1. ©2016 Oscislawski LLC Meaningful Use: Stage 3…and Beyond NJHIMSS/NJHFMA Winter Event January 28, 2016

2. Connecting Healthcare with Legal Excellence SM © 2016 Oscislawski LLC MU Hardship Relief Act of 2015 “Due to the tardiness of the final CMS rule, it is virtually impossible for doctors to meet the requirement deadlines.” Signed into law December 28, 2015 Extends blanket hardship exception for 2015 Reporting Period as a result of significant delay in publication of the 2015 modifications to Stage 2 EP Application Deadline: March 15, 2016 Hospital/CAH Application Deadline: April 1, 2016

3.  “We intend for Stage 3 to be the final stage of the meaningful use framework which leverages the structure identified in the Stage 1 and Stage 2 final rules, while simultaneously establishing a single set of objectives and measures designed to promote best practices and continued improvement in health outcomes in a sustainable manner.” - Preamble to Stage 3 Final Rule (Oct. 16, 2015)

4. Connecting Healthcare with Legal Excellence SM © 2016 Oscislawski LLC Stage 3…Final Countdown? “Final” Stage 3 and Modifications to Meaningful Use in 2015-2017 Rule published October 16, 2015 (“Stage 3 Rule”) Stage 3 Goals Continued Interoperability and HIE Improve Health Outcomes: Better Health, Better Care, Lower Costs Alignment with Other Quality Programs Advanced Use of CEHRT

5. Connecting Healthcare with Legal Excellence SM © 2016 Oscislawski LLC Stage 3 Optional in 2017 Mandatory in 2018 for all providers (regardless of year of participation) 2015 Edition may be adopted and used prior to beginning Stage 3 in 2017 or 2018 Edition combinations permitted but must be fully on 2015 Edition in 2018 Full calendar year reporting for all continuing providers (90 day for new)

6. Connecting Healthcare with Legal Excellence SM © 2016 Oscislawski LLC Stage 3 STAGE 3 OBJECTIVES (FOR NOW!!) Single set of Objectives for EP/Hospital/CAH 1. Protect Patient Health Information 2. Electronic Prescribing 3. Clinical Decision Support 4. CPOE 5. Patient Electronic Access 6. Coordination of Care through Patient Engagement 7. Health Information Exchange 8. Public Health and Clinical Data Registry Reporting

7. Connecting Healthcare with Legal Excellence SM © 2016 Oscislawski LLC Stage 3 1. Protect Patient Health Information ● EP/Hospital/CAH conducts or reviews a security risk analysis in accordance with the requirements in 45 C.F.R. 164.308(a)(1) ● Includes addressing the security (to include encryption) of ePHI data created or maintained by CEHRT… ● AND implementing security deficiencies as part of the provider’s risk management process.

8. Connecting Healthcare with Legal Excellence SM © 2016 Oscislawski LLC Stage 3 2. Electronic Prescribing (eRx) ● More than 25% of all hospital discharge medication orders for permissible prescriptions (new and changed) are queried for a drug formulary and transmitted electronically using CEHRT (Hospital/CAH) ● More than 60% of all permissible prescriptions written by the EP are queried for a drug formulary and transmitted electronically using CEHRT (EP)

9. Connecting Healthcare with Legal Excellence SM © 2016 Oscislawski LLC Stage 3 3. Clinical Decision Support ● Measure 1: EP/Hospital/CAH implements five clinical decision support interventions related to four or more CQMs at a relevant point in patient care for the entire EHR reporting period ● Measure 2: EP/Hospital/CAH has enabled and implemented drug-drug and drug-allergy interaction checks for the entire EHR reporting period

10. Connecting Healthcare with Legal Excellence SM © 2016 Oscislawski LLC Stage 3 4. CPOE ● The following orders created by the EP/Hospital/CAH are recorded using CPOE: o Measure 1 : More than 60% of Medication Orders o Measure 2 : More than 60% Laboratory Orders o Measure 3 : More than 60% Diagnostic Imaging Orders (Expanded from Stage 2 Radiology)

11. Connecting Healthcare with Legal Excellence SM © 2016 Oscislawski LLC Stage 3 5. Patient Electronic Access ● Measure 1 : For more than 80% of all unique patients seen by an EP or discharged from a Hospital/CAH inpatient or ED: o Timely access to VDT health information o Health information available to access through an API ● Measure 2 : For more than 35% of all unique patients seen by the EP or discharged from a Hospital/CAH inpatient or ED, the provider uses clinically relevant information from CEHRT to identify patient-specific educational resources and provides electronic access to such materials

12. Connecting Healthcare with Legal Excellence SM © 2016 Oscislawski LLC Stage 3 6. Coordination of Care through Patient Engagement ● Measure 1 : More than 10% of all unique patients seen by an EP or discharged from a Hospital/CAH inpatient or ED “actively engage” and either: (1) VDT, (2) Access through use of an API OR (3) Both. ● Measure 2 : For more than 25% of all unique patients seen by the EP or discharged from a Hospital/CAH inpatient or ED, a secure message was sent OR in response to a message sent ● Measure 3 : For more than 5% of all unique patients seen by the EP or discharged from a Hospital/CAH inpatient or ED, patient-generated health data or data from non-clinical setting is incorporated into CEHRT

13. Connecting Healthcare with Legal Excellence SM © 2016 Oscislawski LLC Stage 3 7. Health Information Exchange ● Measure 1 : For more than 50% of transitions of care or referrals, the EP/Hospital CAH that transitions or refers their patient to another setting/provider of care (1) creates a summary of care record using CEHRT and (2) electronically exchanges the summary of care record ● Measure 2 : For more than 40% of transitions or referrals received and patient encounters where patient not encountered before, the EP/Hospital/CAH receives or retrieves and incorporate into the patient’s record an electronic summary of care document. ● Measure 3 : For more than 80% of transitions or referrals received and patient encounters where patient not encountered before, the EP/Hospital/CAH performs clinical information reconciliation.

14. Connecting Healthcare with Legal Excellence SM © 2016 Oscislawski LLC Stage 3 7. Public Health and Clinical Data Registry Reporting ● Measure 1: Immunization Registry Reporting ● Measure 2: Syndromic Surveillance Reporting ● Measure 3: Electronic Case Reporting ● Measure 4: Public Health Registry Reporting ● Measure 5: Clinical Data Registry Reporting ● Measure 6: Electronic Reportable Laboratory Result Reporting (Hospital/CAH only)

15. “BRING OUT YOUR DEAD!”

16. Connecting Healthcare with Legal Excellence SM © 2016 Oscislawski LLC The Death of Meaningful Use? “We are now in the process of ending Meaningful Use and moving to a new regime culminating with the MACRA implementation….The Meaningful Use program as it has existed, will now be effectively over and replaced with something better.” - Acting Administrator Andy Slavitt, J.P. Morgan Annual Health Care Conference (Jan. 11, 2016)

17. Connecting Healthcare with Legal Excellence SM © 2016 Oscislawski LLC It’s not Dead Yet! “The current law requires that we continue to measure [MU] under the existing set of standards….While MACRA provides an opportunity to adjust payment incentives…it does not eliminate it, nor will it instantly eliminate all the tensions of the current system…. [O]ur existing regulations – including meaningful use Stage 3 – are still in effect.” - Acting Administrator Andy Slavitt & Acting Assistant Secretary for Health Karen DeSalvo (Jan.19, 2016)

18. Connecting Healthcare with Legal Excellence SM © 2016 Oscislawski LLC The Meaningful Use We Need? Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) (April 16, 2015) Repealed Medicare sustainable growth rate (SRG) formula Sunsets EP payment adjustments at the end of 2018 Establishes two payment tracks: Merit-Based Incentive Payment System (MIPS) Alternative Payment Model (APM) MIPS consolidates PQRS, MU and Value-Based Payment Modifier (VBPM) into single program

19. Connecting Healthcare with Legal Excellence SM © 2016 Oscislawski LLC The Meaningful Use We Need? MACRA and MIPS Transition guided by: (1) Outcomes instead of use of tech, (2) Flexibility and customization, instead of gov. needs, (3) Leveling the technology playing field, and (4) Interoperability and real world uses of technology MIPS measures four performance categories: (1) Quality (2) Resource Use (3) MU and (4) Clinical practice improvement activities MU worth up to 25 points of total “MIPS score”

20. Connecting Healthcare with Legal Excellence SM © 2016 Oscislawski LLC The Meaningful Use We Need? MIPS/APM only apply to Medicare physician and clinician payment adjustments What does this mean for Hospitals/CAHs and MU?? “The EHR incentive programs for Medicaid/Medicare hospitals have a different set of statutory requirements. We will continue to explore ways to align with principles we outlined above as much as possible for hospitals and the Medicaid program.” - Andy Slavitt and Karen DeSalvo

21. Thank you. Any questions? Krystyna Monticello, Esq. Attorneys at Oscislawski LLC kmonticello@oscislaw.com 609-385-0833, ext. 2