Health IT Policy Committee Meeting June 10, 2014 Data Analytics Update 1

PROGRESS AND PERFORMANCE Progress and performance among Eligible Professionals in the first 3 years of the EHR Incentive Program -Who achieved meaningful use in first 3 years? -Who is achieving meaningful use year-over-year? -How does performance on meaningful use objectives vary? 2

Majority of eligible professionals have attested to stage 1 3 Note: Categories are hierarchical and mutually exclusive. For example, a professional that has attested to meaningful use and received an AIU payment and is enrolled with an REC is counted only in the Attested MU category. MU is meaningful use. AIU is adopt/implement/upgrade to certified EHR technology. REC is Regional Extension Center.

Variation in Meaningful Use attainment by physician age, specialty, group size 4 Note: Physician specialty and age are from the CMS EHR Incentive Programs and the 2011 American Medical Association Masterfile. Group size is the number of providers counted under the same billing ID in the 2013 PECOS dataset. All physician data were merged via NPI to the CMS EHR Incentive Program data through April, Likelihood of ever attesting to Stage 1 meaningful use among physicians, April 2014 Age Specialty Group size Relative Risk

Variation in Meaningful Use attainment by area characteristics 5 Urban/Rural Primary Care HPSA % county population Hispanic % county population black % county population in poverty Note: County-level information is pulled from the 2012 Area Resource File. Urban is metropolitan; Rural is non-metropolitan. Primary Care Health Professional Shortage Areas (HPSA) is calculated at the zip code level, based on the CMS Primary Care HPSA zip code definitions from Based on CMS EHR Incentive data through April, Likelihood of ever attesting to Stage 1 meaningful use among physicians, April 2014 Relative Risk

Variation in Meaningful Use attainment by technical assistance, delivery characteristics 6 Note: Regional Extension Center enrollment as of May 4, Patient-Centered Medical Home (PCMH) certification reflects National Committee for Quality Assurance PCMH certification as of May, State Innovation Model reflects professionals in states with Model Testing awards from CMS to implement a State Health Care Innovation Plan to transform health care delivery systems through multi-payer payment reform and other state-led initiatives. Beacon Community reflects professionals located in zip codes that were part of the Beacon Community Program. All data are merged by physician NPI to CMS EHR Incentive Program data through April Regional Extension Center Participation PCMH Certification State Innovation Model Beacon Community Likelihood of ever attesting to Stage 1 meaningful use among physicians, April 2014 Relative Risk

PROGRESS AND PERFORMANCE Progress and performance among Eligible Professionals in the first 3 years of the EHR Incentive Program -Who achieved meaningful use in first 3 years? -Who is achieving meaningful use year-over-year? -How does performance on meaningful use objectives vary? 7

Majority of eligible professionals return to attest year after year attestation patterns among Medicare professionals who first attested to meaningful use in k Medicare eligible professionals attested in % attested in 2011, 2012, and % skipped % 44% of providers who attested in 2011 and skipped 2012 returned in % 16% skipped 2012 Year 1 Year 2 Year 3 84% 7% 9% 9% skipped 2012 and % attested in 2012 Attested in year Attested ever but skipped current year Note: Providers skipping a year include providers who may have retired or no longer be in active practice. Based on analysis of CMS Medicare and Medicaid EHR Incentive Program Electronic Health Record Products Used for Attestation public use data file, March

Some types of physicians were more likely to skip both 2012 and 2013 than others 9 Overall rate9% Rate by characteristic Behavioral Health18% Non-Direct Patient Care12% Primary Care9% Medical Surgical Specialty9% Solo practice15% 2-5 providers12% 6-10 providers10% providers9% 51+ providers7% Rural11% Urban9% Percent of physicians in 2011 attestation cohort who skipped attestation in 2012 and 2013 by characteristic Note: Physician specialty and age are from the CMS EHR Incentive Programs and the 2011 American Medical Association Masterfile. Group size is the number of providers counted under the same billing ID in the 2013 PECOS dataset. Urban is metropolitan; Rural is non-metropolitan. All physician data were merged via NPI to the CMS EHR Incentive Program data through April, Does not include Medicare Advantage providers.

PROGRESS AND PERFORMANCE Progress and performance among Eligible Professionals in the first 3 years of the EHR Incentive Program -Who achieved meaningful use in first 3 years? -Who is achieving meaningful use year-over-year? -How does performance on meaningful use objectives vary? 10

Performance relative to core objective thresholds increases with each payment year and new cohort **Average performance relative to core objective thresholds statistically higher (p<0.001) than reference year/cohort (attestation year 1 and 2011 cohort) in regression model controlling for other physician and practice characteristics. Cohort indicates the year the physician first attested to Medicare Meaningful Use. Score is the average percentage by which the professional exceeded the threshold across all core objectives. Based on Medicare attestation data through April Average performance relative to core objective thresholds by cohort and year of attestation, Medicare physicians Physicians in their 3 rd year of meaningful use scored an average of 86% above the thresholds across all core objectives 11

Physicians in larger practices and participating in PCMH have higher average performance relative to core objective thresholds 12 Performance by characteristic Solo practice78% 2-5 providers79% 6-10 providers79% providers80% 51+ providers85% PCMH Certified87% Not PCMH Certified82% Average performance relative to core objective thresholds by group size and PCMH certification No major differences by other characteristics such as physician age and urban/rural location Note: Group size is the number of providers counted under the same billing ID in the 2013 PECOS dataset. Patient-Centered Medical Home (PCMH) certification reflects National Committee for Quality Assurance PCMH certification as of May, All physician data were merged via NPI to the CMS EHR Incentive Program data through April, 2014.

PLANS FOR NEXT UPDATE Plans for next update in July: Early Stage 2 experience 13

QUESTIONS? Questions? 14