Meaningful Use in 2015_ 6 Things You Should Do Before the Year’s End

1. Presentation Meaningful Use in 2015 6 things to do before the year’s end Presenter: Matt Anderson

2. Good News! CMS has heard your call Final rule announced on October 6, 2015 These changes take effect starting 2015 and continue through 2017.  Changes finally made to Meaningful Use Stage 1 and 2. 02

3. How is ‘Modified Stage 2’ different? Previous Stages Modified Stage 2 90 Continuous days reporting period for 2015 Full year reporting period Complicated framework of “core” and “menu” measures Core and menu measures replaced with 10 objectives Excessive data-entry measures in reporting requirements Eliminated redundant, duplicative, and topped-out measures High performance threshold for Patient Engagement measures Reduced performance threshold 03

4. Stage 1 and Stage 2 Measures Stage 1 Meaningful Use till 2014 (Core Measures) Stage 2 Meaningful Use till 2014 (Core Measures) 1 CPOE for Medications 2 Drug Interaction Checks 3 Maintain Problem List 4 Eprescribing 5 Active Medication List 6 Medication Allergy List 7 Record Demographics 8 Record Vital signs 9 Record Smoking Status 10 Clinical Decision Support 11 Patient Electronic Access 12 Clinical Summaries 13 Protect Electronic Health Information 1 CPOE for Medication, Lab, Radiology Orders 2 Eprescribing 3 Record Demographics 4 Record Vital Signs 5 Record Smoking Status 6 Clinical Decision Support 7 Patient Electronic Access 8 Clinical Summaries 9 Protect Electronic Health Information 10 Clinical Lab Test Results 11 Patient Lists 12 Patient Reminders 13 Patient Education 14 Medication Reconciliation 15 Summary of Care 16 Immunization Registries Data Submission 17 Secure Electronic Messaging Menu Measures 1 Drug Formulary Checks 2 Clinical Lab Test Results 3 Patient Lists 4 Patient Reminders 5 Patient Education 6 Medication Reconciliation 7 Transition of Care Summary Menu Measures 1 Syndromic Surveillance Data Submission 2 Electronic Notes 3 Imaging Results 4 Family Health History 5 Report Cancer Cases 6 Report Specific Cases Public Health Menu Measures 8 Immunization Registries Data Submission 9 Syndromic Surveillance Data Submission 04

5. Stage 1 and Stage 2 Measures Stage 1 Meaningful Use till 2014 (Core Measures) Stage 2 Meaningful Use till 2014 (Core Measures) 1 CPOE for Medications 2 Drug Interaction Checks 3 Maintain Problem List 4 Eprescribing 5 Active Medication List 6 Medication Allergy List 7 Record Demographics 8 Record Vital signs 9 Record Smoking Status 10 Clinical Decision Support 11 Patient Electronic Access 12 Clinical Summaries 13 Protect Electronic Health Information 1 CPOE for Medication, Lab, Radiology Orders 2 Eprescribing 3 Record Demographics 4 Record Vital Signs 5 Record Smoking Status 6 Clinical Decision Support 7 Patient Electronic Access 8 Clinical Summaries 9 Protect Electronic Health Information 10 Clinical Lab Test Results 11 Patient Lists 12 Patient Reminders 13 Patient Education 14 Medication Reconciliation 15 Summary of Care 16 Immunization Registries Data Submission 17 Secure Electronic Messaging Menu Measures 1 Drug Formulary Checks 2 Clinical Lab Test Results 3 Patient Lists 4 Patient Reminders 5 Patient Education 6 Medication Reconciliation 7 Transition of Care Summary Menu Measures 1 Syndromic Surveillance Data Submission 2 Electronic Notes 3 Imaging Results 4 Family Health History 5 Report Cancer Cases 6 Report Specific Cases Public Health Menu Measures 8 Immunization Registries Data Submission 9 Syndromic Surveillance Data Submission 04

6. Modified Meaningful Use 2015 -2017 Objective 1: Protect Patient Health Information Protect patient health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities Objective 2: Clinical Decision Support t Implement clinical decision support interventions relevant to specialty or high clinical priority Enable drug-drug and drug-allergy interactions Objective 3: Computerized Provider Order Entry Medication orders created by the EP should be recorded using computerized provider order entry Lab orders created by the EP should be recorded using computerized provider order entry Radiology orders created by the EP should be recorded using computerized provider order entry t Objective 4: Electronic Prescribing Prescriptions written by the EP should be transmitted electronically using certified EHR technology Stage 1 Exclusion Objective 5: Health Information Exchange When transitioning a patient to another setting of care, or referring the patient, providers should create a Summary of Care record and electronically transmit it using certified EHR techonology 05

7. Modified Meaningful Use 2015 -2017 Stage 1 Exclusion Objective 6: Patient Specific Education Provide patients with specific education resources that are identified by certified EHR technology Stage 1 Exclusion Objective 7: Medication Reconciliation Perform Medication Reconciliation for patients transitioned into the care of the EP Objective 8: Patient Electronic Access (VDT) Provide patients with timely access to view online, download, and transmit their health information Health Information is viewed online, downloaded, or transmitted by patients Reduced from 5% to 1 patient or more Stage 1 Exclusion Objective 9: Secure Messaging Reduced from 5% to functionality fully enabled Provide patients the capability to send and receive a secure electronic message with the EP Objective 10: Public Health Reporting Submit immunization data to an immunization registry Submit syndromic surveillance data to a public health agency Stage 1 Exclusion Providers scheduled to be in Stage 1 in 2015 may claim an exclusion for these measures 06

8. Attestation periods for the Medicare Incentive Program Attestation year 2011 Adoption 2012 Adoption 2013 Adoption 2014 Adoption 2015 Adoption 2016 Adoption Modified Stage 2 90 days Modified Stage 2 90 days Modified Stage 2 90 days Modified Stage 2 90 days Modified Stage 2 90 days _ 2015 Modified Stage 2 Full year Modified Stage 2 Full year Modified Stage 2 Full year Modified Stage 2 Full year Modified Stage 2 Full year Modified Stage 2 Full year 2016 Modified Stage 2 or Stage 3 Full year Modified Stage 2 or Stage 3 Full year Modified Stage 2 or Stage 3 Full year Modified Stage 2 or Stage 3 Full year Modified Stage 2 or Stage 3 Full year Modified Stage 2 or Stage 3 Full year 2017 2018 Stage 3 Full year Stage 3 Full year Stage 3 Full year Stage 3 Full year Stage 3 Full year Stage 3 Full year 07

9. Whats your plan for MU Attestation? MU modifed Stage 2 fnal rule came out a week into the last possible 90-day reporting period, not leaving enough time for practices to create a game plan. How to prepare for Meaningful Use in this short time-frame? 08

10. 6 things your practice must cover before the year’s end! 09

11. Task no 1 Choose the Reporting Period The Final Rule from CMS states that all providers will attest for a 90-day reporting period in 2015. What stage or year you were previously in is irrelevant. 10

12. Task no 2 Perform A Security Risk Analysis Must be conducted at least once before attesting for MU. Identify and correct security defencies. Once done, you can attest to CMS that you have conducted this analysis. A copy of the document must be maintained in case there is an MU audit. 11

13. Task no 3 Read the Exclusions Objective Exclusion Alternate Exclusion Objective 1: Protect Patient Health Information None None Stage 1 EPs may use "Alternate Measure" which has a reduced threshold of implementing one clinical decision support rule, as opposed to five clinical decision support rules. For Drug Interactions, any EP who writes fewer than 100 medication orders during the EHR reporting period. Objective 2: Clinical Decision Support Objective 3: Computerized Provider Order Entry Measure 1: Any EP who writes fewer than 100 medication orders during the EHR reporting period. Measure 2: Any EP who writes fewer than 100 laboratory orders during the EHR reporting period. Measure 3: Any EP who writes fewer than 100 radiology orders during the EHR reporting period. For Measure 1, Stage 1 EPs may use "Alternate Measure" which has a reduced threshold of 30%, as opposed to 60%. For Measures 2 and 3, Stage 1 EPs get an exclusion since Stage 1 did not have an equivalent core measure. Stage 1 EPs may use "Alternate Measure" which has a reduced threshold of 40%, as opposed to 50%. Objective 4: Electronic Prescribing Any EP who writes fewer than 100 Prescriptions 12

14. Read the Exclusions Objective Exclusion Alternate Exclusion Objective 5: Health Information Exchange Any EP who has fewer than 100 Stage 1 EPs get an exclusion since Stage transitions of care or referrals 1 did not have an equivalent core measure. Objective 6: Patient Specific Education Any EP who has no office visits during the EHR reporting period Stage 1 EPs get an exclusion since Stage 1 did not have an equivalent core measure. Objective 7: Medication Reconciliation Any EP who was not the recipient of any transitions of care during the EHR reporting period. Stage 1 EPs get an exclusion since Stage 1 did not have an equivalent core measure. Objective 8: Patient Electronic Access (VDT) Any EP who: a. Neither orders nor creates any of the information listed for inclusion as part of the measures; or b. Conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability. For Measures 2, Stage 1 EPs get an exclusion since Stage 1 did not have an equivalent core measure. 13

15. Read the Exclusions Objective Exclusion Alternate Exclusion Objective 9: Secure Messaging Any EP who has no office visits during the EHR reporting period, or any EP who conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period. Stage 1 EPs get an exclusion since Stage 1 did not have an equivalent core measure. Objective 10: Public Health Reporting Measure Option 1 – Immunization Registry Reporting: • Does not administer any immunizations during the EHR reporting period; • Operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting • Operates in a jurisdiction where no immunization registry or immunization information system has declared readiness to receive immunization data from the EP at the start of the EHR reporting period. Stage 1 EPs need to meet 1 measure only Stage 2 EPs only need to do Measure 1, since they can claim an exclusion for Measure 2 because Stage 2 did not have an equivalent core measure. 14

16. Read the Exclusions Objective Exclusion Alternate Exclusion Measure Option 2 – Syndromic Surveillance Reporting: Objective 10: Public Health Reporting • Is not in a category of providers from which ambulatory syndromic surveillance data is collected by their jurisdiction's syndromic surveillance system; • Operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data • Operates in a jurisdiction where no public health agency has declared readiness to receive syndromic surveillance data 15

17. Task no 4 Read the Exclusions Contact your Public Health Agency Measures: Immunization registry Make sure you have an interface with your state registry. Contact your vendor in case you don’t. Syndromic Surveillance Reporting Your EHR should be capable to extract this report. Identify a Public Health Agency near you to submit this report. *Stage 1: Submit one of these measures *Stage 2: Required to submit just Measure 1, since they can claim an exclusion for Measure 2, because Stage 2 did not have an equivalent core measure 16

18. Task no 5 Create your Audit Folder Required Documentation: KPI Screenshot CQM Screenshots Security Risk Analysis Document Public Health Registration/ Enrollment Request Email Medicaid Patient Volume Report (In case of Medicaid) 17

19. Pre & Post-Payment Audits CMS began pre-payment audits in 2013, starting with attestations submitted during and after Jan 2013. CMS, through its contractor, will also conduct post-payment audits during the course of the EHR Incentive Programs. Providers selected for both audits will have to present supporting documentation to validate submitted attestation data. EPs must keep their audit documentation with them for the next 6 years post attestation. 18

20. Task no 6 Hardship Exceptions to Avoid Medicare Payment Adjustments To be considered for an exception, an eligible professional or eligible hospital must complete a Hardship Exception application along with proof of the hardship. If approved, the hardship exception is valid for 1 payment year only. A new application must be submitted if the hardship continues for the following payment year. 19

21. Hardship Exceptions Eligible professionals can apply for hardship exceptions in the following categories: Infrastructure: EPs must demonstrate that they are in an area without sufficient internet access or face insurmountable barriers to obtaining infrastructure. New Eligible Professionals: Newly practicing EPs who would not have had time to become meaningful users can apply for a 2-year limited exception to payment adjustments. Unforeseen Circumstances: Examples may include a natural disaster or other unforeseeable barrier. Patient Interaction: - Lack of face-to-face or telemedicine interaction with patient. - Lack of follow-up need with patients. Practice at Multiple Locations: Lack of control over availability of CEHRT for more than 50% of patient encounters. PECOS Specialties: An EP that has a primary specialty listed in PECOS as anesthesiology, radiology or pathology 6 months prior to the first day of the payment adjustments that would otherwise apply. 20

22. Task no 7 Registration Information (Bonus point) Check your NPPES logins and make sure that they are working. (To reset the password please call 1-800-465-3203) Visit the Registration Tab to ensure your information is accurate, such as the Payee selection and email address. 21

23. CureMD Meaningful Use resources Meaningful Use Resource Center CureMD Meaningful Use Dashboard 22

24. QA Session &

25. Need Help? Request a demo to see how CureMD can facilitate your practice for Meaningful Use Get in touch with our MU experts at 718-213-4870 muconsulting@curemd.com

26. Thank you! Look out for our email, containing the webinar recording! Meaningful Use in 2015 6 things to do before the year’s end 32