Meaningful Use for Specialists

1. Meaningful Use for Specialists September 28, 2012 Paul Forlenza, VP Policy and Special Projects Priscilla Phelps, Implementation Specialist Larry Gilbert, Director of Outreach and Business Development

2. Objectives • To provide: • General Meaningful Use information • Information on specific criteria • Exclusions • Requirements • Potential concerns • Insights on Clinical Quality Measures (CQMs) • Examples from one specialist • Tools to assist

3. Medicare EHR Incentive Payments to Eligible Professionals Nationwide Source: CMS August 2012 report

4. Medicare EHR Incentive Payments to Eligible Hospitals Nationwide Source: CMS August 2012 report

5. Medicare EHR Incentive Payments to Vermont Eligible Professionals by County Compiled from CMS August 2012 report

6. Medicaid EHR Incentive Payments to Vermont Eligible Professionals Source: DVHA Sept. 2012

7. Medicaid EHR Incentive Payments to Vermont Eligible Hospitals Source: DVHA Sept. 2012

8. Medicaid EHR Incentive Payments to Vermont Eligible Professionals by County Compiled from DVHA Sept. 2012 Report

9. Items to Ponder • Specialists ARE meeting the Meaningful Use criteria and receiving incentive money • Percentage indicated is not enough • “More than” 50% really means at least 51% (rounded) • Both Core and Menu criteria have exclusions on several items • Exclusions count as criteria being “met”

10. Specific Core Criteria • Use of Computerized Provider Order Entry for Medications (C1) • Generate and transmit permissible prescriptions electronically (C4) • Exclusion for providers who write fewer than 100 prescriptions in reporting period • Maintain up-to-date problem list for current/active diagnoses (C3) • Maintain active medication list (C5) • Maintain and active medication allergy list (C6) • No exclusions, but • Have at least ONE entry or an indication of “none” or “no known”

11. More Core • Record and chart changes in vital signs (C8) • Exclusion if height, weight and blood pressure have no relevance to scope of practice • Provide patients with an electronic copy of their health information (C12) • Exclusion if no patients or their agents request an electronic copy

12. Security Risk Assessments • Protect electronic health information (C15) • Security Risk Assessment (SRA) • Requirements in 45 CFR 164.308 (a)(1) list more than a quick review of your EHR security • One SRA for all providers in same office using the same EHR • VITL Implementation Specialists conduct SRAs to allow EPs to meet this measure • Take roughly 5-6 hours to complete, including on-site visit and analysis returned to practice

13. Menu Set Criteria • Implement drug formulary checks (M1) • Exclusion for providers who write fewer than 100 prescriptions in reporting period • Incorporate clinical lab test results into an EHR as structured data (M2) • Requires a lab interface or data entry of results • Exclusion if no labs with results as a numerical or negative/positive format are ordered • Medication reconciliation at a transfer IN from another setting of care (M7) • Summary of Care for patients transitioned TO another setting (M8) • Exclusions: • Not the recipient of a transitioned patient during the reporting period(M7) • No patients are transferred out or referred to another provider (M8)

14. Public Health Measures (PHM) • MUST select one PHM in Menu criteria • Capability to submit data to an immunization registry (M9) • In Vermont, you should select this measure • At this time, take exclusion #2 during attestation – “where no immunization registry has the capacity to receive…” • May also be able to take exclusion #1, if zero immunizations are administered during the reporting period • Immunization registry is under construction • Capability to provide syndromic surveillance data (M10) • In Vermont, this is not a viable option at this time

15. Clinical Quality Measures (10a,b,c) • Must report • Three (3) core or • Core and alternate core to total three (3) • AND • Three (3) from the list of 38 measures • To total six (6) • Current list does not fit many specialties • Select any that are relevant • Then look for those with potential relevance • Or ease of recording • Zeros are acceptable in both the numerator and denominator • No percentages to meet!

16. Real Life Example • Pain management practice, single provider • Live with EHR in February 2011 • Attested to Meaningful Use for 90-day period ending 12/31/11 • Took exclusions for • CPOE (C1), E-prescribing (C4), Providing electronic copies (C12) • Drug formulary checks (M1), Immunization registry (M9) • Clinical Quality Measures: • Reported two core • One alternate core with zeros, as none applied • Low back pain: Use of Imaging studies • Diabetic: foot exams • Pneumonia vaccines for older patients

17. Now Larry’s Presentation

18. Timing for Medicare EP

19. Timing for Medicaid EP

20. Stage 1 Changes • Most voluntary in 2013 – required in 2014 • Change CPOE denominator: # of medication orders • Vital Signs: exclusion and age requirement revised • Test exchange key clinical information removed • Add view, download or transmit patient data

21. Stage 1 Changes • E-prescribing exclusion added (2013) • Menu set exclusion limited (2014) • EP must create record directly in CEHRT (2013)