Meaningful Use 2013 Changes Overview JoAnne Hawkins Meaningful Use

Meaningful Use 2013 Changes Overview JoAnne Hawkins Meaningful Use Sr. Healthcare Policy Analyst DNC (Contractor) for U.S. Indian Health Service January 29, 2013

Today’s Objectives Review and understand CMS EHR Incentive Program Stage 1, 2013 changes Review Patient Volume Calculation changes Review Performance Measure changes 2

2013 Changes All changes made for 2013 are not retroactive to CY/FY 2011 or 2012 3

MEANINGFUL USE 4

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 5

3 Stages of Meaningful Use 6

TIMELINE 7

Eligible Professionals: Incentive Program Timeline CY 2013 01/01/13 First day of calendar and EHR reporting year 10/03/13 Last day to begin 90-day reporting period for the Medicare Incentive Program 12/31/13 Last day of calendar and EHR reporting year 02/28/14 Last day to register and attest

Eligible Hospitals: Incentive Program Timeline FY 2013 10/03/12 07/01/13 First day of calendar and EHR reporting year 09/30/13 11/30/13 Last day of fiscal year and EHR reporting year LAST day to begin 90-day reporting period for the Medicare Incentive Program Last day to register and attest

Medicaid EP/EH MU Timeline 2011 2012 2013 2014* 2015 2016 2017 A/I/U Stage1 MU 90 Days Stage 1 MU 365 Days Stage 2 MU 90 Days Stage 2 MU 365 Days Stage 3 MU 365 Days Stage 3 MU 365 Days A/I/U Stage1 MU 90 Days Stage 1 MU 90 Days Stage 2 MU 365 Days Stage 2 MU 365 Days Stage 3 MU 365 Days A/I/U Stage1 MU 90 Days Stage 1 MU 365 Days Stage 2 MU 365 Days Stage 2 MU 365 Days A/I/U Stage 1 MU 90 Days Stage 1 MU 365 Days Stage 2 MU 365 Days A/I/U Stage 1 MU 90 Days Stage 1 MU 365 Days A/I/U Stage 1 MU 90 Days 10

Medicare EP/EH MU Timeline 2011 2012 2013 2014* 2015 2016 Stage1 MU 90 Days Stage 1 MU 365 Days Stage 1 MU 365 Days Stage 2 MU 90 Days Stage 2 MU 365 Days Stage 3 MU 365 Days Stage1 MU 90 Days Stage 1 MU 365 Days Stage 2 MU 90 Days Stage 2 MU 365 Days Stage 3 MU 365 Days Stage1 MU 90 Days Stage 1 MU 90 Days Stage 2 MU 365 Days Stage 2 MU 365 Days Stage1 MU 90 Days Stage 1 MU 365 Days Stage 2 MU 365 Days 11

Eligible Professionals: Medicare Incentive Payment Example Amount of Payment Each Year of Participation Calendar Year EP Receives a Payment CY 2011 CY 2012 CY 2013 CY2014 CY 2015 and later CY 2011 18,000 CY 2012 12,000 18,000 CY 2013 8,000 12,000 15,000 CY 2014 4,000 8,000 12,000 12,000 CY 2015 2,000 4,000 8,000 8,000 0 2,000 4,000 4,000 0 44,000 39,000 24,000 0 CY 2016 TOTAL 44,000 12

Eligible Professionals: Medicaid Incentive Payment Example 1st Calendar Year EP Receives a Payment Amount of Payment Each Year if Continues Meeting Requirements CY 2011 CY 2011 21,250 CY 2012 8,500 21,250 CY 2013 8,500 8,500 21,250 CY 2014 8,500 8,500 8,500 21,250 CY 2015 8,500 8,500 8,500 8,500 21,250 CY 2016 8,500 8,500 8,500 8,500 8,500 21,250 8,500 8,500 8,500 8,500 8,500 8,500 8,500 8,500 8,500 8,500 8,500 8,500 8,500 8,500 CY 2017 CY 2012 CY 2018 CY 2013 CY 2019 CY 2014 CY 2020 CY 2015 CY 2021 TOTAL CY 2016 8,500 63,750 63,750 63,750 63,750 63,750 63,75013

EP PATIENT VOLUME AND MEDICAID HOSPITAL INCENTIVE CALCULATION 14

Eligible Professionals and Medicaid: Patient Volume Threshold If EP does not practice predominantly at FQHC/RHC: Minimum Medicaid patient volume thresholds If EP does practice predominantly at FQHC/RHC*: Minimum needy individual patient volume thresholds 30% 30% 20% 30% Dentists 30% 30% Certified NurseMidwives 30% 30% NPs 30% 30% PAs practicing at an FQHC/RHC that is led by a PA N/A 30% Eligible Professional (EP) Physicians - Pediatricians * All Tribal/Urban clinics are deemed FQHC/RHC for the CMS incentive program 15

EP Patient Volume Current Patient Volume Calculation is based on Medicaid Paid Claims Beginning in 2013, the patient volume calculation will include: Medicaid paid claims Zero paid claims Individuals enrolled in Medicaid at the time of service CHIP encounters for patients in Title 19 and Title 21 Medicaid expansion programs (still cannot include CHIP stand-alone Title XXI encounters) Release date for New Patient Volume Report will be April 30, 2013. 16

EP Patient Volume Calculation EP Patient Volume Calculation 2013 (Non-Medicaid Expansion State) – Federal Sites Numerator Denominator Medicaid Paid Zero Paid Claims Medicaid Enrolled All encounters for that EP EP Patient Volume Calculation 2013 Medicaid Expansion State – Federal Sites Numerator Medicaid Paid Zero Paid Claims CHIP Medicaid Enrolled Denominator All encounters for that EP 17

EP Needy Patient Volume EP Patient Volume Calculation – Needy Individual (Tribal and Urban sites) Numerator Denominator Medicaid Paid Zero Paid Claims Medicaid Enrolled CHIP (Title 19 & Title 21) Uncompensated Care All encounters for that EP 18

Patient Volume Look-Back Period Prior to 2013, patient volume was calculated on a 90-day period on the previous calendar year (qualification year) Beginning in 2013, states have the option to allow EPs to generate a patient volume report based on a different look-back period, either: across a 90-day period in the last 12 months preceding the provider’s attestation; or a 90-day period in the previous calendar year 19

MEDICAID HOSPITAL INCENTIVE CALCULATION 20

Medicaid Incentive Hospital Calculation Change Prior to 2013, Medicaid Hospital Incentive Calculation was based on the most recent cost report data (previous year) Participation beginning in 2013 can utilize data from the most recent continuous 12-month period prior to attestation FEIR report will be updated to reflect the data elements needed for Medicaid Hospital Incentive Calculation 21

STAGE 1 2013 MU PERFORMANCE AND CLINICAL QUALITY MEASURES 22

2013 MU Requirements Stage 1: 2013 Objectives and Measures Eligible Professionals must complete: 13 core objectives 5 out of 10 objectives from menu set 6 total Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from additional set) Eligible Hospitals must complete: 12 core objectives 5 out of 10 objectives from menu set 15 Clinical Quality Measures Note: A new performance measure report will be released in March 2013

Stage 1: 2013 Performance Measures EP EH Target Core Measure X X X X X X X X X X X X 30% Yes/No 80% 40% 80% 80% 50%: 50% 50% CPOE for Medication Orders *Measure change* Drug Interaction Checks Maintain Problem List E-Prescribing *New Exclusion added* Active Medication List Medication Allergy List Record Demographics Record Vital Signs Record Smoking Status X X X X X Clinical Quality Measures *Removed in 2013* X X X X X X X Yes/No 50% 50% 50% X Yes/No Clinical Decision Support Rule Electronic Copy of Health Information Clinical Summaries Electronic Copy of Discharge Instructions Electronic Exchange of Clinical Information *Removed in 2013* Protect Electronic Health Information

2013: Stage 1 Performance Measures EP EH Target Menu Set Measure X Yes/No Drug Formulary Checks X 50% Advance Directives X X 40% Clinical Lab Test Results X X Yes/No X Patient Lists X 20% Patient Reminders X 10% Patient Electronic Access X X 10% Patient Specific Education Resources X X 50% Medication Reconciliation X X 50% Transition of Care Summary X X Yes/No *Immunization Registries Data Submission X X Yes/No *Syndromic Surveillance Data Submission X Yes/No *Reportable Lab Results to Public Health Agencies

CPOE Objective: Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed health care professional who can enter orders into the medical record per state, local, and professional guidelines. DENOMINATOR: Number of medication orders created by the EP during the EHR reporting period NUMERATOR: The number of medication orders in the denominator recorded using CPOE THRESHOLD: The resulting percentage must be more than 30 percent in order for an EP to meet this measure EXCLUSION: Any EP who writes fewer than 100 medication orders during the EHR reporting period 26

e-Prescribing Objective: Generate and transmit permissible prescriptions electronically (eRx) . DENOMINATOR: Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the EHR reporting period; or Number of prescriptions written for drugs requiring a prescription in order to be dispensed during the EHR reporting period NUMERATOR: The number of prescriptions in the denominator generated, queried for a drug formulary and transmitted electronically using CEHRT THRESHOLD: The resulting percentage must be more than 50 percent in order for an EP to meet this measure EXCLUSIONS: Any EP who: (1) Writes fewer than 100 permissible prescriptions during the EHR reporting period; or (2) Does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP’s practice location at the start of his/her EHR reporting period. 27

Eligible Professionals: Clinical Quality Measures Core Set: If denominator 0, must report on the Alternate Core measures NQF Measure Number and PQRI Implementation # 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 0421 PQRI 128 Adult Weight Screening and Follow-up 28

Eligible Professionals: Clinical Quality Measures Alternate Core Set NQF Measure Number and PQRI Implementation # Clinical Quality Measure Title NQF 0024 Weight Assessment and Counseling for Children and Adolescents NQF 0041 PQRI 110 Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or Older NQF 0038 Childhood Immunization Status 29

Eligible Professionals: 38 Additional Clinical Quality Measures (Choose 3) Diabetes: 9 Heart Failure (HF): 3 Coronary Artery Disease (CAD): 3 Pneumonia Vaccination Status for Older Adults Anti-depressant medication management: 2 Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation Asthma: 3 Appropriate Testing for Children with Pharyngitis Cancer Prevention and/ or Oncology: 6 Smoking and Tobacco Use Cessation: 3 Ischemic Vascular Disease (IVD): 3 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: 2 Prenatal Care: 2 Controlling High Blood Pressure Chlamydia Screening for Women Low Back Pain: Use of Imaging Studies 30

Eligible Hospitals: 15 Clinical Quality Measures 1. 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 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. Anticoagulation overlap therapy 11. Ischemic or Hemorrhagic stroke – Stroke Education 12. Intensive Care Unit VTE prophylaxis 13. Platelet monitoring on unfractionated heparin 14. VTE discharge instructions 15. Incidence of potentially preventable VTE 31

RESOURCES 32

Resources Stage 1 Changes Tip Sheet : http:// www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentiveProgram s/Downloads/Stage1ChangesTipsheet.pdf Stage 2 Final Rule: http:// www.gpo.gov/fdsys/pkg/FR-2012-09-04/pdf/2012-21050.pdf 33

Area MU Contacts Area Area MU Contact Email Phone Number Aberdeen CAPT Scott Anderson [email protected] (605) 335-2504 Alaska Richard Hall Kimi Gosney Karen Sidell [email protected] [email protected] [email protected] (907) 729-2622 (907) 729-2642 (907) 729-2624 Albuquerque Jacque Candelaria [email protected] (505) 946-9311 Bemidji Jason Douglas [email protected] (218) 444-0550 Billings CAPT James Sabatinos [email protected] (406) 247-7125 California Marilyn Freeman Steve Viramontes [email protected] [email protected] (916) 930-3981 x.362 (916) 930-3981 x.359 Nashville Robin Bartlett [email protected] (615) 467-1577 Navajo CDR Michael Belgarde Donna Nicholls [email protected] [email protected] (928) 871-1416 (505) 205-9177 Oklahoma Amy Rubin [email protected] (405) 951-3732 Phoenix CAPT Lee Stern Keith Longie, CIO [email protected] [email protected] (602) 364-5287 (602) 364-5080 Portland Woody Crow [email protected] (503) 414-5594 Tucson Scott Hamstra, MD [email protected] (520) 295-2532

Regional Extension Center REC REC Contact Email Areas NIHB Tom Kauley [email protected]; (505) 977-6053 All ANTHC Richard Hall Kimi Gosney Karen Sidell [email protected]; (907) 729-2622 [email protected]; (907) 729-2642 [email protected]; (907) 729-2624 Alaska CRIHB Tim Campbell Rosario Arreola Pro Amerita Hamlet [email protected]; (707)889-3009 California [email protected]; (916)929-9761 x.1300 [email protected]; (916)929-9761 x.1323 NPAIHB Katie Johnson [email protected]; (503) 416-3272 Portland USET Vicki French [email protected] (615)-467-1578 Aberdeen Albuquerque Bemidji Billings Nashville Navajo Oklahoma Phoenix Tucson

IHS Meaningful Use: Contact Information Contact Title E-mail Phone Chris Lamer Meaningful Use Project Lead, IHS [email protected] (615) 669-2747 Luther MU Project Alexander Manager, DNC [email protected] (301) 443-8114 JoAnne Hawkins MU Healthcare Policy Analyst, DNC [email protected] (505) 767-6600, x1525 Cecelia Rosales MU Requirements Manager, DNC [email protected] (505) 767-6600, x1230 36

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