meaningful use mini-camp presentation

Meaningful Use Mini-CampOctober 21, 2015L I S A I S R A EL , M BA , C P H I MS , C P H Q

E M R / M E A N I N G F U L U S E S P E C I A L I S T

R E D W O O D C O M M U N I T Y H E A LT H C O A L I T I O N

Agenda• Introductions• California Technical Assistance Program• 2015-2017 Modification Final Rule• Challenging Measures• Strategic Planning for Meaningful Use• Q&A

CTAP: California Technical Assistance Program

CTAP:California Technical Assistance Program• New funding program funded by ONC

• CalHIPSO is Regional Extension Center• RCHC is Local Extension Center• RCHC Members/Affiliates are part of RCHC CTAP group

CTAP:California Technical Assistance Program

• Program is milestone-driven• DHCS pays CalHIPSO for each milestone

• CalHIPSO pays RCHC 80% of what DHCS pays them

• The GOOD news:• RCHC will funnel 80% of what CalHIPSO pays them back to the

health centers • Payments are per provider. • Milestones include:

• Enrollment• Successful attestation for AIU or MU• Specialist “bonus”• Legally binding contract with HIE


Milestone CalHIPSO Pays RCHC RCHC Pays Health Center

Signed CTAP Contract $400 $320

EP is Specialist $600 $480

DHCS-Approved AIU Application $1,200 $960

First year attestation (S1, S2, S3) $1,800 $1,440

Subsequent year attestation (S1, S2, S3) $400 $320

HIE Contract $400 $320

• First year/second year attestations based on “scheduled” year for MU program. • 80% pass-through applies to 2015 and may be adjusted in 2016 and 2017• Program is for 3 years – payments payable each year based on milestones met that year


Milestone 2015TA Agreement 320

Specialist Bonus 480

AIU 960

MU Stage 1, Year 1 0

MU Stage 1, Year 2 0

Total Payment for EP for 2015 1760

Example: Dentist, never participated in MU (AIU for 2015)


Example: Family PractitionerScheduled for Stage 2/Year 1 – No HIE Contract Signed

Milestone 2015TA Agreement 320

MU Stage 2, Year 1 1,440

Total Payment for EP for 2015 1,760


• Enrollment• Enrollment package in binder pocket.

• Must have complete enrollment agreement to participate• RCHC has 200 enrollment slots available

• Last year MU attestations ~230 EPs for all health centers• Enroll strategically • Available slots for each health center based on number of EPs as

percentage of total EPs.


• Enrollment, cont’d• Complete Practice Enrollment Agreement first, submit to RCHC

with list of participating EPs• Within 4 months, must have Technical Assistance Agreement

signed by EACH PROVIDER who is participating• TA will be provided to each health center, not each provider

• If you don’t have all of your EPs enrolled, that doesn’t mean all the rest are out of luck!


CTAP:Example of Assignment of Providers

Health Center # of EPs Percentage of total # of Participating Slots assigned

#1 60 20% 40

#2 100 33% 66

#3 20 7% 14

Assumptions: Total EP population assigned to RCHC 300Total slots available: 200

• Prepare for enrollment• Practice enrollment agreement

• Attach list of EPs who will participate• Good time to think about Dental MU because of specialist bonus!!

• Announcement of number of EPs per health center will be made via email next week.

CTAP: What to do now

Stretch Break!

Modification Final Rule2015-2017

DISCLAIMER• All information given in this seminar relates to Medicaid

Meaningful Use rules for EPs only.• Information included in this presentation and seminar is

for informational purposes only.• References to Stage 1 and Stage 2 in this presentation

refer to the stages for which EPs are scheduled in 2015.• The CMS Final Rule reviewed in this presentation may

be found at https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-25595.pdf

https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-25595.pdf

REVIEW OF PROGRAM BASICS• The EHR Incentive Program (“Meaningful Use”) will

pay incentives through 2021. • Eligible professionals can participate for 6 years.• Participation years do not have to be consecutive.• The last year that an eligible professional

can begin participation is 2016.

BIG CHANGES!

BIG CHANGES!• Reporting periods changed• Stages 1 and 2 have merged together• Some measures removed as redundant, duplicative

or topped out• Now 10 Measures for both S1 and S2 – No more

Core/Menu Measures• Nothing was added!

Reporting Periods• 90-day reporting period for 2015 for everyone• Full calendar year reporting period for 2016-2017 for

everyone• Option to report Stage 3 in 2017.

• If report Stage 3 in 2017, can report for 90-day reporting period.

• EVERYONE will report Stage 3 in 2018

Redundant, Duplicative, orTopped OutDrug Formularies* Summary of Care (M1 & M3)Demographics* Lab Results*Up-to-Date Problem List* Patient ListsActive Medication List* RemindersActive Medication Allergy List* Electronic NotesRecord Vital Signs* Imaging Results*Record Smoking Status* Family Health HistoryClinical Visit Summary

* Incorporated into another “active” measureMost items are still required for PCMH certification/recertification

Stages 1 and 2 Have MERGED

Stage 1 Stage 2

One Set of Measures

CPOE Patient Education E-Prescribing Medication Reconciliation Clinical Decision Support Summary of Care (HIE) Patient Electronic Access Public Health Privacy & Security Secure Messaging

CPOE (%)• The Measure: >60% of medication, 30% of lab, and 30%

of radiology orders are entered using CEHRT.• Stage 1 EPs may use alternate measure for medication

orders: 30%• Exclusion: EPs who write fewer than 100 orders each for

medications, labs, and radiology

E-Prescribing (%)• The Measure: >50% of permissible Rx’s are compared to

one formulary and transmitted electronically using CEHRT• Stage 1 – threshold is 40%• Exclusions:• EP writes < 100 prescriptions during reporting period• OR – there is no pharmacy within 10 miles that

accepts e-scripts.

Clinical Decision Support (Y/N)• Measure 1: 5 CDS interventions tied to >= 4 CQMs.• Measure 2: Drug-Drug and Drug-Allergy interaction

checks enabled for entire EHR reporting period.• Exclusion for S2: M2 Only – EP writes < 100 medication

orders• Stage 1 EPs may use Alternate Measure in 2015:

• 1 CDS rule• No drug interaction check

Patient Electronic Access (%)• Measure 1: 50% of unique patients seen are provided

online access within 4 business days• Measure 2: At least 1 patient PER EP actually views/

downloads/transmits (reduced from 5%).• Stage 1 EPs may use alternate exclusion for M2

in 2015, as Stage 1 did not have equivalent Core Measure.

Privacy & Security (Y/N)• Conduct or review a security risk analysis in accordance

with the requirements (see Tip Sheet page 3 for requirements)

• No exclusions

• > 10% of unique patients seen by EP are provided educational resources identified by CEHRT

• Exclusion: No office visits in the EHR reporting period.• Stage 1 EPs may use Alternate Exclusion in 2015 if they did

not intend to select this measure for a Stage 1 Menu choice.Per CMS: “…we acknowledge that it may be difficult for a provider to document intent and will not require such documentation.”

Patient Education (%)

Medication Reconciliation (%)• >50% of patients transitioned into care of EP has

medication reconciliation performed• Stage 2 exclusion: Any EP who was not the recipient of any

transitions of care during the EHR reporting period• Stage 1 EPs may use Alternate Exclusion

in 2015 if they did not intend to select this measure for a Stage 1 Menu choice.

Summary of Care (HIE) (%)• Stage 2: 10% of Summary of Care records are created in

CEHRT and sent electronically• Will go more into this statement in Challenging Measures

section• Stage 1: Alternate Exclusion;

this did not have equivalent Core Measure

Public Health (Y/N)• Active engagement with a Public Health Agency or Clinical

Data Registry to submit electronic public health data using CEHRT.

• Registry options:• Immunization registry• Syndromic Surveillance• Specialized Registry

• Stage 2 must meet 2 of the 3 options• Stage 1 must meet 1 of the 3 optionsMore on this in the Challenging Measures section!

Secure Messaging (Y/N)• 5% of unique patients send electronic message that

contains health information• Modified Objective: Capability = Yes• Stage 1 EPs may use “Alternate Exclusion”

as Stage 1 does not have an equivalent core measure

Technology Updates• 2014 CEHRT will be used for 2015 and 2016 reporting• Until you are ready to attest to Stage 3, you can continue

to use 2014 CEHRT• Must upgrade to 2015 CEHRT to report Stage 3 (2017 or

2018)

Let’s take a break!

Challenging Measures

Patient Electronic Access (Patient Portal)• Measure 1: 50% of unique patients seen are provided

online access within 4 business days• Measure 2: At least 1 patient PER EP actually views/

downloads/transmits (reduced from 5%).• Stage 1 EPs may use alternate exclusion for M2 in 2015, as

Stage 1 did not have equivalent Core Measure

• Challenges• No Exclusions• Portals not available in Spanish

• Possible Solutions• PEDS/Teens – activate PEDS/deactivate at age 12• Activate dental patients• Staff incentive

Patient Electronic Access (Patient Portal)

Summary of Care (HIE)• Challenges

• What does “sent electronically” mean?• Verbiage different from prior rule that stipulated NwHIN Exchange

Participant to send.• Final rule states that CMS is “widening the pathways acceptable for

transmitting Summary of Care records.”• Probably does NOT mean faxing, as CMS states that is analog.• May allow for sending via secure/encrypted email.

• Referral partners not set up to receive electronic transmission

Summary of Care (HIE)• For now:

• Awaiting CMS to publish a FAQ answer to definition of electronic transmission.

• Keep using methods you have for sending electronic referrals and records.• Provider relationships and referral partner office staff – do they have

capacity to receive electronic transmission?• What are other health centers doing?• Discuss at bi-weekly focus calls

Public Health (Y/N)• Active engagement with a Public Health Agency or Clinical

Data Registry to submit electronic public health data using CEHRT.

• Registry options:• Immunization registry – Final rule struck bidirectional requirement• Syndromic Surveillance• Specialized Registry

• Stage 2 must meet 2 of the 3 options• Stage 1 must meet 1 of the 3 options

HIE Gateway

Sonoma County

Marin County

Napa County

Yolo County

Challenges and Options• CalREDIE provider portal:

• Online manual entry – does not meet MU requirements that data be submitted electronically using CEHRT

• California Cancer Registry• EP is excluded if does not diagnose or treat cancer

• Most EPs in our CHCs would meet this exclusion• No other statewide Public Health options

Challenges and Options• Exclusions

• An exclusion will not count as 1 of the 2 needed to successfully attest for this measure

• If exclude for 1, then need to attest for the other 2• If exclude for 2, then need to attest for the remaining 1.

• Likelihood• For Stage 2, attest to immunization registry option, exclude for the

other two options.• Stage 1 only needs to attest to 1 of the 3 options, so IZ registry will

meet this measure

Stand Up and Stretch!

Strategic Planning forMeaningful Use:What to do when you get back to your health centers

• Get a baseline, if you do not have one• Run the reports that you do have and compare them to the final rule

measures• The measures did not change enough to prevent you from using the reports you have!• Are you too low on any of the measures? Let’s find out why!

• CTAP enrollment – get started!• Strategic enrollment – providers who are at highest likelihood of

successful attestation

Strategic Planning for MU

• Update groups in SLR• SLR will go down on/about December 15 for

reprogramming• Anticipated that AIU and group updates will remain open• SLR may take about 5-6 months to reprogram – so

attestation would be extended

• Any providers AIU?• Can do it now!

Strategic Planning for MU

Strategic Planning for MU• Biweekly Focus Calls

• Restarting Thursday, October 29, 2-3 p.m.• Every other Thursday from 2-3 p.m.• Calls will not be recorded – great to team up to have a representative

• Call for topics/questions will go out on Monday prior to the call• Calendar invitations sent out October 14

• If you did not receive one, let me know and I will add you to the invite list

Strategic Planning for MU• Questions?• Freaking out?• Is the sky falling?

Contact Me!This is my job!

May not have the answer, but I know where to find it!

meaningful use mini-camp presentation

Documents