Slides presented at the July 13, 2010 press conference announcing the final rules for Meaningful Use. These rules define what qualifies for stimulus incentive payments under the ARRA/HITECH legislation.

1. Medicare & Medicaid EHR Incentive Program Final Rule Implementing the American Recovery & Reinvestment Act of 2009

3. Medicare & Medicaid Electronic Health Record (EHR) Incentive Program Notice of Proposed Rulemaking (NPRM)

4. Display – December 30, 2009

5. Publication – January 13, 2010

6. NPRM Comment Period Closed – March 15, 2010

7. CMS received 2,000+ comments

8. Final Rule on Display – July 13, 2010

9. Final Rule Published – July XX, 20102

11. Clinical Quality Measures (CQM)

12. Definition of Eligible Professional (EP) and Eligible Hospital/Critical Access Hospital (CAH)

13. Definition of Hospital-based EP

14. Medicare Fee-For-Service (FFS) EHR Incentive Program

15. Medicare Advantage (MA) EHR Incentive Program

16. Medicaid EHR Incentive Program

17. Collection of Information Analysis (Paperwork Reduction Act)

18. Regulatory Impact Analysis3

20. Changes to HIPAA

21. Office of the National Coordinator (ONC) Final Rule – Health Information Technology (HIT): Initial Set of Standards and Certification Criteria for EHR Technology

22. Establishment of Certification Programs for HIT

23. EHR certification requirements

24. Procedures for becoming a certifying body4

26. Clinical Quality Measures

27. Hospital-based EPs

28. Medicaid acute care hospitals

29. Medicaid patient volume

30. Medicaid programs will start in 2011

31. More clarification throughout5

33. Closely links with the ONC Certification and Standards final rules

34. Builds on the recommendations of the HIT Policy Committee and Public Commenters

35. Coordinates with existing CMS quality initiatives

36. Provides a platform that allows for a staged implementation of EHRs over time6

38. Eligible Professionals (EPs)

39. Eligible hospitals and critical access hospitals (CAHs)

40. Medicare Advantage (MA)

41. MA EPs

42. MA-affiliated eligible hospitals

43. Medicaid

44. EPs

45. Eligible hospitals7

46. Who is a Medicare Eligible Provider? *Subsection (d) hospitals that are paid under the PPS and are located in the 50 States or Washington, DC (including Maryland) 8

47. Who is a Medicare Advantage Eligible Provider? 9

48. Who is a Medicaid Eligible Provider? 10

50. The Continuing Extension Act of 2010 modified the definition of a hospital-based EP as performing substantially all of their services in an inpatient hospital setting or emergency room. The rule has been updated to reflect this change.

51. A hospital-based EP furnishes 90% or more of their services in either the inpatient or emergency department of a hospital. 11

53. Ex: Evidence of installation prior to incentive

54. Implemented – Commenced Utilization of

55. Ex: Staff training, data entry of patient demographic information into EHR

56. Upgraded – Expanded

57. Upgraded to certified EHR technology or added new functionality to meet the definition of certified EHR technology12

60. HIT Policy Committee (HITPC) recommendations

61. Listening Sessions with providers/organizations

62. Public comments on HITPC recommendations

63. Comments received from the Department and the Office of Management and Budget (OMB)

64. Revised based on public comments on the NPRM14

65. Conceptual Approach to Meaningful Use 15

67. Engage patients and families in their health care

68. Improve care coordination

69. Improve population and public health

70. Ensure adequate privacy and security protections for personal health information*Adapted from National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America’s Healthcare. Washington, DC: National Quality Forum; 2008. 16

71. Meaningful Use: Changes from the NPRM to the Final Rule 17

72. Meaningful Use: Changes from the NPRM to the Final Rule, cont’d 18

74. To meet certain objectives/measures, 80% of patients must have records in the certified EHR technology

75. EPs have to report on 20 of 25 MU objectives

76. Eligible hospitals have to report on 19 of 24 MU objectives

77. Reporting Period – 90 days for first year; one year subsequently19

83. Stage 1 menu set will be transitioned into core set for Stage 2

84. Will reevaluate measures – possibly higher thresholds24

87. In these cases, the EP, eligible hospital or CAH would be excluded from having to meet that measure

88. Ex: Dentists who do not perform immunizations; Chiropractors do not e-prescribe 26

90. Generate lists of patients by specific conditions for quality improvement, reduction of disparities, research or outreach (can specify particular conditions)

91. Reporting to immunization registries, reportable lab results and syndromic surveillance (can specify for their providers how to test the data submission and to which specific destination)27

93. Have to have 50% of their patient encounters at locations where certified EHR technology is available

94. Would base all meaningful use measures only on encounters that occurred at locations where certified EHR technology is available28

96. Will be deemed meaningful users for Medicaid (even if the State has CMS approval for the MU flexibility around public health objectives)29

98. 2012 – EPs, eligible hospitals and CAHs seeking to demonstrate Meaningful Use are required to electronically submit aggregate CQM numerator, denominator, and exclusion data to CMS or the States.30

100. EPs must report on 3 required core CQM, and if the denominator of 1or more of the required core measures is 0, then EPs are required to report results for up to 3 alternate core measures

101. EPs also must select 3 additional CQM from a set of 38 CQM (other than the core/alternate core measures)

102. In sum, EPs must report on 6 total measures: 3 required core measures (substituting alternate core measures where necessary) and 3 additional measures31

103. CQM: Core Set for EPs 32

104. CQM: Alternate Core Set for EPs 33

105. CQM: Additional Set for EPs Diabetes: Hemoglobin A1c Poor Control Diabetes: Low Density Lipoprotein (LDL) Management and Control Diabetes: Blood Pressure Management Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) Pneumonia Vaccination Status for Older Adults Breast Cancer Screening Colorectal Cancer Screening Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) Anti-depressant medication management: (a) Effective Acute Phase Treatment,(b)Effective Continuation Phase Treatment Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care Asthma Pharmacologic Therapy Asthma Assessment Appropriate Testing for Children with Pharyngitis Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients 34

106. CQM: Additional Set for EPs, cont’d Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients Smoking and Tobacco Use Cessation, Medical assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies Diabetes: Eye Exam Diabetes: Urine Screening Diabetes: Foot Exam Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation Ischemic Vascular Disease (IVD): Blood Pressure Management Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) Prenatal Care: Anti-D Immune Globulin Controlling High Blood Pressure Cervical Cancer Screening Chlamydia Screening for Women Use of Appropriate Medications for Asthma Low Back Pain: Use of Imaging Studies Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control Diabetes: Hemoglobin A1c Control (<8.0%) 35

107. CQM: Eligible Hospitals and CAHs Emergency Department Throughput – admitted patients Median time from ED arrival to ED departure for admitted patients Emergency Department Throughput – admitted patients – Admission decision time to ED departure time for admitted patients Ischemic stroke – Discharge on anti-thrombotics Ischemic stroke – Anticoagulation for A-fib/flutter Ischemic stroke – Thrombolytic therapy for patients arriving within 2 hours of symptom onset Ischemic or hemorrhagic stroke – Antithrombotic therapy by day 2 Ischemic stroke – Discharge on statins Ischemic or hemorrhagic stroke – Stroke education Ischemic or hemorrhagic stroke – Rehabilitation assessment VTE prophylaxis within 24 hours of arrival Intensive Care Unit VTE prophylaxis Anticoagulation overlap therapy Platelet monitoring on unfractionated heparin VTE discharge instructions Incidence of potentially preventable VTE 36

109. Childhood Immunization Status

110. Weight Assessment Counseling for Children and Adolescents

111. Chlamydia Screening for Women

112. Appropriate Testing for Children with Pharyngitis37

114. Register via the EHR Incentive Program website

115. Be enrolled in Medicare FFS, MA, or Medicaid (FFS or managed care)

116. Have a National Provider Identifier (NPI)

117. Use certified EHR technology to demonstrate Meaningful Use

118. Medicaid providers may adopt, implement, or upgrade in their first year

119. All Medicare providers and Medicaid eligible hospitals must be enrolled in PECOS38

121. States will ask providers for additional information in order to make accurate and timely payments

122. Patient Volume

123. Licensure

124. A/I/U or Meaningful Use

125. Certified EHR Technology39

126. Registration: Requirements Name of the EP, eligible hospital or qualifying CAH National Provider Identifier (NPI) Business address and business phone Taxpayer Identification Number (TIN) to which the provider would like their incentive payment made CMS Certification Number (CCN) for eligible hospitals Medicare or Medicaid program selection (may only switch once after receiving an incentive payment before 2015) for EPs State selection for Medicaid providers 40

128. Medicare FFS

129. Medicare Advantage

130. Medicaid

131. Eligible Hospitals and CAHs

132. Medicare FFS

133. Medicare Advantage (paid under Medicare FFS)

134. Medicaid41

135. Incentive Payments for Medicare EPs First Calendar Year (CY) for which the EP Receives and Incentive Payment

136. Additional Incentive Payments for Medicare EPs Practicing in HPSAs First Calendar Year (CY) for which the EP Receives and Incentive Payment

138. $2M base + per discharge amount (based on Medicare/Medicaid share)

139. Hospitals meeting Medicare MU requirements may be deemed eligible for Medicaid payments

140. Payment adjustments for Medicare after 2015

141. No Federal Medicaid payment adjustments

142. Medicare hospitals: No payments after 2016

143. Medicaid hospitals: Cannot initiate payments after 201645

144. Participation in HITECH and other Medicare Incentive Programs for EPs 46

145. Notable Differences Between the Medicare & Medicaid EHR Programs 47

147. Attestation for the EHR Incentive Programs will begin 9 months after the rule is published*

148. EHR incentive payments will be made 11 months after the rule is published*

149. States may launch their programs in January 2011 and thereafter

150. November 30, 2011 – Last day for eligible hospitals and CAHs to register and attest to receive an incentive payment for FFY 2011

151. February 29, 2012 – Last day for EPs to register and attest to receive an incentive payment for CY 2011

152. 2015 – Medicare payment adjustments begin for EPs and eligible hospitals that are not meaningful users of EHR technology**

153. 2016 – Last year to receive a Medicare EHR incentive payment; Last year to initiate participation in Medicaid EHR Incentive Program**

154. 2021 – Last year to receive Medicaid EHR incentive payment***Projected **Statutory 48

156. Early 2011 – EPs and eligible hospitals can register for the Medicare and Medicaid EHR Incentive Programs

157. More Information: http://www.cms.gov/EHRIncentivePrograms49

159. CAH – Critical Access Hospital

160. CCN – CMS Certification Number

161. CHIPRA – Children's Health Insurance Program Reauthorization Act of 2009

162. CMS – Centers for Medicare & Medicaid Services

163. CNM – Certified Nurse Midwife

164. CPOE – Computerized Physician Order Entry

165. CQM – Clinical Quality Measures

166. CY – Calendar Year

167. EHR – Electronic Health Record

168. EP – Eligible Professional

169. eRx – E-Prescribing

170. FFS – Fee-for-service

171. FQHC – Federally Qualified Health Center

172. FFY – Federal Fiscal Year

173. HHS – U.S. Department of Health and Human Services

174. HIT – Health Information Technology

175. HITECH Act – Health Information Technology for Electronic and Clinical Health Act

176. HITPC – Health Information Technology Policy Committee

177. HIPAA – Health Insurance Portability and Accountability Act of 1996

178. HPSA – Health Professional Shortage Area

179. MA – Medicare Advantage

180. MCMP – Medicare Care Management Performance Demonstration

181. MU – Meaningful Use

182. NCVHS – National Committee on Vital and Health Statistics

183. NP – Nurse Practitioner

184. NPI – National Provider Identifier

185. NPRM – Notice of Proposed Rulemaking

186. OMB – Office of Management and Budget

187. ONC – Office of the National Coordinator of Health Information Technology

188. PA – Physician Assistant

189. PECOS – Provider Enrollment, Chain, and Ownership System

190. PPS – Prospective Payment System (Part A)

191. PQRI – Medicare Physician Quality Reporting Initiative

192. Recovery Act – American Reinvestment & Recovery Act of 2009

193. RHC – Rural Health Clinic

194. TIN – Taxpayer Identification Number50