New Jersey Institute of Technology Enterprise Development Center (EDC) 211 Warren Street, Newark, NJ Phone: Fax: Meaningful Use Final Rules & Stage 3 Proposed Rule 1

Modifications to Meaningful Use in – Final Rules

Goals of Modifications Proposed Rule 3 Align with Stage 3 proposed rule to achieve overall goals of programs Synchronize reporting period objectives and measures to reduce burden Continue to support advanced use of health IT to improve outcomes for patients Align with Medicare Access and CHIP Reauthorization Act of 2015 and MIPS

How does it impact 4 Streamlines program by removing redundant, duplicative and topped out measures Aligned reporting period with full calendar year Changes EHR reporting period in 2015 to 90-day period to accommodate modifications Removed the core, menu structure. One set of measures for all stages. Promotes improved patient outcomes and health information exchange

How does it impact 5 Measure Changes Changing the threshold for two measures requiring patient action  2 nd measure in patient electronic access  Secure message Consolidating public health measures in to one measure Changing the eligible hospital electronic prescribing objective to a core objective with exclusions Additional exclusions for providers who have already established the workflows

Changes to timeline 6

7 Stage 1 providers will have additional exclusions in 2015 Stage 1 providers will have additional exclusions in 2016 for most measures except measures like Health Information Exchange measure

Stage 1 Providers in Maintaining the specifications for objectives and measures that have a lower threshold or other measure differences between Stage 1 and Stage 2; Establishing exclusion for Stage 2 measures that do not have an equivalent Stage 1 measure associated with any Stage 1 objective, or where the provider did not plan to attest to the menu objective that would now be otherwise required.

For New Participants 9 All EPs and EHs can report for any 90 days in 2015 First time EP and EH participants in 2016 & 17, any 90 day period Returning participants in 2016 onwards, full year reporting 90 day reporting for providers starting Stage 3 in 2017 Stage 1 Year 1 Medicaid providers can always report for any continuous 90 days, regardless of the year

Final Measure Structure 10

Objectives Removed 11

Objectives Removed 12

Modified Stage 1 and Stage 2 Measures 13 1.Computerized Provider Order Entry (CPOE) – 60% Med, 30% Rad and 30% Lab Stage 1 providers report 30% med Exclusions available 2. Electronic Prescribing (eRx) – 50% EP and 10% EH Stage 1 providers can report 40% Hospitals can exclude in 2015 or Clinical Decision Support – 5 rules + Drug-drug, drug-allergy interaction Stage 1 option – 1 rule Stage 2 – 4 rules must be related to CQMs

Modified Stage 1 and Stage 2 Measures Patient Electronic Access to Health Information – 50% and 1 patient views Stage 1 exclusion for 2 nd measure in 2015 At least one patient views, downloads or transmits information in 2015 and % access in Protect Electronic Health Information Can be conducted anytime before attestation, but during the calendar year Encryption of ePHI in storage 6. Patient Education Stage 1 exclusion in 2015 Can occur anytime before attestation during the reporting period year

Modified Stage 1 and Stage 2 Measures Medication Reconciliation Stage 1 exclusion in Summary of Care – 10% electronic Stage 1 exclusion in 2015 Modified definition - transmit the summary of care record electronically 9. Secure Message Stage 1 exclusion in 2015 Function was enabled in 2015, one patient in 2016 and 5% in 2017 Provider initiated messages should be counted

Modified Stage 1 and Stage 2 Measures 16 Final Public Health Objectives Active engagement definition for public health requirements Active Engagement Option 1–Completed Registration to Submit Data: Within the first 60 days of the reporting period Active Engagement Option 2 - Testing and Validation: Within 30 days of notification from the PH agency Active Engagement Option 3 – Production: Actively sending production data

Modified Stage 1 and Stage 2 Measures 17 Public Health Objectives Public Heath Requirement – Stage 1 EP Must meet 1 of 3, EH must meet 2 out of 4, Stage 2 EP Must meet 2 of 3, EH must meet 3 out of 4  Measure 1– Immunization Registry Reporting Bi-direction removed  Measure 2 – Syndromic Surveillance Reporting  Measure 3 – Case Reporting - Removed  Measure 4 – Public Health Registry Reporting- Removed  Measure 5 – Clinical Data Registry Reporting – Removed  3, 4 & 5 combined back in to Specialized registry and includes cancer case registry option (Measure 3)  Measure 6 – Electronic Reportable Laboratory Results (Measure 4)

Modified Stage 1 and Stage 2 Measures 18

Clinical Quality Measures 19 Proposing no changes to CQM selection or reporting scheme from CQM requirements in Stage 2 rule For EHR reporting period in proposing providers attest to any continuous 90-day period of CQM data during calendar year Either through Medicare EHR Incentive Program attestation site or have the option to electronically report CQM data using established methods for electronic reporting

Clinical Quality Measures 20 For 2017 and subsequent years, providers beyond first year of meaningful use may attest to one full calendar year of CQM data or electronically report CQM data using established methods for electronic reporting outlined Starting 2018, Medicare providers have to report CQMs electronically Alignment with PQRS and IQR programs

Specialized Registry 21 NJ-HITEC has up a specialized registry to satisfy modified Meaningful Use public health requirement Practices and hospitals participating in the specialized registry will benefit from benchmarking against national CQM performance rates show CQM improvement over time, help practices select the best CQMs to avoid 2017 penalties increase reimbursement through Medicare's value- based payment modifier (VM) program. You can sign up today - or contact us through our websitehttp://bit.ly/h-cdr

Stage 3 Proposed Rule

Stage 3 Requirements 23 1.Computerized Provider Order Entry (CPOE) 2.Electronic Prescribing (eRx) 3.Clinical Decision Support – 5 rules + Drug-drug, drug-allergy interaction 4. Patient Electronic Access to Health Information 5. Protect Electronic Health Information 6. Coordination of Care through Patient Engagement 7. Health Information Exchange 8. Public Health Requirement

Stage 3 Requirements 24 Stage 3 will be optional for providers in 2017 and mandatory for all participants in 2018 Coordination of Care through Patient Engagement requires attestation to all three measures but are only required to meet thresholds for two Health Information Exchange also requires all three measures, but providers are only required to meet thresholds for two For the Public Health Reporting objective, eligible professionals are required to report on three measures, while hospitals and CAHs must report four

Stage 3 Seeking Comments 25 The final rule includes a 60-day comment period on the Stage 3 portion of the rule. Seeking comments on Stage 3: Measures Objectives Reporting Periods Any modifications to Stage 3 based on those comments will be proposed through notice and comment rulemaking in future regulations.

New Jersey Institute of Technology Enterprise Development Center (EDC) 211 Warren Street, Newark, NJ Phone: Fax: Bala Thirumalainambi Meaningful Use Director (973) Questions?