Betsy Thompson, M.D., CMS Chief Medical Officer - California ...

Can Specialists Meet theMeaningful Use Criteria?Absolutely!Learn HowBetsy L. Thompson, MD, DrPHChief Medical Officer, CMS, Region IXCalifornia Orthopedic Association Annual MeetingMay 20, 2011

Overview• Background and Policy Context• EHR Incentive Program Basics− Who is Eligible to Participate− How Much Are the Incentives− What Are the Requirements of MeaningfulUse− What You Need to Participate• Electronic Health Information and PaymentReform2

Background and Policy Context

An Unsustainable Status Quo• 46 51 million uninsured Americans• Health insurance premiums for family coverage at asmall business increased 85% since 2000• 16% 17.6%of our economic output tied up in thehealth care system• Without reform, by 2040, 1/3 of economic output tiedup in health care--15% of GDP devoted to Medicareand Medicaid• Without reform, the number of uninsured would growto 58 million in 2020**Source: Urban Institute: “The Cost of Failure to Enact Health Reform: 2010-2020”March 15, 20104

The Three Part Aim• Better Care– Patient Safety– Quality– Patient Experience• Reduce Per Capita Cost– Reduce unnecessary and unjustified medical cost– Reduce administrative cost thru process simplification• Improve Population Health– Decrease health disparities– Improve chronic care management and outcome– Improve community health status5

Federal Government Responds: HITECH Act• Part of American Recovery andReinvestment Act of 2009 (ARRA)• Goal: Every American to have an EHRby 2014• Systematically addresses major barriersto adoption and Meaningful Use:– Money/market reform– Technical assistance, support, and betterinformation– Health information exchange– Privacy and security6

EHR Incentive Program Basics7

Who is a Medicare Eligible Provider (EP)?Eligible Providers in Medicare FFSEligible Professionals (EPs)Doctor of Medicine or OsteopathyDoctor of Dental Surgery or Dental MedicineDoctor of Podiatric MedicineDoctor of OptometryChiropractorEligible HospitalsAcute Care Hospitals*Critical Access Hospitals (CAHs)*Subsection (d) hospitals that are paid under the PPS and are located in the 50 States or Washington, DC(including Maryland)8

Who is a Medicaid EligiblePhysiciansProvider?Eligible Providers in MedicaidEligible Professionals (EPs)Nurse Practitioners (NPs)Certified Nurse-Midwives (CNMs)DentistsPhysician Assistants (PAs) working in a FederallyQualified Health Center (FQHC) or rural health clinic(RHC) that is so led by a PAEligible HospitalsAcute Care Hospitals (now including CAHs)Children’s Hospitals9

How Much Are the Medicare EP Incentives?• Incentive amounts based on Fee-for-Serviceallowable charges• Maximum incentives are $44,000 over 5 years• Incentives decrease if starting after 2012• Must begin by 2014 to receive incentive payments.Last payment year is 2016.• 10% bonus amount available for practicingpredominantly in a Health Professional ShortageArea• Only 1 incentive payment per year10

Medicare EP Incentive PaymentsColumns = first calendar year EP receives a paymentRows = Amount of payment each year if continue to meet requirementsCY 2011 $18,000CY 2011 CY 2012 CY 2013 CY2014 CY 2015and laterCY 2012 $12,000 $18,000CY 2013 $8,000 $12,000 $15,000CY 2014 $4,000 $8,000 $12,000 $12,000CY 2015 $2,000 $4,000 $8,000 $8,000 $0CY 2016 $2,000 $4,000 $4,000 $0TOTAL $44,000 $44,000 $39,000 $24,000 $011

How Much Are the Medicaid EP Incentives?• Maximum incentives are $63,750 over 6 years• Incentives are same regardless of start year• The first year payment is $21,250• Must begin by 2016 to receive incentive payments• No extra bonus for health professional shortageareas available• Incentives available through 2021• Only 1 incentive payment per year12

Medicaid EP Incentive Payments DetailColumns = first calendar year EP receives a paymentRows = Amount of payment each year if continue to meet requirementsCY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016CY 2011 $21,250CY 2012 $8,500 $21,250CY 2013 $8,500 $8,500 $21,250CY 2014 $8,500 $8,500 $8,500 $21,250CY 2015 $8,500 $8,500 $8,500 $8,500 $21,250CY 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250CY 2017 $8,500 $8,500 $8,500 $8,500 $8,500CY 2018 $8,500 $8,500 $8,500 $8,500CY 2019 $8,500 $8,500 $8,500CY 2020 $8,500 $8,500CY 2021 $8,500TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,75013

Notable Differences Between Medicare andMedicaid Incentive ProgramsMedicareFederal Government will implement starting inJanuary 2011Payment reductions begin in 2015 forproviders that do not demonstrate MeaningfulUseMust demonstrate MU in Year 1Maximum incentive is $44,000 for EPs (bonusfor EPs in HPSAs)MU definition is common for MedicareLast year a provider may initiate program is2014; Last year to register is 2016; Paymentadjustments begin in 2015Only physicians, subsection (d) hospitals andCAHsMedicaidVoluntary for States to implement- Most areexpected to start by late summer 2011No Medicaid payment reductionsA/I/U option for 1 st participation yearMaximum incentive is $63,750 for EPsStates can adopt certain additionalrequirements for MULast year a provider may register for andinitiate program is 2016; Last payment year is20215 types of EPs, acute care hospitals (includingCAHs) and children’s hospitals14

What is Meaningful Use?• Meaningful Use is using certified EHR technologyto:− Improve quality, safety, efficiency, and reduce healthdisparities− Engage patients and families in their health care− Improve care coordination− Improve population and public health− All the while maintaining privacy and security• Meaningful Use mandated in law to receive incentives15

What are the Three Main Components ofMeaningful Use?The Recovery Act specifies the following 3components of Meaningful Use:1. Use of certified EHR in a meaningful manner(e.g., e-prescribing)2. Use of certified EHR technology for electronicexchange of health information to improvequality of health care3. Use of certified EHR technology to submitclinical quality measures (CQM) and other suchmeasures selected by the Secretary16

Timeline for Delivery System Reform andTransformation, 2011-2019MUStage 2MUStage 3MUStage 1SuccessfulPayment andService ModelInnovationProgram andPolicy RedesignHealthcareDelivery SystemReform andTransformation2012-20192014-20192011-201917

What are the Requirements of Stage 1Meaningful Use?Eligible Professionals must complete:• 15 core objectives• 5 objectives out of 10 from menu set• 6 total Clinical Quality Measures (3 core oralternate core, and 3 out of 38 from menuset)18

What are the Requirements of Stage 1Meaningful Use?Basic Overview of Stage 1 Meaningful Use:• Reporting period is 90 days for first yearand 1 year subsequently• Reporting through attestation• Objectives and Clinical Quality Measures• Reporting may be yes/no ornumerator/denominator attestation• To meet certain objectives/measures, 80%of patients must have records in thecertified EHR technology19

What are the Requirements of Meaningful Use?Eligible Professionals – 15 Core Objectives1. Computerized physician order entry (CPOE)2. E-Prescribing (eRx)3. Report ambulatory clinical quality measures toCMS/States4. Implement one clinical decision support rule5. Provide patients with an electronic copy of their healthinformation, upon request6. Provide clinical summaries for patients for eachoffice visit7. Drug-drug and drug-allergy interaction checks8. Record demographics20

What are the Requirements of Meaningful Use?Eligible Professionals – 15 Core Objectives (continued)9. Maintain an up-to-date problem list of current andactive diagnoses10.Maintain active medication list11.Maintain active medication allergy list12.Record and chart changes in vital signs13.Record smoking status for patients 13 years or older14.Capability to exchange key clinical informationamong providers of care and patient-authorizedentities electronically15.Protect electronic health information21

What are the Requirements of Meaningful Use?Menu objectives – must complete 5 of 10Eligible Professionals – 10 Menu Objectives1. Drug-formulary checks2. Incorporate clinical lab test results as structureddata3. Generate lists of patients by specific conditions4. Send reminders to patients per patientpreference for preventive/follow up care5. Provide patients with timely electronic access totheir health information22

What are the Requirements of Meaningful Use?Eligible Professionals – 10 Menu Objectives6. Use certified EHR technology to identify patient-specificeducation resources and provide to patient, ifappropriate7. Medication reconciliation8. Summary of care record for each transition ofcare/referrals9. Capability to submit electronic data to immunizationregistries/systems*10. Capability to provide electronic syndromic surveillancedata to public health agencies** At least 1 public health objective must be selected.23

What are the Requirements of Meaningful Use?• A Medicare Eligible Professional who does NOTdemonstrate meaningful use by 2015 will be subjectto payment reductions in their Medicarereimbursement schedule• Medicaid-only EPs are not subject to paymentreductions• Payment reductions may apply for any EP whoaccepts Medicare, even if you only participate inthe Medicaid EHR incentive program24

What are the Requirements?Clinical Quality MeasuresClinical Quality Measures – Core SetNQF Measure Number & PQRIImplementation NumberNQF 0013NQF 0028NQF 0421PQRI 128Clinical Quality Measure TitleHypertension: Blood PressureMeasurementPreventive Care and Screening MeasurePair: a) Tobacco Use Assessment, b)Tobacco Cessation InterventionAdult Weight Screening and Follow-up25

What are the Requirements?Clinical Quality MeasuresClinical Quality Measures – Alternate Core SetNQF Measure Number & PQRIImplementation NumberNQF 0024NQF 0041PQRI 110NQF 0038Clinical Quality Measure TitleWeight Assessment and Counseling forChildren and AdolescentsPreventive Care and Screening:Influenza Immunization for Patients 50Years Old or OlderChildhood Immunization Status26

What You Need to Participate• All providers must:− Register via the EHR Incentive Programwebsite− Be enrolled in Medicare FFS, MA, or Medicaid(FFS or managed care)− Have a National Provider Identifier (NPI)− Use certified EHR technology− Medicaid providers may adopt, implement, orupgrade in their first year• All Medicare providers and Medicaid eligiblehospitals must be enrolled in PECOSwww.cms.gov/EHRIncentivePrograms27

EHR Resources• Get information, tip sheets and more at CMS’ officialwebsite for the EHR incentive programs:www.cms.gov/EHRIncentivePrograms• For more about MU measures:http://www.cms.gov/QualityMeasures/03_ElectronicSpecifications.asp#TopOfPage• Learn about certification and certified EHRs, as wellas other ONC programs designed to supportproviders as they make the transition:http://healthit.hhs.gov28

Electronic Health Information andPayment Reform

Medicare Shared Savings Program• Mandated by Section 3022 of theAffordable Care Act• Establishes a Shared Savings Programusing Accountable Care Organizations(ACOs)• Must be established by January 1,2012• Notice of proposed rulemakingissued March 31 st 2011• CMS is seeking comments on theproposal. Comment period endsJune 6, 2011

Return on Investment from HITWide Spread Adoption of Electronic Health Information(EHI) Technologies for Better Outcomes , Lower Cost , ImprovePopulation HealthImproving Health Care Quality,Cost Performance, Population HealthROI of EHI at Point of Care:• Improved Patient Safety• Reduced Complications Rates• Reduced Cost per Patient Episode of Care• Enhanced cost & quality performanceaccountability• Improved Quality Performance• Improve Community Health SurveillanceBetterOutcomesLowerCostsPopulationHealth

Summary• Real health reform is built on quality andvalue and requires:− Meaningful use of EMRs− All of us working together (specialistsincluded!)323

Thank you!Contact info:betsy.thompson@cms.hhs.gov

APPENDIXClinical Quality MeasuresHITECH Components

What are the Requirements?Clinical Quality MeasuresAdditional set CQM– must complete 3 of 381. Diabetes: Hemoglobin A1c Poor Control2. Diabetes: Low Density Lipoprotein (LDL) Managementand Control3. Diabetes: Blood Pressure Management4. Heart Failure (HF): Angiotensin-Converting Enzyme(ACE) Inhibitor or Angiotensin Receptor Blocker (ARB)Therapy for Left Ventricular Systolic Dysfunction (LVSD)5. Coronary Artery Disease (CAD): Beta-Blocker Therapyfor CAD Patients with Prior Myocardial Infarction (MI)6. Pneumonia Vaccination Status for Older Adults7. Breast Cancer Screening35

What are the Requirements?Clinical Quality MeasuresAdditional set CQM– must complete 3 of 388. Colorectal Cancer Screening9. Coronary Artery Disease (CAD): Oral AntiplateletTherapy Prescribed for Patients with CAD10. Heart Failure (HF): Beta-Blocker Therapy for LeftVentricular Systolic Dysfunction (LVSD)11. Anti-depressant medication management: (a) EffectiveAcute Phase Treatment, (b)Effective Continuation PhaseTreatment12. Primary Open Angle Glaucoma (POAG): Optic NerveEvaluation36

What are the Requirements?Clinical Quality MeasuresAdditional set CQM– must complete 3 of 3813. Diabetic Retinopathy: Documentation of Presence orAbsence of Macular Edema and Level of Severity ofRetinopathy14. Diabetic Retinopathy: Communication with thePhysician Managing Ongoing Diabetes Care15. Asthma Pharmacologic Therapy16. Asthma Assessment17. Appropriate Testing for Children with Pharyngitis18. Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR)Positive Breast Cancer37

What are the Requirements?Clinical Quality MeasuresAdditional set CQM– must complete 3 of 3819. Oncology Colon Cancer: Chemotherapy for Stage IIIColon Cancer Patients20. Prostate Cancer: Avoidance of Overuse of Bone Scan forStaging Low Risk Prostate Cancer Patients21. Smoking and Tobacco Use Cessation, MedicalAssistance: a) Advising Smokers and Tobacco Users toQuit, b) Discussing Smoking and Tobacco Use CessationMedications, c) Discussing Smoking and Tobacco UseCessation Strategies22. Diabetes: Eye Exam23. Diabetes: Urine Screening38

What are the Requirements?Clinical Quality MeasuresAdditional set CQM– must complete 3 of 3824. Diabetes: Foot Exam25. Coronary Artery Disease (CAD): Drug Therapyfor Lowering LDL-Cholesterol26. Heart Failure (HF): Warfarin Therapy Patientswith Atrial Fibrillation27. Ischemic Vascular Disease (IVD): Blood PressureManagement28. Ischemic Vascular Disease (IVD): Use of Aspirinor Another Antithrombotic39

What are the Requirements?Clinical Quality MeasuresAdditional set CQM– must complete 3 of 3829. Initiation and Engagement of Alcohol and OtherDrug Dependence Treatment: a) Initiation, b)Engagement30. Prenatal Care: Screening for HumanImmunodeficiency Virus (HIV)31. Prenatal Care: Anti-D Immune Globulin32. Controlling High Blood Pressure33. Cervical Cancer Screening34. Chlamydia Screening for Women40

What are the Requirements?Clinical Quality MeasuresAdditional set CQM– must complete 3 of 3835. Use of Appropriate Medications for Asthma36. Low Back Pain: Use of Imaging Studies37. Ischemic Vascular Disease (IVD): Complete LipidPanel and LDL Control38. Diabetes: Hemoglobin A1c Control (

HITECH: How the Pieces Fit TogetherRegional Extension CentersWorkforce TrainingMedicare and MedicaidIncentives and PenaltiesADOPTIONMEANINGFUL USEImproved Individual &Population HealthOutcomesIncreasedTransparency &EfficiencyImprovedAbility to Study &Improve Care DeliveryState Grants forHealth Information ExchangeStandards & Certification FrameworkPrivacy & Security FrameworkEXCHANGEHealth IT Practice Research42