Meaningful Use Overview: How to Prepare and Capture Incentive Dollars Brian Pennington

1. Meaningful Use Overview: How to Prepare and Capture Incentive Dollars Brian Pennington Director, Product Management October 20, 2011

2. Key Questions • What is ARRA and the potential incentives? • How does Behavioral Health (BH) fit? • How do you plan for Meaningful Use (MU)?

3. $787 Billion, $50+ Billion for HIT

4. Vision of HITECH • Significant and measurable improvements in through a transformed health care delivery system • Priorities, Goals, Objectives, Measures • Improve quality, safety, & efficiency • Engage patients & their families • Improve care coordination • Improve population and public health; reduce disparities • Ensure privacy and security protections

5. Bending the Curve Towards Transformed HealthAchieving Meaningful Use of Health Data “These goals can be achieved only through the effective use of information to support better decision-making and more effective care processes that improve health outcomes and reduce cost growth” “Phased-in series of improved clinical data capture supporting more rigorous and robust quality measurement and improvement.” Connecting for Health, Markle Foundation “Achieving the Health IT Objectives of the American Recovery and Reinvestment Act” April 2009

6. Three Parts of the HITECH Act • HIT Infrastructure Interoperability • Incentives for the Meaningful Use of Certified EHRs • Improve information privacy and security

7. Medicare Incentives Eligible Providers Hospitals HIT Grants Acute/Primary Care Behavioral Health Medicaid Incentives Eligible Providers Hospitals $787 Billion, $50+ Billion for HIT

8. Medicare Incentives Eligible Providers Hospitals HIT Grants Acute/Primary Care Behavioral Health Medicaid Incentives Eligible Providers Hospitals $787 Billion, $50+ Billion for HIT

9. Medicare Incentives Eligible Providers Hospitals HIT Grants Acute/Primary Care Behavioral Health Medicaid Incentives Eligible Providers Hospitals Hospitals BH/SA not eligible, but could be through new legislation $787 Billion, $50+ Billion for HIT

10. Medicare Incentives Eligible Providers Hospitals HIT Grants Acute/Primary Care Behavioral Health Medicaid Incentives Eligible Providers Hospitals Eligible Providers BH/SA/PH eligible, but only through current definition of “Eligible Professionals” on staff or contracted $787 Billion, $50+ Billion for HIT

11. Maximizing HITECH ROI • HITECH funds are NOT for buying EHR software! • HITECH funds are for MEANINGFULLY USING EHRs

12. Provider Incentives

13. Medicaid Provider Incentives • BH/SA can receive incentives through non-hospital based eligible professionals (EPs) • Physicians • Nurse Practitioners • Dentists • Certified Nurse Midwives • Physician Assistants in an FQHC

14. Medicaid Provider Incentives • The following criteria must be met • Percentage of Medicaid encounters must be 30%+ for each EP over a representative 90-day period • EP must have 50% of their encounters at facilities using a certified EHR • EP must be non-Hospital based (Hospital based means the professional furnishes 90% of services in either inpatient or emergency room of Hospital) • Organization meets Meaningful Use EHR requirements • EPs must assign their incentives to the organization

15. Medicaid Provider Incentives A Part Time Example • Provider is eligible because 70% of encounters are at facilities that use a Certified EHR • Provider can assign the incentives • Measurements are calculated based on the number of encounters at Facilities A and B

16. Clinic Volume Proxy for EP Eligibility Applies under three conditions • The clinics volume is an appropriate proxy for the clinician (e.g. if the EP only sees commercial clients if would not be appropriate for Medicaid volume) • There is an auditable data source to support the clinics volume calculation • The clinic and clinician can only use one methodology each year

17. Clinic Volume Proxy - Example • Using EP Volume Calculation 2 EPs would qualify

18. Clinic Volume Proxy - Example • Using EP Volume Calculation 2 EPs would qualify • Using Proxy Volume calculation 5 EPs would qualify

19. Medicaid Provider Incentives First year of Meaningful Use = # of EPs x $21,250 Years 2-6 of Meaningful Use = # of EPs x $8,500 Total = # of EPs x $63,750

20. Potential Incentive for Average CMHC

21. Medicare Provider Incentives • CMHCs/SA can receive funding based on the number of Eligible Professionals • Capped at $44K/EP based on Medicare billings

22. Penalties Apply if non-MU User Medicare reductions for non-MU users are: 2015 - 99%, 2016 - 98%, 2017 – 97% each subsequent year - 95%. $20M CMHC, with 10% Medicare revenue, would have an ongoing revenue reduction of $100K/year

23. Medicaid Adopt/Implement/Upgrade (A/I/U) • Available in first participation year only • Adopted – acquired and installed • Implemented – commenced utilization of system • Upgraded – expanded or upgraded to certified version of system • System must be certified

24. Registration and Tracking • Registration • EPs must register on the CMS Web site (and on their state’s Medicaid Web site, if applicable) • EPs must assign their incentives to a provider if the provider is to receive incentive funds • Providers must register on the CMS Web site that they are using a Complete ARRA-Certified EHR • Providers must be enrolled in Medicare FFS, MA, or Medicaid (FFS or managed care) and have a National Provider Identifier (NPI) • Tracking • Self attestation • Other ways to be determined by states

25. Corrective Legislation • Introduced in 112th Congress.(Senate) • Many co-sponsors of previous bills are still in office • Goal is to expand Eligible Professionals to include: • Licensed psychologists • Clinical social workers • Expand Hospital Incentives to: • Psychiatric hospitals • Community mental health centers • Substance use treatment facilities

26. Hospital Incentives

27. Existing Medicaid/Medicare Hospital Incentives Transition Factor Year 1,100% Year 2, 75% Year 3, 50% Year 4, 25% ( ) ( ) Total No of Discharges % of Medicaid Business Charity Care Factor $2M + $200 X X X X $20M CMHC, with 70% Medicaid revenue, would receive $1.4M+ in first year if no change in base amount

28. Summary of Provider & Hospital Incentives • Great news! You are eligible today • Even better news! If corrective legislation passes, you have the potential for even more incentives

29. What is Meaningful Use?

30. Meaningful Use • A Meaningful user is an eligible provider who: • Meets Criteria of Stage 1 Meaningful Use • Uses a Certified EHR

31. Meaningful Use Criteria – Final Rule • Core – criteria that are mandatory for Stage 1 • Menu Set – select any 5 to be deferred, except all EPs must select at least one of the PH measures – if a measure is not applicable it does not count as one of the deferred

32. CORE SET

33. CORE SET

34. CORE SET

35. CORE SET

36. CORE SET

37. MENU SET

38. MENU SET

39. MENU SET

40. Deferring Menu Set Criteria – Important Note • For a provider to meet criteria for ARRA incentive funds, they must own (adopt) software required for ALL of ARRA criteria, even if they plan to defer five Menu Set criteria. • The software does not need to be implemented or used, but it must be adopted in order to receive incentive dollars.

41. Quality Reporting for EPs • Six are required, 3 from Core or Alternative and 3 from Non-Core • Clinical Core Measures • Hypertension: Blood Pressure Measurement • Preventative Care and Screening Measure Pair - Tobacco Use Assessment and Tobacco Cessation Intervention • Adult Weight Screening and Follow-Up • Alternate Core Measures • Weight Assessment and Counseling for Children and Adolescents • Preventive Care and Screening: Influenza Immunization for Patients ≥ 50 Years Old • Childhood Immunization Status • Clinical Non-Core Measures (38)

42. 2011 2013 2015 2009 HIT-Enabled Health Reform Meaningful Use Criteria HITECH Policies 2011 Meaningful Use Criteria (Capture/share data) 2013 Meaningful Use Criteria (Advanced care processes with decision support) 2015 Meaningful Use Criteria (Improved Outcomes) Stages of Meaningful Use Stage 1 Stage 2 Stage 3

43. Stage of Meaningful Use Criteria by Year * Avoids payment adjustments only for EPs in the Medicare EHR Incentive Program. ** Stage 3 criteria for Meaningful Use or a subsequent update to the criteria if one is established through rulemaking.

44. What Is Meaningful Use? • Meet Criteria of Stage 1 Meaningful Use Matrix • Use a Certified EHR

45. Certification of EHRs – ARRA ONC-ATCB • Meets Meaningful Use Criteria if provider’s system is 100% certified on all modules • Authorized Testing and Certification Bodies • CCHIT • Drummond Group • InfoGard Laboratories • SLI Global Solutions • ISCA Labs

46. Ambulatory and Inpatient 100% Certified Systems

48. What Does Certification Really Mean? • The EHR passed the federal requirements! • You can generate files to submit to your state and federal regulators: • Import lab result files! • Generate files for immunization registries! • Generate files for syndromic surveillance data! • Generate CQI data for Medicaid! • Generate CCDs! At this point………you are left to…… GO FIGURE OUT WHAT TO DO WITH THE DATA!

49. How do you communicate? Public Health Department Labs EHR A State Medicaid Think Beyond Minimum Requirements EHR B Immunization Registry EHR C Future Interfaces

50. Getting Started with Assessing Your Readiness and a Plan! Specialthanks to ManateeGlensBehavioralHealth (FL) forsharingtheirplanningefforts