measures• 3 out of 6 additional clinical quality measures
In Stage 2, you will be expected to demonstrate meaningful use for a larger portion of your patient population.
Most ODs who complete Stage 1 will follow through the entire meaningful use process. And we recommend that you do the same. Stage 2 will only start in 2014, but remember that you have to complete the program consecutively, so you should start preparing for the next stage as soon as you complete attestation for Stage 1.
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Stage 1What VisionWeb Can Do For You
VisionWeb presents to you UPRISE, Surprisingly Simple, and So Much More than Practice Management & EHR.
VisionWeb presents to you UPRISE, a new way of looking at the eye care industry that is affordable and easy to use! Learn more about a better practice management and EHR solutions!
Get ready for our latest most efficient method of management solutions, and processing claims.
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Stage 1Subscribe to VisonWeb’s Blog
Subscribe to The VisionWeb blog for alerts on the next eBook!
The VisionWeb Blog is also here to help you with every aspect of your practice!
What you’ll learn:
• Best practices for optical dispensing• Tips to increase electronic claims
processing efficiency• Social media and marketing advice• Latest industry trends• Cloud computing updates• Practice management tips• Meaningful Use Advice
Already Completed Stage 1 and Ready to Take the Next Step with Meaningful Use Stage 2?
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VisionWeb provides software and technology services to streamline and simplify the eyecare industry. Through our online ophthalmic product ordering and electronic claim filing solutions, our technology helps eyecare practices, laboratories, manufacturers, and payers drive out inefficiency, increase customer satisfaction, and improve their bottom line.
For more information, visit www.visionweb.com
VitalHealth Software was founded as a collaboration between Mayo Clinic and the Noaber Foundation, and offers the industry’s leading cloud-based ehealth application development platform. Our unique, model-driven application development environment has delivered widely implemented solutions for disease management, collaborative health management and personalized health management.
For more information, visit http://www.vitalhealthsoftware.com/
