1. “No matter how dramatic the end result, the good to great transformations never happened in one fell swoop. There was no single defining action, no grand program, no one killer innovation, no solitary lucky break, no wrenching revolution. Good to great transformation comes about by a cumulative process – step by step, action by action, decision by decision, turn by turn, that adds up to sustained spectacular results. “ Jim Collins Good to Great

2. “No matter how dramatic the end result, the good to great transformations never happened in one fell swoop. There was no single defining action, no grand program, no one killer innovation, no solitary lucky break, no wrenching revolution. Good to great transformation comes about by a cumulative process – step by step, action by action, decision by decision, turn by turn, that adds up to sustained spectacular results. “ Jim Collins Good to Great

3. Meaningful Use Readiness Getting Started: A Meaningful Use Checklist Peter Cucchiara, BSMIS MBA

4. See the path before we walk it To Readiness

5. 1 2 3 4 5 What is MU to you? P l a c e m e n t & C o n s i d e r a t i o n s W h a t i s t h i s w o r k ? Ways to Plan the Process Assessment Tool Demonstration Do we have the right people in the right seats on the bus? Jim Collins

6. What is Meaningful Use Using certified EHR technology in a meaningful manner (which includes e-prescribing for eligible providers and meeting the MU criteria) Use Connecting a certified EHR in a manner that provides for the electronic exchange of health information to improve the quality of care. Connect Submit Using the technology to submit information to CMS on clinical quality measures and other measures selected by CMS. ARRA specifies three requirements for “meaningful use”

7. MU Grocery List 25 Requirements of which we need to fulfill 20 15 Core, 5 Discretionary 6 Clinical Measures 16 Numerator/Denominator Calculations 8 Attestation items Determine our EP Adopt implement upgrade incentive opportunity Volume criteria

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9. What is Meaningful Use – The First Cut Goal A Goal B Goal C Goal D Goal E Improve quality, safety, efficiency, & reduce health disparities Engage Patients and Families Improve Care Coordination Improve Population and Public Health Ensure adequate privacy and security Protection for PHI (15) (4) (3) (2) (1)

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11. What is Meaningful Use – The Second Cut Core - Of the 25 objectives 15 are required - Goal A (11) Goal B (2) Goal C (1) - Goal D (?) Goal E (1) Discretionary Menu - 10 discretionary/menu requirements from which 5 must be chosen - Must choose 1 Goal D measure Improving Population & Public Health - Electronic access for patients (PHR, portal) is discretionary. Clinical Measures - 44 Measures for EP’s - Pick 6 - 3 Core required (BP, Tobacco status, adult weight) or… - 3 Alternates plus additional 3 from remaining pool of 38 Numerators Denominators - Of the 25 objectives 16 require N/D Calculations - 10 Calculations require certified EMR technology - 6 Calculations do not require certified EMR technology Attests - Of the 25 objectives 8 require attestations

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13. What is Meaningful Use – The Third Cut 4P’s

14. Adopt, Implement, Upgrade (AIU) In their first year of participation in the Medicaid incentive payment program, EPs may qualify for an incentive payment by demonstrating any of the following: –that they have adopted (acquired & installed), implemented (commenced utilization), or upgraded (upgrade to a certified version or expanded functionality, e.g. CDSS, e-prescribing)

15. Eligible Providers (EPs) Medicare Doctor of Medicine Doctor of Osteopathy Doctor of Dentistry Doctor of Dental Surgery Doctor of Podiatric Medicine Doctor of Optometry Chiropractor Medicaid Physicians Dentists Nurse Midwives Nurse Practitioners PAs in PA led FQHC* PAs in Rural Health Clinic

16. Volume Criteria –General Rule: 30% patient encounters attributable to those receiving Medicaid. To be measured over any continuous 90-day period in the previous calendar year. –2 Exceptions: 1.If EP practices predominantly in an FQHC or RHC, must have 30% of patient encounters attributable to “needy individuals” Definition of predominantly = over 50% of patient encounters over a period of 6 months occurs at an FQHC or RHC Definition of needy individuals = receiving medical assistance from Medicaid or CHIP; receiving uncompensated care; or receiving care at no-cost or reduced cost based on a sliding- scale 2. Pediatricians may have at least 20% patient encounters attributable to those receiving Medicaid Source: CMS, US DHHS

17. Summing Up So Far 25 Requirements of which we need to fulfill 20 15 Core, 5 Discretionary 6 Clinical Measures 16 Numerator/Denominator Calculations 8 Attestation items Determine our EP Adopt implement upgrade incentive opportunity Volume criteria ? How much work How much time Impact Cost Ready

18. “ Meaningful Use” Criteria a Focal Point Across Previously Disparate Initiatives

19. For example

20. PCMH MU Is it just a matter of Oranges and Apples Recognition/Documentation Paid Per Patient (in NYS) M‘caid, M‘care & Payers State and Federal 9 standards 7 elements 166 factors Certification/Attestation Paid Per Provider Medicaid, Medicare Federal 5 care goals 20 objectives (options and choices) ?

21. Medical HomeMeaningful Use PPC1: Access and Communication PPC2: Patient Tracking & Registry PPC3: Care Management PPC4: Pt Self Management Support PPC5: Electronic Prescribing PPC6: Test Tracking PPC7: Referral Tracking PPC8: Performance Rpt/Imprvmnt PPC9: Advanced Electronic Comm Goal A: Improve quality, safety, _______ efficiency, & reduce health _______ disparities Goal B: Engage Patients and Families Goal C: Improve Care Coordination Goal D: Improve Population and Public Health Goal E: Ensure Adequate Privacy & Security Protection for PHI A Simple Comparison

22. How Much Overlap? PCMH Elements that relate to HIT (69%) Ginsburg, Maxfield, O’Malley, Piekes, Pham, Making Medical Homes Work Moving from Concept to Practice Center for Studying Health System Change #1 December 2008

23. Home Sweet Meaningful Medical Home Patient Centered Care

24. The MU Assessment Tool Some Assessment Tool Results

25. Milestone Map of the Journey EMR Certification (Fall 2010) Transformational Change Assess Numerators And denominators Adopt Implement Upgrade (Fall 2010 – 2011) Stage I April 2011? 2012 Count EP’s And volume criteria (now) Choose Medicare Or medicaid and Calculate 5 year Return (now) EMR Attestation $25K (Late 2010/2011) Stage II 2013 - 2014 Stage III 2014 - 2016

26. Achieving a balance between Recognition Attestation Applied Principles Process Gains Guiding Principle 1

27. MU Three Main Process Work Strands Process HIT/MU/MH Organizational

28. Questions

29. Thank You