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Massachusetts Medicaid EHR Incentive Payment Program
■ Vision & Goals ■ High-level overview – where we are going ■ Medicare vs. Medicaid EHR Incentive Programs ■ Performance and Progress ■ Eligibility Overview ■ Meaningful Use Overview ■ HIT Success Stories
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Agenda
To promote the adoption and meaningful use of interoperable CEHRT to Eligible Professionals (EPs) and Eligible Hospitals (EHs) across the Commonwealth
To improve the quality and coordination of care by connecting providers to patient information instantly through the use of certified EHR technology (CEHRT)
VISION GOAL
Program Overview | Medicaid
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Advance Clinical Processes
Improved Outcomes
Stage 1 MU
Interoperable EHR
Stage 2 MU
Stage 3 MU
Adopt Implement ≠ MU Upgrade
Data Capturing and
Sharing
Additional Stages TBD Where are we going?
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Managed by CMS State manages its own program
Incentive payments for eligible hospitals are based on a number of factors, beginning with a $2 million base payment
Incentive payments for eligible hospitals are based on a number of factors, beginning with a $2 million base payment
Payment reductions begin in 2015 for providers who are eligible but choose not to participate
No Medicaid payment reductions if providers choose not to participate
In the first year and all remaining years, providers have MU objectives and associated measures they must meet to get incentive payments
In the first year, providers can receive an incentive payment for adopting, implementing or upgrading a certified EHR.
In all remaining years, providers must meet the same MU objectives and associated measures as Medicare
EPs can receive a maximum incentive amount of $44,000* (over 5 successive years of program participation) *NOTE: As of 2013, payment amount annually reduced
EPs can receive a maximum incentive amount of $63,750 (over 6 years of program participation)
Medicare EHR Incentive Payment Program Medicaid EHR Incentive Payment Program
Medicare vs. Medicaid EHR Incentive Payment Program
NOTE: Pediatricians that meet the 20% Medicaid patient volume threshold may receive up to $42,500 over a six year period: $14,167 in the first year of participation and up to $5,667 in subsequent years. Pediatricians that meet the 30% Medicaid patient volume threshold may receive the full incentive amount.
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How Much Can a Medicaid Eligible Professional Receive in Incentives?
Incentive Program
Performance and Progress
REGISTRATIONS BY PROVIDER TYPE FROM 10/03/2011 to 06/7/2013
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Performance: Registration Metrics
TOTAL INCENTIVE AMOUNT DISTRIBUTED AS OF 06/7/2013
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Performance: Payment Metrics
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0
500
1,000
1,500
2,000
2,500
3,000
CHC/FQHC Group Individual Hospital Physician's
Organization
Hospitals
1,127 1,344
92
2,591
80
20.4 Million 23.6 Million
49.9 Million
72 Million 1.6 Million
Performance: Payment Metrics
PAYMENTS by PAYEE TYPE FROM 10/03/2011 to 06/7/2013
• CEHRT • Provider Type • Threshold
Eligibility Requirements
ONC CEHRT (CHPL) Acquire system from ONC Certified Health IT Product List
ELIGIBLE PROVIDER TYPES
Physicians: MD / DO • Certified Midwives • Nurse Practitioners Residents • Dentists • Limited License Dentists
No more than 90% of services furnished in hospital setting: POS 21: Inpatient POS 23: Emergency Room
Provider contributed funds to acquisition, implementation, and maintenance of CEHRT hardware and interfaces to meet Meaningful Use *NEW*
Demonstrate at least 30% (20% Pediatricians) paid Medicaid/Medicaid 1115 Waiver encounters in 90 period from previous CY or 12-month period leading up to attestation
Demonstrate at least 30% (20% Pediatricians) were Medicaid/Medicaid 1115 Waiver enrollees in 90 period from previous CY or 12-month period leading up to attestation *NEW*
Effective 2013 and beyond: Providers can include zero-paid and denied claims.
or
or
Y/N 1.
Y/N 2.
Y/N 3.
Y/N 4.
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Eligible Professionals: Requirements
• Core • Menu • CQMs
Meaningful Use
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Patient and Family
Engagement
Population and
Public Health
Clinical Process/
Effectiveness
Efficient Use of Healthcare Resources
Care Coordination Patient Safety
Key Healthcare Policy Domains
Electronically capturing health information in a structured format and using that information to track key clinical conditions
Establishing the functionalities of certified EHR technology that will allow for continuous quality improvement and easy information exchange
Communicating information for care coordination purposes (whether that information is structured or unstructured, but in a structured format whenever feasible)
Implementing clinical decision support tools to facilitate disease and medication management
Beginning to use CEHRTs to engage patients, their families, and report clinical quality measures and public health information
STAGE 3 STAGE 2 STAGE 1
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Focus of Stage 1 Meaningful Use Criteria
Stage
2013 Stage 1 Meaningful Use
Dr. Jones – Practices at 1 Location
Practice Location: 180 Lyman St.
90-Day Reporting Period (Current CY): 6/1/12 – 8/31/12
CEHRT
100% encounters occur at 180 Lyman St.
• 80 unique patients • 70 in CEHRT • 70/80 x 100 = 87%
Provider meets Meaningful Use general requirements
50% of an EP’s encounters must occur at the location or location(s) that utilize CEHRT At least 80% of unique patients must have their data in a CEHRT during the chosen
90-day reporting period
EXAMPLE:
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Meaningful Use: General Requirements
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Stage 1 Requirements | Highlights
Stage 1 Changes required in 2013 and onward:
Generate and transmit permissible prescriptions electronically Capability to exchange key clinical information among providers of care and patient
authorized entities electronically: will no longer be a required core measure. Actual exchange will be required in Stage 2 starting in 2014.
Public Health Objectives: additional “except where prohibited” to the objective regulation language for the three public health measures
Optional in 2013 only:
Record and track changes in vital signs Addition of alternative age limitations, includes blood pressure for patients ages three
and over only and height and weight for all ages. Additional alternative exclusion
Sees no patients 3 years or older is excluded from recording blood pressure
Optional in 2013 and remains optional:
Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines: addition of alternative measure. More than 30 percent of medication orders are recorded using CPOE.
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Stage 2 Requirements | Highlights
2014 Certification Requirements All EHR systems must be certified to the Office of National Coordinators (ONC) 2014 certification
requirements Core & Menu Measure Requirements
EPs must meet 17 Core objectives and 3 of 6 Menu measures Clinical Quality Measures (CQMs)
Electronic submissions of Clinical Quality Measures regardless of what stage of Meaningful Use EPs are in (beginning 2014 and beyond)
EPs must report on 9 out of 64 CQMs selected from at least 3 of the key health care policy domains
MassHealth is currently evaluating the process and system to electronically capture CQMs Meaningful Use Reporting Period
For 2014 only, all EPs attesting to meaningful use will use a 90-day EHR reporting period Health Information Exchange
Connect and electronically transmit data (ex: transmit summary of care record)
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The Benefits of HIE Improve & streamline care coordination Fewer medical errors/improved patient safety Reduce duplication Supports achieving Meaningful Use Reduce costs throughout the care delivery system Ease & improve public health reporting & analytics Foundation for Accountable Care Organizations & value-based healthcare models
Public Health
Small Practice
Hospital
Health System
Payer
Pharmacy
Labs
Mass HIway Last Mile Program 1.855.MA-HIWAY (1.855.624.4929) Option 1
[email protected] mehi.masstech.org/what-we-do/mass-hiway
Mass HIway | Hub for Health Information Exchange
The Mass HIway enables the secure electronic exchange of health information among diverse participants in the Commonwealth:
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“Adopting new technology and achieving meaningful use improved our workflows, helped us refine our policies and procedures, and, best of all, improved patient care” -Dr. Smith
Benefits of Achieving Meaningful Use (MU) – small practice
In this small practice, achieving MU required physicians and staff members to work outside of their comfort zones, but resulted in new policies and procedures that improved healthcare quality. While the financial/time resources required were demanding on this small practice, the benefits are tangible. By implementing an HER and achieving MU, Dr. Smith's practice is now using technology to help improve patient care such as: • E-prescribing • Automated recall processes for preventative services
and chronic disease follow-up • Patient registries (e.g., diabetes and coronary artery
registries) Dr. Smith's practice has seen improved safety and reduced healthcare costs, as well as improved population health. For example, Dr. Smith notes that "being alerted when my patients' BMI falls out of range prompts me to do something about it and has resulted in more frequent discussions with my patients on the importance of weight management." Achieving MU also fostered a relationship between Dr. Smith's practice and the Immunization Registry. Without the MU incentive payments, it was unlikely that the practice would have gone to the trouble of implementing a system that was able to participate in a statewide immunization registry.
Health IT Success Story – Example
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Health IT Success Story – Example
Lessons Learned: Obstetrics & Gynecology Practice
Dr. Jones at this Obstetrics & Gynecology practice offers the following lessons learned for other practices considering health IT adoption: • Use a reliable, local IT company or administrator to
install and maintain your hardware and software • Develop simple and complete patient demographic
and medical information forms that match the software for easy entry
• Make sure your leadership team is ready and able to undertake a complex and stressful long term project
• Prepare financially and establish reserve funds to account for a temporary drop in productivity and increase in payroll and overtime pay
• Schedule short, daily meetings to work through small but important implementation details
• Create deadlines for complete implementation of key components of the program
• Don’t underestimate the amount of time that will need to be dedicated to training
• Don’t let implementation stall out – continue to press on to maximize the functionality of the implementation
• Focus on two or three issues to tackle every week. Do not try to fix every problem simultaneously
• Be patient, ask for assistance when needed, and don’t give up!
“The System has paid for itself several times over in practice efficiency and cost savings” Dr. Jones
Contact Us
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Contact Us
Massachusetts Medicaid EHR Incentive Payment Program: P: 1-855-MassEHR (1-855-627-7347) E: [email protected] F: 508-898-3211
