As 2017 comes to a close, the deadline for providers to avoid a Medicare penalty in 2019 is approaching and the 2018 reporting periods are about to begin. The Centers for Medicare & Medicaid Services (CMS) has designed the Quality Payment Program (QPP) with two tracks clinicians can take under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) - Advanced Alternative Payment Models (APMs) or Merit-based Incentive Payment System (MIPS). As we mentioned at the beginning of this year, the well-known Meaningful Use program has been added as a part of MIPS. There are four components to MIPS: Quality, Improvement Activities, Advancing Care Information (ACI), and Cost. Meaningful Use is part of the ACI component. Providers have until March 31, 2018 to send in their data for 2017 which will increase, decrease, or keep their 2019 Medicare payments the same. The reporting period for 2018 starts January 1, 2018. CMS is taking a gradual approach to implementing the program so the requirements for each year differ.

2017 Requirements:

CMS offers “pick your pace” options in 2017. These include:

• Zero participation – receive a 4% penalty in 2019
• Test – submit a minimum of one quality measure, one improvement activity, or the four required ACI measures and avoid a negative payment adjustment.
• Partial participation – Submit at least 90 days of 2017 data for more than one quality measure, OR more than one improvement activity, OR more than the four required ACI measures and avoid a negative payment adjustment and possibly receive a positive payment adjustment.
• Full participation - Submit at least 90 days of data for all required quality measures, AND all required improvement activities, AND all four required ACI measures and earn a positive payment adjustment.
• Advanced Alternative Payment Model - receive 25% of Medicare payments or see 20% of Medicare patients through an Advanced APM in 2017, and earn a 5% incentive payment in 2019.

Certified Electronic Health Record Technology (CEHRT) Requirements:

• Use either 2014 or 2015 Edition CEHRT or a combination

2018 Requirements:

• Zero participation – penalty increases to 5% in 2020
• MIPS Participation Minimum Performance Periods

o   Quality – 12 months

o   Cost – 12 months

o   Improvement Activities – 90 days

o   Advancing Care Information – 90 days

• To meet the point threshold to avoid a negative payment adjustment, clinicians must:

o   Report all required Improvement Activities.

o  Meet the Advancing Care Information base score and submit 1 Quality measure that meets data completeness.

o  Meet the Advancing Care Information base score, by reporting the 5 base measures, and submit one medium-weighted Improvement Activity.

o   Submit 6 Quality measures that meet data completeness criteria.

CEHRT Requirements:

• Use either 2014 or 2015 Edition CEHRT or a combination
• Receive a 10% bonus if only use 2015 Edition CEHRT

There are only a couple days left in 2017 to make sure you have at least met the requirements for the “Test” option to avoid the penalty in 2019. It’s also important to note that 2018 requires 12 months of reporting for Quality and Cost measures meaning that reporting period is also starting in just a couple days. It’s vital to make sure you are using a product or combination of products that are certified. MDToolbox was one of the only stand-alone e-Prescribing vendors to certify on the 2015 edition CEHRT requirements earlier this year. We are certified for e-Prescribing and Patient Education and are able to integrate with many other products to meet all of the requirements. Contact us for more info on how we can help you meet the MIPS requirements.

As we ring in the new year, medical providers now can say goodbye to the CMS’s “Meaningful Use Incentive Program” (MU) and start preparing for the new Medicare incentive program.

Providers who used qualified systems in 2016 can still attest to Meaningful Use for the 2016 year (you must have been a “meaningful user” of certified electronic medical record system(s) for the minimum reporting period. Visit this website for more info on how the previous year’s MU programs worked and deadlines for attesting: 

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2016ProgramRequirements.html

Now in 2017, Meaningful Use will become one of four components of the new “Merit-Based Incentive Payment System” or MIPS. MIPS is part of the bigger Medicare Access and CHIP Reauthorization or MACRA.² 

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula, which threatened clinicians participating in Medicare with potential payment penalties for 13 years.  

The MACRA program introduces two paths that Medicare providers can choose from for participation:

• Advanced Alternative Payment Models (APMs) (providers apply for a special payment model program) or
• The Merit-based Incentive Payment System (MIPS)  (a performance-based program)

Who Does this Affect?

Providers who are in an Advanced APM or who bill Medicare for more than $30,000 a year and care for more than 100 Medicare patients a year are affected. Providers with less than that are not affected and not part of the program.³  This includes:

• Physician
• Physician assistant
• Nurse practitioner
• Clinical nurse specialist
• Certified registered nurse anesthetist

Advanced Alternative Payment Models (APMs)

The Advanced APMs program allows certain providers to apply for the APM track. This gives added incentive payments to provide high-quality and cost-efficient care. See the APM website for more information on the special programs and how providers can apply:

https://qpp.cms.gov/learn/apms

The Merit-based Incentive Payment System (MIPS)

Most Medicare Providers will be part of MIPS. They will earn a payment adjustment based on evidence-based and practice-specific quality data submitted. According to CMS, the Quality Payment Program policy will reform Medicare payments for more than 600,000 clinicians across the U.S.

Providers participating in the program in 2017 will submit their data by March 2018 and based on submission, their 2019 Medicare payments will be adjusted up, down, or not at all. 

MIPS is broken down into four categories and is setup so that the more Providers participate (and attest to), the higher score (and incentive) providers will get. A Medicare provider who does not participate at all (0%) may see up to 4% negative adjustment in 2019. A provider with a minimal amount of participation (e.g. submit one measure) may be able to avoid adjustment. For partial submission (submit the minimums for a partial year) they will see neutral or positive adjustments, and submit a full year and earn a positive payment adjustment.

If we take a quick look at how each category works:

•  Quality
•  Most Providers will report up to 6 quality measures (including an outcome type measure). Quality measures selected should be focused based on type of care and specialty as appropriate.
•  Reporting period must be a minimum of 90 days.
• There are over 250 quality measures available, be sure to check your health record software system to see which ones they support (can help gather data for you) when planning.
• Measures go across many specialties and problem sets:  For example, “Age Appropriate Screen Colonoscopy” – Report the percentage of patients greater than 85 years old seen by the Provider who received a colonoscopy screening Jan 1 to December 31.

•  Improvement Activities
• Most Providers will attest to completing a minimum of 4 improvement activities for at least 90 days.
• As of the writing of this blog, the CMS tools shows 92 activities to choose from.
• Activities range from care coordination, patient safety changes and beneficiary engagements.
• Examples: Join and participate (for a minimum of 6 months) in your States Prescription Monitoring Program (PMP). Or another example: Engage patients, family and caregivers in developing a plan of care and prioritizing their goals for action, documented in the certified EHR technology.

• Advancing Care Information
• Use a qualified (certified) product (or products) for a minimum of 90 days.
• There are two different programs to pick from depending on your Electronic Health Record Software Certification. For 2017, you will be able to use either a 2014 Certified Product (previously called Stage 2 MU Certification) or a 2015 certified product (certified for the MU Final Ruling criteria). Attest to a minimum of:

• E-Prescribing
• Provide Patient Access
• Send Summary of Care Records
• Receive Summary of Care Records
• Report up to 9 additional measures for bonus credits
• Cost
• No actions required: Cost will be computing from your claims
• The cost category will be calculated in 2017, but will not be used to determine your payment adjustment. In 2018, CMS will start using the cost category to determine your payment adjustment.

Medicare Providers will want to research the programs and decide their level of participation early in 2017. Full year participation would require making sure their Electronic Health Record system is setup for minimal data tracking and other required features like E-Prescribing and Direct Messaging.

References

1. 2017 Program requirements:

   https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2017ProgramRequirements.html

2. MIPS and MACRA:

   http://www.impact-advisors.com/meaningful-use/mips-macra-mu-the-next-evolution-of-healthcare-payment-reform/#sthash.vMkVGSvN.dpuf

3. https://qpp.cms.gov/docs/Quality_Payment_Program_Overview_Fact_Sheet.pdf

4. MIPS Quality Payment Program Website: 

   https://qpp.cms.gov/measures/performance

Primary nonadherence occurs when prescriptions written by a physician are never filled by the patient and is a common problem. A study published by JAMA Dermatology¹ shows that the use of electronic prescribing increases the likelihood of patients picking up their prescriptions.

The study looked at 4,318 prescriptions written for 2,496 patients. Of these, 803 patients received electronic prescriptions and 1,693 received written paper prescriptions. Overall, the primary nonadherence rate was 31.6%. However, when comparing the electronic prescriptions to the paper prescriptions, the primary nonadherence rate was lowered by 16%. Only 15.2% of patients who received an electronic prescription did not fill it. 

“Electronic prescribing has become one of the major criteria to evaluate meaningful use of electronic health records by health care professionals,” stated the researchers. “In this study, we demonstrated that e-prescribing is associated with reduced rates of primary nonadherence. As the healthcare system transitions from paper prescriptions to directly routed e-prescriptions, it will be important to understand how that experience affects patients, particularly their likelihood of filling the prescriptions.”

Why does e-prescribing increase adherence?   A huge part of it might be because e-prescribing eliminates the need to drop off the prescription at the pharmacy and can significantly reduce wait times.   Electronic prescribing allows the Pharmacy to begin filling a prescription before the patient has even left the Doctors office.   It is a huge difference to a patient who can just “swing by” the pharmacy and pick up their prescription, versus handing a prescription to the pharmacist and waiting for them to fill it.   Another factor, may be that many Pharmacies call to remind patients to pick up prescriptions.   If the patient doesn’t show up, the Pharmacy will follow up and remind them their prescription is ready and waiting.    A paper prescription many times never gets to a pharmacist, hence no one reminds them it is waiting.

Medication non-adherence can have many negative health consequences for patients. The JAMA study is a prime example of just how important e-Prescribing is to not only help prescribers and pharmacists, but to also improve adherence in patients. 

¹ Adamson AS, Suarez EA & Gorman AR. Association Between Method of Prescribing and Primary Nonadherence to Dermatologic Medication in an Urban Hospital Population. JAMA Dermatol.  2016. doi: 10.1001/jamadermatol.2016.3491

In our previous post about Direct Messaging, we covered the major benefits of Direct Messaging. One of which being that Direct Messaging is part of Meaningful Use Stage 2 requirements. In this post we are going to dig into a few of the details behind what criteria is required for Meaningful Use Stage 2 and give a brief description of each, along with how MDToolbox helps with the criteria in our Direct Messaging system.

There are three different Meaningful Use Stage 2 criteria that require Direct Messaging:

 1) 170.314(b)(2) Transitions of care – create and transmit transition of care/referral summaries

In Stage 2, providers must be able to send Continuity of Care Documents (CCD/CDA) formatted summary files using Direct Messaging when they transition a patient or refer a patient to another provider or organization. B2 involves first creating the care summary file, which is required to have a minimum field set as well as be formatted in a certain XML format that all other health record systems will understand. And then secondly, transmitting the document via Direct Messaging. The objective requires that the messages are sent using the Direct Protocol which uses secure direct mail addresses and encryption exchange between the servers.   

Electronic Health Record systems can have a separate “Direct inbox” for sending the message or many implement a Send button right from the Chart workflow for the provider – making transfers of chart records streamlined. Some HISP/Direct Messaging vendors (like MDToolbox) offer an API or web services that allow sending the message from anywhere in the application per the EHRs needs. This allows an EHR testing on B2 to have a process that creates the care document and attaches it to a Direct Messaging email for the provider that not only meets the criteria but is a huge benefits to the end users. When the message is sent it becomes encrypted and can only be decrypted by the intended recipient’s system, keeping the patients data safe and secure.

 2) 170.314(b)(1) Transitions of care – receive, display and incorporate transition of care/referral summaries

In Stage 2, providers must also be able to receive these CCD/CDA and other care summary files from other providers and facilities. The first part of the criteria basically just requires having the ability to receive Direct messages. The messages can be received in a standalone inbox provided by your HISP or an embedded inbox within the EHR. Secondly, for this criteria, the EHR must be capable of displaying the received files (most of them XML formatted) in “Human Readable” or a nice formatted output for providers. The EHR needs to apply a stylesheet or other formatting so that the provider can see what was received for many types of files including the CCD/CDA, and other files like CCR (a different XML format).  And finally the criteria also involves incorporating the received attachments. The EHR must be able to upload both the document itself, and for CCD/CDA files be able to allow clinical information reconciliation of things like allergies and problem lists (allowing providers to optionally import data elements to the chart).

Electronic Health Records can incorporate an inbox right inside of the EHR with built in tools for incorporating when signing up with a HISP that offers an API/Web services (like MDToolbox). This gives huge benefits to the provider and makes this their most important (and best) inbox they monitor on a daily basis. With a few clicks, referral charts can be reviewed and filed in the electronic chart.

 3) 170.314(e)(1) View, download, and transmit to 3rd party

In Stage 2, patients must also have access to their CCD Summary of Care files and chart data. Not only do EHRs have to add the ability to view and download the summary from their “patient portal”, but they also need to give patients and their authorized agents the ability to securely transmit the care summary to other providers. The Transmit of the data is required to be done through direct messaging. Some third party vendors patient portals come with direct messaging, but for EHRs that have their own patient portal this becomes a challenge. EHRs must give their patients a new “Send” button that would allow entering another provider or facilities direct address and send it via the secure Direct messaging method.  

As thousands of providers and facilities around the country start taking advantage of the secure “Direct” messaging, it really gives them more than just a couple of check boxes on their meaningful use attestation - it’s a new and better way to transfer records, discuss patient care and communicate. It's more secure, more efficient and can be a great time saver over the traditional communication methods. 

Want more info on Meaningful Use or Direct Messaging API with MDToolbox? Check out our Direct Messaging page and contact us today at info@mdtoolbox.com. 

 Stay tuned for more posts in our 5 Part Direct Messaging Blog Series:

1. Direct Messaging 101
2. Top 5 Benefits of Direct Messaging
3. Direct Messaging and Meaningful Use Stage 2 – Transition of Care (this article)
4. How does Direct Messaging work – Details on how PHI stays secure
5. Direct Messaging and Data Exchange:  What types of files and data can EHRs exchange?

Last week we covered the basics of what Direct messaging is in the healthcare field.  This week we focus on some of the biggest benefits of using Direct messaging. 

1.     Improves Care Coordination

By eliminating the need for outdated communication methods, such as faxing and mailing, and enabling electronic health information exchange with Direct messaging, communication is greatly improved between health care providers. Protected Health Information (PHI) is not only easier to send and receive electronically, but faster.  Instead of waiting for a fax or even worse, snail mail, Direct messaging allows for sending and receiving information almost instantaneously, increasing the efficiency and effectiveness of care coordination. 

2.     Secure

Faxes and envelopes could fall into the wrong hands.  Direct messaging increases the security of sending PHI information by encrypting messages and files and ensuring they are only accessible by the intended recipient.   

3.     Increases Workflow

When a patient’s information is sent by mail or fax, it still needs to be manually entered into the provider’s EHR.  By sending the information electronically, Direct messaging eliminates the need for this data entry and reduces the administrative workload.  Providers can spend more time with their patients, and less time on paper charts. 

Some Direct messaging systems, like MDToolbox-Direct, can also be integrated right into an EHR's workflow.  This increases the workflow even further by allowing providers to send and receive Direct messages in their EHR without having to log into a separate system, as well as incorporate any received information into the patient’s chart right at the time of receiving it. 

4.     Saves Money

In addition to the time saved with Direct messaging, providers can also save money by not having to pay for faxing or postage.  Furthermore, with the improved communication between providers that Direct messaging provides, duplicate procedures and tests can be avoided. 

5.     Reduces Errors

Direct messaging ensures clear and more complete information reaches the correct locations. Illegibility issues due to faxing or handwriting are eliminated by sending the information electronically and providers can be confident the information they send and receive is accurate.

Another huge benefit (and a main factor in the growth of Direct messaging) that we left off this list is that using Direct messaging meets Meaningful Use Stage 2 requirements.  We want to feature this benefit and so in our next Direct messaging blog series post, we delve into this topic in great detail.  Here’s a look at what other topics we have in our series:

5 Part Direct Messaging Blog Series: 

1. Direct Messaging 101
2. Top 5 Benefits of Direct Messaging (this article)
3. Direct Messaging and Meaningful Use Stage 2 – Transition of Care
4. How does Direct Messaging work – Details on how PHI stays secure
5. Direct Messaging and Data Exchange:  What types of files and data can EHRs exchange?

Meaningful Use Stage 2 started at the beginning of the year and it has been off to a slow start. A report from CMS last month showed that only 50 eligible professionals (EPs) had attested to Stage 2¹.  While the latest numbers given have increased to 447 EPs that have attested to Stage 2, this is still a relatively small number.²  Such low numbers point towards a lack of certified products. 

A review of the ONC HIT’s Certified Health IT Product List shows that there were over 3,500 products certified for Ambulatory Stage 1 and only a little over 700 are certified for Ambulatory Stage 2.  It is also interesting to note that out of 988 developers who certified products for Stage 1 (many had several different products, even hundreds), there are only 312 vendors with Stage 2 products.  Of those vendors with Stage 2 products, only 140 have complete EHRs that meet all of the criteria for attesting to Stage 2.  

Only a fraction of products, complete EHRs, vendors, and complete EHR vendors have certified for Meaningful Use Stage 2 compared to those that certified for Stage 1 as of June 13, 2014

CMS has proposed a potential delay in the requirement of all providers to use a 2014 Stage 2 certified product this year.³  If the pending rule passes, then providers will have one more year to use their stage 1 product.  This would also give EHRs extra time to get their product certified for the harder Stage 2 criteria.  The proposed rule is only for 2014, EPs would be required to use 2014 Edition CEHRT for the EHR reporting periods in 2015.  The rule is open for comments until July 21. 

If the rule passes this gives EHRs more time to meet the new criteria of stage 2 and get their product certified.   If it doesn’t pass, providers wanting to attest this year that do not have a Stage 2 certified product may be out of luck.  In order to attest to Stage 2 this year, physicians must report for 90 days.  As it is now, those attesting to Stage 1 for the first time need to report for 90 days before October 1^st, 2014 in order to avoid the 1% Medicare penalty next year.  This means they would need to start by July 1^st, only a little over a week away and before the proposed rule could be finalized. 

As a vendor who recently achieved ONC HIT 2014 Edition Modular EHR certification for our e-Prescribing product, MDToolbox-Rx, we understand how challenging meeting the Stage 2 requirements can be.  Because of this, we hope that the pending CMS rule is approved to give other vendors and providers the extra time they need to meet the criteria. 

MDToolbox offers meaningful use tools to help vendors quickly and easily meet some of the most challenging criteria.  EHRs who integrate our meaningful use certified e-Prescribing module can cross 9 criteria off their list and inherit our certification number towards their Complete EHR.   MDToolbox has also added a new MU2 Direct Messaging Module, MDToolbox-Direct, to our product line.  The Direct messaging module allows sending secure clinical messages via the Surescripts network that meet Meaningful Use Transition of Care and View, Download, Transmit criteria.   Contact us today to find out more about how we can help you get Stage 2 certified.

1.  http://www.healthit.gov/FACAS/sites/faca/files/HITPC_CMS_Update_2014-05-06.pdf
2.  http://www.healthit.gov/facas/sites/faca/files/HITPC_CMSUpdate_2014-06-10.pptx
3. CMS rule to help providers make use of Certified EHR Technology http://www.cms.gov/newsroom/mediareleasedatabase/press-releases/2014-press-releases-items/2014-05-20.html

Previously we covered important Meaningful Use Terms you need to know.  But, as it seems to be with any topic, there are several acronyms you need to know to understand Meaningful Use and the requirements as well.  To help you get started, here are our top 8:

ONC - Office of the National Coordinator for Health Information Technology

The ONC is the department within the U.S. Department of Health and Human Services that is in charge of Meaningful Use and promoting EHR use. 

NIST - National Institute for Standards and Technology

NIST is the agency within the U.S. Commerce Department that is in charge of creating the Meaningful Use test methods that EHRs use to certify on.  The agency creates standards for several other areas as well, including the Security Controls and ID Proofing needed for Electronic Prescribing of Controlled Substances (EPCS).

HITECH Act - Health Information Technology for Economic and Clinical Health Act

The HITECH act was signed into law in 2009 and is the act stipulating incentive payments be paid for Meaningful Use to eligible providers.

EP - Eligible Provider

EPs are healthcare providers that are eligible to attest to Meaningful Use.  The Medicare and Medicaid programs have different types of EPs:

Eligible Medicare EPs include:

• Doctors of Medicine or Osteopathy
• Doctors of Dental Surgery or Dental Medicine
• Doctors of Podiatric Medicine
• Doctors of Optometry
• Chiropractors

Eligible Medicaid EPs include:

• Physicians
• Nurse Practitioners
• Certified Nurse - Midwife
• Dentists
• Physicians Assistants who practice in a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) that is led by a Physician Assistant

CDS - Clinical Decision Support

CDS can be a number of different tools in an EHR that offer healthcare providers patient-specific information to aid in their clinical decisions and is one of the requirements for attesting to Meaningful Use.  A good example of CDS is showing a drug-drug or drug-allergy alert when a provider selects a drug that could have an interaction for the patient.

CPOE - Computerized Physician Order Entry

CPOE is the process of electronically entering medical orders, instead of on paper charts, and is also a requirement for attesting to Meaningful Use.  A prime example is electronically entering a prescription, instead of writing it out by hand on a prescription pad. 

HIE - Health Information Exchange

HIE is the electronic exchange of health information.  It allows health care providers and patients to access and share a patient’s health records electronically.  One of the main goals of Meaningful Use Stage 2 is to increase HIE between providers in order to increase care coordination and patient outcomes.

C-CDA – Consolidated-Clinical Document Architecture

The C-CDA format is a specific format standard that allows EHRs to exchange patient data with each other.  

In our last post, we covered why Meaningful Use is so big in 2014.  When talking about Meaningful Use, there are a lot of terms and requirements that are thrown around and it can get quite confusing.  This week we delve a little deeper into some of the main terms and requirements for meeting Meaningful Use.

1.       Attestation

Meaningful use attestation is the process of demonstrating that an individual or organization is meeting the requirements in order to qualify for the federal government payments.  They must prove (attest to) that they are meaningfully using a certified EHR.  Providers are required to register and attest using the Centers for Medicare & Medicaid Services (CMS) website.  As we mentioned last week, there are three different stages to Meaningful Use and providers must attest annually to whichever stage they are on.  There are three sets of requirements providers must attest to at each stage:  core objectives, menu objectives, and clinical quality measures.

2.       Core Objectives

Each stage of Meaningful Use has its own set of Core Objectives that a provider must meet and attest to.  All Core Objectives are required and have a specific measurement for each objective that must be achieved.  For Stage 1 there are 15 Core Objectives and for Stage 2 there are 17 Core Objectives.  As providers move on to the next stage, the measures get higher and/or include more requirements. 

Here’s an example:

            Core Objective:   Generate and transmit permissible prescriptions electronically (eRx)

Stage 1 Measure:  More than 40% of all permissible prescriptions written by the EP (Eligible Provider) are transmitted electronically

Stage 2 Measure: More than 50% of all permissible prescriptions, or all prescriptions, written by the EP are queried for a drug formulary and transmitted electronically using CEHRT.

3.       Menu Objectives

In addition to the Core Objectives, providers also have to meet and attest to a set of Menu Objectives.  Not all Menu Objectives are required, and providers are allowed to choose a certain number from the set.  In Stage 1, providers must attest to 5 out of 10 Menu Objectives, with at least 1 public health objective selected.  In Stage 2, providers must attest to 3 out of 6 Menu Objectives. 

Here’s an example:

            Stage 1 Menu Objective: Medication reconciliation

Measure:  The EP performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP.

Stage 2 Menu Objective: Record electronic notes in patient records.

Measure: Enter at least one electronic progress note created, edited and signed by an EP for more than 30 percent of unique patients with at least one office visit during the EHR reporting period.

 4.       Clinical Quality Measures

Lastly, providers must attest to a set of Clinical Quality Measures (CQMs).   CQMs look at how well a provider delivers appropriate clinical services to their patients, or the quality of care.  They assess everything from treatments to experiences to outcomes.  As stated on the CMS website, “CQMs help identify areas that require improvement in care delivery, identify differences in care among various populations, and may improve care coordination between health care providers.” 

As of 2014, all providers have to report on the same CQMs regardless of what stage they are on.  There are 64 CQMs categorized into six National Quality Strategy domains which include: (1) Patient and Family Engagement (2) Patient Safety (3) Care Coordination (4) Population/Public Health (5) Efficient Use of Healthcare Resources and (6) Clinical Process/Effectiveness.  Providers must report on 9 of the 64 CQMs and they must cover at least three of the National Quality Strategy domains.  Providers are only allowed to attest to CQMs that their EHR vendor has certified on, so some providers might have a lot less than 64 to pick from. 

Here’s an example:

Clinical Quality Measure: Documentation of Current Medications in the Medical Record

Measure Description: Percentage of specified visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications to the best of his/her knowledge and ability

Domain: Patient Safety

Source:

www.cms.gov

“Meaningful Use” is one of the biggest healthcare buzz terms in 2014, so what’s all the fuss about? Our next series of blog posts is dedicated to answering this, and other questions, about Meaningful Use.

Meaningful Use - The Basics

Meaningful Use was established by the Centers for Medicare & Medicaid Services (CMS) in 2011 as an incentive payment program to encourage the appropriate use of electronic health records (EHR).  The goal of the program is to improve patient care by “meaningfully using” EHRs to meet the following five priorities:

1. Improving quality, safety, efficiency, and reducing health disparities
2. Engaging patients and families in their health
3. Improving care coordination
4. Improving population and public health
5. Ensuring adequate privacy and security protection for personal health information

Meaningful Use Stages

CMS has established certain objectives that healthcare providers must meet in order to receive incentive payments (and avoid penalties).  There are 3 stages to the program, with increasing requirements for participating:

• Stage 1

Providers begin by meeting Stage 1 requirements for a 90 day period within the first year.  Then, depending on the year they started, they must demonstrate 3 months or a year of Meaningful Use in their second year.

The focus of Stage 1 is data capture and sharing, with five main areas:

1. Electronically capturing health information in a standardized format
2. Using that information to track key clinical conditions
3. Communicating that information for care coordination processes
4. Initiating the reporting of clinical quality measures and public health information
5. Using information to engage patients and their families in their care

• Stage 2

Once a provider has achieved Meaningful Use under the Stage 1 criteria, they move on to Stage 2 for two years.

The focus of Stage 2 is advanced clinical processes, with four main areas:

1. More rigorous health information exchange (HIE)
2. Increased requirements for e-prescribing and incorporating lab results
3. Electronic transmission of patient care summaries across multiple settings
4. More patient-controlled data

• Stage 3

The focus of Stage 3 is improved outcomes, with five main areas:

1. Improving quality, safety, and efficiency, leading to improved health outcomes
2. Decision support for national high-priority conditions
3. Patient access to self-management tools
4. Access to comprehensive patient data through patient-centered HIE
5. Improving population health

Why is 2014 Such a Big Year for Meaningful Use?  

• Stage 2 Began

2014 is the first year that Stage 2 criteria have been effective and any providers who began Stage 1 in 2011 or 2012 are now required to begin Stage 2. 

• Last Year to Start Earning Incentives

2014 is the last year that a provider can start participating and earn any EHR incentives.  If a provider starts participating in 2014, they can still earn up to $24,000 in incentives.  In addition, providers must successfully demonstrate meaningful use by October 1, 2014 to avoid a 1% Medicare penalty in 2015.  In 2016, the penalty increases to 2% and then increases again to 3% in 2017.   

• 2014 Certified EHR Technology Required

In 2014, all providers are required to attest to meaningful use using only 2014 Certified EHR Technology, regardless of what stage they are on.  Because of this, all providers are only required to demonstrate meaningful use for a 3-month EHR reporting period.  This is to allow providers sufficient time to upgrade their systems to the necessary technology. 

This also means that all EHRs being used for Meaningful Use have to be recertified using the 2014 criteria by July 1, 2014 in order to allow providers to attest by the October 1^st deadline.

Sources:

www.cms.gov

www.healthit.gov