1. Putting the pieces together: EHR Incentive Programs, Meaningful Use, and Health Information Exchange January 13, 2014 Presented by Samantha Sawdon at Health Innovators

2. - 1 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. MAEHC Mission: Facilitate Universal EHR Adoption Company launched September 2004 –Non-profit registered in the Commonwealth of Massachusetts CEO on board January 2005 Backed by broad array of 34 non-profit MA health care stakeholders

3. - 2 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. MAeHC Selected Three Pilot Sites From 35 Applicants: Brockton, Newburyport, North Adams Provided EHRs to ~600 clinicians practicing in over 200 office locations Created health information exchanges connecting the physicians with each other and with the hospitals Created a quality data center to extract clinical data from EHRs to evaluate effectiveness and measure performance

4. - 3 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Since the pilot program, MAeHC has expanded its experience base and involvement in a variety of projects Regional Extension Center planning, deployment, and operations – New York, Massachusetts, Rhode Island, New Hampshire Beth Israel Deaconess Physician Organization (BIDPO) - 300 Physician EHR implementation Harvard University Health Systems – EHR conversion implementation HEAL 10 New York – Adirondack Region Medical Home Pilot Boston Medical Center – Primary Care Redesign and PCMH Recognition initiative. State Level Health Information Exchange Strategic and Operational Plan Development – Massachusetts and New Hampshire Community-wide EHR Implementation, HIE, and Quality Data Center – Large Healthcare Foundation

5. - 4 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Agenda American Recovery and Reinvestment Act Funding Medicare and Medicaid Incentive Programs Meaningful Use Meaningful Use in the Medical Practice Putting The Pieces Together Questions, Contact Information and Resources

6. - 5 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. American Recovery and Reinvestment Act

7. - 6 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. HITECH: Catalyst for Transformation 6 Pre 2009 20092014 A system plagued by inefficiencies EHR Incentive Program and 62 Regional Extension Centers Widespread adoption & meaningful use of EHRs Three-Part Aim: Better Healthcare Better Health Reduced Costs Paper Records HITECH ActEHRs & HIE Transforming Healthcare

8. - 7 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Agenda American Recovery and Reinvestment Act Funding Medicare and Medicaid Incentive Programs Meaningful Use Meaningful Use in the Medical Practice Putting The Pieces Together Questions, Contact Information and Resources

9. - 8 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Medicare-only Eligible Professionals Could be eligible for both Medicare & Medicaid incentives Medicaid-only Eligible Professionals Eligible Professionals

10. - 9 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Hospitals only eligible for Medicare incentive Could be eligible for both Medicare & Medicaid (most hospitals) Hospitals only eligible for Medicaid incentive Eligible Hospitals

11. - 10 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Comparison of Medicare and Medicaid Incentive Programs MedicareMedicaid Maximum incentive$44,000 ($48,000 in HPSA)$63,750 Payment calculation75% of submitted allowable charges in a year, up to cap Flat payment to cover allowable costs, up to cap EligibilityAny ambulatory Eligible Professional doing Medicare business Any ambulatory Eligible Professional doing Medicaid business Limitations on eligibilityNo mid-levels30% of services must be Medicaid; 20% for peds NPs, NMWs qualify; PAs only in Rural Health Clinics PenaltiesPenalties for non-compliance starting in 2015 No penalties Initial qualifying periodAny 90 continuous days in a calendar year prior to 2015 AIU/continuous 90 day reporting period up to 2016 Qualifying logisticsAttestation to CMS of all requirements, including submission of quality measure numerators and denominators for selected core measures; electronic submission of quality measures starting in 2014 (if available by CMS) Attestation to state Medicaid of all requirements, including submission of quality measure numerators and denominators for selected core measures; electronic submission of quality measures starting in 2014 (if available by CMS)

12. - 11 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Maximum Medicare Incentives Calendar YearAdopt 2011Adopt 2012Adopt 2013Adopt 2014Adopt 2015 and after 201118,000- 201212,00018,000- 20138,00012,00015,000- 20144,0008,00012,000 - 20152,0004,0008,000 0 20162,0004,000 0 201700000 Cumulative Total$44,000 $39,000$24,0000 Multiply allowable Medicare charges by 75% of Part B FFS Professional charges for the payment year, up to the cap of $24,000 HPSA EP qualifies for an extra 10% incentive payment if more than 50% of covered services are provided in a geographic HPSA during the previous year.

13. - 12 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Maximum Medicaid Incentives Calendar Year 201120122013201420152016 201121,250 20128,50021,250 20138,500 21,250 20148,500 21,250 20158,500 21,250 20168,500 21,250 20178,500 20188,500 20198,500 20208,500 20218,500 Cumulative Total $63,750 Max payments if did not accept more than $29,000 from state or local agencies. Pediatricians qualifying at 20% Medicaid encounters receive 33% less.

14. - 13 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Medicare Penalties Important! For 2015 and later, Medicare eligible professionals who do not successfully demonstrate meaningful use will have a payment adjustment to their Medicare reimbursement. The payment reduction starts at 1% and increases each year that a Medicare eligible professional does not demonstrate meaningful use, to a maximum of 5%

15. - 14 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Agenda American Recovery and Reinvestment Act Funding Medicare and Medicaid Incentive Programs Meaningful Use Meaningful Use in the Medical Practice Putting The Pieces Together Questions, Contact Information and Resources

16. - 15 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Meaningful Use: Description The Recovery Act specifies the 3 components of Meaningful Use: Use of certified EHR in a meaningful manner (e.g., e-prescribing) Use of certified EHR technology for electronic exchange of health information to improve quality of health care Use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by the Secretary http://onc-chpl.force.com/ehrcert

17. - 16 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. 16

18. - 17 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Meaningful Use Vision for 2015 Prevention, and management, of chronic diseases A million heart attacks and strokes prevented Heart disease no longer the leading cause of death in the US Medical errors 50% fewer preventable medication errors Health disparities The racial/ ethnic gap in diabetes control halved Care Coordination Preventable hospitalizations and re-admissions cut by 50% Patients and families All patients have access to their own health information Patient preferences for end of life care are followed more often Public health All health departments have real-time situational awareness of outbreaks

19. - 18 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Meaningful Use vision translates to five health related goals Improve quality, safety, efficiency and reduce health disparitiesEngage patients and families in their health careImprove care coordinationImprove population and public healthEnsure adequate privacy and security protections for personal health information

20. - 19 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Data capture and sharing Advanced clinical processes Improved outcomes Meaningful Use objectives and standards are increasing focus on structured data and care coordination Stage 1 2011-13 Stage 2 2014-16 Stage 3 2017  Increases objective thresholds  Menu items become Core objectives  Increases health information exchange between providers for better Care Coordination  Promotes increased patient engagement giving patients secure online access to their health information

21. - 20 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. What the future holds – Stage 2 and Stage 3

22. - 21 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Objectives relate to health related goals Stage 1 - Meaningful Use objectives and standards correlate with health related goals Objective 15 Core Objectives Standard Providers must meet all standards unless an exception applies. Objective 10 Menu Objectives Standard Providers may defer up to 5 items for Stage 1. One menu item selected must be related to public health reporting.

23. - 22 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Meaningful Use Objectives Core Set: Must Do All  Use CPOE  e-prescribing  Drug-drug & drug allergy checks  Medication list  Allergy list  Problem list  Decision support  Record demographics  Smoking status  Vital signs  Clinical summaries to patient  Electronic exchange  Health info to patients  Clinical quality measures  Protect health information Menu Set: Must Do 5 of 10  Incorporate clinical labs  Medication reconciliation  Implement drug-formulary checks  Generate patient list  Patient electronic access  Send reminder  Patient-specific education  Clinical summaries to provider  Submit electronic data to immunization registry*  Submit electronic syndromic surveillance data* *At least 1 public health objective must be selected.

24. - 23 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Objectives relate to health related goals Meaningful Use Stage 2 objectives and standards correlate with health related goals Objective 17 Core Objectives Standard Providers must meet all standards unless an exception applies. Objective 6 Menu Objectives Standard Providers must select 3 menu objectives.

25. - 24 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Stage 2 Meaningful Use Objectives  Record demographics  Smoking status  Vital signs  Clinical summary to patient  Protect health information  CPOE (meds, labs, imaging)  e-Prescribing + Formulary Checks  Drug-drug -allergy checks and 5 CDS Rules  Incorporate clinical labs results  Medication reconciliation  Generate patient list  Patient reminders  Patient-specific education  Submit to immunization registry  eSummary for transitions to provider  View Download and Transmit ePHI  Secure electronic messaging Core Set: Must Do AllMenu Set: Must Do 3 of 6*  Submit electronic syndromic surveillance data  Imaging results access  Family history  Electronic progress notes  Report to cancer registries  Report to specialty registry * Exceptions for menu items do not count towards the total. You must use a different menu item if possible.

26. - 25 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Clinical Quality Measures - 2014 The Recovery Act specifies the 3 components of Meaningful Use: Use of certified EHR in a meaningful manner (e.g. e-prescribing) Use of certified EHR technology for electronic exchange of health information to improve quality of health care Use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by the Secretary 2014 - New CQMs in certified EHRs Removed as a Core Objective but required to demonstrate Meaningful Use Must report CQM data electronically to CMS (Medicare), or to state (Medicaid) 2014 CQM reporting period is the entire year or optional 3 month period identical to the reporting period for meaningful use Beyond 2014 the reporting period for CQMs will be the entire calendar year Submission period must be within 2 months following the reporting period http:// www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/ClinicalQualityMeasuresTipsheet.pdf

27. - 26 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Stage 2 framework for the reporting of CQM Care Coordination Clinical Process Patient & Family Engagement Efficiency Patient Safety Population & Public Health Submit 9 of 64 CQMs from at least 3 of 6 National Quality Standard domains: (includes adult and pediatric recommended core CQMs)

28. - 27 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Agenda American Recovery and Reinvestment Act Funding Medicare and Medicaid Incentive Programs Meaningful Use Meaningful Use in the Medical Practice ARRA - Regional Extension Center of New Hampshire (RECNH) ARRA – Health Information Exchange (HIE) Putting The Pieces Together Questions, Contact Information and Resources

29. - 28 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Meaningful Use is distributed throughout the clinical office visit correlating to the health related goals CPOE Rx Drug-Drug *Formulary ePrescribe Demographics Problems Medications Rx Allergy Vitals Smoking CDS CQM *eLabs *Dx List *Reminders Pt. eCopy Clinical Summary *Pt. eAccess *Education HIE Capable *Rx Reconcile *Referral summary *Immunizations *Syndromic Data Privacy & Security ` * Menu Items Improve quality, safety, efficiency and reduce health disparities Engage patients and families in their health care Improve care coordination Improve population and public health Ensure adequate privacy and security protections for personal health information

30. - 29 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Re-organizing Meaningful Use tasks can follow patient flow Pre-VisitRegistration Patient Intake Provider Visit Check-OutPost Visit *Dx List *Reminders Demographics Vitals Smoking Rx Allergy *Rx Reconcile CPOE Rx Drug-Drug *Formulary ePrescribe Problems Medications CDS *eLabs Pt. eCopy Clinical Summary *Pt. eAccess *Education CQM HIE Capable *Referral summary *Immunizations *Syndromic Data Privacy & Security ` * Menu Items

31. - 30 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Under HITECH, $677 million is allocated to support a nationwide system of RECs that cover every geographic region of the United States to ensure plenty of support to health care providers in communities across the country.

32. - 31 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Practice and Workflow Redesign People TechnologyProcess Staff roles & responsibilities Credentials and capabilities Using technology effectively Privacy & Security Right place, right time Policies & Procedures

33. - 32 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Agenda American Recovery and Reinvestment Act Funding Medicare and Medicaid Incentive Programs Meaningful Use Meaningful Use in the Medical Practice Putting The Pieces Together Questions, Contact Information and Resources

34. - 33 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Medicare and Medicaid Incentives and Penalties Improved Individual & Population Health Outcomes Increased Transparency & Efficiency Improved Ability to Study & Improve Care Delivery ADOPTION EXCHANGE State Grants for Health Information Exchange Standards & Certification Framework Privacy & Security Framework Regional Extension Centers Workforce Training MEANINGFUL USE 33 HITECH – how the pieces fit together

35. - 34 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Federal Health IT Strategic Plan 2011-2015 Source: ONC

36. - 35 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Meaningful Use is the Building Block for other Clinical Transformation Initiatives Stage 2 MUPCMH/ “Stage 3 MU”Million Hearts Registries to manage patient populations Team based care, case management Enhanced access and continuity Privacy & security protections Care coordination Privacy & security protections Patient centered care coordination Improved population health Registries for disease management Evidenced based medicine Patient self management Privacy & security protections Care coordination Structured data utilized Data utilized to improve delivery and outcomes Patient informed Patient engaged, community resources Stage 1 MU Privacy & security protections Basic EHR functionality, structured data Utilize technology Access to information Transform health care

37. - 36 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Agenda American Recovery and Reinvestment Act Funding Medicare and Medicaid Incentive Programs Meaningful Use Meaningful Use in the Medical Practice Putting The Pieces Together Questions, Contact Information and Resources

38. - 37 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Resources Get information, tip sheets and more at CMS’ official website for the EHR incentive programs: www.cms.gov/EHRIncentiveProgramswww.cms.gov/EHRIncentivePrograms Learn about certification and certified EHRs, as well as other ONC programs designed to support providers as they make the transition: http://www.healthIT.gov http://www.healthIT.gov Learn about the National Quality Strategy and what lies ahead for the future: http://www.ahrq.gov/workingforquality/ http://www.ahrq.gov/workingforquality/ Just for fun. www.extormity.comwww.extormity.com

39. - 38 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. http://www.recnh.org http://www.maehc.org Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Collaboration, Participation, and Information

40. - 39 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Samantha Sawdon Senior Practice Consultant Cell: 339-226-2283 ssawdon@maehc.org Regional Extension Center of New Hampshire c/o New Hampshire Hospital Association 125 Airport Road Concord, NH 03301 Tel: 603.717.5420 Fax: 866.440.3007 nh-rec@maehc.org nh-rec@maehc.org Massachusetts eHealth Collaborative © MAeHC. All rights reserved.