1. Presenter James S. Dunnick, SESEDN LLC. Credentials: MD. FACC. CHCQM. CPC. Contact Information: SESEDN@gmail.com jdmd62@gmail.com

2. SESEDN LLC Disclaimer: 1. Do NOT assume I am correct, I make mistakes. 2. Read and self educate. 3. CPT books, government manuals, online resources. 4. Obtain teaching, from more than one source. 5. Auditors opinions will vary. States will vary. 6. Rules change. 7. This is meant as general and initial information only. 8. Always the responsibility of the client to verify the accuracy of information.

3. Meaningful Use Stage 1 and 2 Stage 1 2011-2012 Data capture and sharing Stage 2 2014 Advance clinical processes Stage 3 2016 Improved outcomes

4. Meaningful Use Delay? On May 20, the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) issued a proposed rule that may delay implementation of 2014 edition Certified Electronic Health Record Technology (CEHRT). LA Healthcare Quality Forum. June 2014

5. Meaningful Use Delay? “If it is finalized, it could mean that some EPs will be able to attest to Meaningful Use this year using 2011 CEHRT or a mix of 2011 and 2014 technology,” she said. “It may also allow some EPs to attest this year by meeting the 2013 or 2014 Stage 1 measures even if those providers were scheduled to start Stage 2 this year.” Nadine Robin, Health IT Program Manager for the Louisiana Health Information Technology (LHIT) Resource Center.

6. Meaningful Use Delay? The proposal, if approved, would be valid only for the 2014 reporting year. In 2015, all EPs will still be required to report using the 2014 Edition CERHT.

7. Meaningful Use Delay? CMS admitted problems with EHR technology and implementation and late Tuesday……………

8. Meaningful Use Delay? CMS admitted problems with EHR technology and implementation and late Tuesday formalized its decision to extend Stage 2 of the program for an additional year--through 2016--and to put off the start of Stage 3 until 2017formalized its decision

9. Meaningful Use Delay? CMS MAKES IT OFFICIAL: MU DEADLINES PUSHED BACK TO 2016, 2017:

10. Meaningful Use Delay? The proposal, if (now) approved, would be valid only for the 2014 reporting year. In 2015, all EPs will still be required to report using the 2014 Edition CERHT.

11. For 2014 only “For Medicaid providers only eligible to receive Medicaid EHR incentives, the 3-month reporting period is not fixed, where providers do not have the same alignment needs.”

12. For 2014 only For Medicare providers, this 3-month reporting period is fixed to the quarter of either the fiscal (for eligible hospitals and CAHs) or calendar (for EPs) year in order to align with existing CMS quality measurement programs, such as the Physician Quality Reporting System (PQRS) and Hospital Inpatient Quality Reporting (IQR).

13. Meaningful Use Eligible Professionals (EP) Eligible Hospitals (EH) Eligible Critical Access Hospitals (CAH)

14. Meaningful Use Eligible Professionals (EP) Eligible Hospitals (EH) Eligible Critical Access Hospitals (CAH) Stage 1 and Stage 2 Definitions 2013 or 2014 CERHT 2011 or 2014

15. Meaningful Use Eligible Professionals (EP) Eligible Hospitals (EH) Eligible Critical Access Hospitals (CAH) Stage 1 and Stage 2 Definitions 2013 or 2014 CERHT 2011 or 2014 Core objectives Menu objectives Clinical quality measures National quality strategy domains

16. 2013 EP Stage 1 Eligible professionals must meet: 13 required core objectives 5 menu objectives from a list of 10 Total of 18 objectives CMShttp://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/2013Definition_Stage1_MeaningfulUse.html

17. Meaningful use EP Stage 1 Although some Stage 1 objectives were either combined or eliminated, most of the Stage 1 objectives are now core objectives under the Stage 2 criteria

18. Meaningful Use For many of these Stage 2 objectives: The threshold has been raised The expectation is higher “We expect that providers…. will be able to demonstrate meaningful use…. for an even larger portion of their patient populations.”

19. Meaningful Use Group Practices Can Now Register for Group Practice Reporting Option for 2014 PQRS Participation Eligible professionals (EPs) who wish to participate in the 2014 PQRS program as a group practice can now register for the group practice reporting option (GPRO).group practice reporting option (GPRO) When your group is ready to register, you can access the PV- PQRS Registration System at https://portal.cms.gov. https://portal.cms.gov

20. EHR Reporting Options for Eligible Professionals in 2014 Include: Eligible Professionals in 2014 Include: Options that only apply for the EHR Incentive Program Option 1: Attest to CQMs through the EHR Registration & Attestation System Option 2: eReport CQMs through Physician Quality Reporting System (PQRS) PortalPhysician Quality Reporting System (PQRS) Portal

21. EHR Reporting Options for Eligible Professionals in 2014 Include: Options that Align with Other Quality Programs Option 3: Report individual eligible professionals’ CQMs through PQRS Portal Option 4: Report group’s CQMs through PQRS Portal Option 5: Report group’s CQMs through Pioneer ACO participation or Comprehensive Primary Care Initiative participation

22. Stage 2 Core and Menu Objectives Eligible Professionals Eligible professionals must meet: 17 core objectives 3 menu objectives that they select from a total list of 6 Total of 20 http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html

23. 2014 Clinical Quality Measures Eligible professionals who demonstrate 2014 clinical quality measures (CQMs) will need to report 9 measures, and eligible hospitals will need to report 16. CQMs may be reported electronically, or via attestation. http://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/2014_ClinicalQualityMeasures.html

24. Stage 2 Core and Menu Objectives Eligible Professionals Eligible professionals must meet: 17 core objectives 3 menu objectives that they select from a total list of 6 Eligible professionals who demonstrate 2014 clinical quality measures (CQMs) will need to report 9 measures http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html

25. National Quality Strategy Domains There is also a new requirement in 2014 that the quality measures selected must cover at least 3 of the 6 available National Quality Strategy (NQS) domains, which represent the Department of Health and Human Services’ NQS priorities for health care quality improvement.

26. Clinical Quality Measures The 6 NQS domains are: 1. Patient and Family Engagement 2. Patient Safety 3. Care Coordination 4. Population/Public Health 5. Efficient Use of Healthcare Resources 6. Clinical Process/Effectiveness

27. Stage 2 Core and Menu Objectives Eligible Professionals Total 20? Eligible professionals must meet: 17 core objectives 3 menu objectives that they select from a total list of 6 Eligible professionals who demonstrate 2014 clinical quality measures (CQMs) will need to report 9 measures. Which must cover 3 of 6 NQS domains. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html

28. Stage 2 Core and Menu Objectives Eligible Professionals 17 core objectives 3 of 6 menu objectives 9 CQMs (to include 3 of 6 NQS domains) Total: 17 + 3 + 9 = 29

29. Stage 2 Core and Menu Objectives Eligible Professionals 17 core objectives 3 of 6 menu objectives 9 CQMs (to include 3 of 6 NQS domains) Total: 17 + 3 + 9 = 29*

30. Report on all 17 Core Objectives: 1. Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders 2. Generate and transmit permissible prescriptions electronically (eRx) 3. Record demographic information 4. Record and chart changes in vital signs 5. Record smoking status for patients 13 years old or older

31. Report on all 17 Core Objectives: 6. Use clinical decision support to improve performance on high-priority health condition 7. Provide patients the ability to view online, download and transmit their health information 8. Provide clinical summaries for patients for each office visit 9.Protect electronic health information created or maintained by the Certified EHR Technology 10. Incorporate clinical lab-test results into Certified EHR Technology

32. Report on all 17 Core Objectives: 11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach 12. Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care 13. Use certified EHR technology to identify patient-specific education resources

33. Report on all 17 Core Objectives: 14. Perform medication reconciliation 15. Provide summary of care record for each transition of care or referral 16. Submit electronic data to immunization registries 17. Use secure electronic messaging to communicate with patients on relevant health information

34. Report on 3 of 6 Menu Objectives: 1. Submit electronic syndromic surveillance data to public health agencies 2. Record electronic notes in patient records 3. Imaging results accessible through CEHRT 4. Record patient family health history 5. Identify and report cancer cases to a State cancer registry 6. Identify and report specific cases to a specialized registry (other than a cancer registry)

35. Final Rule II. Summary of Errors. A. Summary of Errors in the Preamble On page 54,041 in our response….. https://www.federalregister.gov/articles/2012/10/23/2012-25975/medicare-and-medicaid-programs-electronic- health-record-incentive-program-stage-2-corrections

36. Final Rule ACTION: Final Rule; Correction. SUMMARY: This document corrects technical errors and typographical errors in the final rule entitled “Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 2”

37. Meaningful Use EP Stage 2, 2014 1. Wow 2. Build a team Providers - MD/DO/NPP Ancillary staff Administration - hospital and office IT 3. Consultants help - state help

38. Stage 2 EP 2014 Meaningful Use SESEDN LLC: James S. Dunnick, MD. FACC. CHCQM. CPC. Hometown Health University: Kathy Whitmire, Managing Director Mark Renfro, HomeTown Health HIT Director Reimbursement Solutions Group Jesus F. Ruiz, CPA

39. Presenter James S. Dunnick, SESEDN LLC. Credentials: MD. FACC. CHCQM. CPC. Contact Information: SESEDN@gmail.com jdmd62@gmail.com