Understanding the CMS EHR Incentive Programs

Understanding the CMS EHR Incentive Programs Adele Allison National Director of Government Affairs

Understanding the CMS EHR Incentive Program ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Summing-up HITECH goals ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Stage 1 – Objectives & Measures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Stage 1 – Objectives & Measures cont. ,[object Object],[object Object],[object Object],[object Object],[object Object]

Medicare Incentive Payments: Fee-For-Service ,[object Object],[object Object],[object Object],[object Object],[object Object],(§ 495.102)

Potential Medicare Incentives Calendar Year First Calendar Year in which the EP Receives an Incentive Payment 2011 2012 2013 2014 2015 and subsequent years 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 Shortage Area Totals* $48,400 $48,400 $42,900 $26,400 $0 * Providers practicing in a federally identified shortage area are eligible for a 10% increase .

Medicaid Incentives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Meaningful Use Medicaid Definitions ,[object Object],[object Object],[object Object],[object Object]

Meaningful Use Medicaid Definitions ,[object Object],[object Object],[object Object],[object Object],[object Object]

Meaningful Use Medicaid Definitions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Meaningful Use Medicaid Definitions Formula 1 : Medicaid Encounter Approach (Total Medicaid encounters in a representative continuous 90-day period in the preceding calendar year) ___________________________________________ X 100 = % (Total Patient Encounters in the same 90-day period) Formula 2 : Managed Care / Medical Home Approach (Total Medicaid patients assigned to the provider in a representative continuous 90-day period in the preceding calendar year with at least 1 encounter in the year preceding the start of the 90-day period) + (Unduplicated Medicaid encounters in that same 90-day period) ________________________________________________________________________ X 100 = % (Total patients assigned to the provider in the same 90-days with at least 1 encounter in the year preceding the start of the 9-day period) + (All unduplicated encounters in that same 90-day period)

Potential Medicaid Incentives Calendar Year First Calendar Year in which the EP Receives an Incentive Payment 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 $0 $8,500 $8,500 $8,500 $8,500 $8,500 2018 $0 $0 $8,500 $8,500 $8,500 $8,500 2019 $0 $0 $0 $8,500 $8,500 $8,500 2020 $0 $0 $0 $0 $8,500 $8,500 2021 $0 $0 $0 $0 $0 $8,500 TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750

Stage 1 – Medicaid Incentive Program ,[object Object],[object Object],[object Object],[object Object],[object Object]

Stage 1 – Medicaid Incentive Program cont. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Medicare EHR Incentive Enrollment ,[object Object],[object Object],[object Object],[object Object],[object Object]

Medicare EHR Incentive Enrollment cont. ,[object Object],[object Object],[object Object],[object Object],[object Object]

Medicare EHR Incentive Enrollment cont. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Medicaid EHR Incentive Enrollment, Generally ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Medicaid EHR Incentive Enrollment cont. ,[object Object],[object Object]

Medicaid EHR Incentive Enrollment cont. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Since Stage 1 Final Rule ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Since Stage 1 Final Rule ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Since Stage 1 Final Rule ,[object Object],[object Object],[object Object],[object Object]

Forecast: Stages 2 & 3 Stage 1 Proposed – Stage 2 Proposed – Stage 3 CPOE for Rx Orders – 30% COPE for Rx and lab/radiology – 60% CPOE for Rx and lab/radiology – 80% ,[object Object],[object Object],[object Object],[object Object],[object Object],Evidence-based interactions: Drug-Drug, Drug-Allergy, Drug-Age, Drug-Dose, Drug-lab, and Drug-condition ePrescribing – 40% ePrescribing transmission of 50% ePrescribing transmission of 80% Demographics – 50% Demographics on 80% of patients and ability to produce stratified quality reports. Demographics on 90% of patients and ability to produce stratified quality reports. Report CQM electronically Continued and expanded CQM reporting. Continued and expanded CQM reporting. Maintain Problem List – 80% Continue Stage 1 80% problems lists are up-to-date Maintain Active Rx List – 80% Continue Stage 1 80% Active Rx lists are up-to-date Maintain active medication allergy List – 80% Continue Stage 1 80% Rx allergy lists are up-to-date Record vital signs – 50% 80% of unique patients have vital signs recorded 80% of unique patients have vital signs recorded Record Smoking Status – 50% 80% of unique patients have smoking status recorded 90% of unique patients have smoking status recorded Implement 1 CDS Rule Use CDS to improve performance on high-priority conditions and establish CDS attributes for purposes of certification. Use CDS to improve performance on high-priority conditions and establish CDS attributes for purposes of certification. Menu Measure – Implement Drug-Formulary Checks Drug-Formulary Checks becomes a Core Measure 80% of Rx orders are checked against relevant formularies Hospital Menu Measure – Record advance directives – 50% Becomes core measure. Advance directives for 50% of patients age 65+ Advance directives for 90% of patients age 65+ Menu Measure – Incorporate Lab Results – 40% Lab Results becomes a Core Measure, but only where results are available. 90% of lab results are electronically ordered through EHR and reconciled with results, where results and structured orders are available.

Forecast: Stages 2 & 3 Stage 1 Proposed – Stage 2 Proposed – Stage 3 Menu Measure – Generate patient lists for specific conditions ,[object Object],[object Object],Use patient lists to manage patients for high-priority health conditions Menu Measure – Reminders to patients age 65+ and/or age 5 and under Measure becomes a Core requirement. 20% of active patients with preference for electronic reminders receive preventive or follow-up reminders Non-existent in Stage 1 At least 1 electronic note for 30% of patient visits. At least 1 electronic note for 90% of patient visits. Menu Measure – Provide electronic copy of health information upon request Continue Stage 1 90% of patients have timely access EHR-enabled patient-specific educational resources – 10% Continue Stage 1 20% offered patient-specific educational resources online in common primary languages. Provide clinical summaries for each office visit – 50% ,[object Object],[object Object],[object Object],Same as Stage 2 Timely electronic access provided to the patient – 10% ,[object Object],[object Object],[object Object],Same as Stage 2

Forecast: Stages 2 & 3 Stage 1 Proposed – Stage 2 Proposed – Stage 3 Timely electronic access and clinical summaries for each office visit. ,[object Object],[object Object],[object Object],[object Object],Non-existent in Stage 1 Online secure patient messaging in use. Same as Stage 2 Non-existent in Stage 1 Patient preferences for communication medium recorded – 20% Patient preferences for communication medium recorded – 80% TBD Exchange data between EHRs and PHRs using standards-based HIE. TBD Patients have ability to report experience of care measures online TBD Ability to upload and incorporate patient-generated data Perform 1 test of HIE ,[object Object],[object Object],[object Object],[object Object],Menu Measure – Medication reconciliation during transitions in care – 50% Medication reconciliation at 80% of care transitions by receiving provider Medication reconciliation at 90% of care transitions by receiving provider Menu Measure – Provide summary of care record during transitions in care- 50% Measure becomes Core. Summary of care record provided electronically for 80% of transitions and referrals Non-existent in Stage 1 List of care team members (including PCP) available for 10% of patients in EHR List of care team members (including PCP) available for 50% of patients in EHR Non-existent in Stage 1 Record a longitudinal care plan for 20% of patients with high-priority conditions Record a longitudinal care plan for 50% of patients with high-priority conditions

Forecast: Stages 2 & 3 Stage 1 Proposed – Stage 2 Proposed – Stage 3 Menu Measure – Submit immunization data Mandatory test. Some immunizations are submitted on an ongoing basis to Immunization Information System (IIS), if accepted and as required by law. ,[object Object],[object Object],Menu Measure – Submit reportable lab data Lab reporting menu option. Ensure lab results and conditions are submitted to public health agencies either directly or through performing labs Mandatory Test. Lab reporting menu. Ensure lab results and conditions are submitted to public health agencies either directly or through performing labs Menu Measure – Submit syndromic surveillance data Measure becomes a core requirement. Mandatory test; Submit if accepted. TBD ,[object Object],[object Object],TBD Patient-generated data submitted to public health agencies Conduct security review analysis and correct deficiencies. TBD TBD

Assessment – “You Are Here” ,[object Object],[object Object],[object Object],[object Object],[object Object]

Assessment – “You Are Here” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Leadership: Administration ,[object Object],[object Object],[object Object],[object Object],[object Object]

Provider Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Practice Redesign ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Practice Redesign ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Practice Redesign ,[object Object],[object Object],[object Object]

Understanding the CMS EHR Incentive Programs

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Andere mochten auch

Andere mochten auch (7)

Ähnlich wie Understanding the CMS EHR Incentive Programs

Ähnlich wie Understanding the CMS EHR Incentive Programs (20)

Mehr von Greenway Health

Mehr von Greenway Health (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Understanding the CMS EHR Incentive Programs