Prepared by: Health Technology Services Regional Extension Center A division of Mountain-Pacific...
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Meaningful Use - Stage 2 Prepared by: Health Technology Services Regional Extension Center A division of Mountain-Pacific Quality Health
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Meaningful Use - Stage 2
Prepared by: Health Technology Services Regional Extension Center
A division of Mountain-Pacific Quality Health
MU Overview MU Stage 2 Final Rule
◦ Core/Menu Objectives◦ Clinical Quality Measures
◦ Payment Adjustments
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Outline
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MU Overview
CMS Rule: http://www.ofr.gov/(X(1)S(uzclbwrx5fwqm2w2mipkysrh))/OFRUpload/OFRData/2012-21050_PI.pdf
ONC Rule: http://www.ofr.gov/(X(1)S(uzclbwrx5fwqm2w2mipkysrh))/OFRUpload/OFRData/2012-20982_PI.pdf
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Rules
VisionEnable significant and measurable improvements in population health through a transformed health care delivery system
Goals:◦ Improving quality, safety, efficiency, and
reducing health disparities◦ Engage patients and families in their health care.◦ Improve care coordination◦ Improve population and public health◦ Ensure adequate privacy and security
protections for personal health information
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Meaningful Use - Goals
Goals Adapted from National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America’s Healthcare. Washington, DC: National Quality Forum; 2008.
Congress established three fundamental criteria:
1. Use of a certified Electronic Health Record (EHR)
that meets guidelines
2. Electronic Exchange of health information
3. Reporting on Clinical Quality and other Measures
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Meaningful Use - Definition
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MU Stage 2 Final Rule
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Stage 2 Timeline
June ‘11 HITPC Recommendations on Stage 2
Feb ‘12 Stage 2 Proposed Rule
May ‘12 NPRM Comment Period Ends
Aug ‘12 Stage 2 Final rule
Oct ‘13/Jan ‘14 Stage 2 Start Dates
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Stages of Meaningful Use
1st Year
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 TBD 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
Eligible Professionals-15 core objectives -5 of 10 menu
objectives -20 total objectives
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Stage 1 to Stage 2Eligible Professionals-17 core objectives -3 of 6 menu
objectives -20 total objectives
Eligible Hospitals-14 core objectives -5 of 10 menu
objectives -19 total objectives
Eligible Hospitals-16 core objectives -3 of 6 menu
objectives -19 total objectives
Changed Exclusions no longer count to meeting one of the
menu objectives Not Changed No change in 50% of EP outpatient encounters
must occur at locations equipped with certified EHR technology
Measure compliance = objective compliance PAs still ineligible, unless lead at RHC/FQHC Denominators based on outpatient locations
equipped with CEHRT and include all such encounters or only those for patients whose records are in CEHRT depending on the measure.
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Meaningful Use - Concepts
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MU Stage 2 EP
Core / MenuObjectives
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Stage 2 EP Core Objectives
Core Objective Measure Stage 2 Change
1. CPOE Use CPOE for more than 60% of medication, 30% of laboratory, and 30% of radiology
Up from 30% of just medication orders
2. E-Rx E-Rx for more than 50% Up from 40%
Drug/formulary checks folded into this measure from Stage 1 menu item
3. Demographics Record demographics for more than 80%
Up from 50%
4. Vital Signs Record vital signs for more than 80%
Up from 50%
5. Smoking Status Record smoking status for more than 80%
Up from 50%
EPs must meet all 17 core objectives:
Challenges!
Core #2 requires the availability of pharmacies in your area to accept eRx.
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Stage 2 EP Core Objectives
Core Objective Measure Stage 2 Change
6. Interventions Implement 5 clinical decision support interventions + drug/drug and drug/allergy
Up from one CDSI rule
Must be linked to at least 4 Clinical Quality Measures (CQMs)
Drug/drug and drug/allergy folded into this measure
7. Labs Incorporate lab results for more than 55%
Up from 40% and no longer a menu item
8. Patient List Generate patient list by specific condition
No longer a menu item
EPs must meet all 17 core objectives:
Challenges!Core #6 CDSI rules must be useful to the provider
at the point of care.
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Stage 2 EP Core Objectives
Core Objective
Measure Stage 2 Change
9. Preventive Reminders
Use EHR to identify and provide reminders for preventive/follow-up care for more than 10% of patients with two or more office visits in the last 2 years
No longer a menu item, but down from 20%
10. Patient Access
Provide online access to health information for more than 50% with more than 5% actually accessing
No longer a menu item and up from 10% on part #1. Replaces electronic access and electronic copy of medical record.
Part #2 is new and requires patient action to meet the measure and additional software. Exclusion for providers in areas with limited Internet access.
EPs must meet all 17 core objectives:
Challenges!
Core #10 requires patient engagement to meet MU.
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Stage 2 EP Core Objectives
Core Objective Measure Stage 2 Change
11. Visit Summaries
Provide office visit summaries for more than 50% of office visits within 1 business day
Down from three business days, percent is the same (50%)
12. Education Resources
Use EHR to identify and provide education resources more than 10%
No longer a menu item
13. Secure Messages
More than 5% of patients send secure messages to their EP
New for Stage 2
Requires patient action to meet the measure
14. Rx Reconciliation
Medication reconciliation at more than 50% of transitions of care
No longer a menu item
EPs must meet all 17 core objectives:
Core #11 has been one of the most challenging measures for EPs.
Core #12 education materials is often limited in the EHR.
Challenges!
Core #13 requires patient engagement to meet MU.
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Stage 2 EP Core Objectives
Core Objective Measure Stage 2 Change
15. Summary of Care
Provide summary of care document for more than 50% of transitions of care and referrals with 10% sent electronically and at least one sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR
No longer a menu item
10% sent electronically is a new requirement
16. Immunizations Successful ongoing transmission of immunization data
No longer a menu item
Requires more than just a test to meet this measure
17. Security Analysis
Conduct or review security analysis and incorporate in risk management process
EPs must meet all 17 core objectives:
Challenges!
Core #15 requires a method to send summary information out side of your own vendor networks.
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Stage 2 EP Menu Objectives
Menu Objective
Measure Stage 2 Change
1. Imaging Results More than 20% of imaging results are accessible through Certified EHR Technology
New for Stage 2
2. Family History Record family health history for more than 20%
New for Stage 2
3. Syndromic Surveillance
Successful ongoing transmission of syndromic surveillance data
Requires more than just a test to meet this measure
EPs must select 3 out of 6 menu objectives:
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Stage 2 EP Menu Objectives
Menu Objective
Measure Stage 2 Change
4. Cancer Successful ongoing transmission of cancer case information
New for Stage 2
Requires more than just a test to meet this measure
5. Specialized Registry
Successful ongoing transmission of data to a specialized registry
New for Stage 2
Requires more than just a test to meet this measure
6. Progress Notes Enter an electronic progress note for more than 30% of unique patients
New for Stage 2
EPs must select 3 out of 6 menu objectives:
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MU Stage 2Hospital
Core/MenuObjectives
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Stage 2 Hospital Core Objectives
Core Objective Measure Stage 2 Change
1. CPOE Use CPOE for more than 60% of medication, 30% of laboratory, and 30% of radiology
Up from 30% of just medication orders
2. Demographics Record demographics for more than 80%
Up from 50%
3. Vital Signs Record vital signs for more than 80%
Up from 50%
4. Smoking Status Record smoking status for more than 80%
Up from 50%
Hospitals must meet all 16 core objectives:
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Stage 2 Hospital Core Objectives
Core Objective Measure Stage 2 Change
5. Interventions Implement 5 clinical decision support interventions + drug/drug and drug/allergy
Up from one CDSI rule
Must be linked to 4 Clinical Quality Measures (CQMs)
Drug/drug and drug/allergy folded into this measure
6. Labs Incorporate lab results for more than 55%
Up from 40%
No longer a Menu objective
7. Patient List Generate patient list by specific condition
No longer a Menu objective
8. eMAR eMAR is implemented and used for more than 10% of medication orders
New for Stage 2
Hospitals EPs must meet all 16 core objectives:
Challenges!Core #5 CDSI rules must be useful to the provider
at the point of care.
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Stage 2 Hospital Core Objectives
Core Objective Measure Stage 2 Change
9. Patient Access Provide online access to health information for more than 50% with more than 5% actually accessing
No longer a menu item and up from 10% on part #1
Replaces electronic access and electronic copy of medical record
Part #2 is new and requires patient action to meet the measure and additional software
10. Education Resources
Use EHR to identify and provide education resources more than 10%
No Longer a Menu objective
Hospitals must meet all 16 core objectives:
Challenges!
Core #9 requires patient engagement to meet MU.
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Stage 2 Hospital Core Objectives
Core Objective Measure Stage 2 Change
11. Rx Reconciliation
Medication reconciliation at more than 50% of transitions of care
No Longer a Menu objective
12. Summary of Care
Provide summary of care document for more than 50% of transitions of care and referrals with 10% sent electronically and at least one sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR
No longer a menu item
10% sent electronically is a new requirement
Hospitals must meet all 16 core objectives:
Challenges!
Core #12 requires a method to send summary information out side of your own vendor networks.
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Stage 2 Hospital Core Objectives
Core Objective Measure Stage 2 Change
13. Immunizations Successful ongoing transmission of immunization data
No longer a menu item
Requires more than just a test to meet this measure
14. Labs Successful ongoing submission of reportable laboratory results
No longer a menu item
Requires more than just a test to meet this measure
15. Syndromic Surveillance
Successful ongoing submission of electronic syndromic surveillance data
No longer a menu item
Requires more than just a test to meet this measure
16. Security Analysis
Conduct or review security analysis and incorporate in risk management process
Hospitals must meet all 16 core objectives:
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Stage 2 Hospital Menu Objectives
Menu Objective
Measure Stage 2 Change
1. Progress Notes Enter an electronic progress note for more than 30% of unique patients
New for Stage 2
2. E-Rx More than 10% electronic prescribing (eRx) of discharge medication orders
New for Stage 2
3. Imaging Results More than 20% of imaging results are accessible through Certified EHR Technology
New for Stage 2
Hospitals must select 3 out of 6 menu objectives:
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Stage 2 Hospital Menu Objectives
Menu Objective
Measure Stage 2 Change
4. Family History Record family health history for more than 20%
New for Stage 2
5. Advanced Directives
Record advanced directives for more than 50% of patients 65 years or older
6. Labs Provide structured electronic lab results to EPs for more than 20%
New for Stage 2
Hospitals must select 3 out of 6 menu objectives:
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Changes to Stage 1
Denominator: Unique Patient with at least one medication in their med list
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Changes to Stage 1
Denominator: Number of Orders during the EHR Reporting Period
Age Limits: Age 2 for Blood Pressure & Height/Weight
Age Limits: Age 3 for Blood Pressure, No age limit for Height/Weight
CPOE - Optional in 2013 and beyond
Vital Signs - Optional in 2013 Required in 2014+
Exclusion: All three elements not relevant to scope of practice
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Changes to Stage 1
Exclusion: Allows BP to be separated from height/weight
One test of electronic transmission of key clinical information
Requirement removed effective 2013
Vital Signs - Optional in 2013 Required in 2014+
Test of HIE– Effective 2013
Objective: Provide patients with e-copy of health information upon request Objective: Provide electronic access to health information
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Changes to Stage 1
Replacement Objective: Provide patients the ability to view online, download and transmit their health information
Immunizations Reportable Labs Syndromic Surveillance
Addition of “except where prohibited” to all three
E-Copy and Online Access - Required in 2014+
Public Health Objectives – Effective 2013
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Clinical Quality Measures
CQMs are no longer a meaningful use core objective, but reporting CQMs is still a requirement for meaningful use.
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Clinical Quality Measures
All providers must select CQMs from at least 3 of the 6 HHS National Quality Strategy domains:
Patient and Family Engagement Patient Safety Care Coordination Population and Public Health Efficient Use of Healthcare Resources Clinical Processes/Effectiveness
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CQM - Domains
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CQM – Changes 2014 and Beyond
Provider Prior to 2014 2014 and Beyond Regardless of Stage
EPs Complete 6 out of 44 •3 core or 3 alt. core •3 menu
Complete 9 out of 64 Choose at least 1 measure in 3 NQS domains Recommended core CQMs include: •9 CQMs for the adult population •9 CQMs for the pediatric population •Prioritize NQS domains
Eligible Hospitals and CAHs
Complete 15 out of 15 Complete 16 out of 29 •Choose at least 1 measure in 3 NQS domains
CMS selected the CQMs for the proposed core set based on analysis of several factors: Conditions that contribute to the morbidity and
mortality of the most Medicare and Medicaid beneficiaries
Conditions that represent national public/ population health priorities
Conditions that are common to health disparities
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Core CQMs for EPs
Conditions that disproportionately drive healthcare costs and could improve with better quality measurement
Measures that would enable CMS, States, and the provider community to measure quality of care in new dimensions, with a stronger focus on parsimonious measurement
Measures that include patient and/or caregiver engagement
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Core CQMs for EPs (cont’d)
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Payment Adjustments(Penalties)
The HITECH Act stipulates that for Medicare EPs a payment adjustment applies if they are not a meaningful EHR user.
An EP/Hospital becomes a meaningful EHR user when they successfully attest to meaningful use under either the Medicare or Medicaid EHR incentive program
Adopt, implement and upgrade (AIU) does not constitute meaningful use. A provider receiving a Medicaid incentive for AIU would still be subject to the Medicare payment adjustment.
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Payment Adjustments
% Adjustment Assuming less than 75% of EPs are meaningful EHR users for CY 2018 and subsequent years
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EP Payment Adjustments
2015 2016 2017 2018 2019 2020+
EP is not subject to e-Rx penalty in 2014
99% 98% 97% 96% 95% 95%
EP is subject to e-Rx penalty in 2014
98% 98% 97% 96% 95% 95%
% Adjustment Assuming more than 75% of EPs are meaningful EHR users for CY 2018 and subsequent years
2015 2016 2017 2018 2019 2020+
EP is not subject to e-Rx penalty in 2014
99% 98% 97% 97% 97% 97%
EP is subject to e-Rx penalty in 2014
98% 98% 97% 97% 97% 97%
EP who has demonstrated meaningful use in 2011 or 2012
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EP EHR Reporting Period
Payment Adjustment Year 2015 2016 2017 2018 2019 2020
Full Year EHR Reporting Period
2013 2014 2015 2016 2017 2018
EP who demonstrates meaningful use in 2013 for the first time
Payment Adjustment Year 2015 2016 2017 2018 2019 2020
90 day EHR Reporting Period
2013
Full Year EHR Reporting Period
2014 2015 2016 2017 2018
EP who demonstrates meaningful use in 2014 for the first time
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EP EHR Reporting Period
Payment Adjustment Year 2015 2016 2017 2018 2019 2020
90 day EHR Reporting Period
2014 2014
Full Year EHR Reporting Period
2015 2016 2017 2018
In order to avoid the 2015 payment adjustment the EP must attest no later than Oct 1, 2014 which means they must begin their 90 day EHR reporting period no later than July 1, 2014.
To Avoid Payment Adjustments: EPs must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years.
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EP Payment Adjustments
% Decrease in the Percentage Increase to the IPPS Payment Rate that the hospital would otherwise receive for that year:
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Subsection (d) Hospital Payment Adjustments
2015 2016 2017 2018 2019 2020+
% Decrease 25% 50% 75% 75% 75% 75%
For a hospital that has demonstrated meaningful use in 2011 or 2012 (fiscal years):
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Subsection (d) Hospital EHR Reporting Period
Payment Adjustment Year 2015 2016 2017 2018 2019 2020
Full Year EHR Reporting Period
2013 2014 2015 2016 2017 2018
For a hospital that demonstrates meaningful use in 2013 for the first time:
Payment Adjustment Year 2015 2016 2017 2018 2019 2020
90 day EHR Reporting Period
2013
Full Year EHR Reporting Period
2014 2015 2016 2017 2018
For a hospital that demonstrates meaningful use in 2014 for the first time:
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Subsection (d) Hospital EHR Reporting Period
Payment Adjustment Year 2015 2016 2017 2018 2019 2020
90 day EHR Reporting Period
2014 2014
Full Year EHR Reporting Period
2015 2016 2017 2018
In order to avoid the 2015 payment adjustment the hospital must attest no later than July 1, 2014 which means they must begin their 90 day EHR reporting period no later than April 1, 2014
To Avoid Payment Adjustments: Hospitals must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years.
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Subsection (d) Hospital Payment Adjustments
Applicable % of reasonable costs reimbursement which absent payment adjustments is 101%: :
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Critical Access Hospital (CAH) Payment Adjustments
2015 2016 2017 2018 2019 2020+
% of reasonable costs
100.66%
100.33% 100% 100% 100% 100%
For a CAH who has demonstrated meaningful use prior to 2015 (fiscal years):
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CAH EHR Reporting Period
Payment Adjustment Year 2015 2016 2017 2018 2019 2020
Full Year EHR Reporting Period
2015 2016 2017 2018 2019 2020
For a CAH who demonstrates meaningful use in 2015 for the first time:
Payment Adjustment Year 2015 2016 2017 2018 2019 2020
90 day EHR Reporting Period
2015
Full Year EHR Reporting Period
2014 2015 2016 2017 2018
To Avoid Payment Adjustments: CAHs must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years.
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CAH Payment Adjustments
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Questions?
Rick YearryHealth Technology Services | Regional Extension
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Contact Information
