An Update on Implementing Meaningful Use
Across Indian Country
Joint MU Conference, Albuquerque, NMJanuary 19, 2011
Stephanie Klepacki, IT SpecialistMU Program Manager
Indian Health Service (IHS), Office of Information Technology (OIT)
2
Today’s Session
• What is Meaningful Use?• CMS EHR Incentive Program Eligibility
Requirements• Demonstration of Meaningful Use• Implementing Meaningful Use Across Indian
Country• RPMS Reporting & Meaningful Use Toolkit• CMS & REC Registration Information
3
What is Meaningful Use?• Meaningful Use is using certified EHR
technology to:• Improve quality, safety, efficiency, and reduce health
disparities• Engage patients and families in their health care• Improve care coordination• Improve population and public health• All the while maintaining privacy and security
• CMS provides incentive payments to promote adoption and meaningful use of a certified EHR
Slide content provided by CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
4
What isMeaningful Use?• 3 stages of Meaningful Use• Requirements will increase over time…more work
lies ahead
Stage 12011-2012
Stage 22013-2014
Stage 32015+
Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
CMS EHR Incentive Program Eligibility Requirements
5
6
EP Eligibility – General
• Eligible Professionals (EPs) • Must choose the Medicare OR Medicaid incentive
program; not eligible for both• Eligibility determined by law• Hospital-based EPs are NOT eligible for incentives
• DEFINITION: 90% or more of their covered professional services in either an inpatient or emergency room (Place of Service codes 21 or 23) of a hospital
• Incentives are based on the individual, not the practice
Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
7
EP Eligibility – Medicare
• Medicare Eligible Professionals include:• Doctors of medicine or osteopathy• Doctors of dental surgery or dental medicine• Doctors of podiatric medicine• Doctors of optometry• Chiropractors
• Specialists are eligible if meet one of above criteria
Slide content provided by CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
8
EP Eligibility –Medicaid
• Medicaid Eligible Professionals include:• Physicians• Nurse practitioners• Certified nurse-midwives• Dentists• Physician assistants working in a Federally Qualified
Health Center (FQHC) or rural health clinic (RHC) that is so led by a physician assistant
Slide content provided by CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
9
EP Eligibility – Medicaid (cont’d)
• Medicaid Eligible Professionals must also meet one of the three patient volume thresholds:• Pediatricians: Have a minimum of 20% Medicaid
patient volume• Have a minimum of 30% Medicaid patient volume• EPs that work primarily in FQHC or RHC: Have a
minimum of 30% Needy Individual patient volume, defined as patients:• Enrolled in Medicaid or CHIP,• Received uncompensated care, or• Received care on a reduced fee scale
Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
10
Hospital Eligibility
• IHS hospitals are eligible to participate in both the Medicare and Medicaid incentive programs
• Eligibility determined by law• Eligible IHS Hospitals include:
• Acute Care Hospitals• Critical Access Hospitals (CAHs)
• For Medicaid, must meet a 10% Medicaid patient volume requirement; no requirement for Medicare
Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
11
IncentivesSummary
MEDICARE MEDICAID
Eligible Providers
HospitalsEligible
ProvidersHospitals
Incentives Start
CY 2011 FY 2011 CY 2011 FY 2011
IncentivesEnd
CY 2016(max. 5 years)
FY 2015(max. 4 years)
2021(max. 6 years, must start by
2016)
2021(max. 6 years,
must start by 2016)
Incentive Amount
Up to $44,000 total per provider; based on %
Medicare claims (bonus for EPs in
HPSAs)
Varies, depending on % Medicare
inpatient bed days. CAHs paid based on EHR costs and
% Medicare inpatient bed days
Up to $63,750 total per provider;
based on 85% of EHR costs
Varies, depending on % Medicaid
inpatient bed days
Reimbursement Reduced
CY 2015 FY 2015 No penalties No penalties
12
Do I Have toDemonstrate MU?
• To receive incentive payments, EPs and hospitals must meet all eligibility requirements and:• 1st Participation Year, Medicaid: Both EPs and
hospitals only have to adopt, implement, or upgrade to a certified EHR• This does not have to start in 2011
• All Other Participation Years, Medicaid: Demonstrate Meaningful Use of a certified EHR
• All Participation Years, Medicare: Demonstrate Meaningful Use of a certified EHR
Demonstration of Meaningful Use
13
What it Means toDemonstrate MU
Providers HospitalsReport on 15 core objectives & 5 objectives from a menu set of 10
- Must meet performance targets on most objectives
Report on 14 core objectives & 5 objectives from a menu set of 10
- Must meet performance targets on most objectives
Report on 6 total Clinical Quality Measures (3 core, 3 menu set)
- No performance targets
Report on 15 total Clinical Quality Measures
- No performance targetsSlide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
14
MU Stage 1Core Set Objectives
CORE SET TARGETS AND OBJECTIVES
Eligible Professionals (15) Eligible Hospitals (14)
>30%: Computerized physician order entry (CPOE): Unique patients w/at least 1 medication on medication list have at least 1 medication ordered w/CPOE
>40%: E-Prescribing (eRx) N/A
Report ambulatory clinical quality measures to CMS/States Report hospital clinical quality measures to CMS or States
Yes/No: Implement one clinical decision support rule
>50%: Provide patients with an electronic copy of their health information, upon request
>50%: Provide clinical summaries for patients for each office visit >50%: Provide patients with an electronic copy of their discharge instructions at time of discharge, upon request
Yes/No: Implement drug-drug and drug-allergy interaction checks during the entire EHR reporting period
>50%: Record demographics
>80%: Maintain an up-to-date problem list of current and active diagnoses
>80%: Maintain active medication list
>80%: Maintain active medication allergy list
>50%: Record and chart changes in vital signs
>50%: Record smoking status for patients 13 years or older
Test Performed (Yes/No): Capability to exchange key clinical information among providers of care and patient-authorized entities electronically
Yes/No: Conduct or review a security risk analysis per CFR 164.308(a)(1) and implement security updates as necessary & correct deficiencies 15
MU Stage 1Menu Set Objectives
MENU SET TARGETS AND OBJECTIVES
Eligible Professionals Eligible Hospitals
Yes/No: Implement drug-formulary checks for entire EHR reporting period
>40%: Incorporate clinical lab test results as structured data
Yes/No: Generate lists of patients by specific conditions
>10%: Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate
>50%: Medication reconciliation at transitions of care
>50%: Summary of care record for each transition of care/referrals
Performed Test (Yes/No): Capability to submit electronic data to immunization registries/systems*
Performed Test (Yes/No): Capability to provide electronic syndromic surveillance data to public health agencies*
>20%: Send reminders to patients per patient preference for preventive/follow up care
>50%: Record advanced directives for patients 65 years or older
>10%: Provide patients with timely electronic access to their health information (within 4 business days)
Performed Test (Yes/No): Capability to provide electronic submission of reportable lab results to public health agencies*
*At least 1 public health objective must be selected
NOTE: States have the option to require one or more of the items shown in italic font as core objectives 16
Clinical Quality Measuresfor EPs
• Clinical Quality Measures (CQM) – Core Set for Eligible Professionals
NQF Measure Number & PQRI Implementation Number
Clinical Quality Measure Title
NQF 0013 Hypertension: Blood Pressure Measurement
NQF 0028 Preventive Care and Screening Measure Pair: a) Tobacco Use Assessment, b) Tobacco Cessation Intervention
NQF 0421PQRI 128
Adult Weight Screening and Follow-up
Slide content provided by CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
17
Clinical Quality Measures for EPs (cont’d)
• CQM – Alternate Core Set for Eligible Professionals
NQF Measure Number & PQRI Implementation Number
Clinical Quality Measure Title
NQF 0024 Weight Assessment and Counseling for Children and Adolescents
NQF 0041PQRI 110
Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or Older
NQF 0038 Childhood Immunization Status
Slide content provided by CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
18
• Must also choose 3 of 38 menu set measures
Clinical Quality Measures for Hospitals and CAHs
• CQM for eligible hospitals and CAHs - must report on all1. Emergency Department Throughput – admitted patients –
Median time from ED arrival to ED departure for admitted patients
2. Emergency Department Throughput – admitted patients – Admission decision time to ED departure time for admitted patients
3. Ischemic stroke – Discharge on anti-thrombotics
4. Ischemic stroke – Anticoagulation for A-fib/flutter
5. Ischemic stroke – Thrombolytic therapy for patients arriving within 2 hours of symptom onset
Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
19
Clinical Quality Measures forHospitals and CAHs
• CQM for eligible hospitals and CAHs (cont’d)6. Ischemic or hemorrhagic stroke – Antithrombotic therapy
by day 2
7. Ischemic stroke – Discharge on statins
8. Ischemic or hemorrhagic stroke – Rehabilitation assessment
9. VTE prophylaxis within 24 hours of arrival
10. Intensive Care Unit VTE prophylaxis
11. Anticoagulation overlap therapy
12. Platelet monitoring on unfractionated heparin
13. VTE discharge instructions
14. VTE discharge instructions
15. Incidence of potentially preventable VTE
Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)
20
Role of the States andMedicaid MU
• Medicaid Eligibility, Patient Volume Calculation• Each State can pick from the proposed methodologies,
OR, • Propose a new method for CMS review and approval• If CMS approves a method for one state, it may be
considered an option for all states
21
Role of the States andMedicaid MU (cont’d)
• MU Objectives: States can seek CMS prior approval to require the 4 Public Health MU objectives to be core for their Medicaid providers• Generate lists of patients by specific conditions for quality
improvement, reduction of disparities, research, or outreach (can specify particular conditions)
• Reporting to immunization registries, • Reportable lab results, and/or • Syndromic surveillance (can specify for their providers
how to test the data submission and to which specific destination)
22
Implementing Meaningful Use Across Indian Country
23
Certification/MU(C/MU) Team
• MU Federal Lead/COTR: Stephanie Klepacki• EHR Cert. Federal Lead: Chris Lamer• C/MU Contractor PM: MB Leaf• 3 C/MU Teams
National MU Team: 5 FTEs EHR Certification Team: 2 FTEs MU/IPC Field Team: 12 IHS Area MU Coordinators
+ 16 contractor IPC-MU Consultants
24
National MU Team• Role
o Analysis of ONC & CMS rule requirementso Training/educationo Outreach & communicationo Stakeholder collaboration & coordinationo MU web site and ListServ managemento RPMS gap analysiso Develop requirements for MU tools
o Medicaid Patient Volume Reporto MU Performance Report for EPs and Hospitalso Coordinate development of MU Clinical Quality Measure reports
o Field Team support
25
EHR CertificationTeam
• Roleo Analysis & implementation of EHR certification requirements
and testingo RPMS gap analysiso Coordination of RPMS development for required changeso Conduct baseline, pre-certification, and certification testingo Complete all paperwork/requirements for EHR certification in
both ambulatory and inpatient settings
26
MU/IPC Field Team
• Roles• Ensure MU is implemented within all facilities at each Area• Provide MU training within each Area• Determine each State Medicaid Program’s requirements for MU
and payment• Monitor each State’s readiness for MU• Identify each State’s health information exchange (HIE)
requirements (e.g. can they connect to the Nationwide Health Information Network-NHIN)
• Coordinate with EHR Deployment Team, Improving Patient Care (IPC) & State and National Indian Health Board National Regional Extension Center (REC) staff
• Compile information and provide assistance as needed to register with CMS, State Medicaid, and to complete Provider Agreement with an REC 27
Area MU Coordinators
Area MU Coordinator Contact Information
Aberdeen CAPT Scott Anderson [email protected]; (605) 335-2504
Alaska
Richard HallKimi GosneyErika Wolter
[email protected]; (907) [email protected]; (907) [email protected]; (907) 729-3907
Albuquerque
CAPT Theresa Tsosie-Robledo (Acting) [email protected]; 505-414-2769
Bemidji Jason Douglas Alan Fogarty, CIO
[email protected]; (218) 444-0550 [email protected]; (218) 444-0538
Billings CAPT James
Sabatinos [email protected]; (406) 247-7125
California Marilyn Freeman,
RHIA
[email protected]; (916) 930-3981, ext. 362
Nashville CDR Robin Bartlett [email protected] ; (615) 467-1577
Navajo LCDR Andrea Scott [email protected]; (928) 292-0201
Oklahoma CDR Amy Rubin [email protected]; (405) 951-3732
Phoenix CAPT Lee Stern Keith Longie, CIO
[email protected]; (602) 364-5287 [email protected]; (602) 364-5039
Portland CAPT Leslie Dye Donnie Lee, MD
[email protected]; (503) 326-3288 [email protected]; (503) 326-2017
Tucson Scott Hamstra, MD [email protected]; (520) 295-2532
28
Area MU Consultants(Contractors,15-mos Term)
Area MU Consultants Contact Information
Team Lead (ABQ) JoAnne [email protected]; (505) 263-
6917
Regional Consultant #1 TBD
Regional Consultant #2 TBD
Aberdeen Carol Smith [email protected]; (605) 355-2500
Alaska
1) Karen Sidell2) Rochelle (Rocky) Plotnick
[email protected]; (907) [email protected]; (907) 729-2679
Albuquerque TBD
Bemidji TBD
Billings Jeremy [email protected] ; (406) 247-
7125
California Tim [email protected]; (707) 889-
3009
Nashville Robin [email protected]; (615) 467-
1577
Navajo TBD
Oklahoma Ursula Hill [email protected]; (405) 365-6069
Phoenix Kelly Morris [email protected]; Phone TBD
Portland Angela [email protected] ; 503-858-3330
Tucson Rick [email protected]; (520) 603-
6817
29
RPMS Reporting & MU Toolkit
30
31
• Patient Volume Report• MU Performance Report for EPs and Hospitals• MU Clinical Quality Measures Report • EHR MU Guide• EHR Costs Guidance• IHS Cost Report Guidance for State Medicaid Offices• Facility MU Status/Readiness Assessment tool
• Provider Inventory • EHR Status Verification• CMS Bulk Registration Guidance
Coming Soon
32
Patient Volume Report
• Nearing completion of requirements documentation• Anticipated mid-March release• Calculates
• Whether EP/hospital meets the Medicaid minimum patient volume thresholds• Group practice rate in lieu of calculating the rate for each
individual EP • Will be added to RPMS Third Party Billing (TPB)• Relies on information stored in RPMS TPB• Sites using a COTS TPB will not be able to run this
report
• Show performance on all MU objectives that calculate a rate, e.g., CPOE rate, demographic rate, e-prescribing rate, etc.
• May also include measures that require a yes/no answer, e.g., performance of a test of facility’s ability to electronically exchange key clinical information
• If all objectives included, then may suffice as the attestation report for submittal to CMS or the respective State
• Included in PCC Management Reports initially and subsequently added to a new MU tab in iCare
• Two versions of the Stage 1 report:o 1st release: All objectives that we can report now without
the need to wait for changes to be made to RPMS. (Mid-March release)
o 2nd release: All objectives, including those for which changes needed to be made to RPMS. (TBD)
MU Performance Reports for EPs & Hospitals
33
34
MU Clinical Quality Measures Report• 2 new reports added to the RPMS Clinical Reporting
System (CRS) (EP and Hospital Report)• Release Plano 1st Release
9 EP measures (3 core/3 alternate core/3 menu set [pap, mammogram, and colorectal cancer screening)
CRS v11.0 Patch 1, est. mid-Marcho 2nd Release
All 15 hospital measures CRS v11.0 Patch 2, est. late April
o 3rd Release Remaining 35 EP menu set measures CRS v11.1. est. June 30
• The reports will also be added to a new MU tab in iCare
35
Other Resources
• EHR MU Guide o EHR Deployment Team + MU Teamo Documentation showing steps for entering MU information into
the EHR GUI o Release: TBD
• EHR Costs o MU Team developing formula/calculation for hospitals to
determine their EHR costso Release: February
• IHS Cost Report Guidance for State Medicaid Officeso Required by states to determine incentives as IHS does not
routinely submit cost reportso IHS is working with CMS to develop a uniform approach for all
stateso Release: TBD
Other Resources (cont’d)
• Facility MU Status/Readiness Assessment Toolo Post-deployment MU status for use by IPC-MU Consultantso Based on EHR Deployment & IPC assessment toolso Release: TBD
• Provider Inventoryo In concert with REC provider sign-up & sub-recipient collaboration, Area
MU Consultants are compiling provider lists o Baseline for status tracking, reporting
• EHR Status Verificationo In concert with Provider Inventory, Area MU Consultants are reviewing
EHR Deployment Team data o Baseline for status tracking & reporting
36
Other Resources (cont’d)
• CMS Bulk Registration Guidanceo IHS is working with CMS on secure bulk upload of registration datao Process to save time & effort for providers & hospitalso IHS is checking on capability for Tribes and State Medicaid siteso Release: TBD
37
CMS and REC Registration Information
38
Register with Whom for What?!• You must REGISTER for incentive payments via:
o Medicare Incentives Only: CMS national website for Medicareo Medicaid Only OR Both Medicaid & Medicare: BOTH CMS
national website + State Medicaid website o You must register with CMS first even if you are participating in ONLY
the Medicaid program
• You should COMMIT to a Regional Extension Centero NIHB National REC vs. State RECso Per Dr. Cullen, IHS providers should sign up with the NIHB National
RECo Tribal providers are encouraged to sign with a REC (National or
State) of their choosing o Sign-up ASAP by completing a provider agreement!!!o Release of critical ONC funding to support RECs is dependent upon
the expedited receipt of provider agreements 39
Registering for theCMS Incentive Program
• If you will participate in the Medicaid EHR Incentive Program, you must register with CMS and your respective State
• Registration open now- Alaska - Mississippi
- Iowa - North Carolina
- Kentucky - South Carolina
- Louisiana - Tennessee
- Oklahoma - Texas
- Michigan
• Registration opens in February 2011- California
- Missouri
- North Dakota
40
Registering (cont’d)• Currently must register each EP separately. • CMS estimates secure batch registration available in April. • Not required to provide information on which certified EHR you are
using when you register.• First register on the CMS website and then with your respective
State, if applying for Medicaid incentives.• EPs may switch between the two programs anytime prior to first
payment; after that, may only switch once before 2015.• CMS recommends hospitals register for both programs, even if you
don’t know yet if you meet the Medicaid patient volume requirements.
• Visit CMS website for more information• http://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestati
on.asp#TopOfPage
CMS recommends waiting until State Medicaid site is available
before initiating registration.41
Regional Extension Centers
• All federal sites must register with the National Indian Health Board’s National Regional Extension Center (NIHB National REC)o Registration occurring now via NIHB website
http://www.nihb.org/rec/rec.php
• Tribal sites may register with an REC of their choice, including the NIHB National RECo ONC list of RECs
http://healthit.hhs.gov/portal/server.pt?open=512&objID=1495&mode=2
42
Resources to Get Help andLearn More
• IHS Meaningful Use Websitehttp://www.ihs.gov/recovery/index.cfm?module=dsp_arra_meaningful_use
• Sign up for the IHS Meaningful Use listserv (see instructions at the top of the Meaningful Use website)
• Get information, tip sheets, and more at CMS’ official website for the EHR incentive programswww.cms.gov/EHRIncentivePrograms
• Learn about EHR certification and certified EHRs, as well as other ONC programs designed to support providers as they make the transitionhttp://healthit.hhs.gov
43
Contact Information
• IHS Meaningful Use Contacts• Theresa Cullen, RADM, MD, MS IHS Chief Information Officer (301) 443-9848 [email protected]
• Stephanie Klepacki, Meaningful Use Project Lead, IHS (505) 821-4480 [email protected]
• MB Leaf, Meaningful Use Project Manager, DNC (301) 704- 2608 [email protected]
44
Question & Answer Session
It’s time to…
46
Top Related