Zoom mu v 0.2

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Zoom to Meaningful Use

How to receive your incentive dollars quickly

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What is Meaningful Use?

• Government program to promote adoption of electronic health record systems (EHR)

• Part of the ARRA (stimulus) legislation• $32 billion was set aside for this purpose• Physicians receive incentive payments for

“meaningful use” of an EHR• Administered through the Medicare and

Medi-Cal programs

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What do I need to start?

• A certified EHR– ZoomMD is ONC-ATCB certified by CCHIT

• You must be a Medicare or Medi-Cal provider.• Must have an NPI number through NPPES

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Specific Medicare / Medi-Cal requirements

• Can participate in either the Medicare or Medi-Cal program (one-time switch allowed)

• For the Medicare program, you must have $24000 in annual charges to Medicare

• For the Medi-Cal program, 30% of your patient volume must be Medi-cal patients (20% if you are a pediatrician)

• Your inpatient volume cannot exceed 90% of your total volume

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The ZoomMD methodThemes to live by

• It is a practice effort, not a doctor effort– Everyone must fulfill their role– With everyone doing their part, MU is achievable

• MU Champion is designated by the practice• Physician has ultimate responsibility• Choose options wisely and let the system do the

heavy lifting whenever possible.• Track, track, track• Keep your eyes on the goal

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What do I have to do to earn the incentive payments?

• Meet meaningful use requirements– 15 core measures– 5 menu measures– 3 core or alternate core clinical quality measures– 3 additional clinical quality measures

• These requirements will increase in stages over time.

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Moving forward: Staging of “Meaningful use” “These goals can be achieved only through the effective use of information to support better decision-making and more effective care processes that improve health outcomes and reduce cost growth.”

2011 Stage 1Data capture and sharing

2013 Stage 2Advanced clinical processes

2015 Stage 3Improved outcomes

“Phased-in series of improved clinical data capture supporting more rigorous and robust quality measurement and improvement.”

Connecting for Health, Markle Foundation “Achieving the Health IT Objectives of the American Recovery and Reinvestment Act” April 2009

Focus of:

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Roles – Color legendColor Role

Physician/NP/PA

MA or Nurse

Front office staff/ administrationZoomMD setup

Each position will have a specific role.The above indicates primary responsibility for data entry. Others will still have a responsibility to review data and take any appropriate action.

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MU Stage 1 Measures – Core. Must meet ALL 15Green = provider; Yellow = MA; Brown = office; Blue = ZoomMD

Measure Metric Measure Metric

Problem List 80% Electronic Prescriptions 40%

Active Medication Allergy List 80% CPOE (for medication only) 30%

Active Medication List 80% Drug-drug and drug-allergy alerts Turn on

Smoking Status (>13 y.o.a.) 50% Electronically exchange info Test

Vital Signs and Growth Charts 50% Clinical decision support rules 1

Clinical Summaries 50% Report quality measures 6

Electronic copy of health info 50% Privacy and security of patient data in EHR

YES

Patient Demographics 50%

MU Stage 1 Measures – Menu set. Must meet 5 of 10Blue = potential choices setup by ZoomMD. Rest not required in Stage 1

Measure Metric Measure Metric

Drug formulary checks Yes Electronic Immunization data Test

Labs as structured data* 40% Syndromic Surveillance Test

Patients and Conditions list

YES Reminders (<5 or >65) 20%

Patient-Specific education

10% Electronic patient access to information

10%

Medication reconciliation 50%

Summary of Care provided for transitions of care

50%

*Interface with Quest is included at no additional charge

MU Stage 1 Clinical Quality Measures – Reportable through EHR

Report 3 core or alternate coreCORE MEASURES

1. Hypertension: Blood Pressure Measurement

2. a. Tobacco Use Assessment b. Tobacco Cessation Intervention

3. Adult Weight Screening and Follow-up

------------------ALTERNATE CORE MEASURES------------------------

1. Weight Assessment and Counseling for Children and Adolescents

2. Influenza Immunization for Patients ≥ 50Years Old

3. Childhood Immunization Status

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MU Stage 1: Clinical Quality Measures Additional set

• Choose and submit 3 additional quality measures from a list of 38

• Chooses measures appropriate to your specialty• Do not have to achieve any particular number in

the measure reported• Primary care physicians can achieve this

requirement by reporting on a single disease – Diabetes Mellitus

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What do I do?Physicians/Nurse practitioners/PAs

A. Electronic prescriptions1. Computerized physician order entry (medication only)

B. Report on core or alternate core measures2. Tobacco Use Assessment and Tobacco Cessation Intervention3. Weight

a. Adult Weight Screening and Follow-upb. Weight Assessment and Counseling for Children and Adolescents

(pediatrics)

4. Order influenza vaccine for patients >50 (substitute for 1 or 2 above)

C. Choose and report 3 quality measures for your specialty5. Diabetes recommended for primary care

D. Order labs through Quest

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What do I do? Physicians/NPs/PAsData Review recommended for patient safetyReview is not mandated for Meaningful Use

• Problem List• Medication related information

– Active Medication Allergy List– Active Medication List– Drug-drug and drug-allergy alerts (automatically fire)– Drug formulary information

• Smoking Status (>13 y.o.a.)• Vital Signs and Growth Charts (Growth charts – peds)• Labs received into EHR• Childhood immunization status (pediatricians)

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What do I do?Medical Assistant

• Enter Problem List– Based on provider’s prior note

• Active Medication Allergy List– Enter based on old records and patient report

• Active Medication List– Enter patient’s current medication

• Smoking Status (>13 y.o.a.)– Record patient’s smoking status

• Vital Signs and Growth Charts– Enter vital signs and growth charts at each visit

• Measure blood pressure

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What do I do?Business/Administration/Front office

• Demographics entry– Ensure all patients have all demographics and

insurance information and map to Newcrop• Clinical Summaries– Give each patient a copy of their clinical summary

• Electronic copy of health info– Give or send patients electronic copy of health info

upon request• Privacy and security of patient data in EHR– Plan, monitor, report

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What do I do?Practice designee – ZoomMD to assist

• Build – clinical decision support rule – one rule

• Setup – practice to receive electronic lab results from Quest

• Test– Electronically exchange information– Electronic Immunization data– Syndromic Surveillance

• Done automatically– Drug formulary checks– Turn on drug-drug and drug-allergy alerts– Patients and conditions list

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Physicians: Four steps to Meaningful UsePhysician role + other roles = achievement of meaningful use

Zap your prescriptions electronicallyPrescribe electronically

Offer assistance with weight reduction. Review patient weight and follow-up as required

Offer tobacco cessation help. Review tobacco use and intervene as required

Measure clinical quality.Record data as required for selected clinical quality measures

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Why is it important for me the physician to achieve Meaningful Use?

• Enhance quality of care• Meaningful use criteria will become standard of care• Improved communication with other physicians• Collection of data in structured format will enable

data analysis and can drive outcomes• Incentive payments

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Medicare program: Incentive Payments for Eligible Professionals (physicians) for Meaningful Use of EHR

In dollars. Green = Assumes providers meet all criteria in 2011 or 2012

Funding year

Adoption year

2011 2012 2013 2014 2015

2011 18000

2012 12000 18000

2013 8000 12000 15000

2014 4000 8000 12000 12000

2015 2000 4000 8000 8000

2016 2000 4000 4000

TOTAL 44000 44000 39000 24000 PENALTY

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Medicare Penalties for not meeting MUPenalties are applied to each physician’s

Medicare payments

2015 2016 2017 and beyond

1% 2% 3%

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Eligible professional (physician) – Medi-Cal incentive payments (Dollars)Medi-Cal program has no penalties. Typical schedule.

Calendar year

Adoption year

2011 2012 2013 2014 2015 20162011 212502012 8500 212502013 8500 8500 212502014 8500 8500 8500 212502015 8500 8500 8500 8500 212502016 8500 8500 8500 8500 8500 212502017 8500 8500 8500 8500 85002018 8500 8500 8500 85002019 8500 8500 85002020 8500 85002021 8500TOTAL 63750 63750 63750 63750 63750 63750