Meaningful Use Stage 2 = Value Based Purchasing

1. Meaningful Use Stage 2 = Value Based Purchasing Michele P. Madison mmadison@mmmlaw.com 404-504-7621

2. Value Based Purchasing • Linking provider payments to improved performance by health care providers. • This form of payment holds health care providers accountable for both the cost and quality of care they provide. • It attempts to reduce inappropriate care and to identify and reward the best-performing providers www.healthcare.gov

3. Value Based Purchasing • Required by the Affordable Care Act, which added Section 1886(o) to the Social Security Act • Quality incentive program built on the Hospital Inpatient Quality Reporting (IQR) measure reporting infrastructure • Next step in promoting higher quality care for Medicare; pays for care that rewards better value and patient outcomes, instead of just volume of services • Funded by a 1% reduction from participating hospitals’ base operating diagnosis-related group (DRG) payments for FY 2013, increasing to 2% by FY 2017 • Uses measures that have been specified under the Hospital IQR Program and results published on Hospital Compare for at least one year

4. Meaningful Use • Defines what criteria providers must achieve to be eligible for financial payments • Intended to change provider behavior • Part of the overall program to encourage the adoption of Electronic Health Records

5. Development of Meaningful Use ARRA –February 17, 2009 Meaningful Use Proposed Definition Health IT Policy Committee-Provided a Matrix to Define Terms Final Matrix Approved August 14, 2009 Proposed Rule Published January 13, 2010 Final Rule Published July 28, 2010 Proposed Requirements 2011 Stage 2 Proposed Rule Published 2012 Final Rule August 23, 2012

6. Value Based Purchasing

7. VBP 2014-Clinical Process Domain • 13 Clinical Process of Care Measures 8 Patient Experience of Care Dimensions 1.AMI-7a Fibrinolytic Therapy Received within 30 Minutes of Hospital Arrival 2.AMI-8 Primary PCI Received within 90 Minutes of Hospital Arrival 3.HF-1 Discharge Instructions 4.PN-3b Blood Cultures Performed in the ED Prior to Initial Antibiotic Received in Hospital 5.PN-6 Initial Antibiotic Selection for CAP in Immunocompetent Patient

8. Clinical Process of Care 6.SCIP-Inf-1 Prophylactic Antibiotic Received within One Hour Prior to Surgical Incision 7.SCIP-Inf-2 Prophylactic Antibiotic Selection for Surgical Patients 8.SCIP-Inf-3 Prophylactic Antibiotics Discontinued within 24 Hours After Surgery 9.SCIP-Inf-4 Cardiac Surgery Patients with Controlled 6 a.m. Postoperative Serum Glucose 10.SCIP–Inf–9 Postoperative Urinary Catheter Removal on Postoperative Day 1 or 2. 11.SCIP-Card-2 Surgery Patients on a Beta Blocker Prior to Arrival That Received a Beta Blocker During the Perioperative Period 12.SCIP-VTE-1 Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered 13. SCIP-VTE-2 Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis within 24 Hours

9. Patient Caregiver Experience • Nurse Communication • Doctor Communication • Hospital Staff Responsiveness • Pain Management • Medicine Communication • Hospital Cleanliness/Quietness • Discharge Information • Overall Hospital Rating

10. Outcome Domain • 3 Mortality Measures • MORT-30-AMI Acute Myocardial Infarction (AMI) 30-day mortality rate • MORT-30-HF Heart Failure (HF) 30-day mortality rate • MORT-30-PN Pneumonia (PN) 30-day mortality rate • New measure

11. Points = Payments Three domains: Clinical Process of Care (13 measures) Patient Experience of Care (8 HCAHPS dimensions) Outcome (3 mortality measures) •Hospitals are awarded points for Achievement and Improvement for each measure or dimension, with the greater set of points used •Points are added across all measures to reach the Clinical Process of Care and Outcome domain scores •Points are added across all dimensions and are added to the Consistency Points to reach the Patient Experience of Care domain score

12. Meaningful UseStage 2

13. Health Outcome Policy Priorities Improve Quality, Safety, Efficiencies and Reduce Health Disparities Engage Patients and Families Improve Care Coordination Improve Population and Public Health Ensure Adequate Privacy and Security Protections for Personal Health Information

14. Final Rule Stage 1: Electronically capturing health information in a coded format Track key clinical conditions and communicating that information for Care Coordination Purposes Implement Clinical Decision Support tools to facilitate disease and medication management; reporting clinical quality measures; and public health information

15. Stages 2014--2015 Stage 2 Encourage the use of Health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible, such as the electronic transmission of orders entered using CPOE and the electronic transmission of diagnostic test results. Stage 3 Focus on promoting improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to comprehensive patient data and improving population health

16. Stage 2 Meaningful Use • Preliminary Measures Initially Published by HIT Policy Committee in January 2011 • Proposed Rule Published March 7, 2012 • Comments received until May 6, 2012 • Final Rule August 23, 2012

17. Stage 2 Proposed Rule • Stage 2 Meaningful Use Definition • New Clinical Quality measures • New Reporting Mechanisms

18. Stage of Meaningful Use

19. Meaningful Use Elements • Eligible Professionals have 15 Core Elements • Hospitals have 14 Core Elements • Menu Sets offer flexibility, but at least one Menu set must address a public objective • 5 objectives out of 10 from the Menu Set • 6 Total Clinical Quality measures • If an element is not applicable and the provider does not have any eligible patients then the measure may be excluded

20. Meaningful Use Stage 2 • Eligible Professionals • 17 Core Objectives • 3 of 5 Menu Objectives • Eligible Hospitals • 16 Core Objectives • 2 of 4 Menu Objectives

21. Clinical Quality Measures The Quality Measures should match up with other CMS Programs • The same measures for different program measure sets • Coordinating quality measurement stakeholder involvement efforts and opportunities for public input • Identifying ways to minimize multiple submission requirements and mechanisms

22. Quality Measures • Quality Measures Track the Intent of CMI • Transforming our health care system to provide: • Higher quality care • Better health outcomes • Lower cost through improvement

23. Clinical Quality Measures • Patient and Family Engagement • Patient Safety • Care Coordination • Population and Public Health • Efficient Use of Healthcare Resources • Clinical Processes/Effectiveness

24. Clinical Quality Measures Eligible Professionals: 9 CQMs: PQRS Reporting Hospitals: 16 CQMs

25. CQM Reporting • EHR Incentive Program + PQRS Option 2: • Submit and satisfactorily report CQMs under PQRS EHR Reporting option using CEHRT • Requirements for PQRS are in CY 2012 Medicare Physician Fee Schedule final rule (76 FR 73314) • Hospitals report through CMS designated transmission

26. Medicare Payment Adjustments • Medicare decrease in reimbursement applies if a provider only Adopts, Implements or Upgrades without achieving Meaningful Use • Depends upon the % of Eligible Professionals who achieved Meaningful Use

27. Exceptions from Reduction inReimbursement Proposed Exemptions on an application basis • Insufficient internet access two years prior to the payment adjustment year • Newly practicing EPs for two years • Extreme circumstances such as unexpected closures, natural disaster, EHR vendor going out of business, etc.

28. Medicaid Changes • Expanded potential patients • Expanded patients to be included • Included zero pay patients • Expanded the Hospitals without a CCN

29. Meaningful Use Drives Value Based Purchasing

30. Synergies • Encourages adoption of EHR which supports data submission • Supports incentives to drive changes in behavior • Clinical Quality Measures focus on specific clinical activities to improve outcomes • Payment based upon quality outcomes • Drives concept of reporting for payment

31. Healthcare Redesign Changing Behavior Requires Reporting = Improved Outcomes and Reimbursement

32. Thank you Michele Madison Partner, HealthCare mmadison@mmmlaw.com 404-504-7621 This presentation is provided as a general informational service to clients and friends of Morris, Manning & Martin LLP. It should not be construed as, and does not constitute, legal advice on any specific matter, nor does this message create an attorney-client relationship. These materials may be considered Attorney Advertising in some states. Please note, prior results discussed in the material do not guarantee similar outcomes.