Stage 2 Meaningful Use - Transforming into a Superhero (Alabama MGMA)

Stage 2 Meaningful Use – Transforming into a Superhero Adele Allison National Director of Government Affairs March 2, 2012 Less Risk, More Results. That’s Success

Future of Meaningful Use – Stage 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

U.S. Government 101 – Ten Questions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The Hill ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Legislation and Health IT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The HIPAAMIPPACHIPRAARRAPPACA Era! ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ARRA/HITECH (Generally ) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Summing-up HITECH Goals ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Meaningful Use – 3-Part Equation ,[object Object],[object Object],[object Object],[object Object],Shamrock Meaningful Use of a Shamrock

Stage 1 – Objectives & Measures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Medicare Incentive – Stage 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Potential Medicare Incentives Calendar Year First Calendar Year in which the EP Receives an Incentive Payment 2011 2012 2013 2014 2015 and subsequent years – Penalties Start 2011 $18,000 2012 $12,000 $18,000 2013 $8,000 $12,000 $15,000 2014 $4,000 $8,000 $12,000 $12,000 2015 $2,000 $4,000 $8,000 $8,000 $0 2016 $2,000 $4,000 $4,000 $0 TOTAL $44,000 $44,000 $39,000 $24,000 $0 Shortage Area Totals* $48,400 $48,400 $42,900 $26,400 $0 * Providers practicing in a federally identified shortage area are eligible for a 10% increase .

Medicaid Incentives – Stage 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Potential Medicaid Incentives Calendar Year First Calendar Year in which the EP Receives an Incentive Payment 2011 2012 2013 2014 2015 2016 2011 $21,250 2012 $8,500 $21,250 2013 $8,500 $8,500 $21,250 2014 $8,500 $8,500 $8,500 $21,250 2015 $8,500 $8,500 $8,500 $8,500 $21,250 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250 2017 $0 $8,500 $8,500 $8,500 $8,500 $8,500 2018 $0 $0 $8,500 $8,500 $8,500 $8,500 2019 $0 $0 $0 $8,500 $8,500 $8,500 2020 $0 $0 $0 $0 $8,500 $8,500 2021 $0 $0 $0 $0 $0 $8,500 TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750

Meaningful Use – State of the Union ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],YTD Eligible Professionals – Year 1 Payments 4,550 Internal Med. 4,896 Family Med. 1,652 Cardiology 388 OB/Gyn 1,031 Gastro 757 Urology 534 Nephrology 738 Gen’l Surgery 837 Orthopedics 569 Neurology 4,960 Other YTD Eligible Professionals – Year 1 Payments 13,652 Physicians 3,176 Nurse Prac. 401 Mid-Wives 887 Dentists 203 Physician Asst.

Meaningful Use – State of the State (AL) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Since Stage 1 Final Rule – July, 2010 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Stage 2 Meaningful Use – HIE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Certified EHR Technology ,[object Object],[object Object],[object Object],BASIC EHR – Everyone must have; “fundamental set of criteria;” Statutorily defined BASIC CORE EHR – EHR is certified for Core measures sought for the Stage sought by EP; Addresses specialists E.g., Psychiatrist does not do vitals = no certified vitals product required CORE MENU MENU EHR – Most dynamic; Only certified for that sought by EP for Stage sought

Since Stage 1 – Timelines ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Meaningful Use – Stage 2Timing ,[object Object],[object Object],[object Object],First Payment Year Payment Year 2011 2012 2013 2014 2015 2011 Stage 1 Stage 1 Stage 2 Stage 2 Stage 3 2012 Stage 1 Stage 1 Stage 2 Stage 3 2013 Stage 1 Stage 2 Stage 3 2014 Stage 1 Stage 3 2015 Stage 3 First Payment 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

Proposed Stage 1 Changes – CY2013 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Proposed Stage 1 Changes – CY2013 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ONC Original HIE Vision Medicaid Individual Facilities State Agencies Health Information Organizations Inter-State Public Health Corrections Fed Agencies Other States Statewide HIE MD Office MD Offices Hospital (CAHs) Hospital Other Community Providers Private HIE

Alabama One Health Record Dr. Smith Rural Health Emergency Urban Center Query Retrieve Billy Bob RHIO ONC Standard XDS Use Case : Car Wreck

Alabama One Health Record Dr. Smith Internist Dr. Heart Cardiologist ) Consult Referral Consult Report Betty Lou Use Case : Arrythmia ONC Standard DIRECT

Stage 2 Measures – 17 Core 17 Core Objectives No. Objective Measure Threshold New, Revised, Expanded, or Unchanged Exclusion 1 Computerized Provider Order Entry (CPOE) Use CPOE for medication, lab and radiology orders entered by any professional permitted by law 60% ( ↑ from 40%) Expanded EP has < 100 Rx, lab, radiology orders collectively 2 Generate and Transmit Permissible Prescriptions Electronically Using a certified EHR technology and compared to at least 1 drug formulary (still excludes controlled substance [Sch. II-V] and OTC) 65% ( ↑ from 40%) Expanded ,[object Object],[object Object],3 Record Patient Demographics Gender, race, ethnicity, DOB, and preferred language as structured data 80% ( ↑ from 50%) Expanded None 4 Record Vital Signs and Chart Changes Height & weight (all ages), blood pressure (ages 3+), BMI (all ages), and growth charts for children (0-20) as structured data 80% ( ↑ from 50%) Revised ,[object Object],[object Object],[object Object],5 Record Smoking Status Patients age 13 and older as structured data 80% ( ↑ from 50%) Expanded EP does not see pts. age 13+

Stage 2 Measures – 17 Core 17 Core Objectives No. Objective Measure Threshold New, Revised, Expanded, Consolidated or Unchanged Exclusions 6 Implement Clinical Decision Support and Track Compliance ,[object Object],[object Object],[object Object],5 Rules and Rx alerting by attestation Expanded / Consolidated None 7 Provide Patients with Clinical Summaries For each office visit to patients within 24 hours , which includes up-to-date lists of problems, medications and Rx allergies (paper and electronic must be avail. to pt.) 50% (Unchanged) Expanded / Consolidated EP has no office visit during EHR reporting period 8 Implement Systems to Protect Privacy and Security of Patient Data Conduct/review a security risk analysis; implement security updates as necessary and correct security deficiencies; encrypt data at rest in accordance with 45 CFR 164.312(a)(2)(iv) and 45 CFR 164.306(d)(3) During Reporting Period by attestation Expanded None 9 Incorporate Clinical Lab Test Results into EHR Incorporated as structured data – positive/negative or numerical format – within the EHR 55% ( ↑ from 40% and made Core) Expanded EP orders no lab tests during EHR reporting period 10 Generate Lists of Patients by Condition 1 List with a Specific Condition for use in quality improvement, reduction of disparities, research or outreach By attestation (Made Core) Unchanged None 11 Send Reminders to Patients Preventative and follow-up care for all patients based on clinically relevant info for anyone with an OV in past 24 months 10% ( ↓ from 20%, all patients and Made Core) Expanded EP has no office visit in previous 24 months

Stage 2 Measures – 17 Core 17 Core Objectives No. Objective Measure Threshold New, Revised, Expanded, Consolidated or Unchanged Exclusions 12 Timely Electronic Access to Health Information Patients can view online, download and transfer info within 4 days of being available to EP, subject to EPs discretion to withhold certain info ,[object Object],[object Object],New ,[object Object],[object Object],13 Use EHR for Patient-Specific Education Resources Provide patient-specific education resources to all patients 10% (Unchanged but made Core and “if appropriate removed) Expanded EP has no office visit during EHR reporting period 14 Perform Medication Reconciliation During transitions of care (TOC) 65% ( ↑ from 50% and Made Core) Expanded EP not recipient of any TOC during EHR reporting period 15 Provide Summary of Care Record Patients referred or transitioned to another provider or setting and electronically transmit to a different system. ,[object Object],[object Object],Expanded; New EP neither transfers nor refers patient during EHR reporting period

Stage 2 Measures – 17 Core *Exclusion does not apply if the registry can accept data through a designated HIE. 17 Core Objectives No. Objective Measure Threshold New, Revised, Expanded, Consolidated or Unchanged Exclusions 16 Use of secured messaging with Patients Send secured messages to patients seen during reporting period 10% New EP has no office visit during EHR reporting period 17 Submission of Electronic Immunization Data to Registry/Information Systems Ongoing submission During Entire EHR Reporting Period (Made Core) Expanded ,[object Object],[object Object],[object Object]

Stage 2 Measures – 3 of 5 Menu * Exclusion does not apply if data can be accepted through a designated HIE 3 of 5 Menu Objectives No. Objective Measure Threshold New, Revised, Expanded, Consolidated or Unchanged Exclusions 1 Submission of Electronic Syndromic Surveillance Data Ongoing data submission to Public Health agencies (where agencies can accept electronic data) During Entire EHR Reporting Period Expanded ,[object Object],[object Object],[object Object],2 Imaging Results and Information Are accessible through the CEHRT 40% New EP does not perform diagnostic interpret. Of scans/test whose result is an image during reporting period 3 Patient Family Health History Structured data entry for one or more first-degree relatives 20% New EP has no office visits during reporting period 4 Submission of Cancer Cases Ongoing data submission to a state cancer registry During Entire EHR Reporting Period New ,[object Object],[object Object],5 Submission of Specialized Cases Ongoing data submission to a specialized registry During Entire EHR Reporting Period New ,[object Object],[object Object]

Clinical Quality Measures (CQMs) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Assessment – “You Are Here” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

IT Vendor and Practice Redesign ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Practice Redesign ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Copies available at: [email_address] Follow me on Twitter: www.twitter.com/Adele_Allison

Stage 2 Meaningful Use - Transforming into a Superhero (Alabama MGMA)

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Stage 2 Meaningful Use - Transforming into a Superhero (Alabama MGMA)