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Meaningful Use for Specialists. September 28, 2012 Paul Forlenza , VP Policy and Special Projects Priscilla Phelps , Implementation Specialist Larry Gilbert , Director of Outreach and Business Development. Objectives. To provide: General Meaningful Use information - PowerPoint PPT Presentation
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Meaningful Use for Specialists
September 28, 2012
Paul Forlenza, VP Policy and Special ProjectsPriscilla Phelps, Implementation Specialist
Larry Gilbert, Director of Outreach and Business Development
1
Objectives
To provide:•General Meaningful Use information•Information on specific criteria
• Exclusions• Requirements• Potential concerns
•Insights on Clinical Quality Measures (CQMs)•Examples from one specialist•Tools to assist
2
Medicare EHR Incentive Payments to Eligible Professionals Nationwide
Eligible ProfessionalsProgram-to-Date Providers Paid
Program-to-Date Payment Amount
(in millions)
Doctors of Medicine/Osteopathy 66,367 $1,140
Dentists 66 $1
Optometrists 2,875 $45
Podiatrists 3,524 $63
Chiropractors 1,485 $19
Total Eligible Professionals 74,317 $1,267
Source: CMS August 2012 report3
Medicare EHR Incentive Payments to Eligible Hospitals Nationwide
Eligible HospitalsProgramto-Date
Providers Paid
Program-to-Date Payment
Amount(in millions)
Subsection (d) Hospitals 1,147 $2,221
Critical Access Hospitals 186 $115
Total Hospitals 1,333 $2,336
Source: CMS August 2012 report4
Medicare EHR Incentive Payments to Vermont Eligible Professionals by County
County Providers
Addison 8
Bennington 7
Chittenden 33
Franklin 4
Lamoille 1
Rutland 5
Washington 3
Windham 2
Windsor 12
Total 75Compiled from CMS August 2012 report
5
Medicaid EHR Incentive Payments to Vermont Eligible Professionals
Source: DVHA Sept. 2012
Nurse Practitioner 72 Obstetrics/Gynecology 16 Neurology 2
Family Practice 58 Certified Nurse Midwife 8 Endocrinology 1
Physician Unknown Specialty 34 Dentist 7 Hematology/Oncology 1
Internal Medicine 25 General Surgery 4 Orthopedic Surgery 1
Pediatric Medicine 22 Addiction Medicine 2
Osteopathic Manipulative Medicine 1
Psychiatry 17Clinical Nurse Specialist 2 Total 273
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Medicaid EHR Incentive Payments to Vermont Eligible Hospitals
Hospitals 7
Source: DVHA Sept. 2012
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Medicaid EHR Incentive Payments to Vermont Eligible Professionals by County
Addison 8Bennington 15Caledonia 30Chittenden 45Essex 5Franklin 27Grand Isle 0Lamoille 18Orange 17Orleans 35Rutland 16Washington 24Windham 20Windsor 13
Total 273
Compiled from DVHA Sept. 2012 Report
8
Items to Ponder
• Specialists ARE meeting the Meaningful Use criteria and receiving incentive money
• Percentage indicated is not enough • “More than” 50% really means at least 51% (rounded)
• Both Core and Menu criteria have exclusions on several items• Exclusions count as criteria being “met”
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Specific Core Criteria• Use of Computerized Provider Order Entry for Medications (C1)• Generate and transmit permissible prescriptions electronically (C4)
• Exclusion for providers who write fewer than 100 prescriptions in reporting period
• Maintain up-to-date problem list for current/active diagnoses (C3)• Maintain active medication list (C5)• Maintain and active medication allergy list (C6)
• No exclusions, but• Have at least ONE entry or an indication of “none” or “no known”
10
More Core
• Record and chart changes in vital signs (C8)• Exclusion if height, weight and blood pressure have no relevance to
scope of practice
• Provide patients with an electronic copy of their health information (C12)
• Exclusion if no patients or their agents request an electronic copy
11
Security Risk Assessments
•Protect electronic health information (C15)• Security Risk Assessment (SRA)• Requirements in 45 CFR 164.308 (a)(1) list more than a quick
review of your EHR security• One SRA for all providers in same office using the same EHR
•VITL Implementation Specialists conduct SRAs to allow EPs to meet this measure
• Take roughly 5-6 hours to complete, including on-site visit and analysis returned to practice
12
Menu Set Criteria
• Implement drug formulary checks (M1)• Exclusion for providers who write fewer than 100 prescriptions in reporting period
• Incorporate clinical lab test results into an EHR as structured data (M2)• Requires a lab interface or data entry of results• Exclusion if no labs with results as a numerical or negative/positive format are
ordered
• Medication reconciliation at a transfer IN from another setting of care (M7)• Summary of Care for patients transitioned TO another setting (M8)
• Exclusions:• Not the recipient of a transitioned patient during the reporting period(M7)• No patients are transferred out or referred to another provider (M8)
13
Public Health Measures (PHM)MUST select one PHM in Menu criteria
•Capability to submit data to an immunization registry (M9)• In Vermont, you should select this measure• At this time, take exclusion #2 during attestation – “where no
immunization registry has the capacity to receive…”• May also be able to take exclusion #1, if zero immunizations are
administered during the reporting period• Immunization registry is under construction
•Capability to provide syndromic surveillance data (M10)• In Vermont, this is not a viable option at this time
14
Clinical Quality Measures (10a,b,c)Must report
• Three (3) core or• Core and alternate core to total three (3)
AND• Three (3) from the list of 38 measures• To total six (6)
•Current list does not fit many specialties• Select any that are relevant• Then look for those with potential relevance
• Or ease of recording• Zeros are acceptable in both the numerator and denominator
•No percentages to meet!
15
Real Life Example• Pain management practice, single provider• Live with EHR in February 2011• Attested to Meaningful Use for 90-day period ending 12/31/11• Took exclusions for
• CPOE (C1), E-prescribing (C4), Providing electronic copies (C12)• Drug formulary checks (M1), Immunization registry (M9)
• Clinical Quality Measures:• Reported two core • One alternate core with zeros, as none applied• Low back pain: Use of Imaging studies• Diabetic: foot exams• Pneumonia vaccines for older patients
16
Now Larry’s Presentation
17
Timing for Medicare EP
1st Year of MU
Stage of Meaningful Use
2011 2012 2013 2014 2015 2016
2011 1 1 1 2 2 3
2012
1 1 2 2 3
2013 1 1 2 2
2014
1 1 2
2015 1 1
2016 1
For 2014 only, 90 day reporting period to allow for upgrade to 2014 CEHRT
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Timing for Medicaid EP
1st Year of MU
Stage of Meaningful Use
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
2011 1 1 1 2 2 3 3
2012
1 1 2 2 3 3
2013 1 1 2 2 3 3
2014
1 1 2 2 3 3
2015 1 1 2 2 3 3
2016
1 1 2 2 3 3
2017 1 1 2 2 3
For 2014 only, 90 day reporting period to allow for upgrade to 2014 CEHRT
19
Stage 1 Changes• Most voluntary in 2013 – required in 2014• Change CPOE denominator: # of medication orders• Vital Signs: exclusion and age requirement revised• Test exchange key clinical information removed• Add view, download or transmit patient data
21
Stage 1 Changes• E-prescribing exclusion added (2013)• Menu set exclusion limited (2014)• EP must create record directly in CEHRT (2013)
22