1. And Electronic
Health Records

2. Purpose of the Incentive
The HITECH Act established the $17.2 billion
fund for EHR incentives. It's purpose is two
fold:

Move physicians and hospitals toward the
meaningful use of a certified EHR,

Establish a mechanism to actively
exchange patient information among
providers

3. Meaningful Use is driven by five
principles
• Improving quality, safety and efficiency
• Engaging patients in their care
• Increasing coordination of care
• Improving the health status of the
population
• Ensuring privacy and security

4. Who Is Eligible

Doctors of medicine or osteopathy

Doctors of dental surgery or dental
medicine

Doctors of podiatric medicine

Doctors of optometry

Chiropractors
NOTE: Hospital based practitioners are NOT
eligible

5. Physicians wrestle with technical
details of meaningful use
www.NHINWatch.com
Thursday, January 20, 2011
Healthcare providers have discovered that identifying
the technologies to perform some meaningful use
measures is not as easy as federal rules might suggest.

6. How much is paid?

Medicare – 75% of the allowed charges for
professional services provided by physicians up
to a total of $44,000 over five years

Medicaid – Must have minimum of 30% of
Medicaid patient volume unless Pediatrician then
only 20% Medicaid volume (Only 2/3)

Can receive up to $63,750 over 6 years

7. Must Choose Medicare or Medicaid

For obvious reasons, you must choose to
participate under one program or the
other. Cannot participate in both.

You will receive one payment per year
regardless of which program you choose.

8. Why Medicaid is Easier
MEDICAID –Only for first participation year
• Adopted –Acquired and Installed
Eg: Evidence of installation prior to incentive
• Implemented –Commenced Utilization of
Eg: Staff training, data entry of patient demographic information
into EHR
• Upgraded –Expanded Upgraded to certified EHR
technology or added new functionality to meet the definition
of certified EHR technology
• Must be certified EHR technology capable of
meeting meaningful use
• No EHR reporting period
28

9. Medicare

Reporting Period: The reporting period for the
EHR Incentive program using a certified EHR is
any continuous 90 day period during the first
payment year.

Note that although the measure specifications
assume a full calendar year you should only
calculate the denominator and numerator from
the first day of the 90 day reporting period to the
last day of the 90 day reporting period.

10. Must Start by 2014 to get
Must Start by 2012 to get payments at all
Medicare Payment Details
full payment
CY 2011 CY 2012 CY 2013 CY 2014 CY 2015
CY 2011 $18,000
CY 2012 $12,000 $18,000
CY 2013 $8,000 $12,000 $15,000 Last payment in 2016
CY 2014 $4,000 $8,000 $12,000 $12,000
CY 2015 $2,000 $4,000 $8,000 $8,000
CY 2016 $2,000 $4,000 $4,000 $0
TOTAL $44,000 $44,000 $39,000 $24,000 $0

11. Medicaid Payment Details
Payments do NOT decrease
like Medicare payments do.
CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016
CY 2011 $21,250
CY 2012 $8,500 $21,250
CY 2013 $8,500 $8,500 $21,250
CY 2014 $8,500 $8,500 $8,500 $21,250
CY 2015 $8,500 $8,500 $8,500 $8,500 $21,250
CY 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250
CY 2017 $8,500 $8,500 $8,500 $8,500 $8,500
CY 2018 Total Payments are same
$8,500 $8,500 $8,500 $8,500
Regardless of start year
CY 2019 $8,500 $8,500 $8,500
CY 2020 $8,500 $8,500
CY 2021 $8,500
TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750

12. What are the requirements
for “meaningful use”?
1. Use certified EHR in a meaningful
manner
2. Use certified EHR to exchange
patient health data electronically
3. Use certified EHR to submit clinical
quality measures

13. What is a certified EHR?
 Must include a clinical data repository and
Computerized Physician Order Entry (CPOE)
supported by CDS.
 ePrescribing technology to electronically
•
transmit prescriptions to pharmacies.
 Exchange health information electronically with
external entities.
 E-submission of claims complying with HIPAA
Claims Attachment regulations
 Quality reporting metrics.

14. Certified EHRs

Must be certified by an ONC-Authorized
Testing and Certification Bodies (ONC-
ATCBs).

You must get the certification number in
order to register for incentive payments

Approximately 260 certified ambulatory
care EHRs (number is growing every day)

15. Two Types of Criteria
EHR Functionality
Clinical Quality
Measures

16. Functionality Meaningful Use
Criteria Defined

For eligible professionals, there are a total of 25
meaningful use objectives.

To qualify for an incentive payment, 20 of these
25 objectives must be met.

There are 15 required core objectives.

The remaining 5 objectives may be chosen from
the list of 10 menu set objectives.

80% of patients in EHR

17. EHR Functionality Criteria
Core Set 15 Menu Set 10
Mandatory Select 5 20 Criteria
Needed

18. 15 Required MU Criteria
• 1. Computerized provider order entry (CPOE)
• 2. E-Prescribing (eRx)
• 3. Report ambulatory clinical quality measures to CMS/States
• 4. Implement one clinical decision support rule
• 5. Provide patients with an electronic copy of their health information, upon
request
• 6. Provide clinical summaries for patients for each office visit
• 7. Drug-drug and drug-allergy interaction checks
• 8. Record demographics
• 9. Maintain an up-to-date problem list of current and active diagnoses
• 10. Maintain active medication list
• 11. Maintain active medication allergy list
• 12. Record and chart changes in vital signs
• 13. Record smoking status for patients13 years or older
• 14. Capability to exchange key clinical information among providers of care and
patient-authorized entities electronically
• 15. Protect electronic health information

19. Menu Objectives
• 1. Drug-formulary checks
(Choose 5)
• 2. Incorporate clinical lab test results as structured data
• 3. Generate lists of patients by specific conditions
• 4. Send reminders to patients per patient preference for preventive/follow up
care
• 5. Provide patients with timely electronic access to their health information
• 6. Use certified EHR technology to identify patient-specific education resources
and provide to patient, if appropriate
• 7. Medication reconciliation
• 8. Summary of care record for each transition of care/referrals
• 9. Capability to submit electronic data to immunization registries/systems*
• 10. Capability to provide electronic syndromicsurveillance data to public health
agencies*
• * At least 1 public health objective must be selected.

20. Clinical Quality Measures

6 total Clinical Quality Measures

3 core or alternate core, and

3 out of 38 from additional set

2011 –Eligible Professionals are required to
submit aggregate CQM numerator, denominator,
and exclusion data to CMS or the States by
ATTESTATION.

2012 –Eligible Professionals are required to
electronically submit aggregate CQM numerator,
denominator, and exclusion data to CMS or the
States.

21. Clinical Quality Measures
Core
Hypertension: Blood Pressure Measurement
Preventive Care and Screening Measure Pair:
− a) Tobacco Use Assessment,
− b) Tobacco Cessation Intervention
Adult Weight Screening andFollow-up

22. Clinical Quality Measures
Alternate Core

Weight Assessment and Counseling for Children and
Adolescents

Preventive Care and Screening: Influenza Immunization
for Patients 50 years and older

Childhood Immunization Status

23. Additional Set CQM–EPs must complete 3 of 38
• 1. Diabetes: Hemoglobin A1c Poor Control
• 2. Diabetes: Low Density Lipoprotein (LDL) Management and Control
• 3. Diabetes: Blood Pressure Management
• 4. Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or AngiotensinReceptor
Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
• 5. Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior
Myocardial Infarction (MI)
• 6 Pneumonia Vaccination Status for Older Adults
• 7. Breast Cancer Screening
• 8. Colorectal Cancer Screening
• 9. Coronary Artery Disease (CAD): Oral AntiplateletTherapy Prescribed for Patients with CAD
• 10. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
• 11. Anti-depressant medication management: (a) Effective Acute Phase Treatment,
(b)Effective Continuation Phase Treatment
• 12. Primary Open Angle Glaucoma (POAG): 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)

24. Best Practices
 Decide if you want to go for the Medicare or
Medicaid incentive program by looking at your
numbers. Medicaid is best.
 Determine the MU and CQM you want to report on.
Give this one some thought – big brother is watching.
 Create a “Meaningful Use” folder on your computer
and in your filing cabinet. Document everything.
Capture and save/print screen shots of registration.
Copy/scan agreements.
 Seek help.

25. What Next??
Step 1: Familiarize yourself with the
CMS EHR Incentive Program website
Step 2: Contact us for help with registration
and attestation.
Step 3: Collect EHR Incentive Payments

26. Frequently Asked Questions
• Who is responsible for demonstrating meaningful
use of certified EHR technology, the provider or
the vendor?
• “To receive an EHR incentive payment, the
provider (eligible professional (EP), eligible
hospital or critical access hospital (CAH)) is
responsible for demonstrating meaningful use of
certified EHR technology under both the Medicare
and Medicaid EHR incentive programs.” CMS
Website
• In plain English, you are.
•

27. Frequently Asked Questions
• What if my electronic health record (EHR) system
costs much more than the incentive the
government will pay? May I request additional
funds?
• “The Medicare and Medicaid EHR Incentive
Programs provide incentives for the meaningful
use of certified EHR technology. The incentives
are not a reimbursement of costs, and maximum
payments have been set.” CMS Website
•

28. Frequently Asked Questions
• Is the physician the only person who can enter
information in the EHR in order to qualify for the
Medicare and Medicaid EHR Incentive Programs?
• “No. Any licensed healthcare professional can
enter orders into the medical record per state,
local, and professional guidelines. The remaining
meaningful use objectives do not specify any
requirement for who must enter information.”
CMS Website
•

29. Frequently Asked Questions
• Are payments from the Medicare and Medicaid
EHR Incentive Programs subject to federal
income tax?
• “We note that nothing in the Act excludes such
payments from taxation or as tax-free income.
Therefore, it is our belief that incentive payments
would be treated like any other income. Providers
should consult with a tax advisor or the Internal
Revenue Service regarding how to properly report
this income on their filings.”
• CMS Website
•

30. Frequently Asked Questions
• In a group practice, will each provider need to
demonstrate meaningful use in order to get
Medicare and Medicaid electronic health record
(EHR) incentive payments or can meaningful use
be calculated or averaged at the group level?
• “Yes. Medicare and Medicaid incentive payments
are made on a per EP basis, not by practice. Each
EP will need to demonstrate the full requirements
of meaningful use in order to qualify for the EHR
incentive payments”. CMS Website
•

31. We will provide you with a free consultation
to help you with Meaningful Use issue and to
document your clinical and financial goals as
they relate to EHR technology, develop a
roadmap for success and help you to get the
most out of your EHR investment.
We can help you.
Contact us at (800) 431-3454.
www.healthinfotexas.com
info@healthinfotexas.com