This document discusses how healthcare organizations can connect quality data requirements from meaningful use (MU) to operational improvements. It provides an overview of MU implications for staffing, alliances/referrals, and use of quality data. Organizations are encouraged to use quality metrics and outcomes data to tell their quality story, maximize benefits across payors and programs, and operationalize MU by focusing on users and workflow. As MU requirements progress, organizations will need to assess changing IT and staffing needs to effectively support higher data volumes and complexity.

1. Beyond Meaningful Use:
Connecting quality data requirements to business
operational improvements
Linda ClenDening, MS, CMPE
PYA

2. Agenda
• Data and quality clinical outcomes
• Regulatory information highlights and audits
• Meaningful Use (MU) implications for
– Staffing/Roles
– Alliances/Referrals
– Meaningful data

3. Quality Outcomes

4. Quality Data in the Exam Room
xx% of my patients over 18 who have their tonsils
removed experience post-surgical hemorrhaging.
These outcomes are less than the national average of
yy% of patients over 18.

5. Quality Data
What’s the source of the data?

6. Communicating About Quality
If he’s using clinical outcomes statistics in the exam
room, where else is he using them?

7. Doctor’s Lounge
Communicating with referring
physicians?

8. Board Table
Quality contractual requirements between
hospitals and physicians
– Employment arrangements
– Clinical co-management
– ACOs
– Other partnerships

9. Negotiating Table
Once quality metrics are
operationalized for one payor, the
provider can build on that strength
to discuss quality with other
contracting payors.

10. Website
How is he attracting patients to his practice based
on quality outcomes?

11. Take Away #1
• What story are you telling about the
physicians in your practice using the quality
data collected in the MU process?
• Focus on a core measure metric or clinical
quality metrics and develop the story.

12. MU Statistics as of
June 2013
Medicare EP.s
Medicaid EP.s
$3,000,000,000
$2,500,000,000
Almost
6 billion
dollars to
EP.s todate
$2,000,000,000
$1,500,000,000
$1,000,000,000
$500,000,000
$2011
2012
2013 YTD
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/June_PaymentRegistration_Summary.pdf

13. Real World Impact of MU
•
More than 458 million test results were entered into the EHR by 111,954
Eligible Providers (EP.s).
•
Medication reconciliation was performed on over 40 million patient transitions
of care by 83,035 EP.s.
More than 4.3 million patient transitions of care summaries were generated
by 24,827 EP.s.
•
By Robert Tagalicod, Director, Office of E-health Standards and Services http://www.cms.gov/eHealth/ListServ_RealWorldImpact_MeaningfulUse.html

14. Meaningful Use
Headlines
• July 30, 2013 – AHA and AMA, as well as CHIME
(College of Healthcare Information Management
Executives), request more time for Stage 2.
• July 30, 2013 –AHA report calls for a delay of Eligible
Hospital Stage 2 deadline of October 1, 2013.
• September 24, 2013 – Senators call for one-year
Stage 2 Meaningful Use extension.
As reported in HealthLeaders Media and EHRIntelligence.

15. Meaningful Use
Current Details
• Stage 2 Meaningful Use (MU) Attestation begins in calendar year
2014 for Eligible Providers (EP.s).
– If a provider began MU in 2011, he/she will meet three consecutive
years of MU before beginning Stage 2 in 2014.
– All other providers meet two years of MU before advancing to Stage 2
in their third reporting year.
• For 2014 only, all providers – regardless of MU stage – are only
required to demonstrate MU for a 3 month reporting period.
• Beginning in 2015, Medicare eligible professionals who do not
successfully demonstrate meaningful use will be subject to a
payment adjustment.

16. Penalty Scenarios
Requirement to Avoid Penalty
First Year of
MU
2015
2016
2017
2011
Achieve MU in 2013
(365 days)
Achieve MU in 2014
(One 3-month
quarter)
Achieve MU in 2015
(365 days)
2012
Achieve MU in 2013
(365 days)
Achieve MU in 2014
(One 3-month
quarter)
Achieve MU in 2015
(365 days)
2013
Achieve MU in 2013
(Any 90-consecutive-day
period)
Achieve MU in 2014
(One 3-month
quarter)
Achieve MU in 2015
(365 days)
2014
Achieve MU in 2014 (Any
90-consecutive-day
period ending no later
than 3 months before the
end of the reporting
period)
Achieve MU in 2014
(One 3-month
quarter)
Achieve MU in 2015
(365 days)

17. MU Role in New Care Model
Development
•
•
•
•
Consolidation/M&A
ACOs
Clinically Integrated Networks
Private Payor Network
Development/Contracting
• Others

18. MU & Consolidation
• Weathering the storm with a bigger ship:
– From 2000 to 2010, hospital physician employment
rose 32%.
– Hospitals directly employ about a quarter of all U.S.
physicians.
– By 2013, two-thirds of physicians will work for
hospitals or large groups.
• Strategic Consideration:
– Affiliate or merge with an organization without an MU
plan or at risk of a penalty?

19. MU & Consolidation
• Transaction Due Diligence Consideration:
– Meaningful Use due diligence now occurs in most
healthcare transactions.
– Organizational readiness for Meaningful Use
Attestation requires detailed supporting
documentation.

20. MU & ACOs
• Public Payor
• Medicare
• Medicaid
• Private Payor
• Private Payors (Blue Cross, United, Cigna, Aetna)
• ACOs with private insurers in effect or development at
four times the rate of Medicare ACOs
• Large Employers
• Self-Insured Hospitals and Health Systems

21. MU & ACOs
• ACO 33 Quality Measures include:
– Percent of PCPs who Successfully Qualify for MU
Payment
– CQMs overlap with ACO measures

22. Clinical Quality Measure (CQM) Overlap with
ACO and Other Programs
Stage 2 2014 CQM Measure
Other CMS Program
Controlling High Blood Pressure Percentage of patients 18-85 years of
age who had a diagnosis of hypertension and whose blood pressure
was adequately controlled (<140/90mmHg) during the measurement
period.
ACO; EHR PQRS; Group
Reporting PQRS
Use of High-Risk Medications in the Elderly
PQRS
Preventive Care and Screening: Tobacco Use: Screening and Cessation
Intervention
ACO; EHR PQRS
Group Reporting
PQRS
Use of Imaging Studies for Low Back Pain
Preventive Care and Screening: Screening for Clinical Depression and
Follow-Up Plan
EHR PQRS; ACO; Group
Reporting PQRS
Documentation of Current Medications in the Medical Record
PQRS; EHR PQRS
Preventive Care and Screening: Body Mass Index (BMI) Screening and
Follow-Up
EHR PQRS; ACO; Group
Reporting
PQRS

23. 2013 PQRS
• If you have EPs that meet MU, don’t leave
money on the table:
– 2013: 0.5% incentive
– 2015: 1.5% penalty
• Assess crosswalk opportunities for quality
reporting across programs.

24. MU & Private Payor Contracting
• A growing number of private payers have added
the MU requirements to their P4P programs:
– Aetna, United and WellPoint
– Highmark modified "Quality Blue" program to include
MU:
• Require copy of attestation
• Incorporate CQM for physician practice best practice
indicator program
• Payors not setting up proprietary mini-MU
programs
– Rather use developed MU system
– Similar to using DRGs as a reference price for rates

25. Take Away #2
• Incorporate MU into Compliance Program.
– Compliance Officer involvement in attestation and annual
review.
• Ensure attestation documentation is consistent with
CMS’s recommendations.
• Prepare for more oversight – not just from CMS.
• Maximize MU attestation benefits with other payors
and alliances.

26. Operationalizing
to imperfect users.
Adapting a perfect
program…

27. Operationalizing
Much more about the people,
than the systems.

28. Meaningful Use Progression
As Meaningful
Use
requirements
progress there
will be a
higher volume
of data
requirements
and more
complexity.
The systems
need to carry
the burden to
prompt users
to do the right
thing.

29. We can only do so much.

30. MU Staffing Changes
Other
No staffing changes made
Group 2
Group 1
Increased clinical staff
Increased clerical staff
0%
10%
20%
30%
40%
50%
60%

31. MU Staffing Changes?
• Increased data input demands on current staff.
• Hired dedicated quality manager.
• Shift in resources in IT department to focus on MU
readiness.
• We used outside consultants for MU attestation.

32. MU Staffing Changes
Increased duties and responsibilities of
current staff, including
Administrator/Director.
Use of consultants for MU implementation
and attestation process.
New IT team members: Quality staff, EMR
analysts, and EMR trainers

33. New IT Staff Positions
No
Group 2
Group 1
Yes
0%
20%
40%
60%
80%

34. New IT Staff Positions for MU?
• Not yet, but we are discussing these.
• Hired a portal manager.

35. IT Staff Positions Added
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Group 1
Group 2
Report/data
specialist
Clinical data
analyst
Training
Other

36. IT Functional Roles Changing
40%
35%
30%
25%
20%
15%
Group 1
10%
Group 2
5%
0%
Increase in
support/
help desk
Increase in
liaison/
networking
support
Increase in
leadership/
management
Other

37. Staffing Changes
EMR Build Specialists
Healthcare Analytics
Project Management
Program Management
Application Development
Data Architecture
Quality Assurance
Source: 7 Hottest IT Healthcare Skills http://www.cio.com/slideshow/detail/70112#slide1 www.CIO.com October 18, 2012

38. IT Functional Roles Changing
• Anticipate increased need of support for
– New hardware
– Networking
– Remote access
– Interoperability issues
2012 HIMSS Leadership Survey

39. Strategic Partnerships
based on Quality?
45%
40%
35%
30%
25%
Group 1
20%
Group 2
15%
10%
5%
0%
Yes
No
Unknown

40. MU effect on Alliance Decisions
Other (please specify)
MU not considered
Group 2
Referral partners
MU attested
Group 1
Referral partners
asked about MU
0%
20%
40%
60%
80%
100%

41. Take Away #3
• Re-assess staff skills and training for EHR
usage.
• Determine possible staff duty changes.
• Document process and workflow redesign for
EHR/MU implementation.
• Update all affected policies and procedures.
• Redesign monthly reports and dashboards to
include key MU metrics.

42. The Meaningful Use Goal
❝Language is the road map of a culture. It tells
you where its people come from and where
they are going.❞
‒Rita Mae Brown
Healthcare providers, executives, and staff are
engaged in developing a new language.

43. Thank you!
Linda ClenDening, MS, CMPE
Manager
PYA
lclendening@pyapc.com
615-305-5218
865-684-2735