Meaningful Use: a Primer Mary Mitchell Director of Meaningful Use - - PowerPoint PPT Presentation
Health Information Technology Extension Center of Los Angeles Meaningful Use: a Primer Mary Mitchell Director of Meaningful Use A project of L.A. Care Health Plan A project of L.A. Care Health Plan What is Meaningful Use? Defined as: A.
A project of L.A. Care Health Plan A project of L.A. Care Health Plan
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A project of L.A. Care Health Plan
Meaningful Use Quality Reporting Clinical Decision Support Improving Care Coordination Engaging Patients Managing Population Health
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A project of L.A. Care Health Plan
Stage I
Stage II
Stage III
* to be defined in future rulemaking
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A project of L.A. Care Health Plan
Improved Outcomes Increased Efficiency
Challenges
Records Conversion Change
Access Adaptation
Responsiveness Practice
Patient Involvement
Investment of Time and Money
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Good News: You are already achieving many of these measures!
Medicare:
achieving meaningful EHR use Medicaid:
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provide to patient, if appropriate
* At least 1 public health objective must be selected
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1. Hypertension blood pressure measurement 2. Preventive care and screening measure pair
3. Adult weight screening and follow up 4. Weight assessment and counseling for children and adolescents 5. Preventive care and screening
6. Childhood immunization status
A project of L.A. Care Health Plan
EPs must complete 3 of 38
1. Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b) Effective Continuation Phase Treatment 2. Appropriate Testing for Children with Pharyngitis 3. Asthma Assessment 4. Asthma Pharmacologic Therapy 5. Breast Cancer Screening 6. Cervical Cancer Screening 7. Chlamydia Screening for Women 8. Colorectal Cancer Screening 9. Controlling High Blood Pressure
Retinopathy
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EPs must complete 3 of 38 (continued)
Therapy for Left Ventricular Systolic Dysfunction (LVSD)
(ER/PR) Positive Breast Cancer
b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies
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training, support and technical assistance to help primary care providers select, implement and use EHRs
country to become meaningful users of EHRs within four years
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Provider Type/License Eligible for subsidized REC Services Eligible for Medi-Cal Incentives1 Eligible for Medicare Incentives Medical Doctor (MD) YES2 YES3 YES3 Doctor of Osteopathy (DO) YES2 YES3 YES3 Psychiatrists (MD) NO4 YES3 YES3 Dentist NO4 YES YES Nurse Practitioner (NP) YES2 YES3 NO Certified Nurse Midwife (CNM) YES2 YES3 NO Chiropractor NO4 NO YES Physician Assistant (PA) YES2 YES5 NO Psychologists NO4 NO NO Optometrists NO4 YES YES Podiatrists (DPM) NO4 NO YES Residents NO YES3 YES3
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1Must meet Medi-Cal Patient volume criteria: 3Non-Hospital based: if more than 90% or the provider’s services are performed in a hospital in-patient or emergency roomMinimum 30% Medicaid patient volume setting, that provider is Hospital-Based and not eligible for the EHR incentive program Minimum 20% Medicaid patient volume and is a pediatrician
4May be eligible for REC services on a Fee for Service basisPractice predominantly in a Federally Qualified Health Center or Rural Health Clinic and have a minimum 30% patient volume of needy individuals
5Physician Assistants are only eligible if practicing in FQHC or RCH that is “Physician Assistant-led” 2Non-Hospital based, certified in Internal Medicine, Family Practice, Pediatrics, Adolescent Medicine, OB/GYN, or FamilyPractice practicing in one of the following settings: Physician Practices of 10 providers or less Community health centers, primary care clinics and rural health clinics Ambulatory care clinics associated with public hospitals, critical access hospitals, or rural hospitals Other medically underserved settings
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First Calendar Year in Which Eligible Provider Receives a Medicaid Incentive Payment Calendar Year 2011 2012 2013 2014 2015 2016 2011 $21,250 2012 $8,500 $21,250 2013 $8,500 $8,500 $21,250 2014 $8,500 $8,500 $8,500 $21,250 2015 $8,500 $8,500 $8,500 $8,500 $21,250 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250 2017 $8,500 $8,500 $8,500 $8,500 $8,500 2018 $8,500 $8,500 $8,500 $8,500 2019 $8,500 $8,500 $8,500 2020 $8,500 $8,500 2021 $8,500 Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750
uninsured patients over any 90 day period during the year.
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First Calendar Year in Which Eligible Provider Receives a Medicare Incentive Payment Calendar Year 2011 2012 2013 2014 2015 + 2011 $18,000 2012 $12,000 $18,000 2013 $8,000 $12,000 $15,000 2014 $4,000 $8,000 $12,000 $12,000 2015 $2,000 $4,000 $8,000 $8,000 $0 2016 $2,000 $4,000 $4,000 $0 Total $44,000 $44,000 $39,000 $24,000 $0
reimbursement for the entire year.
A project of L.A. Care Health Plan
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $
Medicare* $44,000 $39,000 $24,000 $0 Medicaid** $63,750 $63,750 $63,750 $63,750
* Eligible for payments up to 75% of Medicare billings (min. $25K to qualify for full amount) ** 30% of patients visits must be Medicaid to qualify for full amount (20% for pediatricians)
OR
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Medicare Medicaid
Federal Government will implement Voluntary for States to implement (may not be an option in every State) Claims payment reductions begin in 2015 for providers that do not demonstrate Meaningful Use No Medicaid payment reductions Must demonstrate MU in Year 1 Adopt/Implement/Upgrade option for 1st participation year Maximum incentive is $44,000 for EPs Maximum incentive is $63,750 for EPs MU definition is common for Medicare States 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 Five types of EPs, acute care hospitals (including CAHs) and children’s hospitals
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members; subsidized services for PPCPs.
Care Health Plan Providers
Providers in L.A. County including anyone with prescribing privileges.
– Practices of less than 10 – Community health centers – Public hospitals
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Incentives & Penalties
Certification Framework
Framework
Improved Individual & Population Health Outcomes Increased Transparency & Efficiency Improved Ability to Study & Improve Care Delivery ADOPTION MEANINGFUL USE EXCHANGE Health IT Practice Research
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A project of L.A. Care Health Plan
Readiness Assessment Practice Workflow Redesign EHR
Implementation
Achieving Meaningful Use Prepare for Future Pay for Performance Partnering with state and local HIEs HIT Education & Training EHR System Selection
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You have an EHR?
No EHR?
Focus on Stage 1 Clinical Measures It all starts with Meaningful Use!
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Right EHR? Timelines? How? Scanning? Configuration? Productivity loss? Use Hospital EHR? Necessary? Urgent? Use IPA/MSO? Buy? Will I miss out? Workflow? Test runs? Patient impact? Staff training? Meaningful Use? Cash flow? Incentives? Out of pocket costs? Penalties? Pay for Performance?
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TOP 10 EHR LESSONS LEARNED
1. The transition takes longer than you’ll expect; it’s too hard to scan charts as patients come in 2. Scanning/organizing/sorting take time to do it right, especially for cross-referencing systems 3. Data conversion from my old system (e.g. medical billing company) can come with a substantial cost (as much as $10k) if buying from a new or different vendor 4. I didn’t have an IT person with my old system; now I need one 5. I need support for both my internal network and software 6. I need to clarify and access the ongoing support I’ll need (e.g. response time) 7. Staff learning curve varies by person; some take much longer to adapt 8. Your EHR vendor will pursue your loyalty for their products & services, and solid implementation will make or break your investment 9. I need to check the financial stability of my EHR vendor before signing
We can help you with proper planning & implementation to avoid learning the hard way!
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Important Dates
period for calendar year 2011 for the Medicare EHR Incentive Program
receive an Incentive Payment for calendar year (CY) 2011
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