Meaningful Use:Progress Report and Defining Success

BriefingMarch 1, 2012

Christine Bechtel, Vice President, National Partnership for Women & Families

David Lansky, President and Chief Executive Officer, Pacific Business Group on Health

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Agenda• Introduction• Background• Window of opportunity• Stage 1 experiences• Discussion on what consumers and purchasers expect

Meaningful Use to achieve by 2015

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Introduction

• First of two briefings on the Meaningful Use incentive program

– Today: • Review Meaningful Use program background, structure, and progress to

date• Discuss long-term goals for the program in order to provide feedback on

short-term program design

– Second briefing: • Review CPDP’s specific recommendations on the notice of proposed rule

making (NPRM) for Stage 2 -- late March/early April

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Background

• Health IT is a critical platform for improving patient care

• Robust use of health IT will result in big gains in care coordination, efficiency, and quality

• Congress recognized this when it passed HITECH Act of 2009 to reward Medicare and Medicaid providers for “Meaningful Use” of certified electronic health records (EHRs)

• Meaningful Use is intended to drive use of EHRs in a way that serves the interests of patients and the public -- traditionally, EHRs were employed by providers for largely administrative purposes

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• Meaningful Use is a gradual, escalating program – and providers can get on the escalator whenever they want

• Who can participate?

Background

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Medicare

– Clinicians: Physicians, osteopaths, dentists, podiatrists, optometrists and chiropractors

– Hospitals: Acute care and critical access hospitals

Medicaid

– Clinicians: Physicians, dentists, certified nurse-midwives, nurse practitioners, and physician assistants

– Hospitals: Acute care and children’s hospitals

Staging of Meaningful Use

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Window of Opportunity

• Meaningful Use is a crucial opportunity for consumers and purchasers to make significant changes to the way care is delivered

– Reaches a large swath of Medicare and Medicaid clinicians and hospitals

– Has $44B in taxpayer funding behind it– Influences and supports other key federal programs– Impacts care for patients in the private sector

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Timing Is Everything• By 2015, Medicare incentive dollars run out (payment reductions

begin)

• For Medicaid, providers don’t experience payment cuts and incentive payment continue until 2021

• Calls from other stakeholders for ONC to slow down

• Consumers and purchasers must make a strong push so the program reflects what matters and to ensure health IT supports new delivery and payment models (Stages 2 and 3)

• The wheels for future phases are already in motion:– Stage 2 notice of proposed rule making is out for public comment– Stage 3 criteria are being discussed

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Program Structure• To receive incentive dollars, providers must:

– Register for program

– Fulfill functional criteria and submit clinical quality measures

Eligible professionals• 20 Functional criteria (15 core, 5 menu)• 6 Clinical quality measures (3 core/alternate core, 3 alternate set)

• Eligible hospitals• 19 Functional criteria (14 core, 5 menu)• 15 Clinical quality measures (all core)

– Attest that they successfully met Meaningful Use requirements using certified EHR technology

• “Attest” to objectives and measures

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Lessons From Stage 1 Implementation

• Program is reaching a lot of providers

– Active registrants in 2011

120,000 Medicare clinicians

50,000 Medicaid clinicians

2,800 Medicare/Medicaid hospitals

– Big ripple effect on health care industry

Number of hospitals using health IT more than doubled in the last two years

Many health systems and doctor’s offices implementing health IT -- even those not eligible for Meaningful Use incentive payments

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Experiences with Stage 1 Implementation to Date

• Requirements not as tough as expected (i.e., objectives and thresholds) for early adopters

• Providers attesting to date have been successful

– 99.99% success rate among Medicare clinicians– 100% success rate among Medicare hospitals

• Providers have the most challenges with – Criteria that require them to create or modify workflows

Patient engagement Care Coordination

– Quality measurement

11Source: CMS, “Medicare & Medicaid EHR Incentive Program,” January 2012

Deferral and Exclusion Rates for Stage 1 Criteria

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Objective Deferral rates for EPs

Deferral ratesfor EHs

Summary of care transitions 85% 93%

Send reminders to patients 77% NA

Medication reconciliation 56% 75%

Syndromic surveillance 70% 79%

Patient education resources 49% 62%

Patient lists 27% 34%

Objective Exclusion rates for EPs

Exclusion rates for EHs

E-copy of health information 75% 68%

Office visit summaries 2% N/A

E-copy of discharge summaries N/A 59%

Source: CMS, “Medicare & Medicaid EHR Incentive Program,” January 2012

Source: ONC, “HIT Policy Committee Meaningful Use Workgroup, Presentation to HIT Policy Committee,” November 2011 13

• A number of providers’ concerns about quality measurement are about technical challenges, and the Health IT Policy Committee is working to address them

− EHR products often require significant customization/ reprogramming to retrieve data submission of quality metrics

− EHR calculated quality measurement results are often inaccurate− Measure specifications aren’t clear and there are errors in

measure definitions (occurred during retooling these measures for e-reporting)

Stage 1 Quality Measurement

Is Stage 1 Improving Patient Care?

• Stage 1 (data collection) lays an important foundation

• To realize the full value of Stage 1, must put the pedal to the metal in Stages 2 and 3 (information exchange and improvement)

• Key wins from Stage 1

– 5 Part Framework includes quality/safety/disparities, patient engagement, care coordination, population health and privacy -- for example:

CPOE Drug-drug and drug-allergy interaction checks Medication reconciliation at transitions in care* Reminders for preventive and follow-up visits* Patient-specific educational resources* Patient access to electronic health information* Collection of RELG, smoking status, and vital signs

14* = Menu option

Back To The Future

• Consumers and purchasers need to make it clear what they expect Meaningful Use to achieve by 2015 – Then use 2013 criteria as the launch pad

• A cohesive and robust advocacy strategy is needed to hold the line and ensure the biggest gains

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Four Goals Meaningful Use Should Achieve By 2015

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• Welcome audience feedback on where they think these goals hit the target, and where they miss it

The Goals

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1. Longitudinal EHR contains information needed to support high quality care and decision-making, and data to support quality measurement and public reporting

2. Improve care coordination and efficiency by sending and receiving appropriate personal health information to and from all participants in the care process, including patients, caregivers, providers, and others

3. Apply best-in-class evidence-based care practices to promote safety, efficiency, effectiveness, and patient-centered care

4. Report and improve key indicators of quality and efficiency (multi-site and longitudinal) for consumer choice, quality improvement, and accountability

Goal #1

Longitudinal EHR contains information needed to support high quality care and decision-making, and data to support quality measurement and public reporting

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• Patient-reported outcomes• Granular data categories

related to disparities• Patient-reported symptoms• Care plans• Care team members

• Patient preferences• Lab results – esp. hospital labs• Health risks• Formulary linkage• Email address• Indications for assessing

appropriateness

Examples:

Goal #2

Improve care coordination and efficiency by sending and receiving appropriate personal health information to and from all participants in the care process, including patients, caregivers, providers, and others

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• Networked information model for sharing and querying of data residing in multiple locations (include a focus on specialty registries)

• Electronic platform to collect patient-reported outcomes, patient experience, and quality of shared decision-making

• Secure, user-friendly platforms for patients to access information, share information with their providers, and gain easier access to the health care system itself

Goal #3

Apply best-in-class evidence-based care practices to promote safety, efficiency, effectiveness, and patient-centered care

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• For clinicians

– Decision support for prescribing and adjusting medications– Decision support algorithms for test ordering (e.g., MRI for back pain)– Reminders for preventive screenings, follow-up care

• For patients

– Use of mobile phone texts for reminders and follow-up care– Personalized, customized education resources– Shared decision-making tools and resources

Examples:

Goal #4

Report and improve key indicators of quality and efficiency (multi-site and longitudinal) for consumer choice, quality improvement, and accountability

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• Clinical outcomes• Patient-reported outcomes• Patient experience• Patient activation and engagement • Disparities (Measures that are

considered “disparities sensitive” and stratifying quality reports by demographic data to reduce disparities)

• Appropriateness of care • Care coordination and care

transitions • Patient safety• Efficiency of resource use

Examples:

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How the world would look for a knee replacement patient in 2015

Data capture (Goal 1)

• Race, ethnicity, language, gender (RELG)• Patient preferences• Care team members• Care plan• Patient’s risk factors• Patient’s symptoms and function prior to

and after surgery

Information exchange (Goal 2)

• Rehabilitation center and specialists all have access to needed information

• Consumers have online access to their health information

• Care summary and plan sent to primary care post-surgery

Reporting and improving quality indicators (Goal 4)

•Providers display performance dashboard•Robust quality and outcomes data used for payment•CMS publicly reports which surgeons are improving patient functioning and providing cost-effective care

Use of best-in class evidence-based care (Goal 3)

•Selection of appropriate patients and implants based on patient requirements and evidence of effectiveness•Most cost-effective drug is applied•Care is aligned with patient values and preferences

Discussion On 2015 Strategy

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Opportunities To Get Involved

• CPDP is active in ONC’s Health IT Policy Committee and other forums

• CMS and ONC notice of proposed rule making (NPRM) for Stage 2 requirements (February-April)

• Advanced notice of proposed rule making (ANPRM) on governance of health information exchange (March/April)

• Health IT Policy Committee request for comments (RFC) for Stage 3 (later this year)

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About the Consumer-Purchaser Disclosure ProjectThe Consumer-Purchaser Disclosure Project is a coalition dedicated to improving the quality and affordability of health care in America for consumers and health care purchasers. The project ’s mission is to put the patient in the driver’s seat — to share useful information about provider performance so that patients can make informed choices and the health care system can better reward the best performing providers. The coalition is comprised of leading national and local consumer organizations, employers and labor organizations. The Consumer-Purchaser Disclosure Project is funded by the Robert Wood Johnson Foundation along with support from participating organizations.

For more information go to http://healthcaredisclosure.org

Or Contact:Christine ChenSenior Policy AnalystConsumer-Purchaser Disclosure Projectcchen@pbgh.org

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