meaningful use final rule updates 2015
TRANSCRIPT
Meaningful Use Final Rule UpdatesFriday, October 16, 2015
Disclaimer: Nothing that we are sharing is intended as legally binding or prescriptive advice. This presentation is a synthesis of publically available information and best practices.
Meaningful Use Final RuleMarch 2015
MU Proposed Rule Changes
October 2015MU Final Rule Announced
Meaningful Use
www.cms.gov
Uses certified electronic health record technology to:
Improve quality, safety, efficiency, and reduce health disparities
Engage patients and family
Improve care coordination and population and public health
Maintain privacy and security of patient information
Meaningful Use Eligibility
Doctors of medicine or osteopathy
Doctors of dental surgery or dental
medicine
Doctors of podiatry
Doctors of optometry Chiropractors
MU1 vs MU2
MU1• 13 Core• 5/10 Menu• Total: 18
MU2• 17 Core• 3/6 Menu• Total: 20
Penalties
• Based on 2 years’ prior performance
• 2015 is the first year providers are subject to penalties
• Can reach as high as 5% by 2019
Data Year Penalty Year Penalty Amount
2014 2015 -1%
2015 2016 -2%
Continues at additional -1% each year
Meaningful Use TimelineFirst year as a Meaningful EHR user Stage of MU
Stage of
2015
Meaningful Use
2016 2017
2011 Modified Stage 2 Modified Stage 2 Modified Stage 2 or 3
2012 Modified Stage 2 Modified Stage 2 Modified Stage 2 or 3
2013 Modified Stage 2 Modified Stage 2 Modified Stage 2 or 3
2014 Modified Stage 2* Modified Stage 2 Modified Stage 2 or 3
2015 Modified Stage 2* Modified Stage 2 Modified Stage 2 or 3
2016 N/A Modified Stage 2 Modified Stage 2 or 3
*The modifications to Stage 2 include alternate exclusions and specifications for certain objectives and measures for providers who were scheduled to demonstrate Stage 1 of meaningful use in 2015.NOTE: Alternate exclusion reporting continues in 2016 for CPOE (all providers) and eRX (for eligible hospitals) only.
www.cms.gov
MU2 Changes with Modified Rule
= CQMs stay the same
= One year reporting period shortened to 90 days
= Core and Menu framework ends:• 17 Core Objectives to 9 Core Objectives• 3 out of 6 menu items reduced to 1 public health objective (2 options)
More Changes …= Attestation no longer needed for:• Demographics• Vital signs• Smoking status• Clinical summaries• Structured lab results• Patient list• Patient reminders• Summary of care (measures 1 and 3, but not 2)• Electronic notes• Imaging results• Family health history
What’s Left?• Protect PHI• Clinical Decision Support• CPOE• Electronic Prescribing• HIE• Patient Specific Education• Medication Reconciliation• Patient Electronic Access• Secure Messaging• Public Health Reporting: pick 2 of 3 measures:
- IMM registry - syndromic surveillance reporting- specialized registry
Changes in Objectives
Patient Electronic AccessMeasure 2 - Instead of 5%, this measure now requires only 1 patient seen by the EP during the EHR reporting period to VDT to a 3rd party
EP Secure Electronic MessagingInstead of 5% threshold, EP only has to note messaging was fully enabled during the EHR reporting period (yes/no)
MU Stage 1 First Time Attester Exceptions
• Clinical decision support - only 1 rule
• CPOE - reduced thresholds
• Electronic prescribing - reduced thresholds
• HIE - may claim exclusion
• Patient education - may claim exclusion
• Medication reconciliation - may claim exclusion
• Patient electronic access (VDT) - pay claim exclusion for measure 2, but not measure 1
• Secure messaging - pay claim exclusion
• Public health reporting - only need to report one measure
What’s On the Horizon:2015-2017
Thresholds 2015 2016 2017 2018eprescribing 50% 50% 50% 60%CPOE 60/30/30 60/30/30 60/30/30 60/60/60Pt. Electronic Access 50% 50% 50% 80%Pt. Education 10 10 10 35Secure Messaging Capability to send
and receive1 patient 5% 25%
Pt. Actively Engages with EHR
1 patient 1 patient 5% 10%
HIE 10% 10% 10% 60%Reconciliation 50% of med. 50% of med. 50% of med. 80% of med.,
medication allergy, & current problem
list
What’s On the Horizon:Stage 3
All EPs must attest for 2018.
EPs may voluntarily elect to attest for Stage 3 in 2017 and only have to report for 90 days.
Summary of Care, Measure 2 40% of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, the EP must incorporate into the patient’s record an electronic summary of care document from a source other than the providers EHR system
For public health reporting, can choose 2: a) immunization registry reporting b) syndromic surveillance reporting c) electronic case reporting d) public health registry reportinge) clinical data registry reporting
Patient Engagement 5% of all unique patients seen by EP must have patient-generated health data or data from a non-clinical setting incorporated in to the EHR
What’s On the Horizon:MIPS
• April 2015 - Congress passed “doc-fix” bill (MACRA - Medicare Access CHIP Reauthorization Act of 2015), repealing the SGR and enacting Merit-Based Incentive Program (MIPS)
• Incentive programs set to expire in CY 2018; MIPS begins in CY 2019, with performance year of 2017 - CMS laying groundwork for smooth transition
WHAT IS IT?- Part B Providers scored from 0 - 100• VBM-measured quality outcomes (30 points)• VBM-measured resource use (30 points) *VBM cost measures• MU (25 points)• Clinical Practice Improvement (15 points) * new category
- COSTS: 2019: +/- 4.0% → 2022: +/-9.0%- BENEFIT: Simplifies from 3 programs to 1- 5% lump sum payment to those in alternative payment models (e.g., ACO,
demonstration project)
Attest by February 29, 2016(unless CMA extends it)
CMS encourages providers to apply for hardship exceptions, which are reviewed case-by-case.
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FEBRUARY 2016
CMS 60-Day Comment Period
CMS has instituted a 60-day comment period to gather feedback on its "vision for the EHR Incentive Programs going forward." Feedback will be used to inform future policy as CMS continues its rule making to implement the Medicare Access and CHIP Reauthorization Act (MACRA), expected in spring 2016.
