8/27/2015 American Academy of Pediatrics Ohio Section Cathy Costello, JD OHIP Manager, REC Services May 13,

Who is the Ohio Health Information Partnership? 8/27/20152

The Ohio Health Information Partnership Nonprofit partnership State-designated Regional Extension Center and Health Information Exchange Federal funding through Office of National Coordinator of HIT, Department of Health & Human Services Board members have vested interest in its success 8/27/20153

4 OHIP’s Founders

How can we help achieve the State’s health transformation objectives? 8/27/20155

Addressing the Hot Spots Regional Extension Center Services – Helps providers adopt EHRs and achieve meaningful use – Available at no cost to pediatricians regardless of physician’s eligibility for Medicaid incentives Health Information Exchange – Connects providers so they can electronically exchange data to better coordinate care 8/27/20156

Regional Extension Center Services 8/27/20157 Care Summaries e-Prescribing

Regional Extension Center Physician Sign-ups 8 Over 60,000 physicians have signed up nationally to receive REC services 8/27/2015

9 Preferred EHR Vendors

8/27/ ProOhio Vendor Program IT Support Document Imaging Human Resources Billing & Coding Security Controls Change Management Data Management

8/27/ Loan Program

HEALTH INFORMATION EXCHANGE 8/27/201512

An HIE moves patient information electronically among physician offices, hospitals and other health professionals directly involved in a patient’s care, such as pharmacies and labs. 8/27/2015 What is a Health Information Exchange? 13

Create a secure, sustainable Health Information Exchange To protect ALL patient records; Enable providers to access necessary, patient- authorized health information; and Improve the overall level of health care provided throughout the state of Ohio. 8/27/2015 What is OHIP’s Vision? 14

Phasing of HIE Services Hospitals 100 Offices 20 Hospitals 200 Offices 20 Hospitals 200 Offices Confidential, For Internal Discussion Only 8/27/2015

Prioritize coordination of care; Everyone pays a little; No one pays a lot; and Everyone helps enroll/implement physicians. 8/27/2015 Community Model 16

More Information on REC Services and HIE Development 8/27/201517

Priorities for Meaningful Use 8/27/2015 Structured Lab Results Care Summaries e-Prescribing 18

Medicaid AdoptImplementUpgrade 8/27/201519

Notable Differences Between the Medicare & Medicaid Incentives MedicareMedicaid Reimbursement for eligible professionals Based on Medicare Part B allowed charges Based on patient mix (EHR cost assumed) Types of eligible professionals Physicians, dentists, podiatrists, optometrists, chiropractor Physicians, dentists, nurse midwife, nurse practitioner and some PAs First payment year Demonstrate meaningful use over a continuous 90 days in the calendar year Can be for adopt, implement or upgrade only Subsequent payment yearsMust be consecutiveNeedn’t be consecutive for EPs PaymentsNo payments for years after 2016 Payments can start as late as 2016 and no payments after 2021 Penalties if not a MUserYesNo Consistent across nationYesStates choose to implement 20

Medicaid: 1st Payment Year For “Adopt, Implement, Upgrade” Eligible professionals can receive incentives for adoption, implementation and upgrade of certified EHR technology in their first year of participation “Adopt, implement, or upgrade” means: – Install or commence utilization of certified EHR technology capable of meeting meaningful use requirements; or – Expand the functionality of certified EHR technology capable of meeting meaningful use requirements at the practice site, including staffing, maintenance, and training. – Upgrade from existing EHR technology to certified EHR technology per the ONC EHR certification criteria. 21

Medicaid: 1st Payment Year For “Adopt, Implement, Upgrade” All eligible Medicaid providers will be “deemed” to have met the cost-base of the Medicaid EHR incentives—need only to demonstrate that the EHR system is CMS certified under the ATCB certification program. A practitioner can demonstrate that an EHR system is certified and the practitioner has Adopted/Implemented/Upgraded the system by uploading a copy of a: 1) Purchase order; 2) Contract; or 3) EHR software license to the Medicaid incentive program website during registration for the incentives. 8/27/201522

Medicaid Eligible Professional Incentive The Medicaid EHR incentive program reimbursement for eligible professionals is paid out over a six-year period. Professionals that meet Medicaid eligibility criteria will be paid the maximum incentive regardless of the cost of the certified EHR system that the professional is using. Pediatricians that meet the Medicaid 20% patient volume threshold will be paid $14,160 for the first year with a total EHR incentive of $42,500. Pediatricians that meet the Medicaid 30% patient volume threshold will be paid $21,250 for the first year with a total EHR incentive of $63,750. Pediatricians that fall between 20% and 30% Medicaid patient volume will be paid at the 20% threshold (i.e., $14,160 for the first year with a total incentive of $42,500). 8/27/201523

Meaningful Use Timeline Medicaid Incentives 8/27/2015 First Registration for the Incentive Program: Medicaid: June 2011 Demonstrate Eligibility: 20% Medicaid Patient Volume—Pediatricians 30% Medicaid Patient Volume—All Other Eligible Professionals Adopt, Implement or Use a Certified EHR System July 2011 First Payments Issued for Medicaid EHR Incentives: Maximum 1 st Year: $21,250 per Physician or Eligible Professional that Qualifies; No cost-based Reimbursement 24

What is MPIP? Ohio’s EHR program is the Medicaid Provider Incentive Program (MPIP) – Who is eligible? Eligible Hospitals: (acute care, cancer, children’s) Eligible Professionals: (physician, dentist, certified nurse midwives, nurse practitioners, Physician Assistants when practicing at an FQHC/RHC so led by a PA) – The MPIP will be available through CY 2021, but participation in the program is for 6 years, which can be non-consecutive years. 25

Notes on Medicaid Incentive Program Pediatricians (including subspecialists) that meet the eligibility requirements in Ohio will be eligible for Medicaid incentives at the 20% patient volume level. Must have pediatric board certification. All other physicians eligible at the Medicaid 30% patient volume level. Patient volume will be calculated based on the Medicaid services rendered on any one day to an individual where Medicaid paid for part or all of the service. 8/27/201526

Notes on Medicaid Incentive Program Medicaid eligibility will be determined by a practitioner’s Medicaid patient volume over a 90 day period in the preceding calendar year. The practice can choose the 90 day period for eligibility, but it must be for 3 consecutive months (e.g., January 1 – March 31, 2010 Medicaid patient volume to draw down 2011 EHR incentives). Medicaid will use an online attestation form that automatically calculates the eligibility based on patient volume totals entered by practitioner. There will be a slight adjustment to totals based on SCHIP population figures in the provider’s county. 8/27/201527

MPIP will be open in June 2011 – In March, first milestone of the MPIP system build was the completion of testing of the interface between the federal system (the National Level Repository) and MPIP. – In April, Ohio’s State Medicaid Health Information Technology Plan (SMHP) was approved by CMS. – In May, ODJFS will be putting the finishing touches on the customized build of the MPIP system: Ohio now appears in the state drop down box on CMS’ website, allowing Ohio providers to begin registration for Ohio’s program. In June, the launch of MPIP will occur, allowing providers to complete enrollment at Ohio’s MPIP site and upon approval, be eligible to receive their 1 st payment. 28

What is needed to register federally for either Medicare or Medicaid? Confirmed National Provider Identifier and NPPES account and password CMS/National Level Repository registration PECOS (for dual hospitals) 29

National Provider Identifier 30

CMS Registration 31

What is needed to enroll in MPIP? Once finished at the national registration website, providers will be sent to the Ohio site to begin MPIP enrollment. They will need: An active Medicaid provider agreement. – Providers without one will be directed to: MPIP uses only Electronic Funds Transfer (EFT). So providers who get paper warrants will have to go to Ohio Shared Services to sign up for EFT. 32

First-time User Registration 33 First-time users will receive a link to begin Registration

34 First-time User Registration Enter NPI, TIN, CMS Confirmation Number Enter the NPI, TIN and CMS Confirmation Number and click Register

35 First-time User Registration Establish Password Enter CMS Confirmation Number. Enter and confirm Password. Click Save to Continue.

Welcome Page 36 Press Continue to proceed with the MPIP enrollment process After logging into MPIP the first time, the user will see the Welcome page

Adopt, Implement, Upgrade (AIU) 37 Select AIU Designation Enter the CMS EHR Certification Number Select Supporting Documentation and Upload Upload AIU Documents

MPIP Registration 38

Stay in touch with Medicaid Visit the ODJFS MPIP Website at: Send an at 39

Why Is This Work Important? MOVING TO MEANINGFUL USE 8/27/201540

Meaningful Use Timeline Medicare Incentives 8/27/2015 First Registration for the Incentive Program: Medicare: January Days Meaningful Use April First Day of Attestation For Meaningful Use May 2011 First Payments Issued for Medicare EHR Incentives Maximum 1 st Year: $18,000 per Physician or Eligible Professional 41

Meaningful Use Tips Use Meaningful Use Attestation Calculator before going to actually register: Print out calculator’s summary page to see how close you are to meeting meaningful use Use the calculator as a guide for explaining the MU core and menu items and the exclusions 8/27/201542

Core and Menu Criteria Professionals must complete each of the core criteria unless unable to, due to scope of practice, population served or number in the denominator. For example: – Chiropractor and e-prescribing – CAH and no patients have requested electronic access Professionals may defer up to 5 of the menu criteria until stage 2 43

Core Criteria (15): All Patients: Record demographics Maintain an up-to-date problem list Maintain active medication list Maintain active medication allergy list EHR Patients: CPOE E-Prescribing Record and chart changes in vital signs Record smoking status Provide patients with an electronic copy of their health information Provide clinical summaries for patients for each office visit Implemented (Yes or No): Report Clinical Quality Measures Drug (D-A, D-D) Interactions Implement one clinical decision support rule Electronically exchange key clinical information Protect electronic health information created or maintained by certified EHR 44

Menu Criteria Professionals and hospitals may defer up to 5 of the menu criteria until stage 2 At least one of the criteria from population and public health must be included in order to qualify as a meaningful user 45

Menu Criteria (5 of 10): All Patients : Provide patients timely electronic access to their health information. Provide patient-specific education resources through the use of certified EHR technology. EHR Patients: Lab test results are stored as structured data Send appropriate reminders for preventive/follow up care Perform medication reconciliation on > 50% of transitions of care or relevant encounters. Provide a summary of care record for transitions of care and referrals. Implemented (Yes or No): Implement drug -formulary checks Generate at least one report of patients by specific condition Perform at least one test of submission of electronic data to immunization registries/systems. * Perform at least one test of providing electronic syndromic surveillance data to public health agencies. * * At least 1 public health objective must be selected 46

Reporting of Clinical Quality Measures EPs would be required to provide clinical data on 2 measure groups: – A core set of 3 measures (or alternates) (3 of 6) – 3 additional measures selected from among 38 others (3 of 38) EHR must be certified for these measures (ONC ‘CHPL’ website for confirmation)

Core Quality Measures for EPs Measure NumberClinical Quality Measure Title NQF 0013 Blood pressure measurement Percentage of patient visits for patients aged 18 years and older with a diagnosis of hypertension who have been seen for at least 2 office visits, with blood pressure (BP) recorded. NQF 0028 Tobacco use assessment and intervention 1.Percentage of patients aged 18 years and older who have been seen for at least 2 office visits who were queried about tobacco use one or more times within 24 months 2.Percentage of patients aged 18 years and older identified as tobacco users within the past 24 months and have been seen for at least 2 office visits, who received cessation intervention. NQF 0421 PQRI 128 Adult Weight Screening and Follow-up 1.Percentage of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documented in the medical record AND 2.if the most recent BMI is outside parameters, a follow-up plan is documented. 48

Alternate Core Quality Measures for EPs Measure NumberClinical Quality Measure Title NQF 0024 Weight Assessment and Counseling for Children and Adolescents Percentage of patients years of age who had an outpatient visit with a Primary Care Physician (PCP) or OB/GYN and who had evidence of BMI percentile documentation, counseling for nutrition and counseling for physical activity during the measurement year. NQF 0041, PQRI 110 Influenza Immunization for Patients ≥ 50 Years Old Percentage of patients aged 50 years and older who received an influenza immunization during the flu season (September through February). NQF 0038 Childhood Immunization Status Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio(IPV), one measles,mumps and rubella (MMR); two H influenza type B (HiB); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); two hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and nine separate combination rates. 49

Menu Quality Measures 38 other measures addressing: – Diabetes – Cardiovascular disease – Prevention – Asthma – Appropriate use of teste – Smoking and Tobacco use – Alcohol and Drug dependence – Oncology – Depression management – Others 50

Resources “Meaningful Use” information on the Health and Human Services web site: – “Meaningful Use” on the CMS web site: – Testing criteria for each of the EHR modules: – ents.html ents.html Quality Measure Specifications on the CMS web site: – fications.asp fications.asp 51

Questions? Cathy Costello, JD /27/201552