Meaningful use and PCMH How to kill two birds with one (or more) stones!

Meaningful use and PCMH

How to kill two birds with one (or more) stones!

To Do:

•Quickly review meaningful use criteria and PCMH

•Identify the similarities between the two programs

•Shamelessly plug the services available from

NC AHEC

NC AHEC Statewide Map

3

Mountain Greensboro South East Northwest Southern Regional

Area L Charlotte Wake Eastern

www.ahecqualitysource.com

What is Meaningful Use?

• Funds will be distributed through Medicare and Medicaid incentive payments to eligible professionals “EPs”, who are “meaningful EHR users.”

• The Recovery Act establishes financial incentives beginning in January 2011 for eligible professionals (EPs) who are meaningful EHR users.  Beginning in 2015, payment adjustments will be imposed on EPs who are not meaningful EHR users.

Health Information Technology for Economic and Clinic Health (HITECH) Act

• To receive the financial incentives (and avoid reductions), providers must demonstrate “meaningful use” of health information technology

• This means Eligible Providers must:▫Use a certified EHR (system certification

began October 2010) with clinical decision support

▫Electronic exchange of information. At minimum, eRx (electronic prescribing) and coordination of care

▫Capturing and generating data reports on specific indicators and quality of care

Meaningful Use – The Very Basics

Payments for Meaningful use of Certified EHR from 2011 – 2015

• Medicaid Providers (up to $63,750 per provider) 1. Based on Medicaid Patient Volume2. MD, DO, DDS, NP, CNM & PAs with exceptions

OR

• Medicare Providers (up to $44,000 per provider)1. Based on % of allowable charges2. MD, DO

HITECH Act

To be eligible for Incentive Payments:

• The eligible professional must meet the Medicaid or Medicare program requirements

• The EHR system being adopted and used by the eligible professional MUST meet federal certification standards.

•And… the provider must demonstrate or attest to using specific functions of the EHR required in the meaningful use final rule.

Medicare vs. Medicaid differences

Medicare Medicaid

Federal Government will implement State by State implementation (including option for additional requirements)

Payment reductions begin in 2015 for providers that do not demonstrate MU

No Medicaid payment reductions

Must demonstrate MU in Year 1 for 90 day reporting period, 12-month reporting in subsequent years

Adopt/Implement/Upgrade option for 1st participation year (by attestation/contract), 90 days in year 2, 12 months thereafter

Maximum incentive is $44,000 for EPs - (10% bonus for EPs in HPSAs)

Maximum incentive is $63,750 for EPs

EP qualifying based on allowable charges – provider specific

EP qualifying can be based on practice ratio of encounters to achieve 30% threshold

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

Last year a provider may initiate program is 2016

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Quick Overview:

•Successful Meaningful Use in Stage One:▫Qualify for Incentive program under

Medicare or Medicaid▫Use of an ARRA Certified EHR system▫Adopt, implement or upgrade your system

OR ▫Attest to the successful completion and use

of 15 Core Elements▫Attest to the successful completion and use

of 5 of the 10 Additional Items ▫Quality measures

Meaningful Use: A Phased Approach

Between NOW and 2015

Stage 1Use CPOE to collect discrete health data, implement clinical decision support

tools, report quality measures, track conditions and

coordinate care.

Stage 2Focus on structured data exchange and continuous quality

improvement. Criteria Due: end of

2011.

Stage 3Advanced decision

support and population health.

Criteria due: end of 2013.

Stage 1 Objectives Stage 1 Measures

Use CPOE for medication orders

1) More than 30% of unique patients with at least one medication in their medication list have at least one medication order entered using CPOE

Implement drug-drug and drug-allergy interaction checks

2) The practice enabled this functionality

Generate and transmit permissible prescriptions electronically (eRx)

3) More than 40% of all permissible prescriptions are E-prescribed

Record demographics (language, gender, race, ethnicity, DOB)

4) More than 50% of all unique patients have demographics recorded as structured data

Maintain an up-to-date problem list of current and active diagnoses

5) More than 80% of all unique patients have at least one entry or an indication that no problems are known for the patient recorded as structured data.

Stage 1 Policy Priority: Improving quality, safety, efficiency, and reducing health

disparities

6/9/10

Stage 1 Policy Priority: Improving quality, safety, efficiency, and reducing health

disparities Stage 1 Objectives Stage 1 Measures Maintain active medication list

6) More than 80% of all unique patients have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data

Maintain active medication allergy list

7) More than 80% of all unique patients have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data

Record and chart changes in vital signs (height, weight, BP, BMI, growth charts)

8) More than 50% of all unique patients age 2 and over have height, weight and blood pressure recorded as structured data

Record smoking status for patients 13 years old or older

9) More than 50% of all unique patients 13 years old or older have smoking status recorded as structured data

Implement one clinical decision support rule and compliance tracking

10) Implement one clinical decision support rule

Report ambulatory clinical quality measures to CMS or the States

11) 3 measures including BP, Tobacco use/cessation, Weight PLUS 3 more from list of 38 indicators

6/9/10 Health Outcomes Policy Priority

Objectives Measures

Engage patients and families in their health care

Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies), upon request

12) More than 50% of all patients who request an electronic copy of their health information are provided it within 3 business days

Provide clinical summaries to patients for each office visit

13) Clinical summaries provided to patients for more than 50% of all office visits within 3 business days

Improve care coordination

Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically

14) Perform at least one test of certified EHR technology's capacity to electronically exchange key clinical information

Ensure adequate privacy and security protections for personal health information

Protect electronic health information through the implementation of appropriate technical capabilities

15) Conduct or review a security risk analysis and implement security updates as necessary and correct identified security deficiencies as part of its risk management process

Implement drug-formulary checks

1) Functionality is enabled and has access to at least one internal or external drug formulary

Incorporate clinical lab-test results into certified EHR technology as structured data

2) More than 40% of all clinical lab tests results whose results are either in a positive/negative or numerical format are incorporated as structured data

Generate lists of patients by specific conditions to use for quality improvement, research or outreach

3) Generate at least one report listing patients with a specific condition.

Send reminders to patients per patient preference for preventive/ follow up care

4) More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the reporting period

Menu Set – Choose 5 of 10Improving quality, safety, efficiency, and reducing health disparities

Provide patients with timely electronic access to their health information (lab results, problem list, medications, etc.)

5) More than 10% of all unique patients provided timely electronic access to their health information (available to the patient within four business days)

Identify patient-specific education resources and provide those resources to the patient if appropriate

6) More than 10% of all unique patients during the EHR reporting period are provided patient-specific education resources

The EP who receives a patient from another setting/provider of care or believes an encounter is relevant should perform medication reconciliation

7) The EP who receives a patient from another setting of care or provider of care (or believes an encounter is relevant) should perform medication reconciliation

The EP who transitions their patient to another setting/provider of care should provide summary of care record for each transition of care or referral

8) The EP who transitions their patient to another setting/provider of care provides a summary of care record for more than 50% of transitions of care and referrals.

Menu Set ctd.– Choose 5 of 10Engage patients and families in their health care – Improve care coordination

Submit electronic data to immunization registries or Immunization Information Systems

9) Performed at least one test of capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries have the capacity to receive the information electronically)

Submit electronic syndromic surveillance data to public health agencies

10) Performed at least one test of capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies have the capacity to receive the information electronically)

Menu Set ctd.– Choose 5 of 10Improve population and public health (must choose at least 1 of these 2)

So, what is PCMH?

What’s in a name?

•Patient Centered Medical Home (PCMH)▫What is it?

- It’s a concept - A model for care delivery.

▫Care is coordinated across all elements of the patient’s community, including the health care system, and is facilitated by health information technology, to ensure patients get care when and where they need and want it. – AAFP

PCMH, A History….• The AAP introduced the medical home concept in

1967, initially referring to a central location for archiving a child’s medical record.

• 2002 the AAP expanded the medical home concept to include these operational characteristics: accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care.

• The AAFP, 2004

• The ACP, 2006“advanced medical home”

The AAP, AAFP, ACP, and AOA, representing approximately 333,000 physicians, have developed the following joint principles to describe the characteristics of the PC-MH.

The Patient Centered Medical Home (PCMH) is an approach to providing comprehensive primary care for children, youth and adults. The PCMH is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family.

Principles:• Personal physician• Physician directed medical practice• Whole person orientation• Care is coordinated and/or integrated

Joint Principles of the Patient Centered Medical HomeFebruary 2007

Consensus?

•Right now, by most standards…

•“Achieved PCMH recognition from NCQA”

•383 NC providers in November•507 NC providers in January

Source: NCQASource: NCQA

National Committee on Quality Assurance’s (NCQA) definition:

•The Patient Centered Medical Home is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.

27

NCQA PCMH Content and ScoringStandard 1: Access and CommunicationA. Has written standards for patient access and patient

communication**B. Uses data to show it meets its standards for patient access

and communication**

Pts

45

9

Standard 2: Patient Tracking and Registry Functions A. Uses data system for basic patient information (mostly

non-clinical data) B. Has clinical data system with clinical data in searchable

data fields C. Uses the clinical data system D. Uses paper or electronic-based charting tools to organize

clinical information**E. Uses data to identify important diagnoses and conditions

in practice**F. Generates lists of patients and reminds patients and

clinicians of services needed (population management)

Pts

2

33

64

3

21

Standard 3: Care ManagementA. Adopts and implements evidence-based guidelines for

three conditions **B. Generates reminders about preventive services for

clinicians C. Uses non-physician staff to manage patient care D. Conducts care management, including care plans,

assessing progress, addressing barriers E. Coordinates care//follow-up for patients who receive care

in inpatient and outpatient facilities

Pts3

4

35

5

20

Standard 4: Patient Self-Management Support A. Assesses language preference and other communication

barriersB. Actively supports patient self-management**

Pts24

6

Standard 5: Electronic Prescribing A. Uses electronic system to write prescriptions B. Has electronic prescription writer with safety checksC. Has electronic prescription writer with cost checks

Pts33

2

8

Standard 6: Test Tracking A. Tracks tests and identifies abnormal results

systematically** B. Uses electronic systems to order and retrieve tests

and flag duplicate tests

Pts7

6

13

Standard 7: Referral Tracking A. Tracks referrals using paper-based or electronic

system**

PT4

4

Standard 8: Performance Reporting and Improvement A. Measures clinical and/or service performance by

physician or across the practice** B. Survey of patients’ care experience C. Reports performance across the practice or by

physician **D. Sets goals and takes action to improve performance E. Produces reports using standardized measures F. Transmits reports with standardized measures

electronically to external entities

Pts

3

33

3

21

15

Standard 9: Advanced Electronic Communications A. Availability of Interactive Website B. Electronic Patient Identification C. Electronic Care Management Support

Pts121

4

**Must Pass Elements

Improving Quality of Care by Organizing Care Around Patients

Although the earlier PCMH program addressed many of these issues, PCMH 2011 strengthens and adds to existing elements.

Robust patient centeredness is an important program goal:

• There is a stronger focus on integrating behavioral healthcare and care management

• Patient survey results help drive quality improvement

• Patients and their families are involved in quality improvement.

NCQA Statement on new standards

PCMH 2011 Basics

•There are six standards, ▫including 6 must pass elements,

•Score of these elements results in one of three levels of recognition

•Requires completion of a web-based data collection tool and supporting documentation

Source: NCQA

Source: NCQA

Source: NCQA

Hmm…..

35

NCQA PCMH Content and Scoring & MU!Standard 1: Access and Communication

A. Has written standards for patient access and patient communication**

B. Uses data to show it meets its standards for patient access and communication**

Pts

45

9

Standard 2: Patient Tracking and Registry Functions A. Uses data system for basic patient information (mostly

non-clinical data) B. Has clinical data system with clinical data in searchable

data fields C. Uses the clinical data system D. Uses paper or electronic-based charting tools to organize

clinical information**E. Uses data to identify important diagnoses and conditions

in practice**F. Generates lists of patients and reminds patients and

clinicians of services needed (population management)

Pts

2

33

64

3

21

Standard 3: Care ManagementA. Adopts and implements evidence-based guidelines for

three conditions **B. Generates reminders about preventive services for

clinicians C. Uses non-physician staff to manage patient care D. Conducts care management, including care plans,

assessing progress, addressing barriers E. Coordinates care//follow-up for patients who receive care

in inpatient and outpatient facilities

Pts3

4

35

5

20

Standard 4: Patient Self-Management Support A. Assesses language preference and other communication

barriersB. Actively supports patient self-management**

Pts24

6

Standard 5: Electronic Prescribing A. Uses electronic system to write prescriptions B. Has electronic prescription writer with safety checksC. Has electronic prescription writer with cost checks

Pts33

2

8

Standard 6: Test Tracking A. Tracks tests and identifies abnormal results

systematically** B. Uses electronic systems to order and retrieve tests

and flag duplicate tests

Pts7

6

13

Standard 7: Referral Tracking A. Tracks referrals using paper-based or electronic

system**

PT4

4

Standard 8: Performance Reporting and Improvement A. Measures clinical and/or service performance by

physician or across the practice** B. Survey of patients’ care experience C. Reports performance across the practice or by

physician **D. Sets goals and takes action to improve performance E. Produces reports using standardized measures F. Transmits reports with standardized measures

electronically to external entities

Pts

3

33

3

21

15

Standard 9: Advanced Electronic Communications A. Availability of Interactive Website B. Electronic Patient Identification C. Electronic Care Management Support

Pts121

4

**Must Pass Elements

Source: NCQA

Source: NCQA

Source: NCQA

Source: NCQA

Source: NCQA

Source: NCQA

Source: NCQA

Source: NCQA

Source: NCQA

Source: NCQA

Source: NCQA

Show me the $$$

Dollars and Sense….

•Meaningful use Incentive $ from CMS▫($44,000 or $63,750 per eligible provider)

•Efficiencies ▫Workflows, UDS data, PDSA data, patient

sat… etc•Health Information Exchange•Accountable Care Organizations

▫Shared savings in reducing readmissions…. etc

Chart is placed at vitals station

H,W,BP Taken & recorded

Patient is called to vitals station

Patient is taken to exam room

Chart is placed in sleeve on exam door

Paper trigger

Paper trigger

Template needed

How many vitals stations?

How often do we room without vitals?

Are cuffs and scales available in rooms?

How many BPs do we miss?

Quick little QI project on BPs

Could result in:

BPs taken/recorded (affects Rx, MU)

in BP outcomes if change of location (PCMH, MU)

in number of BMIs recorded (MU)

All could result in $$ (everybody speaks the language of $$)

Baseline (blue) to 12 months (red)23 practices working on Diabetes

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Paper Charts

Electronic Health

Records

Meaningful use of

HIT

Improved Clinical

Outcomes

Patient Centered Medical Home

Learn how to:

•Select a certified EHR that meets your needs

•Implement an EHR for optimal use in your practice

Learn how to:

•Assess the needs of your practice in an EHR system.

•Redesign your paper practice to ready for an EHR.

Learn how to:

•Use your EHR to meet the federal requirements for the HITECH Act Meaningful Use Incentive Payments from Medicare or Medicaid

Learn how to:

Produce population –based reporting to test the efficacy of your care

Use proven methods and techniques to improve the outcomes of your patients

Learn how to:

• Meet the requirements of the NCQA Recognition program for PCMH

•Approach the PCMH application process with improvement techniques

1. Electronic Disease Registry

2. Templates to Guide Care

3. Disease Protocols and Team Based

Care

4. Patient Self Management

Support

Practice support

Coordinator

QIConsultan

ts

Practice-basedconsulting

services Practice Support

Coordinator Technical

Assistance Specialist

QIConsultan

ts

www.ahecqualitysource.com

Websites

www.ahecqualitysource.com

www.ncqa.org

www.cms.gov/EHRIncentivePrograms