overview of meaningful use august 30, 2010 ihs office of information technology

Overview of Meaningful Use

August 30, 2010

IHS Office of Information Technology

Today’s Session

This training will cover the following topics:• EHR Incentive Programs – a Background

• Who Is Eligible to Participate• How Much are the Incentives• What are the Requirements/Meaningful Use• What You Need to Participate• Timeline of the Programs

• Meaningful Use and IHS• Contacts and Resources

EHR Incentive Programs – A Background

Establishment of the EHRIncentive Programs

• “The American Recovery and Reinvestment Act of 2009 (ARRA) is an unprecedented effort to jumpstart our economy, create or save millions of jobs, and put a down payment on addressing long-neglected challenges so our country can thrive in the 21st century… preserve and improve affordable health care…”

http://www.recovery.gov

• Included in ARRA is the Health Information Technology for Economic and Clinical Health (HITECH) Act, which:• “Seeks to improve American health care delivery

and patient care through an unprecedented investment in health information technology.”

http://www.recovery.gov/

Establishment of the EHRIncentive Programs (cont’d)•HITECH Act Programs

• Electronic Health Record (EHR) Incentive Program

• Authorizes the Centers for Medicare and Medicaid Services (CMS) to make incentive payments to eligible hospitals to promote the adoption and meaningful use of interoperable certified EHR technology

• One of several HITECH Programs created by ARRA

• Examples of other programs include:• Regional Extension Centers: Assist providers

seeking to adopt and become meaningful users of health IT

• Beacon Communities: Provides communities with funding to build and strengthen health IT infrastructure and exchange capabilities

What is the EHRIncentive Program?

• EHR Incentive Programs were established by law (ARRA)• This program is voluntary. However, Medicare penalties

start in 2015 for hospitals and eligible professionals (EPs) that do not demonstrate Meaningful Use. There are no Medicaid penalties.

• Programs for Medicare and Medicaid (they are different)• Programs for hospitals and EPs

• EPs must choose between the Medicare and Medicaid programs; they are not eligible for both

• Hospitals may participate in both programs if meet eligibility requirements

• Must use certified EHR technology AND demonstrate adoption, implementation, upgrading or meaningful use

• Medicare incentive program is federally run by CMS; Medicaid incentive program is run by States and is voluntary

Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)

EHR Incentive Programs – Eligible Professionals

EP Eligibility – General

• Eligible Professionals (EPs) • Must choose the Medicare OR Medicaid incentive

program; not eligible for both• Eligibility determined by law• Hospital-based EPs are NOT eligible for

incentives• DEFINITION: 90% or more of their covered professional

services in either an inpatient or emergency room (Place of Service codes 21 or 23) of a hospital

• Definition of hospital-based determined by law

• Incentives are based on the individual, not the practice


EP Eligibility – Medicare

• Medicare Eligible Professionals include:• Doctors of medicine or osteopathy• Doctors of dental surgery or dental medicine• Doctors of podiatric medicine• Doctors of optometry• Chiropractors

• Specialties are eligible if meet one of above criteria

Slide content provided by CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)

EP Eligibility –Medicaid

• Medicaid Eligible Professionals include:• Physicians• Nurse practitioners• Certified nurse-midwives• Dentists• Physician assistants working in a Federally

Qualified Health Center (FQHC) or rural health clinic (RHC) that is so led by a physician assistant


EP Eligibility – Medicaid (cont’d)

• Medicaid Eligible Professionals must also meet one of the three patient volume thresholds:• Have a minimum of 30% Medicaid patient

volume• Pediatricians ONLY: Have a minimum of 20%

Medicaid patient volume• Working in FQHC or RHC ONLY: Have a

minimum of 30% patient volume attributed to needy individuals


Participation with Other Incentive Programs

• Participation in EHR incentive program and other Medicare incentive programs

Other Medicare Incentive Program

Eligible for HITECH EHR Incentive Program?

Medicare Physician Quality Reporting Initiative (PQRI)

Yes, if the EP is eligible.

Medicare Electronic Health Record Demonstration (EHR Demo)

Yes, if the EP is eligible.

Medicare Care Management Performance Demonstration (MCMP)

Yes, if the practice is eligible. The MCMP demo will end before EHR incentive payments are available.

Electronic Prescribing (eRx) Incentive Program

If the EP chooses to participate in the Medicare EHR Incentive Program, they cannot participate in the Medicare eRx Incentive Program simultaneously in the same program year. If the EP chooses to participate in the Medicaid EHR Incentive Program, they can participate in the Medicare eRx Incentive Program simultaneously.


How Much are theIncentives for Medicare?• Medicare Incentive Payments Overview

• Incentive amounts based on Fee-for-Service allowable charges

• Maximum incentives are $44,000 over 5 years• Incentives decrease if starting after 2012• Must begin by 2014 to receive incentive payments • Last payment year is 2016• Extra 10% bonus amount available for practicing

predominantly in a Health Professional Shortage Area (HPSA) (identifies, by zip code or county, areas lacking sufficient clinicians to meet primary care needs)

• Only one (1) incentive payment per year


How Much are the Incentives – Medicare? (cont’d)

• Medicare Incentive Payments Detail

Amount of Payment Each Year if Continues Meeting Requirements

1st Calendar Year EP Receives a Payment

CY 2011 CY 2012 CY 2013 CY2014CY 2015 and later

CY 2011 $18,000

CY 2012 $12,000 $18,000

CY 2013 $8,000 $12,000 $15,000

CY 2014 $4,000 $8,000 $12,000 $12,000

CY 2015 $2,000 $4,000 $8,000 $8,000 $0

CY 2016 $2,000 $4,000 $4,000 $0

TOTAL $44,000 $44,000 $39,000 $24,000 $0


How Much are the Incentivesfor Medicaid?

• Medicaid Incentive Payments Overview• Maximum incentives are $63,750 over 6 years• Incentives are same regardless of start year• The first year payment is $21,250• Must begin by 2016 to receive incentive

payments• No extra bonus for health professional shortage

areas available• Incentives available through 2021• Only one (1) incentive payment per year


How Much are the Incentives – Medicaid? (cont’d)

• Medicaid Incentive Payments Detail

Amount of Bonus Each Year if Continues Meeting Requirements

1st Calendar Year EP Receives a Payment

CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016

CY 2011 $21,250

CY 2012 $8,500 $21,250

CY 2013 $8,500 $8,500 $21,250

CY 2014 $8,500 $8,500 $8,500 $21,250

CY 2015 $8,500 $8,500 $8,500 $8,500 $21,250

CY 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250

CY 2017 $8,500 $8,500 $8,500 $8,500 $8,500

CY 2018 $8,500 $8,500 $8,500 $8,500

CY 2019 $8,500 $8,500 $8,500

CY 2020 $8,500 $8,500

CY 2021 $8,500

TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)

EHR Incentive Programs – Hospitals

Who is Eligible toParticipate?

• IHS hospitals are eligible to participate in both the Medicare and Medicaid incentive programs

• Eligibility determined by law• Medicare Eligible Hospitals include:

• Acute Care Hospitals• Subsection (d) hospitals that are paid under the PPS

and are located in the 50 States or Washington, DC (including Maryland)

• Critical Access Hospitals (CAHs)


Who is Eligible toParticipate? (cont’d)

• Medicaid Eligible Hospitals include:• Acute Care Hospitals (now including CAHs)

• Medicaid included critical access hospitals in its definition of “acute care hospital” (but incentive calculation is like other acute care hospitals; does not follow the Medicare CAH formula)

• Children’s Hospitals• Acute care hospitals must meet a 10%

Medicaid patient volume threshold


How Much are the Incentives?• $2M base + per discharge amount (based on

Medicare/Medicaid share which effectively lowers the incentive amount)• Hospitals with larger Medicare/Medicaid

populations will receive larger incentive payments• Medicare Critical Access Hospitals calculation

does not start with a $2M base; uses EHR costs and Medicare share

• Medicare’s calculation derives a yearly payment amount, while Medicaid’s calculation derives a total amount that States may pay eligible hospitals


How Much are the Incentives? (cont’d)

• Payment adjustments for Medicare begin in 2015• No Federal Medicaid payment adjustments

• Medicare hospitals: No payments after 2016


How Much arethe Incentives? (cont’d)

• Medicaid Hospital specifics• Similar to Medicare hospital methodology• Payment is calculated, then disbursed over 3-6 years• No annual payment may exceed 50% of the total

calculation; no 2-year payment may exceed 90%• Hospitals cannot initiate payments after 2016 and

payment years must be consecutive after 2016• States must use auditable data sources in

calculating the hospital incentive (e.g., cost report)• Payments through 2021


How Much are the Incentives? Medicare Subsection D Calculation

• Medicare Subsection D Hospital Calculation

(Base Amount + Discharge Related Amount Applicable for Each Year)*

[(Medicare inpatient-bed-days + Medicare Advantage inpatient-bed-days) / {(total inpatient-bed days) *

(estimated total charges – charity care charges)/(estimated total charges)}]

* Transition Factor Applicable for Each Year


How Much are the Incentives? Medicare CAH Calculation• Medicare Critical Access Hospital

Calculation

[ (Reasonable costs incurred in that cost reporting period)+

(Similarly incurred costs from previous cost reporting periods to the extent they have not been fully

depreciated as of the cost reporting period involved) ]x

[CAH’s Medicare Share + 20 percentage points]

NOTE: Medicare Share is calculated the same way as shown previously for Subsection D hospitals. When the 20 percentage points are added, the total cannot be more than 100%.

How Much Are the Incentives? Medicaid Hospital Calculation

• Medicaid Acute Care (including CAH) Calculation

(Overall EHR Amount) * (Medicaid Share) Where:

Overall EHR Amount = {Sum over 4 year of [(Base Amount)+ Discharge

Related Amount Applicable for Each Year) * Transition Factor Applicable for Each Year]} *

Medicaid Share =[(Medicaid inpatient-bed-days + Medicaid managed

care inpatient-bed-days) / {(total inpatient-bed days) * (estimated total charges – charity care

charges)/(estimated total charges)}]Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)

IncentivesSummary

MEDICARE MEDICAIDEligible

ProvidersHospitals

Eligible Providers

Hospitals

Incentives Start

CY 2011 FY 2011 CY 2011 FY 2011

IncentivesEnd

CY 2016(max. 5 years)

FY 2015(max. 4 years)

2021(max. 6 years, must start by

2016)

2021(max. 6 years, must start by

2016)

Incentive Amount

Up to $44,000 total per

provider; based on % Medicare claims (bonus

for EPs in HPSAs)

Varies, depending on %

Medicare inpatient bed days. CAHs

paid based on EHR costs and

% Medicare inpatient bed

days

Up to $63,750 total per

provider; based on 85% of EHR

costs

Varies, depending on %

Medicaid inpatient bed

days

Reimbursement Reduced

CY 2015 FY 2015 No penalties No penalties

Meaningful Use Requirements

What are the Requirements/

Meaningful Use?• As mandated by law, to receive the

incentives EPs and hospitals must adopt and demonstrate meaningful use of certified EHR technology• Exception: The provider/hospital’s first

year of the Medicaid incentives only require adopting, implementing, or upgrading to certified EHR technology and do not require the achievement of meaningful use. All other years require demonstration of meaningful use.

What are the Requirements/ Adopt/Implement/Upgrade?

• MEDICAID – only for first participation year• Adopted – Acquired and Installed

• Eg: Evidence of installation prior to incentive

• Implemented – Commenced Utilization of• Eg: Staff training, data entry of patient demographic

information into EHR

• Upgraded – Expanded • Upgraded to certified EHR technology or added new

functionality to meet the definition of certified EHR technology

• The EHR technology must be certified and capable of meeting meaningful use

• No EHR reporting periodSlide content provided by CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)

What are the Requirements/ Meaningful Use? (cont’d)• Meaningful Use is using certified EHR

technology to:• Improve quality, safety, efficiency, and

reduce health disparities• Engage patients and families in their health

care• Improve care coordination• Improve population and public health• All the while maintaining privacy and

security


What are the Requirements/ Meaningful Use? (cont’d)• ARRA specifies the following 3

components of Meaningful Use:

1. Use of certified EHR in a meaningful manner (e.g., e-prescribing)

2. Use of certified EHR technology for electronic exchange of health information to improve quality of health care

3. Use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by the Secretary


What are the Requirements/

Meaningful Use? (cont’d)• EHR Certification and MU are not the same

thing• Certification is what the EHR can do –

responsibility of OIT

• MU is how the EHR is used – responsibility of providers and hospitals with assistance from national staff

• EHR Deployment Team is responsible for deploying (implementing) the EHR at sites that do not have it

• It is the responsibility of the facility staff to ensure they know the MU requirements and use the EHR as needed to meet MU

Real Life Exampleof MU

What are the Requirements/ Meaningful Use? (cont’d)

• RPMS sites must be using the EHR to meet MU

• Sites only using RPMS roll-and-scroll will not meet MU

• Commercial vendors of EHRs are subject to same MU requirements, standards, process and schedule as RPMS EHR


• Rule making was open to public comment• Listened to many comments received• Established 3 stages of meaningful use:

2011, 2013 and 2015

Stage 12011-2012

Stage 22013-2014

Stage 32015+



• Basic Overview of Stage 1 Meaningful Use:• Payments based on calendar year for providers

and federal fiscal year for hospitals• Reporting period is any consecutive 90 days for

first year and 1 year subsequently• Reporting through attestation• Objectives and Clinical Quality Measures• Reporting may be yes/no or

numerator/denominator attestation• To meet certain objectives/measures, 80% of

patients must have records in the certified EHR technology



Providers Hospitals

15 core objectives 14 core objectives

5 objectives out of 10 from menu set

5 objectives out of 10 from menu set

6 total Clinical Quality Measures - 3 core or alternate core - 3 out of 38 from menu set

15 total Clinical Quality Measures

Stage 1 Objectives and Measures Reporting



• Some MU objectives not applicable to every provider’s clinical practice, thus they would not have any eligible patients or actions for the measure denominator

• In these cases, the eligible professional, eligible hospital or CAH would be excluded from having to meet that measure• E.g.: Dentists who do not perform immunizations;

Chiropractors do not e-prescribe• Exclusions do not count against the 5 deferred

measures



• Core Objectives: 15 for EPs and 14 for Hospitals1. Computerized physician order entry (CPOE)2. E-Prescribing (e-Rx) – EPs only3. Drug-drug and drug-allergy interaction checks4. Record demographics5. Implement one clinical decision support rule6. Maintain an up-to-date problem list of current and

active diagnoses7. Maintain active medication list8. Maintain active medication allergy list9. Record and chart changes in vital signs10. Record smoking status for patients 13 years or older



• Core Objectives (cont’d)11. Report clinical quality measures to CMS/States (EPs

report ambulatory; hospitals report inpatient measures)

12. Provide patients with an electronic copy of their health information, upon request

13. Provide patients with an electronic copy of their discharge instructions at time of discharge, upon request - hospitals only

14. Provide clinical summaries for patients for each office visit – EPs only

15. Capability to exchange key clinical information among providers of care and patient-authorized entities electronically

16. Protect electronic health informationSlide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)


• Menu Objectives: EPs and hospitals choose 5 of 10 and must include at least 1 public health objective (marked with asterisk)1. Drug-formulary checks2. Record advanced directives for patients 65 years or

older – hospitals only3. Incorporate clinical lab test results as structured data4. Generate lists of patients by specific conditions5. Use certified EHR technology to identify patient-

specific education resources and provide to patient, if appropriate

6. Medication reconciliation7. Summary of care record for each transition of

care/referralsSlide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)


• Menu Objectives (cont’d)8. Capability to submit electronic data to

immunization registries/systems*9. Capability to provide electronic submission of

reportable lab results to public health agencies* - hospitals only

10. Capability to provide electronic syndromic surveillance data to public health agencies*

11. Send reminders to patients per patient preference for preventive/follow up care – EPs only

12. Provide patients with timely electronic access to their health information – EPs only



• An Eligible Professional who works at multiple locations, but does not have certified EHR technology available at all of them would:• Have to have 50% of their total patient

encounters at locations where certified EHR technology is available

• Would base all meaningful use measures only on encounters that occurred at locations where certified EHR technology is available



• States can seek CMS prior approval to require the following 4 MU objectives to be core for their Medicaid providers:• Generate lists of patients by specific conditions

for quality improvement, reduction of disparities, research, or outreach (can specify particular conditions)

• Reporting to immunization registries, reportable lab results, and syndromic surveillance (can specify for their providers how to test the data submission and to which specific destination)



• Meaningful Use for hospitals that qualify for both Medicare & Medicaid payments• Attest/Report on Meaningful Use to CMS for the

Medicare EHR Incentive Program• Will be deemed meaningful users for Medicaid

(even if the State has CMS approval for the MU flexibility around public health objectives)



• A Medicare hospital or Eligible Professional who does NOT demonstrate meaningful use by 2015 will be subject to payment reductions in their Medicare reimbursement schedule

• Medicaid-only EPs and hospitals that are not eligible for the Medicare incentive are not subject to the Medicare payment reductions

• Payment reductions may apply for any EP who accepts Medicare, even if you only participate in the Medicaid EHR incentive program



• Future Stages of Meaningful Use• Intend to propose 2 additional Stages through

future rulemaking. Future Stages will expand upon Stage 1 criteria.

• Stage 1 menu set will be transitioned into core set for Stage 2.

• Administrative transactions will be added.• CPOE measurement will increase to 60%.• Will reevaluate other measures – possibly

higher thresholds.• Stage 3 will be further defined in next

rulemaking.Slide content provided by CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)

Clinical Quality Measuresfor EPs• Clinical Quality Measures – Core Set for Eligible

Professionals

NQF Measure Number & PQRI Implementation Number

Clinical Quality Measure Title

NQF 0013 Hypertension: Blood Pressure Measurement

NQF 0028 Preventive Care and Screening Measure Pair: a) Tobacco Use Assessment, b) Tobacco Cessation Intervention

NQF 0421PQRI 128

Adult Weight Screening and Follow-up


Clinical Quality Measures for EPs (cont’d)• Clinical Quality Measures – Alternate

Core Set for Eligible Professionals

NQF Measure Number & PQRI Implementation Number

Clinical Quality Measure Title

NQF 0024 Weight Assessment and Counseling for Children and Adolescents

NQF 0041PQRI 110

Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or Older

NQF 0038 Childhood Immunization Status


Clinical Quality Measures for EPs (cont’d)

• Additional set CQM for EPs– must report 3 of 381. Diabetes: Hemoglobin A1c Poor Control 2. Diabetes: Low Density Lipoprotein (LDL) Management

and Control 3. Diabetes: Blood Pressure Management4. Heart Failure (HF): Angiotensin-Converting Enzyme

(ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)

5. Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)

6. Pneumonia Vaccination Status for Older Adults7. Breast Cancer Screening



• Additional set CQM for EPs (cont’d)8. Colorectal Cancer Screening9. Coronary Artery Disease (CAD): Oral Antiplatelet

Therapy Prescribed for Patients with CAD10. Heart Failure (HF): Beta-Blocker Therapy for Left

Ventricular Systolic Dysfunction (LVSD)11. Anti-depressant medication management: (a)

Effective Acute Phase Treatment, (b) Effective Continuation Phase Treatment

12. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation

13. Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy



• Additional set CQM for EPs (cont’d)14. Diabetic Retinopathy: Communication with the

Physician Managing Ongoing Diabetes Care 15. Asthma Pharmacologic Therapy 16. Asthma Assessment17. Appropriate Testing for Children with Pharyngitis18. Oncology Breast Cancer: Hormonal Therapy for

Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer

19. Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients

20. Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients



• Additional set CQM for EPs (cont’d)21. Smoking and Tobacco Use Cessation, Medical

Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies

22. Diabetes: Eye Exam23. Diabetes: Urine Screening24. Diabetes: Foot Exam25. Coronary Artery Disease (CAD): Drug Therapy for

Lowering LDL-Cholesterol26. Heart Failure (HF): Warfarin Therapy Patients with

Atrial Fibrillation



• Additional set CQM for EPs (cont’d)27. Ischemic Vascular Disease (IVD): Blood Pressure

Management 28. Ischemic Vascular Disease (IVD): Use of Aspirin or

Another Antithrombotic29. Initiation and Engagement of Alcohol and Other

Drug Dependence Treatment: a) Initiation, b) Engagement

30. Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)

31. Prenatal Care: Anti-D Immune Globulin32. Controlling High Blood Pressure33. Cervical Cancer Screening34. Chlamydia Screening for Women



• Additional set CQM for EPs (cont’d)35. Use of Appropriate Medications for Asthma 36. Low Back Pain: Use of Imaging Studies 37. Ischemic Vascular Disease (IVD): Complete Lipid

Panel and LDL Control 38. Diabetes: Hemoglobin A1c Control (<8.0%)

• Clinical Quality Measures align with Physicians Clinical Quality reporting (PQRI)

• Alignment between 4 HITECH CQM and the CHIPRA initial core set that providers report to States


Clinical Quality Measures for Hospitals and CAHs

• CQM for eligible hospitals and CAHs - must report on all1. Emergency Department Throughput – admitted

patients – Median time from ED arrival to ED departure for admitted patients

2. Emergency Department Throughput – admitted patients – Admission decision time to ED departure time for admitted patients

3. Ischemic stroke – Discharge on anti-thrombotics4. Ischemic stroke – Anticoagulation for A-fib/flutter5. Ischemic stroke – Thrombolytic therapy for

patients arriving within 2 hours of symptom onset


Clinical Quality Measures forHospitals and CAHs

• CQM for eligible hospitals and CAHs (cont’d)6. Ischemic or hemorrhagic stroke – Antithrombotic

therapy by day 27. Ischemic stroke – Discharge on statins8. Ischemic or hemorrhagic stroke – Rehabilitation

assessment9. VTE prophylaxis within 24 hours of arrival10. Intensive Care Unit VTE prophylaxis11. Anticoagulation overlap therapy12. Platelet monitoring on unfractionated heparin13. VTE discharge instructions14. VTE discharge instructions15. Incidence of potentially preventable VTE


What You Needto Participate• All providers must:

• Register via the EHR Incentive Program website starting Jan 2011

• http://www.cms.gov/EHRIncentivePrograms/50_Registration.asp#TopOfPage

• Be enrolled in Medicare FFS, MA, or Medicaid (FFS or managed care)

• Have a National Provider Identifier (NPI)• Use certified EHR technology

• Medicaid providers may adopt, implement, or upgrade in their first year

• All Medicare providers and Medicaid eligible hospitals must be enrolled in PECOS• www.cms.gov/EHRIncentivePrograms


What You Need toParticipate (cont’d)

• Registration: Medicaid Specific Details• States will interface with the EHR Incentive

Program registration website• States will ask providers to provide and/or

attest to additional information in order to make accurate and timely payments, such as:• Patient Volume• Licensure• Adopt/Implement/Upgrade EHR or Meaningful

Use• Certified EHR Technology


What You Need toParticipate (cont’d)

• Registration requirements include• Name of the eligible professional, hospital or CAH• National Provider Identifier (NPI)• Business address and business phone• Taxpayer Identification Number (TIN) to which the

provider would like their incentive payment made• Medicare or Medicaid program selection (may

only switch once after receiving an incentive payment before 2015) – EPs only

• CMS Certification Number (CCN) – Hospitals only

• State selection for Medicaid providers


What You Need toParticipate (cont’d)• Certified EHR Technology

• Required in order to achieve meaningful use or A/I/U• Standards and certification criteria announced on July

13, 2010. See http://healthit.hhs.gov/standardsandcertification for more information

• ONC in process of authorizing “testing and certification bodies” for temporary certification program

• Certified products are expected to be available in the Fall• List of certified EHRs and EHR modules will be posted on

ONC web site• Educational sessions will be held August 18, 2010• Visit http://healthit.hhs.gov/certification for more

information• Email [email protected] with questions


http://healthit.hhs.gov/standardsandcertification

http://healthit.hhs.gov/certification

mailto:[email protected]

Notable Differences Between Medicare and Medicaid Incentive Programs

Medicare Medicaid

Federal Government will implement starting in January 2011

Voluntary for States to implement - Most are expected to start by late summer 2011

Payment reductions begin in 2015 for providers that do not demonstrate Meaningful Use

No Medicaid payment reductions

Must demonstrate MU in Year 1 A/I/U option for 1st participation year

Maximum incentive is $44,000 for EPs (bonus for EPs in HPSAs)

Maximum incentive is $63,750 for EPs

MU definition is common for Medicare States can adopt certain additional requirements for MU

Last year a provider may initiate program is 2014; Last year to register is 2016; Payment adjustments begin in 2015

Last year a provider may register for and initiate program is 2016; Last payment year is 2021

Only physicians, subsection (d) hospitals and CAHs

5 types of EPs, acute care hospitals (including CAHs) and children’s hospitals


Timeline of the Program

• Fall 2010 – Certified EHR technology will be available and listed on website

• January 2011 – Registration for the EHR Incentive Programs begins

• January 2011 – For Medicaid providers, States may launch their programs if they so choose

• April 2011 – Attestation for the Medicare EHR Incentive Program begins

• May 2011 – Medicare EHR incentive payments begin

• November 30, 2011 – Last day for hospitals to register and attest to receive an incentive payment for FY 2011


Timeline of the Program(cont’d)

• February 29, 2012 – Last day for EPs to register and attest to receive an incentive payment for CY 2011

• 2015 – Medicare payment adjustments begin for EPs and eligible hospitals that are not meaningful users of EHR technology

• 2016 – Last year to receive a Medicare EHR incentive payment; Last year to initiate participation in Medicaid EHR Incentive Program

• 2021 – Last year to receive Medicaid EHR incentive payment


ONC Programs Designed toSupport Achievement of Meaningful Use

Area of Support ONC ProgramTechnical Assistance Regional Extension Center Program:

ONC has provided funding for 70 regional extension centers that will help providers with EHR vendor selection and support and workflow redesign. Go to http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__rec_program/1495

Health Information Exchange

State Health Information Exchange Program: Funding and technical assistance to states to support providers in achieving health information exchange requirementsNationwide Health Information Network Activities: Expanded definitions, specifications and sample implementations to support exchange to achieve meaningful use

Breakthrough Examples Beacon Communities ProgramDemonstration communities involving clinicians, hospitals and consumers who are showing how EHRs can achieve breakthrough improvements in care

Human Resources Workforce Training ProgramsSeveral distinct programs that are supporting the education of up to 45,000 new health IT workers to support implementation


http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__rec_program/1495

http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__rec_program/1495

Meaningful Use and IHS

ARRA Objectives for IHS OIT

• IHS Office of Information Technology (OIT) objectives for its ARRA funding include:• Contribute to the revitalization of the American

economy• Significant expansion in the use of information technology

(IT) service companies and significant purchases of hardware from U.S. based IT companies

• Job creation

• Deploy a certified EHR that meets the requirements of meaningful use (MU)

• Implement a personal health record (PHR) tool• Upgrade the reliability, redundancy, and security of

the IHS network • Ensure an adequate telemedicine infrastructure

MU and IHS

• IHS has been using an electronic medical record for over 25 years

• IHS’ EHR solution: RPMS Electronic Health Record• As of June, 2010, RPMS EHR in use at over 220

outpatient facilities, including 4 Alaska village clinics

• As of April 22, 2010, increased deployment of the RPMS EHR from 5 to 16 inpatient facilities

• Vista Imaging implemented at 53 sites

MU and IHS(cont’d)

• IHS is ahead of the curve with some of the Meaningful Use requirements• RPMS EHR deployment as previously described

is consistent with the Meaningful Use goal of increasing EHR adoption across the U.S.

• Public Health surveillance – since 2009 IHS has been reporting information on H1N1

• Electronic clinical quality reporting - since 2002 IHS has been reporting clinical quality measures with the Clinical Reporting System (CRS)

• IHS has ongoing relationships with ONC and CMS

IHS MU & EHR Certification Teams

• MU Core Team• Federal Lead: Stephanie Klepacki• Contractor Project Manager: MB Leaf + Team of 3.5

FTEs• Analysis of CMS Rule requirements• Identify and manage changes needed to RPMS to support MU

and determine provider eligibility (e.g. calculation of Medicaid patient volume; reports for MU objectives)

• Training/Education, Outreach, Communication & Collaboration• MU web site and ListServ

• EHR Certification Team• Federal Lead: Chris Lamer• Contractor Team Lead: Cathy Whaley + 1 FTE

• Analysis & implementation of ONC Rule requirements and NIST test scripts

• Identify and manage changes needed to RPMS to achieve certification

• Internal pre-certification testing

IHS Readiness• Now:

• Certification and MU Teams are identifying and implementing changes needed to RPMS to support certification and/or MU

• MU Coordinators starting to “spread” MU within their Areas• These positions are critical and will be the foundation for

ensuring MU success not only in Stage 1 but also Stages 2 and 3

• October 2010: Contracted Area support for MU and integration with Improving Patient Care (IPC) initiative• Funded by ARRA• Temporary positions - approximately 15 months in duration

• Spring 2011: IHS expects RPMS EHR Certification; hospitals and EPs will start assessing if they meet MU

EHR Certification• EHR Certification

• Issued by entities (like CCHIT) approved by the Office of the National Coordinator for Health Information Technology (ONC)

• Functionality of the EHR will be verified by the National Institute of Standards & Technology (NIST) test scripts

• ONC has not approved certification entities yet

• Separate certifications are required for the IHS RPMS EHR system • Ambulatory: RPMS was certified as a developmental EHR

in 2007 and will be recertified in 2011• Inpatient: RPMS will be certified in 2011

• Commercial vendors of EHRs are subject to same requirements, standards, process and schedule as RPMS EHR

Who Do Sites Contact for the RPMS EHR?• Sites should contact their Area Clinical Applications

Coordinator (CAC)• There is a list posted on the EHR website, EHR Current

Status page (http://www.ihs.gov/CIO/EHR/index.cfm?module=currentstatus)

• Click the link labeled: Click here to see the maps and table of currently deployed EHR sites

• Scroll down to the bottom of the page where a list of the EHR Live Sites and Area Contacts are displayed

• The IHS EHR web site contains a lot of information on EHR implementation• http://www.ihs.gov/CIO/EHR/index.cfm

• EHR implementation is a lengthy, difficult and worthwhile process. There are many sites in the queue. Interested sites should sign up now to get on the list.

http://www.ihs.gov/CIO/EHR/index.cfm?module=currentstatus

http://www.ihs.gov/CIO/EHR/index.cfm?module=currentstatus

http://www.ihs.gov/CIO/EHR/index.cfm

Non-RPMS Sites and MU

• Each EHR vendor is responsible for ensuring that its products are certified and capable of supporting Meaningful Use; IHS accepts this responsibility for the RPMS EHR• Non-RPMS sites will be dependent upon

certification of their commercial-off-the-shelf (COTS) products

• Interoperability is based on COTS solutions• Nationwide health information network

Connect software is available for COTS products to use• Open source software from the Office of the

National Coordinator

Non-RPMS Sites and MU (cont’d)

• Benefits to non-RPMS sites for MU Stage 1 (2011-2012)• Through ARRA, OIT is providing funding for

contracted MU and IPC support, which will assist all facilities, not just RPMS facilities

• As of July 7, 2010 $33.18 million of ARRA funding has been spent on infrastructure, benefiting all programs that participate in the IHS network, whether or not they are on RPMS

• An additional $3.5 million of ARRA funding was provided for non-RPMS tribal programs to create interfaces that would enable them to send data to IHS


• Benefits to non-RPMS sites (cont’d)• Meaningful Use guidance

• MU Listserv • MU Website• MU training sessions. Nearly 35 live, web-based

training sessions have been conducted with more planned.

• Conferences and meetings, including the Indian Health Information Management Conferences

• Personal Health Record• Coordinating with the National Indian Health Board

Regional Extension Center (REC)• Advocacy with State Medicaid programs for inclusion

of Tribal sites


• Benefits to non-RPMS sites (cont’d)• Share requirements and programming logic for:

• Quality measures• Immunization exchange• Public health reporting• Lab surveillance for reportable disease

Acronyms

ACA – Patient Protection and Affordable Care Act HIPAA – Health Insurance Portability and Accountability Act of 1996

A/I/U – Adopt, implement or upgrade HPSA – Health Professional Shortage Area

CAH – Critical Access Hospital MA – Medicare Advantage

CCN – CMS Certification Number MCMP – Medicare Care Management Performance Demonstration

CHIPRA – Children’s Health Insurance Program Reauthorization Act of 2009 MU – Meaningful Use

CMS – Centers for Medicare & Medicaid Services NCVHS – National Committee on Vital and Health Statistics

CNM – Certified Nurse Midwife NP – Nurse Practitioner

CPOE – Computerized Physician Order Entry NPI – National Provider Identifier

CQM – Clinical Quality Measures NPRM – Notice of Proposed Rulemaking

CY – Calendar Year OMB – Office of Management and Budget

EHR – Electronic Health Record ONC – Office of the National Coordinator of Health Information Technology

EP – Eligible Professional PA – Physician Assistant

eRx – E-Prescribing PECOS – Provider Enrollment, Chain, and Ownership System

FFS – Fee-for-service PPS – Prospective Payment System (Part A)

FQHC – Federally Qualified Health Center PQRI – Medicare Physician Quality Reporting Initiative

FFY – Federal Fiscal Year Recovery Act – American Reinvestment & Recovery Act of 2009

HHS – U.S. Department of Health and Human Services RHC – Rural Health Clinic

HIT – Health Information Technology RHQDAPU – Reporting Hospital Quality Data for Annual Payment Update

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

TIN – Taxpayer Identification Number

HITPC – Health Information Technology Policy CommitteeSlide content provided by CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)

Contact Information and Resources

Contact Information

• IHS Meaningful Use Contacts

• Theresa Cullen, RADM, MD, MS IHS Chief Information Officer (301) 443-9848 [email protected]• Stephanie Klepacki, Meaningful Use Project Lead, IHS (505) 821-4480 [email protected] • MB Leaf, Meaningful Use Project Manager, Serco (505) 798-1448 [email protected]




Resources to Get Help andLearn More

• IHS Meaningful Use Websitehttp://www.ihs.gov/recovery/index.cfm?module=dsp_arra_meaningful_use

• Sign up for the IHS Meaningful Use listserv (see instructions at the top of the Meaningful Use website)

• Get information, tip sheets, and more at CMS’ official website for the EHR incentive programswww.cms.gov/EHRIncentivePrograms

• Learn about EHR certification and certified EHRs, as well as other ONC programs designed to support providers as they make the transitionhttp://healthit.hhs.gov

http://www.ihs.gov/recovery/index.cfm?module=dsp_arra_meaningful_use



http://www.cms.gov/EHRIncentivePrograms

http://healthit.hhs.gov/

It’s time to…

overview of meaningful use august 30, 2010 ihs office of information technology

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