Kareo - The Ins & Outs of Meaningful Use Stage 2
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Transcript of Kareo - The Ins & Outs of Meaningful Use Stage 2
PAGE 1 KAREO | CONFIDENTIAL
Listen. Learn. Implement.The Ins & Outs of Meaningful Use
Stage 2
PAGE 2 KAREO | CONFIDENTIAL
Your Hosts Today…
Elizabeth WoodcockMBA, FACMPE, CPC
Lea ChathamContent Marketing Manager, Kareo
PAGE 3 KAREO | CONFIDENTIAL
Discover Kareo … www.kareo.com
Over 17,000 providers use Kareo to improve operations and patient care.
When your practice runs better, your patients feel it.
Electronic Health Records
Practice management
Billing Services
PAGE 4 KAREO | CONFIDENTIAL
Elizabeth Woodcock, MBA, FACMPE, CPC
Professional Speaker, Trainer, & Author
Specializing in Medical Practice Management
Author of 12 Best-Selling Practice Management Books
Fellow in the American College of Medical Practice Executives
Certified Professional Coder
MBA in Healthcare Management from The Wharton School of Business
BA from Duke University
Elizabeth W. Woodcock, MBA, FACMPE, CPCWoodcock & Associates
Speaker, Trainer, AuthorAtlanta, Georgia404.373.6195
PAGE 5 KAREO | CONFIDENTIAL
Background
February 2009American Recovery and Reinvestment Act
“TITLE XIII—HEALTH INFORMATION TECHNOLOGY”
HITECH Act
“Eligible professionals” will be paid for “demonstrating use of a qualified electronic health record in a meaningfulmanner.”
Logo: CMS.gov
PAGE 6 KAREO | CONFIDENTIAL
Background
Meaningful Use
Stage One
Stage Two
Stage Three
September 4, 2012 Federal Register 21050Final Rule: Medicare and Medicaid Programs; Electronic Health Record Incentive Program – Stage 2
PAGE 7 KAREO | CONFIDENTIAL
Background
Vendors received the “Final Rule” on the constitution of CEHRT systems
Certified EHR
Technology (CEHRT)Photo: Teenspeak.org
PAGE 8 KAREO | CONFIDENTIAL
Background
In order to allow time for vendors to create and physicians to implement…
Stage Two 2014
PAGE 9 KAREO | CONFIDENTIAL
Background
1st Year
Stages of Meaningful Use2011 2012 2013 2014 2015 2016 2017
2011 1 1 1 2 2 3 32012 1 1 2 2 3 32013 1 1 2 2 32014 1 1 2 22015 1 1 22016 1 12017 1
Year One: 90 DaysSubsequent Years: 365 Days
PAGE 10 KAREO | CONFIDENTIAL
Background
1st Year
Meaningful Use Annual Incentive Payments2011 2012 2013 2014 2015 2016 [….] TOTAL
2011 MCR $18,000 $12,000 $8,000 $4,000 $2,000 $0 $0 $44,000 MCD $21,250 $8,500 $8,500 $8,500 $8,500 $8,500 $0 $63,750
2012 MCR $18,000 $12,000 $8,000 $4,000 $2,000 $0 $44,000 MCD $21,250 $8,500 $8,500 $8,500 $8,500 $8,500 $63,750
2013 MCR $15,000 $12,000 $8,000 $4,000 $0 $39,000 MCD $21,250 $8,500 $8,500 $8,500 $17,000 $63,750
2014 MCR $12,000 $8,000 $4,000 $0 $24,000 MCD $21,250 $8,500 $8,500 $25,500 $63,750
2015 MCR $0 $0 $0 $0 MCD $21,250 $8,500 $34,000 $63,750
2016 MCR $0 $0 $0 MCD $21,250 $ 42,500 $63,750
MCR = Medicare; MCD = Medicaid. MCD participants must begin participation by 2016.
PAGE 11 KAREO | CONFIDENTIAL
Background
20143-month reporting period
First‐time Stage TwoSecond‐year Stage OneFor Medicare, must correspond with the fiscal quarter four chances
PAGE 12 KAREO | CONFIDENTIAL
Meaningful Use: Stage One
Core Measures
15Menu
Measures
5CQMs*
6 MUMeaningful
Use
Meaningful Use: Stage Two
Core Measures
17Menu
Measures
3CQMs
9 MUMeaningful
Use
Stage Two
*One of the “core measures”; CQM: clinical quality measure
PAGE 13 KAREO | CONFIDENTIAL
•Maintain core-menu structure– 17 core objectives– 3 of 6 menu– Retain exclusions, but can’t use them to disqualify
•9 clinical quality measures (CQMs)– No longer one of the criteria– Considered part and parcel of MU
Stage Two
PAGE 14 KAREO | CONFIDENTIAL
Stage Two
Criteria Old (MU1) Threshold
New (MU2) Threshold
CPOE 30% (med) 60% (med); 30% (lab/rad)
eRx 40% 50%
Demographic info 50% 80%
Vitals 50% 80%
Smoking status 50% 80%
Clinical summaries 50% (3 days) 50% (1 day)
Patient education 10% (menu) 10% (core)CPOE: Computerized Physician Order Entry
PAGE 15 KAREO | CONFIDENTIAL
Stage Two
In addition to higher measure thresholds…
• Completely new criteria
• Stage One menu-based criteria now core
• Multi-layer criteria
Cartoon: Doug Savage
PAGE 16 KAREO | CONFIDENTIAL
Stage Two
PAGE 17 KAREO | CONFIDENTIAL
Objective: Record smoking status for patients 13+ years old
Measure: >80% of all unique patients 13+ years old seen by the EP have smoking status recorded as structured data
Stage Two: Sample MU Core Criteria
PAGE 18 KAREO | CONFIDENTIAL
Objective: Provide clinical summaries for patients for each office visit
Measure: Clinical summaries provided to patients or patient-authorized representatives for >50% of office visits
Stage Two: Sample MU Core Criteria
PAGE 19 KAREO | CONFIDENTIAL
Objective: Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference
Measure: >10% of all unique patients who have had 2+ office visits with the EP within the past 24 months before the beginning of the EHR reporting period were sent a reminder, per patient preference
Stage Two: Sample MU Core Criteria
PAGE 20 KAREO | CONFIDENTIAL
Stage Two: Sample MU Core Criteria
Objective: Provide patients the ability to view online, download and transmit their health information with 4 business days of the information being available to the EP
*for both measures, only patients seen by the eligible professional (EP) during the reporting period
Measure: (1) >50% of all unique patients are provided timely online access (4 business days) to their health information; and (2) >5% of all unique patients (or authorized representative) view, download or transmit to a third party their health information*
PAGE 21 KAREO | CONFIDENTIAL
Objective: Use electronic messaging to communicate with patients on relevant health information
CEHRT: certified electronic health record technology
Measure: A secure message was sent using the electronic messaging function of CEHRT by >5% of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period
Stage Two: Sample MU Core Criteria
Appendix
PAGE 22 KAREO | CONFIDENTIAL
Stage Two: Menu-based Criteria
•Capability to submit electronic syndromicsurveillance data to public health agencies
•Record electronic notes in patient records• Imaging results accessible through CEHRT•Record patient family health history• Identify and report cancer cases to a public health central cancer registry
• Identify and report specific cases to a specialized registry (other than a cancer registry)
CEHRT: Certified Electronic Health Record Technology
PAGE 23 KAREO | CONFIDENTIAL
Meaningful Use: Stage Two
Core Measures
17Menu
Measures
3CQMs
9 MUMeaningful
Use
Stage Two
*One of the “core measures”; CQM: clinical quality measure
Out of 6
PAGE 24 KAREO | CONFIDENTIAL
Clinical quality measures– 9 measures out of 64– None are “required” but some are recommended– Electronic submission as of 2014, in Year Two+– Alignment with existing quality programs▪PQRS▪Shared Savings Program (ACOs)▪NCQA Patient-Centered Medical Home Recognition
PQRS: Physician Quality Reporting System; ACO: accountable care organization; NCQA: National Committee for Quality AssuranceCMS: Centers for Medicare & Medicaid Services
Stage Two: Clinical Quality Measures
PAGE 25 KAREO | CONFIDENTIAL
Stage Two: Clinical Quality Measures
CQM domains• Patient and family engagement• Patient safety• Care coordination• Population and public health• Efficient use of healthcare resources• Clinical processes/effectiveness
9 required measures must come from at least three different domains
PAGE 26 KAREO | CONFIDENTIAL
Confirmation that penalties begin in 2015
Avoidance of penalties1. Ineligible for program2. Successful participant in 20133. At minimum, successful participant by October 1,2014
▪ Register by July 1, 2014▪ Attest by the end of September 2014
…or meet one of the criteria for exclusion
Medicare Payment Adjustments
PAGE 27 KAREO | CONFIDENTIAL
Medicare Payment Adjustments
Criteria for Exclusion▪ Infrastructure: Lack Internet availability/barriers to
obtaining IT infrastructure
▪ New eligible professional (2 years)
▪ Unforeseen circumstances (e.g., natural disasters)
▪ Particular specialty/physician▪ Limited interaction with patients
▪ Lack of control of EHR access
▪ Taxonomy codes: 30 (Diagnostic Rad); 36 (Nuclear Med); 94 (Interventional Rad*); 30 (Anesthesiology); and 22 (Pathology)
*Exclusion under review by CMS (1/2/13)
PAGE 28 KAREO | CONFIDENTIAL
•Important– Adjustments will be applied to all Medicare
reimbursement– Medicaid reimbursement will not be affected– Medicaid participants need to demonstrate
meaningful use to avoid Medicare adjustments– Must continue to demonstrate meaningful use
Medicare Payment Adjustments
PAGE 29 KAREO | CONFIDENTIAL
Medicare Payment Adjustments
Year eRx PQRS EHR Total2012 -1.0% - - -1.0%2013 -1.5% - - -1.5%2014 -2.0% - - -2.0%2015 -2.0% -1.5% -1.0% -4.5%2016 -2.0% -2.0% -4.0%2017 -2.0% -3.0% -5.0%2018 -2.0% up to -5% up to -7%2019 -2.0% up to -5% up to -7%
PAGE 30 KAREO | CONFIDENTIAL
Question & Answer Session
Listen. Learn. Implement.The Ins & Outs of
Meaningful UseStage 2
Your Questions…
PAGE 32 KAREO | CONFIDENTIAL
Source
September 4, 2012 Federal Register 21050Final Rule: Medicare and Medicaid Programs; Electronic Health Record Incentive Program –Stage 2
http://www.gpo.gov/fdsys/pkg/FR-2012-09-04/pdf/2012-21050.pdf
PAGE 33 KAREO | CONFIDENTIAL
Appendix: Remaining MU Core Criteria
• Incorporate clinical lab-test results into CEHRT as structured data
• Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach
• Use clinically relevant information from CEHRT to identify patient-specific education resources and provide those resources to the patient
• The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation
PAGE 34 KAREO | CONFIDENTIAL
Appendix : Remaining MU Core Criteria
• The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral
• Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with application law and practice
• Use CPOE for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines
• Generate and transmit permissible prescriptions electronically (eRx)
PAGE 35 KAREO | CONFIDENTIAL
Appendix : Remaining MU Core Criteria
• Record the following demographics: preferred language, sex, race, ethnicity, date of birth
• Record and chart changes in vital signs• Use clinical decision support to improve performance on
high priority health conditions• Protect electronic health information created or maintained
by the CEHRT through the implementation of appropriate technical capabilities
PAGE 36 KAREO | CONFIDENTIAL
Elizabeth W. Woodcock, MBA, FACMPE, CPCWoodcock & AssociatesSpeaker, Trainer, Author
Atlanta, Georgia404.373.6195
Your Speaker