Data Analytics Update

Health IT Policy Committee MeetingApril 8, 2014

Data Analytics Update

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STAGE 1 MEANINGFUL USE EXPERIENCE

Stage 1 meaningful use experience

Majority of eligible providers have attested to stage 1

3

Medicaredischarges(n=11m)

Beds(n=790k)

Hospitals(n=5011)

Professionals(n=527k)

93%

90%

83%

56%

5%

6%

8%

15%

3%

19%

2%

7%

4%

2%

Attested MU AIU onlyRegistered EHR Incentive Program Enrolled RECNot participating

Note: Categories are hierarchical and mutually exclusive. For example, a hospital that has attested and received AIU payment and is enrolled with an REC is counted only in the Attested MU category. See Data Sources and Definitions slides for more details.MU is meaningful use. AIU is adopt/implement/upgrade to certified EHR technology. REC is Regional Extension Center.

Most attesting providers far exceeded minimum requirements for stage 1 objectives

4Note: Percentages represent percent of eligible hospital attestations that reported a score in the corresponding range for the objective.Calculations based on attestations processed as of June 2013.

>=10 <15

>=15 <20

>=20 <25

>=25 <30

>=30 <35

>=35 <40

>=40 <45

>=45 <50

>=50 <55

>=55 <60

>=60 <65

>=65 <70

>=70 <75

>=75 <80

>=80 <85

>=85 <90

>=90 <95

>= 95 <100

100

Core ObjectivesCPOE for medication orders 1% 1% 2% 2% 3% 3% 4% 4% 4% 5% 6% 9% 12% 31% 12%Maintain problem list 6% 12% 21% 48% 12%Active medication list 2% 4% 10% 64% 21%Medication allergy list 1% 2% 10% 70% 16%Record demographics 0% 0% 0% 1% 1% 1% 2% 4% 8% 71% 12%Record vital signs 0% 1% 1% 1% 2% 4% 6% 10% 19% 51% 4%Record smoking status 0% 0% 1% 1% 2% 4% 6% 9% 15% 49% 12%Electronic copy of health info 0% 1% 1% 2% 1% 3% 3% 4% 4% 9% 72%Electronic copy discharge instr 0% 0% 1% 3% 1% 3% 4% 5% 7% 9% 66%Menu ObjectivesAdvance directives 0% 0% 1% 1% 1% 2% 3% 5% 9% 44% 34%Clinical lab test results 0% 0% 0% 0% 0% 0% 1% 3% 5% 7% 11% 52% 20%Patient-specific ed resources 1% 2% 1% 2% 3% 3% 3% 3% 3% 4% 5% 5% 6% 7% 10% 10% 14% 14% 2%Medication reconciliation 2% 3% 4% 5% 5% 10% 10% 16% 20% 23% 2%Transition of care summary 4% 5% 5% 6% 6% 12% 11% 17% 13% 9% 12%

Objective score reported at attestation (numerator/denominator)

Eligible Hospitals

Most attesting providers far exceeded minimum requirements for stage 1 objectives

5Note: Percentages represent percent of eligible hospital attestations that reported a score in the corresponding range for the objective.Calculations based on attestations processed as of June 2013.

>=10 <15

>=15 <20

>=20 <25

>=25 <30

>=30 <35

>=35 <40

>=40 <45

>=45 <50

>=50 <55

>=55 <60

>=60 <65

>=65 <70

>=70 <75

>=75 <80

>=80 <85

>=85 <90

>=90 <95

>= 95 <100

100

Core ObjectivesCPOE for medication orders 1% 1% 2% 2% 3% 3% 4% 4% 4% 5% 6% 9% 12% 31% 12%Maintain problem list 6% 12% 21% 48% 12%Active medication list 2% 4% 10% 64% 21%Medication allergy list 1% 2% 10% 70% 16%Record demographics 0% 0% 0% 1% 1% 1% 2% 4% 8% 71% 12%Record vital signs 0% 1% 1% 1% 2% 4% 6% 10% 19% 51% 4%Record smoking status 0% 0% 1% 1% 2% 4% 6% 9% 15% 49% 12%Electronic copy of health info 0% 1% 1% 2% 1% 3% 3% 4% 4% 9% 72%Electronic copy discharge instr 0% 0% 1% 3% 1% 3% 4% 5% 7% 9% 66%Menu ObjectivesAdvance directives 0% 0% 1% 1% 1% 2% 3% 5% 9% 44% 34%Clinical lab test results 0% 0% 0% 0% 0% 0% 1% 3% 5% 7% 11% 52% 20%Patient-specific ed resources 1% 2% 1% 2% 3% 3% 3% 3% 3% 4% 5% 5% 6% 7% 10% 10% 14% 14% 2%Medication reconciliation 2% 3% 4% 5% 5% 10% 10% 16% 20% 23% 2%Transition of care summary 4% 5% 5% 6% 6% 12% 11% 17% 13% 9% 12%

Objective score reported at attestation (numerator/denominator)

Eligible Professionals

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Some differences in stage 1 attestation by hospital location, size, and type

Apr-11

Jun-11

Aug-11Oct-

11

Dec-11

Feb-12

Apr-12

Jun-12

Aug-12Oct-

12

Dec-12

Feb-13

Apr-13

Jun-13

Aug-13Oct-

13

Dec-13

Feb-14

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Perc

ent o

f hos

pita

ls

Note: Large = 400+ staffed beds; Medium = 100-399 staffed beds; Small = <100 staffed beds. Rural = non-metropolitan; Urban = metropolitan. See Data Sources and Definitions slides for more details.

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Some differences in stage 1 attestation by physician specialty, no differences rural/urban location

All AmbulatoryPhysicians(n=619k)

PhysiciansAttested MU

(n=247k)

9% 4%

51%48%

39%48%

Radiology/Pathology/AnesthesiologyMedical/Surgical SpecialtyPrimary Care

Data reflect physicians not participating via Medicare Advantage only; an additional 49k professionals (non-physician professionals and Medicare Advantage physicians) have attested. Data on all ambulatory physicians are from SK&A Office Based Provider Data Base, 2012. Primary care includes: family practice, general practice, internal medicine, obstetrics/gynecology, adolescent medicine, pediatrics, and geriatrics. Rural = non-metropolitan; Urban = metropolitan.

All AmbulatoryPhysicians(n=619k)

PhysiciansAttested MU

(n=247k)

10% 10%

90% 90%

Rural Urban

UPCOMING DATA ON MEANINGFUL USE IMPLEMENTATION AND IMPACTS

Upcoming data on meaningful use implementation and impacts

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Most 2014 attestations likely in 3rd and 4th quarters

9

2011 2012 20130

500

1000

1500

2000

Q4Q3Q2Q1

Timing of 90-day attestations, 2011-2013

Draft timeline of upcoming data on implementation and impacts

10

Q214

Q314

Q414

Q115

Continue monitoring provider adoption of functionalities necessary for Stage 2 and potential Stage 3 objectives

-- Hospital survey data collected in late 2013(AHA Health IT Supplement)

-- Hospital survey data collected in late 2014(AHA Health IT Supplement)

-- Physician survey data collected in mid 2014(National Ambulatory Medical Care Survey EHR Supplement)

Monitor number of providers attesting to Stage 2 and their performance on Stage 2 objectives

-- EHR Incentive Program attestation data (most 2014 attestations expected to occur in quarters 3 and 4; data from early attesters may be available after quarter 2)

Evaluate proposed Stage 3 objectives to identify potential policy adjustments and best practices for implementation

-- 12 quantitative and qualitative research projects funded by the Agency for Healthcare Research and Quality

Continue assessing whether physicians report clinical benefits from meaningful use functionalities and objectives

-- Physician survey data on benefits from meaningful use EHRs and proposed Stage 3 objectives collected mid 2013 (Physician Workflow Survey)

Estimated date of data availability(calendar year quarters)

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DATA SOURCES AND DEFINITIONS

Data Sources and Definitions

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Data Sources and Definitions

Hospital DataTo describe hospital progress to Meaningful Use by key characteristics, data on all CMS certified hospitals as of

March 2013 were merged to data from the CMS EHR Incentive Program, the ONC Regional Extension Center (REC) Program, and the American Hospital Association (AHA) Annual Survey by CMS Certification Number (CCN). The final analysis file contained 4,970 hospitals, 97% of which matched to the AHA Annual Survey.

Hospitals were categorized into 1 of 5 hierarchical and mutually exclusive categories: (1) Attested MU – hospitals successfully attested to Stage 1 Meaningful Use under the Medicare EHR Incentive Program or received payment for attesting to Stage 1 Meaningful Use under the Medicaid EHR Incentive Program. Category includes some hospitals that had successfully attested but still had Medicare payment for the attestation pending.(2) AIU only – hospitals received Medicaid EHR Incentive Program payment for AIU but not yet attested or received payment for attesting to Meaningful Use.(3) Registered EHR incentive program – hospitals registered for the Medicare or Medicaid EHR Incentive Program but had not yet attested or received payment for AIU or Meaningful Use.(4) Enrolled REC – hospitals enrolled with an REC but not yet registered for the Medicare or Medicaid EHR Incentive Program.(5) Not participating – hospitals not registered for the Medicare or Medicaid EHR Incentive Program and not enrolled with an REC.

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Data Sources and Definitions

Professional DataTo describe professional progress to Meaningful Use, data from the CMS EHR Incentive Program were merged to

data from the ONC Regional Extension Center Program by National Provider Identifier (NPI). Professionals were categorized into 1 of 5 hierarchical and mutually exclusive categories. (1) Attested MU – professionals successfully attested to Stage 1 Meaningful Use under the Medicare EHR Incentive Program or received payment for attesting to Stage 1 Meaningful Use under the Medicaid EHR Incentive Program. Category includes some professionals that had successfully attested but still had Medicare payment for the attestation pending.(2) AIU only – professionals received Medicaid EHR Incentive Program payment for AIU but not yet attested or received payment for attesting to Meaningful Use.(3) Registered EHR incentive program – professionals registered for the Medicare or Medicaid EHR Incentive Program but had not yet attested or received payment for AIU or Meaningful Use.(4) Enrolled REC – professionals enrolled with an REC but not yet registered for the Medicare or Medicaid EHR Incentive Program.(5) Not participating – professionals not registered for the Medicare or Medicaid EHR Incentive Program and not enrolled with an REC.

To monitor professional progress to Meaningful Use by key characteristics, characteristics of physicians who had successfully attested to Stage 1 Meaningful Use were compared to characteristics of all ambulatory physicians nationally using data from the 2012 SK&A Office-Based Provider data base.