1. NY Medicaid HITECHEHR Incentive Program James J. Figge, M.D., M.B.A. Medical Director, Office of Health Insurance Programs January, 2011 MSSNY Town Hall Seminars: The Road to Meaningful Use and The HITECH EHR Incentive Program The Medicaid Incentive Program: Collaborate for Better Patient Care

2. NY Medicaid HITECHEHR Incentive Program Topics NY Medicaid programs that complement the federal Health Information Technology for Economic and Clinical Health (HITECH) program: –Electronic Prescribing (eRx) Incentive –Patient-Centered Medical Home (PCMH) Incentive NY Medicaid HITECH EHR incentive program 2

3. NY Medicaid HITECHEHR Incentive Program Objectives Upon completion of this activity, physicians will: learn about NY Medicaid incentive programs for e-prescribing and the patient-centered medical home; learn the components of meaningful use of a certified EHR under HITECH; learn the importance of adoption relative to the federal incentive programs. 3

4. NY Medicaid HITECHEHR Incentive Program Electronic Prescribing Nationwide: – In 2009, 12% of the 1.63B original prescriptions were transmitted electronically Accelerating trend: – 2007-2008: +130% – 2008-2009: +181% 4 Source: 2009 National Progress Report on E-Prescribing, Surescripts LLC.2009 National Progress Report on E-Prescribing

5. NY Medicaid HITECHEHR Incentive Program NY Medicaid eRx Incentive Provides an incentive payment for dispensed ambulatory Medicaid e-prescriptions 5 Eligible Practitioners Physicians (M.D./D.O.) Dentists Nurse Practitioners Podiatrists Optometrists Licensed Midwives Prescriber Incentive $0.80 per prescription/refill* Pharmacy Incentive $0.20 per prescription/refill* * Max 1 original plus 5 refills per 180-day period.

6. NY Medicaid HITECHEHR Incentive Program eRx Incentive Requirements Prescriber – must have an individual NPI, and – must be enrolled in Medicaid fee-for- service (FFS) 6

7. NY Medicaid HITECHEHR Incentive Program eRx Incentive Requirements Incentive only applies to prescriptions created electronically, and transmitted via computer-to-computer electronic data interchange – faxed prescriptions are not eligible – [faxed prescription] ≠ eRx 7

8. NY Medicaid HITECHEHR Incentive Program eRx Incentive Requirements Electronic transaction must comply with Medicare Part D standards – NCPDP SCRIPT 8.1 or 10.6 – Includes prescriber's individual NPI Incentive only applies to prescription medications – No OTC medications or medical supplies – No controlled substances at this time 8

9. NY Medicaid HITECHEHR Incentive Program Patient-Centered Medical Home PCMH is a care model where each patient has an ongoing relationship with a personal clinician who leads a team that takes collective responsibility for patient care 9

10. NY Medicaid HITECHEHR Incentive Program Patient-Centered Medical Home Care is supported by electronic tools – patient registries, EHRs, e-prescribing, and health information exchange (HIE) – goal is to improve care coordination, quality, and patient safety 10

11. NY Medicaid HITECHEHR Incentive Program NCQA PCMH Recognition Program National Committee for Quality Assurance (NCQA), Patient-Centered Medical Home program – Three levels: Level 1 can be achieved without an EHR Level 2 requires some electronic functions Level 3 requires a fully functional EHR 11

12. NY Medicaid HITECHEHR Incentive Program NY Medicaid PCMH Incentive Eligibility for enhanced payments: – Office-based practices (e.g., physicians and nurse practitioners) – Federally Qualified Health Centers (FQHCs) – Diagnostic & Treatment Centers – Hospital Outpatient Departments (Medicaid managed care program only) 12

13. NY Medicaid HITECHEHR Incentive Program NY Medicaid PCMH Incentive Incentive payments available through Medicaid fee-for-service (FFS) and Medicaid managed care programs Incentive amount varies based on NCQA PCMH level achieved 13

14. NY Medicaid HITECHEHR Incentive Program Medicaid EHR Incentive Program Created by the HITECH Act Administered by the States under guidance and oversight of the Centers for Medicare and Medicaid Services (CMS) Designed to provide financial incentives for adoption and meaningful use of certified EHRs 14

15. NY Medicaid HITECHEHR Incentive Program Medicaid EHR Incentive Program Meaningful use of certified EHR technology includes: – Electronic Prescribing – Electronic exchange of health information to improve the quality of health care – Reporting of clinical quality measures 15

16. NY Medicaid HITECHEHR Incentive Program Who Is Eligible? Physicians (M.D. and D.O.) Nurse Practitioners Certified Nurse-Midwives Dentists Physician Assistants, only if practicing in a FQHC or Rural Health Clinic (RHC) led by a Physician Assistant 16

17. NY Medicaid HITECHEHR Incentive Program Patient Volume Requirements Eligible professionals (EPs) must demonstrate that 30% of patient encounters are Medicaid – Exceptions: Pediatricians may receive 2/3 incentive amount with 20% Medicaid patient volume EPs in FQHCs and RHCs may qualify by demonstrating 30% of encounters are “needy individuals” 17

18. NY Medicaid HITECHEHR Incentive Program Calculating Patient Volume Standard formula uses number of Medicaid patient encounters relative to total encounters in any 90-day period in the preceding calendar year Alternate formula takes into account a practitioner's entire managed care or medical home patient panel 18

19. NY Medicaid HITECHEHR Incentive Program Calculating Patient Volume Clinics and group practices may use overall clinic/practice patient volume as a proxy for each EP – Some limitations apply: 42 CFR 495.306(h) All methods include alternate 20% threshold for pediatricians and use of “needy individuals” criteria for FQHCs/RHCs 19

20. NY Medicaid HITECHEHR Incentive Program How Much is Available? 20 All Practitioners (at least 30% Medicaid/needy) Pediatricians (at least 20% but less than 30% Medicaid) Year 1$21,250$14,167 Year 2$8,500$5,667 Year 3$8,500$5,667 Year 4$8,500$5,667 Year 5$8,500$5,667 Year 6$8,500$5,667 Total$63,750$42,500 Note: program participation years do not need to be contiguous.

21. NY Medicaid HITECHEHR Incentive Program Restrictions on EP Eligibility EPs may not be "hospital-based" – defined as 90% or more of services rendered in inpatient hospital or emergency room settings Must select either the Medicare or Medicaid program (one-time option to switch) May only participate in one state under the Medicaid option 21

22. NY Medicaid HITECHEHR Incentive Program Adoption, Implementation and/or Upgrading EHR Technology First year: – EPs must demonstrate adoption, implementation, and/or upgrade Adopt: Acquire and install system Implement: Training, data migration, commence utilization Upgrade: Expand and improve existing system to meet definition of certified EHR technology 22

23. NY Medicaid HITECHEHR Incentive Program Meaningful Use of EHR Technology Subsequent years: – Meet meaningful use and clinical quality metric reporting requirements For Stage 1 meaningful use (2011-2012), same core and menu set as Medicare* 23 * States may request permission from CMS to mandate certain public health reporting options

24. NY Medicaid HITECHEHR Incentive Program 24 Defining Meaningful Use HITECH Act specifies three components: – Electronic prescribing – Electronic exchange of health information – Submission of clinical quality measures

25. NY Medicaid HITECHEHR Incentive Program Stage 1 EP Meaningful Use Criteria 25 Core SetMenu Set Meaningful Use Objectives 15 core objectives 5 of 10 menu set objectives Clinical Quality Measures 3 core measures, or 3 alternate core measures 3 of 38 menu set measures Stage 1 meaningful use objectives and clinical quality measures include required core set and menu set choices

26. NY Medicaid HITECHEHR Incentive Program EP Clinical Quality Measures EPs must submit six measures for Stage 1 MU: – 3 core or 3 alternate core – 3 of 38 from menu set Aligned with Physicians Quality Reporting Initiative (PQRI) and CHIPRA initial core set Submit by attestation for 2011 – in 2012, EPs must submit electronically 26

27. NY Medicaid HITECHEHR Incentive Program EP Clinical Quality Measures 27 NQF Measure Number/ PQRI Implementation Number EP Clinical Quality Measure (Core Set) NQF 0013Hypertension: Blood pressure measurement NQF 0028 Preventive Care and Screening Measure Pair: a)Tobacco Use Assessment b)Tobacco Cessation Intervention NQF 0421 PQRI 128 Adult Weight Screening and Follow-up

28. NY Medicaid HITECHEHR Incentive Program EP Clinical Quality Measures 28 NQF Measure Number/ PQRI Implementation Number EP Clinical Quality Measure (Alternate Core Set) NQF 0024 Weight Assessment and Counseling for Children and Adolescents NQF0041 PQRI 110 Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or Older NQF 0038Childhood Immunization Status

29. NY Medicaid HITECHEHR Incentive Program Enrollment Process (1) Login to CMS Registration website: – Supply demographic/financial information – Select program (Medicare/Medicaid) – Select state 29

30. NY Medicaid HITECHEHR Incentive Program Enrollment Process (2) Login to NY Medicaid website: – Verify eligibility – Attest to adopt, implement, upgrade or meaningful use of certified EHR technology 30

31. NY Medicaid HITECHEHR Incentive Program Medicaid EHR Incentive Timeline CMS registration website opens for EHR Incentive Programs (both Medicare and Medicaid in some states) on January 3, 2011 NY Medicaid web-based attestation functions expected to begin fourth quarter-2011, dependent upon CMS and state approvals 31

32. NY Medicaid HITECHEHR Incentive Program Medicaid EHR Incentive Timeline Last year to initiate participation is 2016 Participants may skip a year, but no payments will be issued after 2021 32

33. NY Medicaid HITECHEHR Incentive Program Incentive Payments for Medicare EPs First Calendar Year (CY) for which the EP Receives an Incentive Payment CY 2011CY 2012CY 2013CY2014CY 2015 and later CY 2011$18,000 CY 2012$12,000$18,000 CY 2013$8,000$12,000$15,000 CY 2014$4,000$8,000$12,000 CY 2015$2,000$4,000$8,000 $0 CY 2016$2,000$4,000 $0 TOTAL$44,000 $39,000$24,000$0 33 Additional 10% Incentive Payment for Medicare EPs Practicing in HPSAs

34. NY Medicaid HITECHEHR Incentive Program Medicare Penalties for Not Achieving Meaningful Use 34

35. NY Medicaid HITECHEHR Incentive Program Notable Differences Between the Medicare & Medicaid EHR Programs MedicareMedicaid Federal Government will implement (will be an option nationally) Voluntary for States to implement (may not be an option in every State) Payment reductions begin in 2015 for providers that do not demonstrate Meaningful Use No Medicaid payment reductions Must demonstrate MU in Year 1A/I/U option for 1 st participation year Maximum incentive is $44,000 for EPs (bonus for EPs in HPSAs) Maximum incentive is $63,750 for EPs MU definition is common for MedicareStates can adopt certain additional requirements for MU Last year a provider may initiate program is 2014; Last year to register is 2016; Payment adjustments begin in 2015 Last year a provider may initiate program is 2016; Last year to register is 2016 Only physicians, subsection (d) hospitals and CAHs 5 types of EPs, acute care hospitals (including CAHs) and children’s hospitals 35

36. NY Medicaid HITECHEHR Incentive Program Appendices Contact Information Meaningful Use Core Set of Objectives – EP Meaningful Use Menu Set of Objectives – EP Clinical Quality Measures – Menu Set – EP 36

37. NY Medicaid HITECHEHR Incentive Program Contact Information For New York State Department of Health: James J. Figge, M.D., M.B.A., Medical Director NYS Department of Health, Office of Health Insurance Programs One Commerce Plaza, Suite 826 Albany, NY 12260  (518) 474-8045  jjf06@health.state.ny.usjjf06@health.state.ny.us For The Medical Society of the State of New York: Ron Pucherelli  rpucherelli@mssny.orgrpucherelli@mssny.org Eileen Clinton  eclinton@mssny.orgeclinton@mssny.org  (518) 465-8085 37

38. NY Medicaid HITECHEHR Incentive Program Stage 1 MU Criteria – EP Core Set (1) 38 Health Outcomes Policy Priority Stage 1 Meaningful Use Objective (EPs) Improving quality, safety, and efficiency, and reducing health disparities Use Computerized Provider Order Entry (CPOE) for medication orders Implement drug-drug and drug-allergy interaction checks Generate and transmit permissible prescriptions electronically (eRx) Record patient demographics (preferred language, gender, race, ethnicity, DOB) Maintain an up-to-date problem list of current and active diagnoses

39. NY Medicaid HITECHEHR Incentive Program Stage 1 MU Criteria – EP Core Set (2) 39 Health Outcomes Policy Priority Stage 1 Meaningful Use Objective (EPs) Improving quality, safety, and efficiency, and reducing health disparities Maintain active medication list Maintain active medication allergy list Record and chart changes in vital signs (height, weight, blood pressure, BMI, growth charts) Record smoking status (patients 13 and older) Implement one clinical decision support rule Report ambulatory clinical quality measures to CMS or the State

40. NY Medicaid HITECHEHR Incentive Program Stage 1 MU Criteria – EP Core Set (3) 40 Health Outcomes Policy Priority Stage 1 Meaningful Use Objective (EPs) Improve care coordination Capability to exchange key clinical information electronically among providers of care and patient- authorized entities Ensure adequate privacy and security for personal health information Implement systems to protect privacy and security of patient data in the EHR Engage patients and families in their health care On request, provide patients with an electronic copy of their health records Provide patients with clinical summaries for each office visit

41. NY Medicaid HITECHEHR Incentive Program Stage 1 MU Criteria – EP Menu Set (1) 41 Health Outcomes Policy Priority Stage 1 Meaningful Use Objective (EPs) Improving quality, safety, and efficiency, and reducing health disparities Implement drug-formulary checks Incorporate clinical lab test results into certified EHRs as structured data Generate lists of patients by specific conditions Send reminders to patients (per patient preference) for preventive and follow-up care Improve care coordination Perform medication reconciliation between care settings Provide summary of care record for patients referred or transitioned to another provider or setting

42. NY Medicaid HITECHEHR Incentive Program Stage 1 MU Criteria – EP Menu Set (2) 42 Health Outcomes Policy Priority Stage 1 Meaningful Use Objective (EPs) Engage patients and families in their health care Provide patients with timely electronic access to their health information Use certified EHR technology to identify patient- specific education resources and provide to patient as appropriate Improve population and public health Capability to submit electronic syndromic surveillance data to public health agencies (one test) Capability to submit immunization data electronically to State immunization registry (one test)

43. NY Medicaid HITECHEHR Incentive Program CQM: EP Menu Set (1) 1.Diabetes: Hemoglobin A1c Poor Control 2.Diabetes: LDL Management and Control 3.Diabetes: Blood Pressure Management 4.Heart Failure : ACE Inhibitor or ARB for Left Ventricular Systolic Dysfunction 5.Coronary Artery Disease: Beta-Blocker Therapy for Patients with Prior MI 6.Pneumonia Vaccination Status for Older Adults 7.Breast Cancer Screening 8.Colorectal Cancer Screening 9.Coronary Artery Disease: Oral Antiplatelet Therapy 10.Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction 11.Anti-depressant medication management 12.Primary Open Angle Glaucoma: Optic Nerve Evaluation 13.Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy 14.Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care 15.Asthma Pharmacologic Therapy 16.Asthma Assessment 17.Appropriate Testing for Children with Pharyngitis 18.Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer 19.Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients 43

44. NY Medicaid HITECHEHR Incentive Program CQM: EP Menu Set (2) 20.Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients 21.Smoking and Tobacco Use Cessation, Medical assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies 22.Diabetes: Eye Exam 23.Diabetes: Urine Screening 24.Diabetes: Foot Exam 25.Coronary Artery Disease: Drug Therapy for Lowering LDL-Cholesterol 26.Heart Failure : Warfarin Therapy Patients with Atrial Fibrillation 27.Ischemic Vascular Disease: Blood Pressure Management 28.Ischemic Vascular Disease: Use of Aspirin or Another Antithrombotic 29.Initiation and Engagement of Alcohol and Other Drug Dependence 30.Prenatal Care: Screening for Human Immunodeficiency Virus 31.Prenatal Care: Anti-D Immune Globulin 32.Controlling High Blood Pressure 33.Cervical Cancer Screening 34.Chlamydia Screening for Women 35.Use of Appropriate Medications for Asthma 36.Low Back Pain: Use of Imaging Studies 37.Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control 38.Diabetes: Hemoglobin A1c Control (<8.0%) 44