1. Meaningful Use Elizabeth W. Woodcock, MBA, FACMPE, CPC Update: 2015 Sponsored by

2. © 2015 Type your questions Arrow opens and closes your panel How to Ask a Question

3. © 2015 Elizabeth W. Woodcock, MBA, FACMPE, CPC Speaker, Author, Trainer www.elizabethwoodcock.com  MBA, Wharton School of Business, University of Pennsylvania  BA, Duke University  Fellow, American College of Medical Practice Executives  Certified Professional Coder  Author, 12 textbooks and more than 500 Articles  Founder and Principal, Woodcock & Associates  Former Consultant, Medical Group Management Association; Group Practice Services Administrator, University of Virginia Health Services Foundation; Former Senior Associate, Health Care Advisory Board Your Speaker

4. © 2015 Agenda  Background  News!  Proposed Stage Two  Proposed Stage One  Proposal  Penalties  Q&A Session To all participants: Please note that this presentation is focused on eligible professionals, not eligible hospitals or critical access hospitals.

5. © 2015 Background February 2009 American Recovery and Reinvestment Act “ TITLE XIII—HEALTH INFORMATION TECHNOLOGY” HITECH Act “Eligible professionals” will be paid for “demonstrating use of a qualified electronic health record in a meaningful manner.”

6. © 2015 Background 1st Year Meaningful Use Annual Incentive Payments 201120122013201420152016[….]TOTAL 2011 MCR $18,000 $12,000 $8,000 $4,000 $2,000 $0 $44,000 MCD $21,250 $8,500 $0 $63,750 2012 MCR $18,000 $12,000 $8,000 $4,000 $2,000 $0 $44,000 MCD $21,250 $8,500 $63,750 2013 MCR $15,000 $12,000 $8,000 $4,000 $0 $39,000 MCD $21,250 $8,500 $17,000 $63,750 2014 MCR $12,000 $8,000 $4,000 $0 $24,000 MCD $21,250 $8,500 $25,500 $63,750 2015 MCR $0 MCD $21,250$8,500$34,000 $63,750 2016 MCR $0 MCD $21,250 $ 42,500 $63,750 MCR = Medicare; MCD = Medicaid. MCD participants must begin participation by 2016.

7. © 2015 Background Transmitted via email Review the audit request – complete? limited (to one measure)? Retain documentation for 6 years CMS – and (2015) OIG http://go.cms.gov/1J6buIs http://bit.ly/1dB9eg3 Audit Information Government Sample

8. © 2015 News! “Shorten the EHR reporting period in 2015 to 90 days…” -Patrick Conway, MD

9. © 2015 News! April 15, 2015 Medicare and Medicaid Programs; Electronic Health Record Incentive Program— Modifications to Meaningful Use in 2015 Through 2017; Proposed Rule March 30, 2015 Medicare and Medicaid Programs; Electronic Health Record Incentive Program-Stage 3; Proposed Rule CMS Proposals Final Rules Expected

10. © 2015 News! When the Final Rule is released, the Meaningful Use criteria for Stage One and Stage Two will change. Giving you less than 6 weeks to prepare [Last Day to Start in Order to Get your 90 Days in] www.asha.org

11. © 2015 9 Core Objectives 1 Public Health Objective PROPOSAL Proposed Stage Two

12. © 2015 Proposed Stage Two Eliminated!! Patients who secure electronic message Patients who download, online or transmit to a third party their health information electronically PROPOSAL

13. © 2015 No Longer Required to Report Record Demographics Record Vital Signs Record Smoking Status Clinical Summaries Structured Lab Results Patient List Patient Reminders Summary of Care (1-Any Method; 3-Test) Electronic Notes Imaging Results Family Health History PROPOSAL Proposed Stage Two

14. © 2015 Proposed Stage Two 1. Protect Electronic Health Information [Conduct or review a Security Risk Analysis] 2. Clinical Decision Support (CDS) [Implement 5 CDS interventions for 4+ CQMs or high- priority health conditions] [Enable and implement drug-drug and drug-allergy interaction checks] PROPOSAL CQM = Clinical Quality Measures

15. © 2015 Proposed Stage Two 3. Computerized Provider Order Entry (CPOE) [Use CPOE for 60%+ medication orders, 30%+ lab orders, and 30%+ radiology orders] 4. ePrescribing [50%+ are queried for a drug formulary and transmitted electronically] PROPOSAL

16. © 2015 Proposed Stage Two 5. Summary of Care [EP who transitions or refers their patient to another setting of care or provider of care that uses CEHRT creates a summary of care record; and electronically transmits such summary to a receiving provider for 10%+ transitions of care and referrals] 6. Patient Specific Education [Patient-specific education resources identified by CEHRT are provided to patients for 10%+ of all unique patients with an office visit seen by the EP] EP = eligible professional; CEHRT = certified electronic health record technology PROPOSAL

17. © 2015 Proposed Stage Two 7. Medication Reconciliation [EP performs medication reconciliation for 50%+ of transitions of care in which the patient is transitioned into the care of the EP] PROPOSAL

18. © 2015 Proposed Stage Two 8. Patient Electronic Access [50%+ of all unique patients seen by the EP during the reporting period are provided timely – within 4 business days after the information is available to the EP – online access to their health information] [At least one patient seen by the EP during the reporting period views, downloads, or transmits his or her health information to a third party] PROPOSAL

19. © 2015 Proposed Stage Two 9. Secure Electronic Messaging [During the reporting period, the capability for patients to send and receive a secure electronic message was fully enabled] PROPOSAL

20. © 2015 Proposed Stage Two 10. Public Health and Clinical Data Registry (CDR) Reporting The EP is in “active engagement” with a public health agency (PHA) or CDR Option 1: the EP completed registration to submit data to a PHA or CDR within 60 days after the start of the reporting period, and is waiting an invitation from the PHA or CDR to begin testing Option 2: the EP is in the process of testing and validation of the electronic submission of the data Option 3: the EP is electronically submitting production data to the PHA or CDR PROPOSAL

21. © 2015 Proposed Stage Two 10. Public Health and Clinical Data Registry (CDR) Reporting Attest to any 2… 1. Immunization registry reporting (bi-directional) 2. Syndromic surveillance reporting 3. Case reporting 4. Public health registry reporting* 5. Clinical data registry reporting* *can report – and count – more than one registry PROPOSAL http://go.cms.gov/1JfPiPr List of Qualified CMS Registries

22. © 2015 Proposed Stage One 1. Protect Electronic Health Information 2. CDS – 1 rule relevant to specialty/high clinical priority 3. CPOE – 30% medications only 4. ePrescribing – 40% transmitted electronically 5. Patient electronic access – 50% provided access within 4 business days 6. Public Health/Clinical Data Registry Reporting – same as Modified Stage Two PROPOSAL

23. © 2015 Proposal Clinical quality measures  9 measures out of 64, covering at least three domains  None are “required” but some are recommended  Zero in the denominator is a positive response  Can report through the PQRS Portal  CQM reporting period can be different than the rest of MU PROPOSAL

24. © 2015 Proposal 24 1st Year Stages of Meaningful Use [as of April 2015] 2011201220132014201520162017 20111111 or 2222 or 3 2012 111 or 2222 or 3 2013 11222 or 3 2014 1122 2015 112 2016 11 2017 1 Appendix

25. © 2015 Payment Adjustments (based on Medicare reimbursement) Note: Exceptions will be made on a case-by-case basis for significant hardships (e.g., rural practices without sufficient Internet access) YearPenalty 20151% 20162% 20173% Beyond4% to 5% No Medicaid Adjustments 2018 – Final Year of Penalties MACRA of 2015 Penalties Medicare Access and CHIP Reauthorization Act of 2015

26. © 2015 Penalties However, every eligible professional will be assigned a “composite score” based on: 1.Quality 2.Resource use 3.Clinical practice improvement activities… 4. and Meaningful Use Will replace PQRS, VBPM and MU!

27. © 2015 Questions & Answers

28. © 2015 Elizabeth W. Woodcock, MBA, FACMPE, CPC Woodcock & Associates Speaker, Trainer, Author Atlanta, Georgia 404.373.6195 elizabeth@elizabethwoodcock.com www.elizabethwoodcock.com These handouts may not be reproduced without the written consent of the speaker. Your Speaker

29. © 2015 Sources Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Modifications to Meaningful Use in 2015 Through 2017; Proposed Rule http://www.gpo.gov/fdsys/pkg/FR-2015-04- 15/pdf/2015-08514.pdf Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 3; 2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification Program Modifications; Proposed Rules http://www.gpo.gov/fdsys/pkg/FR-2015-03- 30/pdf/2015-06685.pdf