Meaningful use and cpoe cme presentation

Saint Luke's Care
presents

"Meaningful Use" and CPOE
1 credit hour of Category 1 CME
Free CME for Saint Luke's Care physicians
Upon completion of the online learning module, the participant will
 List three required portions of the Electronic Health Record that must be completed for a hospital to reach “Meaningful Use”.
 List the three required areas for electronic quality measure documentation and reporting by hospitals.
 Know that 30% of unique hospitalized patients must have more than one medication entered via CPOE
 Know that only physicians working primarily in the outpatient environment are eligible for incentives to use an Electronic
Health Record.
 List the three stages of the HI-TECH Act
 Know that hospitals will begin incurring penalties if they are not meeting Meaningful Use goals by 2015.

Target Audience: All SL Care physicians

Content: The federal EHR incentive program: Achieving ‘meaningful use’,
Robert Tennant, MA, Senior Policy Advisor, Medical Group Management Association (MGMA), Washington, D.C.
&
Healthcare IT and Stimulus Readiness: The American Recovery and Reinvestment Act of 2009,
Melody Kolb, MBA, Director, Business Analysis-McKesson Corp, Alpharetta, GA

Planning Committee:
Brent W. Beasley, MD, FACP - Medical Director, Saint Luke's Care, Saint Luke’s Health System, Kansas City, MO
John Yeast, MD – Vice President of Medical Affairs, Saint Luke’s Health System, Kansas City, MO
Carl Dirks, MD – Chief Medical Information Officer, Saint Luke’s Health System, Kansas City, MO
Shauna Todd, RN, BSN - Quality and Implementation System Analyst, Saint Luke’s Care, Kansas City, MO
Sharon Hoffarth, MD, MPH, FACPM – Medical Director, Primaris, Columbia, MO

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of
Primaris and Saint Luke's Care. Primaris is accredited by the Missouri State Medical Association to provide continuing medical education for physicians.

Primaris designates this educational activity for a maximum of 1 hours AMA PRA Category 1 Credit™. Physicians should claim credit commensurate with the extent of their participation in the activity.

For questions please contact Shauna Todd (stodd@saint-lukes.org)
or Brent Beasley (bbeasley@saint-lukes.org)

WASHINGTON LINK
Advocacy and information

The federal EHR incentive program:
Achieving ‘meaningful use’
By the MGMA Government
Affairs Department,
govaff@mgma.com
O n July 13, 2010, the Centers for
Medicare & Medicaid Services (CMS)
published the final rule outlining specifica-
• Increasing compliance flexibility
through exclusions for criteria that fall
outside the scope of practice;
tions for the “meaningful use” of EHR tech-
• Removing the criteria that require
nology. Mandated as part of the American
manual chart review to calculate specific
Recovery and Reinvestment Act of 2009
measure thresholds; and
(ARRA), the EHR incentive program will
mgma.com provide payments to eligible professionals • Removing administrative transactions,
• mgma.com/ (EPs) who meet certain qualifications using including electronic claim submission
medicarepaymentpolicies
certified software. and electronic eligibility verification
• Contact Congress to voice
your opinions at
As a result of advocacy by MGMA and criteria.
mgma.com/policy other groups, the final rule significantly re-
duced the requirements that were originally
proposed. Change to hospital-based EP
Modifications to the final rule include:
ARRA outlined that hospital-based EPs who
• Eliminating the requirement that all 25
furnish substantially all their services in a
meaningful-use criteria had to be met to
hospital setting are not eligible for incentive
qualify for the incentives;
payments. The Continuing Extension Act of
• Reducing the number of required criteria 2010 modified the definition of a hospital-
from 25 to 20; based EP as “a practitioner who performs
substantially all of [his or her] services in an
• Requiring 15 core criteria and five add
‘inpatient hospital setting or emergency
criteria that EPs choose from a menu
room.’” The final rule on meaningful use re-
of 10;
flects this change. Hospital-based EPs are
• Decreasing the threshold for now defined as EPs who furnish 90 percent
meaningful-use measures (i.e., the or more of their allowed services in hospital
percentage of prescriptions sent inpatient settings or hospital emergency de-
electronically was reduced from 75 partments.
percent to 40 percent);
Payments and reporting periods
Who is eligible?
Those EPs who qualify to receive EHR in-
Medicare Medicaid centive payments via the Medicare program
can receive up to $44,000 over five years
Doctors of medicine or osteopathy Physicians with payments beginning as early as 2011.
EPs will receive an incentive payment for
Doctors of dental surgery or dental medicine Dentists
up to 75 percent of Medicare allowable
Doctors of podiatric medicine Certified nurse midwives charges for covered professional services
furnished in a payment year. An EP who
Doctors of optometry Nurse practitioners predominantly furnishes services in a geo-
graphic Health Professional Shortage Area is
Chiropractors who are legally authorized to Physician assistants who practice in a feder-
practice under state law ally qualified health center or rural health eligible for a 10 percent increase in the
clinic led by a physician assistant maximum incentive payment amount.

p a g e 1 4 • MGMA Connexion • September 2010 ©2010 Medical Group Management Association. All rights reserved.

First calendar year that the EP receives an incentive payment
Calendar year
2011 2012 2013 2015 2015 and later

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

The total maximum EHR incentive demonstrate meaningful use of certi- Health & Human Services secretary
payment amounts for Medicare EPs fied EHR technology will be subject to to decrease payments by as much as
are outlined on page 15. payment adjustments for their 5 percent.
Under the Medicaid program, EPs Medicare-covered professional services
EPs participating in the Medicaid
are eligible for up to $63,750 over six in 2015. The penalties include the fol-
incentive program are not subject to
years if at least 30 percent of their pa- lowing reduced payment amounts:
penalties.
tients are Medicaid patients. Pediatri-
cians are eligible for two-thirds of the • 2015 – 1 percent decrease;
Medicaid incentives if 20 percent to • 2016 – 2 percent decrease; Meaningful-use criteria
29 percent of their patients are on
• 2017 and beyond – 3 percent To qualify for the incentives, EPs must
Medicaid and 100 percent of the in-
decrease; and meet all 15 of the core objectives and
centive if they reach the 30 percent
select five additional objectives from
threshold. • In 2019 and beyond – ARRA the menu objectives list. If an EP quali-
Payments under this Medicare in- permits the U.S. Department of
centive program will be disbursed see Washington Link, page 16
through a single payment contractor
Core objectives (all required) Menu objectives (must select five)
to the tax identification number pro-
vided by the qualifying EP. And then, 1. Implement computerized physician order entry 1. Use drug-formulary checks
provided EPs meet certain conditions,
2. Use e-prescribing (eRx) 2. Incorporate clinical lab test results as structured
they can reassign their incentive pay- data
ment to one employer or entity. 3. Report ambulatory clinical quality measures to 3. Generate lists of patients by specific conditions
CMS/states
For the first year an EP receives an
4. Implement one clinical decision support rule 4. Send reminders to patients per patient
incentive payment, the EHR reporting preference for preventive/follow-up care
period is any continuous 90 days be- 5. Provide patients with an electronic copy of their 5. Provide patients with timely electronic access
health information upon request to their health information
ginning and ending within the year.
6. Provide clinical summaries for patients for each 6. Use certified EHR technology to identify
For every year after the first payment office visit patient-specific education resources and
provide to patient, if appropriate
year, the EHR reporting period in- 7. Use drug-drug and drug-allergy interaction
checks 7. Perform medication reconciliation
cludes the entire year.
Note: For the first year of participa- 8. Record demographics 8. Provide summary of care record for each
transition of care/referrals
tion, EPs in the Medicaid incentive 9. Maintain an up-to-date problem list of current 9. Submit electronic data to immunization
program are not required to prove and active diagnoses registries/systems

they have attained meaningful use, 10. Maintain active medication list 10. Provide electronic syndromic surveillance data
to public health agencies
only that they have been “adopting,
11. Maintain active medication allergy list
implementing or upgrading to certi-
fied EHR technology … .” 12. Record and chart changes in vital signs

13. Record smoking status for patients 13 years
or older
Penalties
14. Exchange key clinical information among
providers of care and patient-authorized
While the EHR incentive program is entities electronically
voluntary, EPs who do not successfully 15. Protect electronic health information

©2010 Medical Group Management Association. All rights reserved. MGMA Connexion • September 2010 • p a g e 1 5

from page 15

WASHINGTON LINK

fies for an exclusion, he or she may select lect three additional CQM from a set of 38
four menu objectives. One of the menu ob- CQM (other than the core/alternative core
jectives must be a public health measures).
objective (No. 9 or 10 from the list on EPs must report on six total measures:
page 15). three required core measures (substituting
alternative core measures where necessary)
and three additional measures.
Meaningful use for EPs who work at
multiple sites
Product certification
An EP who works at multiple locations but
does not have certified EHR technology The Office of the National Coordinator for
available at all of them would need to indi- Health Information Technology (ONC) pub-
cate that at least 50 percent of his or her lished a final rule outlining the “temporary”
total patient encounters were at locations EHR software certification process. ONC
that use certified EHR technology. In addi- permits any organization to apply to be-
tion, the EP would need to base all mean- come an Authorized Certification and Test-
ingful-use measures only on encounters ing Body (ACTB). It is anticipated that
that occurred at locations that use certified multiple organizations will be designated as
technology. ACTBs and that product testing and certifi-
cation will begin this year.

Clinical quality measures overview
Registration
EPs seeking to demonstrate meaningful use
in 2011 must submit aggregate clinical qual- To register for the program, EPs must be en-
ity measures (CQM) numerator, denomina- rolled in Medicare Fee for Service (FFS),
tor and exclusion data to CMS or the states Medicare Advantage or Medicaid (FFS or
by attestation. In other words, they must managed care). In addition, participants
certify to the government that they have must have a national provider identifier
met all the requirements. In 2012, EPs will and be enrolled in Provider Enrollment,
be required to electronically submit aggre- Chain and Ownership System.
gate CQM numerator, denominator and ex- Go to mgma.com for additional informa-
clusion data to CMS or the states. tion on these Medicare and Medicaid EHR
EPs must report on three required core incentive programs.
CQM. If the denominator of one or more of For program information and to register
the required core measures is zero, then EPs for the program, go to cms.gov/EHRIncen-
are required to report results for up to three tivePrograms.
alternative core measures. EPs also must se-

Required clinical quality core criteria Alternative core criteria

Hypertension: blood pressure management Influenza immunization for patients
50 years of age or older

Tobacco use assessment and cessation Weight assessment and counseling for
intervention children and adolescents

Adult weight screening and follow-up Childhood immunization status

p a g e 1 6 • MGMA Connexion • September 2010 ©2010 Medical Group Management Association. All rights reserved.

Copyright of MGMA Connexion is the property of Medical Group Management Association and its content
may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express
written permission. However, users may print, download, or email articles for individual use.

Reprinted with permission from the Medical Group Management Association, 104 Inverness Terrace East,
Englewood, Colorado 80112. 877.275.6462. www.mgma.com. Copyright 2010.

Healthcare IT and Stimulus Readiness
The American Recovery and Reinvestment Act of 2009

September 21, 2010

Melody Kolb, MBA
Director, Business Analysis

Copyright © 2010 McKesson Corporation. All Rights Reserved. DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION

HITECH Overview
Estimated Payments from Stimulus

$30.0 $27.4
$25.0

$20.0 $19.0

$15.0
$9.7
$10.0

$5.0

$‐
Low Scenario
Low Scenario Approved High Scenario
High Scenario

CMS estimated payouts (billions) for both Medicare
and Medicaid, less penalties from 2011 – 2019
Medicaid

Copyright © 2010 McKesson Corporation. All Rights Reserved. 3 DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION

HITECH Overview
Estimated Timeline
2015 – Medicare penalties begin for EPs and eligible hospitals
that are not meaningful users of EHR technology
July 28, 2010
y ,
Federal Register Publication 2016 – Last yr to receive a Medicare EHR incentive payment;
Last yr to apply for Medicaid EHR incentives
Final Rule for Stage 1
Meaningful Use 2021 – Last year to receive Medicaid EHR incentive payment
January 2011
Registration for EHR Incentive
Programs begins
December 31, 2011 December 31, 2013
States may launch programs
Stage 2 criteria available Stage 3 criteria available
for Medicaid providers

January 1, 2011 May 2011 February 29, 2012
Medicare / Medicaid EHR incentive Last day for EPs to
incentive program f
i ti for payments b i
begin register/attest f CY11
i / for
physicians begins incentive payment

October 1, 2010 April 2011 November 30, 2011
Medicare / Medicaid Attestation for Last day for eligible hospitals /
incentive program for Medicare incentive CAHs to register/attest for
hospitals begins program begins FY11 incentive payment


Stage 1 Meaningful Use
Final Rule Significant Changes
 14 Core objectives; all required for Stage 1
─ Ten additional Menu objectives; select/meet 5 of the 10 for Stage 1
• Must choose at least 1 of the population and public health
objectives (pg 44328)
• Proposing to require all Stage 1 Menu objectives in Stage 2
─ Previously 23 hospital objectives

 Emergency Department (
g y p (POS 23) included in measures for
)
12 objectives
 Clinical quality measures reduced from 35 to 15 measures
 Clinical decision support rules decreased from 5 to 1
 Electronic copy of health information provided within 3
business days (previously 48 hrs)
Source: U.S. Department of Health & Human Services. Medicare and Medicaid Programs; Electronic Health Record Incentive Program. Vol. 75, No. 144. / Federal Register /
July 28, 2010 / Final Rule. Retrieved from http://federalregister.gov/a/2010-17207

Final Rule Significant Changes (Continued)
 Electronic insurance eligibility & claims submission
objectives expected for Stage 2 ((pg 44353)
 Advance directives and patient-specific education
resources Menu objectives added
 Measure threshold changes include:
─ CPOE increased from 10% to 30% but for Med orders only
─ Demographics, Vital Signs, smoking status, electronic copy of health
information, Med Reconciliation and Summary Care Record all
decreased from 80% to 50%
─ Incorporating structured Lab results decreased from 50% to 40%

 Eligibility still based on CCN (CMS Certification Number)
─ Potential for legislative change

Methods of Measure Calculation

 Mandates certified EHR technology must include ability to
calculate measures (pg 44334)
─ Clinical Performance Analytics™ (15.0 ARRA SP) meets requirement
for the 14 threshold calculations
 5 measures with a denominator of unique patients
regardless of whether the patient’s records are maintained
using certified EHR technology
─ Patients seen more than once during the EHR reporting period are
only counted once in the denominator for the measure
─ All measures relying on the term “unique patient” relate to what is
contained in the patient’s medical record (pg 44334)
─ Includes the objectives for problems, medications, allergies,
j g
demographics and patient-specific education
Source: TABLE 3: Stage 1 Meaningful Use Objectives and Associated Measures Sorted by Method of Measure Calculation. U.S. Department of Health & Human Services.
Medicare and Medicaid Programs; Electronic Health Record Incentive Program. Vol. 75, No. 144. / page 44376 / Federal Register / July 28, 2010 / Final Rule. Retrieved from
http://federalregister.gov/a/2010-17207

Methods of Measure Calculation (Continued)

 9 measures with a denominator based on counting actions
for patients whose records are maintained using certified
EHR technology
─ Subset of unique patients based on objectives criteria
─ Intent is to ensure a minimum of 80% of records are maintained, e.g.,
problems, allergies & medication measures (pg 44330)

 9 measures requiring only a Yes/No attestation

 15 hospital clinical q
p quality measures to CMS or the States
y
─ Detailed electronic specifications available on the CMS website at:
http://www.cms.gov/QualityMeasures/03_ElectronicSpecifications.asp#TopOfPage

Source: TABLE 3: Stage 1 Meaningful Use Objectives and Associated Measures Sorted by Method of Measure Calculation. U.S. Department of Health & Human Services.
Medicare and Medicaid Programs; Electronic Health Record Incentive Program. Vol. 75, No. 144. / page 44376 / Federal Register / July 28, 2010 / Final Rule. Retrieved from
http://federalregister.gov/a/2010-17207

Computerized Physician Order Entry

 Requires 30% of unique patients with ≥1 medication listed in
med list must have ≥1 med order entered via CPOE

 Expands objective/measure to include Emergency
Department (POS 23)

 Finalizes a Stage 1 threshold for CPOE of 30% for EPs and
hospitals (pg 44333)
h it l
─ Finalizes a Stage 2 threshold for CPOE of 60% EPs and hospitals
─ Considering adding measures related to CPOE orders for services
beyond medication orders in Stage 2 and beyond (pg 44322)


Computerized Physician Order Entry (Cont’d)
(Cont d)

 Recommends any licensed healthcare professional can enter
orders into the medical record per state local and professional
state,
guidelines (pg 44332)
─ Decreases opportunities for clinical decision support and adverse
pp pp
interaction
─ Balances potential workflow implications of requiring the ordering
provider to enter every order directly especially in the hospital setting
directly,
─ Removes possibility of presenting alerts to someone without clinical
judgment; excludes clerical staff from entering orders in CPOE


Clinical Quality Measures
 Ability to report on 15 hospital quality measures to CMS or
State
─ ED throughput (2)
─ Ischemic or hemorrhagic stroke (7)
─ VTE (6)

 Required to attest results are automatically calculated by
certified EHR in 2011
─ Electronically submit requirements beginning in 2012 (pg 44432)

 Electronic med admin record (eMAR) required to calculate 7
( ) q
of the 15 measures
 Required to maintain evidence of incentive qualification for 6
or 10 years (pg 44439 / 44468)
Source: Excerpt from TABLE 10: Clinical Quality Measures for Submission by Eligible Hospitals and CAHs for Payment Year 2011-20125. U.S. Department of Health & Human
Services. Medicare and Medicaid Programs; Electronic Health Record Incentive Program. Vol. 75, No. 144. / page 44418 / Federal Register / July 28, 2010 / Final Rule.
Retrieved from http://federalregister.gov/a/2010-17207

Clinical Quality Measures (Cont’d)
(Cont d)

 15 hospital quality measures:
1.
1 ED Throughput – admitted patients (Median time from ED arrival to ED departure) ED 1
ED-1
2. ED Throughput – admitted patients (Admission decision time to ED departure time) ED-2
3. Ischemic stroke – Discharge on anti-thrombotics STROKE-2
4. Ischemic stroke – Anticoagulation for A-fib/flutter STROKE-3
g
5. Ischemic stroke – Thrombolytic therapy for pts arriving within 2 hrs of symptom onset STROKE-4*
6. Ischemic or hemorrhagic stroke – Antithrombotic therapy by day 2 STROKE-5*
7. Ischemic stroke – Discharge on statins STROKE-6
8. Ischemic or hemorrhagic stroke – Stroke education STROKE-8
9. Ischemic or hemorrhagic stroke – Rehabilitation assessment STROKE-10
10. VTE prophylaxis within 24 hours of arrival VTE-1*
11 Intensive Care Unit VTE prophylaxis VTE-2*
11. VTE 2
12. Anticoagulation overlap therapy VTE-3*
13. Platelet monitoring on unfractionated heparin VTE-4*
14. VTE discharge instructions VTE-5
15. Incidence of potentially preventable VTE VTE-6* Asterisk indicates eMAR required.

Source: Excerpt from TABLE 10: Clinical Quality Measures for Submission by Eligible Hospitals and CAHs for Payment Year 2011-20125. U.S. Department of Health & Human
Services. Medicare and Medicaid Programs; Electronic Health Record Incentive Program. Vol. 75, No. 144. / page 44418 / Federal Register / July 28, 2010 / Final Rule.

Meaningful Use Measurement
McKesson s
McKesson’s Comprehensive Solution
McKesson provides a comprehensive strategy for measuring meaningful use
that supports immediate and long term objectives.
Analytics Strategic Components
IT Functionality Measures
• Calculation of IT adoption rates
Calculation of IT adoption rates
• Installed as Clinical 10.3 is installed
• Measures process of care Software and content
must be implemented for
Quality Benchmarks Collaborative
Quality Benchmarks Collaborative™ Stage 1 Meaningful Use
g g
measurement
• Calculation and submission of quality measures
• 10.3 and design guide dependency
• Measures quality of care delivery

Clinical Outcomes  Measures Software and content
• Measures  patient outcomes pre and post adoption must be implemented for
• Supports nursing and  physician alignment Stage 2 Meaningful Use
measurement
• Measures outcomes of care
Measures outcomes of care


Hospital Based
Hospital-Based Eligible Professionals (EP)

 Legislative Change: The Continuing Extension Act of 2010
(HR 4851)
─ Only hospital-based physicians, who provide more than 90% of
Medicare/Medicaid services in a hospital inpatient or emergency
room setting (POS 21 & 23), are excluded from receiving
Medicare/Medicaid incentives
─ Physicians, who provide Medicare/Medicaid services p
y , p primarily at
y
hospital outpatient centers and clinics, are eligible for EHR
incentives (pgs 44439–44440)


Meaningful Use
HITECH Program Stages

Stage Goal
Stage 1 Electronic Capture of Patient Data

Stage 2
g Improved Clinical Processes
p
Stage 3 Quality Measurement & Improvement

 Proposed updating meaningful use criteria on a biennial basis (pg 44321):

 Stage 2 proposed by end of calendar year 2011

 Stage 3 proposed by end of calendar year 2013

 Clear indication that Stage 3 will not be last year of requirements ( 44323)
(pg


“Reporting Period” Defined
Reporting Period
 For the First Year Incentive Qualifications
─ 90 consecutive day reporting period to prove MU through required measures
─ Provider determines reporting period within payment year
Eligible Hospitals Eligible Professionals
First Payment
Year Earliest Earliest
Last Date Last Date
Date Date
2011 10/1/2010 7/1/2011 1/1/2011 10/1/2011
2012 10/1/2011 7/1/2012 1/1/2012 10/1/2012
2013 10/1/2012 7/1/2013 1/1/2013 10/1/2013

─ “Attestation methodology” proposed in 2011, with selected compliance reviews
• Electronic reporting of quality measures to CMS starts in 2012
• Other measures remains through attestation until further testing and
advancement made in HIT (pg 44436)
 Subsequent Years
─ Entire 12 months of the respective year
• Eligible Hospitals: Federal Fiscal Year (October 1 – September 30)
• Eligible Professionals: Calendar Year

Respective Criteria per Payment Year

First Payment Year
Payment Year 2011 2012 2013 2014 2015
2011 Stage 1 Stage 1 Stage 2 Stage 2 TBD
2012 Stage 1 Stage 1 Stage 2 TBD
2013 Stage 1 Stage 1/2* TBD
2014 Stage 1 TBD
* Discrepancy between TABLE 1: Stage of Meaningful Use Criteria by Payment Year which states “Stage 1” and page 44322 which states “anticipate updating
the criteria of meaningful use to Stage 2 in time for the 2013 payment year and therefore anticipate for their second payment year (2014), an EP, eligible
hospital, or CAH whose first payment year is 2013 would have to satisfy the Stage 2 criteria of meaningful use to receive the incentive payments” Retrieved
July 28, 2010, from http://federalregister.gov/a/2010-17207

 Signifies when payment is reported/earned, not necessarily paid

Source: TABLE 1: Stage of Meaningful Use Criteria by Payment Year. U.S. Department of Health & Human Services. Medicare and Medicaid Programs; Electronic Health
Record Incentive Program. Vol. 75, No. 144. / page 44323 / Federal Register / July 28, 2010 / Final Rule. Retrieved from http://federalregister.gov/a/2010-17207


Meaningful Use
Application Criteria
 Register at the EHR Incentive Program website beginning January,
2011 (http://www.cms.gov/EHRIncentivePrograms)
 Must be enrolled in Medicare FFS, MA or Medicaid (FFS or managed
care)
 Need a National Provider Identifier (NPI)

 Use certified EHR technology to demonstrate Meaningful Use

 Medicare providers and Medicaid eligible hospitals must be enrolled in
PECOS (Provider Enrollment, Chain and Ownership System)
 Attestations can be submitted beginning in April, 2011 for Medicare;
Medicaid determined based on CMS approval of State HIT plan

Source: http://www.cms.gov/EHRIncentivePrograms/Downloads/EHR_Incentive_Program_Agency_Training_v8-20.pdf


Meaningful Use
Incentive Payment Detail
 First payments anticipated May 2011

 Payments to be made within 15 – 46 days after application approved

 Eligible Hospitals may be able to “skip” a year, but will lose that year’s
payment for Medicare

 Medicaid payment years need not be consecutive prior to FY 2016

 No restrictions on EHR incentive payment; treated similar to bonus
payment

 Payments will be based on most recently submitted Cost Report and
calculated by the FIs/MACs

 Payments to be paid through single p y
y p g g payment contractor
January 28, 2010 / Final Rule. Retrieved from http://federalregister.gov/a/2010-17207


Meaningful Use
Certification
 Final Rule published in Federal Register June 24, 2010
 Timeline
─ Applications open July 1; expected to “open doors” by end of August
─ First certified systems expected “Fall 2010”
 Remote testing required by Accredited Testing & Certification Bodies (ATCB)
─ Testing on developers systems or at operational site
 Must strictly adhere to requirements established by HHS
─ May offer other programs, but cannot add requirements to HHS certification
─ No grandfathering of previous certifications supported by HHS
 Certification attestation required with service packs/subsequent code releases
─ Attest to no changes to applications that would affect certification criteria
 Horizon Clinicals 10.3
─ September: Apply for certification
─ October: targeted Generally Available (GA)

Copyright © 2010 McKesson Corporation. All Rights Reserved. DATE SENSITIVE MATERIAL – SUBJECT TO MODIFICATION

Hospital Stimulus Program
Medicare Based
Medicare-Based Incentives
 Requires “meaningful use” of certified
Potential Medicare Incentive for
Electronic Health Record (EHR) Saint Luke's Health System
─ Stage 1 final requirements posted to Federal (thousands)
Register July 28, 2010 (official 60 days later) $12,000

Potential for ~ $20.9 million over 4 years
 Formula based primarily on acute inpatient
Based on 42,646 discharges;
discharges and Medicare share $10,000 46.7% Medicare Days; 3.0% Charity
─ Initial A t
I iti l Amt = $2M + $200 per di h
discharge
$8,307
for discharges between 1,150 and 23,000
$8,000
─ Medicare Share based on inpatient bed days,
excluding those not paid under IPPS, $6,265
with an adjustment for charity care $6,000
$ Stage
─ 100% yr 1, 75% yr 2, 50% yr 3, 25% yr 4 1
90 days
$4,201
 Must qualify initially between FY 2011 – FY
$4,000 1
2013 to receive max 12 mo

─ Reduced i
R d d incentives f FY 2014 – FY 2015
ti for 2 $2,112
12 mo
─ No payments to providers after FY 2016 $2,000
TBD
─ May miss a year, but lose that year’s payment 12 mo
$0 $0
─ Estimate first payment year paid out within 15 – $0
46 d
days (if applying after M 2011)
l i ft May, 2011 2012 2013 2014 2015 2016

 Hospitals are permitted to participate in Federal Fiscal Year (begins October 1)

Medicaid incentives as well (min 10%)

Medicare Based
Medicare-Based Penalties
 Non-compliance of EHR requirements Potential Medicare Penalties for
results in penalties Saint Luke's Health System
(thousands)
─ Penalties begin in FY 2015 $0
$0
─ Impacts Medicare only – not Medicaid

 Penalized through reductions in market ($2,000)
(
($1,956)
)
basket adjustments
─ FY 2015 – 25% cut in applicable increase ($4,000)
($3,982)
─ FY 2016 – 50% cut
─ FY 2017 and beyond – 75% cut
y
($6,000)
($6 000)
($6,031) ($6,100) ($6,172)
 Projections based on historical national
average market basket adjustment of 3.1% ($8,000)
─ FY 2015: 3.1% X 25% = 0.775% penalty Potential for ~ $24.2 million penalty
─ FY 2016: 3.1% X 50% = 1.550% penalty between 2015 - 2019
($10,000) Based on $247.0 million current
─ FY 2017+: 3.1% X 75% = 2.325% penalty annual Medicare reimbursement

($12,000)
2014 2015 2016 2017 2018 2019
Federal Fiscal Year (begins October 1)


Medicaid Based
Medicaid-Based Incentives
 Requires “meaningful use” of certified EHR
Potential Medicaid Incentive for
by second year Saint Luke's Health System
─ State administered – and optional (thousands)
$5,000
─ State may not add to federal MU objectives, but
can require certain menu objectives
 Formula based primarily on inpatient Potential for ~ $5.0 million over 3-6 years
$ ,
$4,000 Based on 42,646 discharges;
discharges and Medicaid share 11.0% Medicaid Days; 3.0% Charity
─ Use the 4-yr total based on Medicare formula
assuming 100% Medicare
$3,000
─ Cap based on Medicaid share
$2,479
─ Potential to transition over 3 – 6 years
Can not exceed 50% in any year; 90% in 2 yrs $1,983
$2,000
─ Payment years need not be consecutive
─ First year payment for Implementation, Adoption
or U
Upgrading
di $1,000
 Must qualify by FY 2016 to receive max $497

─ No payments to providers after FY 2021
$0 $0 $0
$0
 Must have at least 10% of patient volume 2011 2012 2013 2014 2015 2016
as Medicaid or be a children’s hospital Federal Fiscal Year (begins October 1)

 Unlike Medicare, no penalties

Appendix B
Clinical Quality Measures for Hospitals

Source: TABLE 10: Clinical Quality Measures for Submission by Eligible Hospitals and CAHs for Payment Year 2011-20125. U.S. Department of Health & Human Services.
Medicare and Medicaid Programs; Electronic Health Record Incentive Program. Vol. 75, No. 144. / page 44418 – 44420 / Federal Register / January 28, 2010 / Final Rule.
p g g

Footnote: In the event that new clinical quality measures are not adopted by 2013, the clinical quality measures in this Table would continue to apply.

Copyright © 2010 McKesson Corporation. All Rights Reserved.

TABLE 10: Clinical Quality Measures
for Submission by Elig. Hospitals/CAHs for Payment Year 2011 2012
2011-2012

Measure No.
Identifier Measure Title, Description & Measure Steward
Emergency Title: Emergency Department Throughput – admitted patients Median time from ED arrival to ED departure
Department (ED)-1 for admitted patients
Description: Median time from emergency department arrival to time of departure from the emergency room
NQF 0495 for patients admitted to the facility from the emergency department
Measure Developer: CMS/Oklahoma Foundation for Medical Quality (OFMQ)
ED-2
ED 2 Title: Emergency Department Throughput – admitted patients
Admission decision time to ED departure time for admitted patients
NQF 0497 Description: Median time from admit decision time to time of departure from the emergency department of
emergency department patients admitted to inpatient status
Measure Developer: CMS/OFMQ
Stroke-2
St k 2 Title: Ischemic t k
Titl I h i stroke – Di h
Discharge on anti-thrombotics
ti th b ti
Description: Ischemic stroke patients prescribed antithrombotic therapy at hospital discharge
NQF 0435 Measure Developer: The Joint Commission
Stroke-3 Title: Ischemic stroke – Anticoagulation for A-fib/flutter
Description: Ischemic stroke patients with atrial fibrillation/flutter who are prescribed anticoagulation therapy
NQF 0436 at hospital discharge.
Measure Developer: The Joint Commission
Stroke-4 Title: Ischemic stroke – Thrombolytic therapy for patients arriving within 2 hours of symptom onset
Description: Acute ischemic stroke patients who arrive at this hospital within 2 hours of time last known well
NQF 0437 and for whom IV t-PA was initiated at this hospital within 3 hours of time last known well.
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Access detailed electronic specifications of the clinical quality measures for EPs, eligible hospitals, and CAHs on the CMS website at

2011-2012

Measure No.
Stroke-5
Stroke 5 Title: Ischemic or hemorrhagic stroke – Antithrombotic therapy by day 2
Description: Ischemic stroke patients administered
NQF 0438 antithrombotic therapy by the end of hospital day 2.
Stroke-6 Title: Ischemic stroke – Discharge on statins
Description: Ischemic stroke patients with LDL ≥ 100 mg/dL, or LDL not measured, or who were on a lipid
mg/dL measured or, lipid-
NQF 0439 lowering medication prior to hospital arrival are prescribed statin medication at hospital discharge.
Stroke-8 Title: Ischemic or hemorrhagic stroke – Stroke education
Description: Ischemic or hemorrhagic stroke patients or their caregivers who were given educational
NQF 0440 materials d i th h
t i l during the hospital stay addressing all of the following: activation of emergency medical system,
it l t dd i ll f th f ll i ti ti f di l t
need for follow-up after discharge, medications prescribed at discharge, risk factors for stroke, and warning
signs and symptoms of stroke.
Stroke-10 Title: Ischemic or hemorrhagic stroke – Rehabilitation assessment
Description: Ischemic or hemorrhagic stroke patients who were assessed for rehabilitation services.
Venous Title: VTE prophylaxis within 24 hours of arrival
Thromboembolism Description: This measure assesses the number of patients who received VTE prophylaxis or have
(
(VTE)-1
) documentation why no VTE prophylaxis was g
y p p y given the day of or the day after hospital admission or surgery
y y p g y
end date for surgeries that start the day of or the day after hospital admission.

2011-2012

Measure No.
VTE-2
VTE 2 Title: Intensive Care Unit VTE prophylaxis
Description: This measure assesses the number of patients who received VTE prophylaxis or have
NQF 0372 documentation why no VTE prophylaxis was given the day of or the day after the initial admission (or transfer)
to the Intensive Care Unit (ICU) or surgery end date for surgeries that start the day of or the day after ICU
admission (or transfer).
p
VTE-3 Title: Anticoagulation overlap therapy
Description: This measure assesses the number of patients diagnosed with confirmed VTE who received an
NQF 0373 overlap of parenteral (intravenous [IV] or subcutaneous [subcu]) anticoagulation and warfarin therapy. For
patients who received less than five days of overlap therapy, they must be discharged on both medications.
Overlap therapy must be administered for at least five days with an international normalized ratio (INR) ≥ 2
prior to discontinuation of the parenteral anticoagulation therapy or the patient must be discharged on both
meds.
VTE-4 Title: Platelet monitoring on unfractionated heparin
Description: This measure assesses the number of patients diagnosed with confirmed VTE who received
NQF 0374 intravenous (IV) UFH therapy dosages AND had their platelet counts monitored using defined parameters
such as a nomogram or protocol.


2011-2012

Measure No.
VTE-5
VTE 5 Title: VTE discharge instructions
Description: This measure assesses the number of patients diagnosed with confirmed VTE that are
NQF 0375 discharged to home, to home with home health, home hospice or discharged/ transferred to court/law
enforcement on warfarin with written discharge instructions that address all four criteria: compliance issues,
dietary advice, follow-up monitoring, and information about the potential for adverse drug
reactions/interactions.
VTE-6 Title: Incidence of potentially preventable VTE
Description: This measure assesses the number of patients diagnosed with confirmed VTE during
NQF 0376 hospitalization (not present on arrival) who did not receive VTE prophylaxis between hospital admission and
the day before the VTE diagnostic testing order date.


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