1. MEANINGFUL USE UPDATE 2014 Mark Huang, M.D. Chief Medical Information Officer Rehabilitation Institute of Chicago Associate Professor Department of PM & R Feinberg School of Medicine Northwestern University

2. DISCLOSURES No personal disclosures

3. OBJECTIVES  Provide overview of Erx and Meaningful use programs  Analyze how these programs can impact your practice  Discussion: –steps in how to meet qualifications for the incentive programs

4. CMS INCENTIVE PROGRAMS

5. E-RX INCENTIVE PROGRAM Electronic Prescribing (eRx) Incentive Program –Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorized a new and separate incentive program for EPs who are successful electronic prescribers as defined by MIPPA. –Started 2009, runs to 2014 –Penalties were based on eRx compliance in 2012 –Exemption deadline was Jan 2013

6. WHAT IS MEANINGFUL USE?  The American Recovery and Reinvestment Act of 2009 (Recovery Act) includes the Health Information Technology for Economic and Clinical Health Act, (“HITECH Act”) which established programs under Medicare and Medicaid to provide incentive payments to EPs, hospitals, and critical access hospitals for the “meaningful use” of certified EHR technology.

7. MEANINGFUL USE PROGRAMS CMS website

8. MEDICARE MEANINGFUL USE  The last year to begin participation and receive an incentive payment is 2014.  To receive the maximum incentive payment, eligible professionals must have started participation by 2012.  Must demonstrate meaningful use for each year of participation in the program.meaningful use  Must demonstrate use for ALL patients seen not just medicare patients

9. MEDICARE MEANINGFUL USE CMS website

10. MEDICARE MEANINGFUL USE CMS website  Penalties start in 2015 (1% payment reduction increasing annually to 5%)  Those who attest in 2014 need have reporting period before Oct 1 st to avoid 2015 penalty

11. WHO CAN PARTICIPATE  Eligible professionals –M.D., D.O. –Must have 10% or more of professional services claims to CMS provided in an outpatient setting (i.e. less than 90% inpatient medicare related charges)  Practices cannot participate –Each provider must register individually

12. STAGE 1 OF MEANINGFUL USE  13 Core Objectives: –everyone who participates in the program must meet.  9 Menu Objectives: –report on 5 out of the 9 available menu objectives  9 Clinical Quality Measures:

13. CORE MEASURES –Computerized physician order entry –Drug-drug and drug-allergy interaction checks –E-Prescribing (eRx) –Implement clinical decision support rule –Provide patients with ability to view download and transmit health information online –Provide clinical summaries for patients for each office visit –Record demographics

14. CORE MEASURES 9-15 –Maintain an up-to-date problem list of current and active diagnoses –Maintain active medication list –Maintain active medication allergy list –Record and chart changes in vital signs (height and weight –Record smoking status for patients 13 years or older –Protect electronic health information

15. MENU ITEMS  Public health objectives: must choose one of following –Submit electronic data to immunization registries OR –Submit electronic syndromic surveillance bed at the public health agencies

16. MENU ITEMS CMS website

17. CLINICAL QUALITY MEASURES  There are no thresholds for these you simply have to report on these  Your should be able to produce reports on these automatically

18. QUALITY MEASURES CMS website

19. QUALITY MEASURES CMS website

20. QUALITY MEASURES CMS website

21. QUALITY MEASURES CMS website

22. ADDITIONAL STAGES  Stage 2 –Mostly same measure but higher thresholds –New objectives to improve patient care through better clinical decision support, care coordination and patient engagement (secure messaging) –Increased software certification requirements  Stage 3 –Increased emphasis on communication between providers, visit summaries, lab and radiology as discrete data

23. REPORTING PERIODS  Year 1: usually a 90 day period for first year  Year 2: typically full calendar year –Exception when proceeding to next stage, then have 90 day reporting period –Exception made for 2014 (90 day period allowed)  Typically have to complete registration for attestation for prior year reporting by end of February

24. IMPACT TO YOUR PRACTICE  Need to invest in certified EHR technology  Establish workflows to accommodate meeting the menu objectives –Increased documentation need to report on quality measures –Increased need to collect demographic and other history elements –Who will do this (RN’s, MA’s vs physicians)  Provide patient access to their records electronically

25. GETTING STARTED  Decide on if you wish to participate –Erx is already incorporated into meaningful use –Larger penalties with meaningful use  If participating, purchase and implement certified EHR technology  Perform workflow analysis  Register for attestation  Monitor for compliance  Complete attestation

26. CONSIDERATIONS FOR AAPMR  Need to develop rehabilitation specific quality measures  Need to coordinate with other specialties how meaningful use can be modified specifically for specialists  Lobby for post acute care facilities to be eligible for incentives