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GE Healthcare Camden Group Insights Blog

What’s Up with Meaningful Use?

Posted by Matthew Smith on May 6, 2015 10:43:53 AM

By Lucy Zielinski, Vice President, The Camden Group

Stage3.pngYou have not escaped attesting for Meaningful Use. Even after 2018, Meaningful Use will be one of the categories used to award incentives starting in 2019 under the just-passed Medicare Access and CHIP Reauthorization Act, H.R. 2, now known as “MACRA.” Unless you are leaving practice in the next two years, and/or Medicare is not a big portion of your practice, you should move forward with electronic health record (“EHR”) implementation and Meaningful Use attestation to avoid a three percent penalty in 2017.  

The good news is that attesting for Stage 2 Meaningful Use just got easier with new rules proposed by the Centers for Medicare and Medicaid Services (“CMS”) and the Office for the National Coordinator for Health Information Technology. Proposed changes include:

  • Reduces the Stage 2 objectives, and measures are scaled back; those scheduled for Stage 1 can attest to a “modified” Stage 2.
  • Attestation period reduced to 90 days from a full year.
  • Removes measures that have become redundant, duplicative, or have reached widespread adoption
  • Reduces the view-download-transmit requirement to one patient
  • Reduces the secure messaging requirement from five percent to solely having the capability

Stage 3 Meaningful Use

The current requirement to be at Stage 3 by 2018 or face up to a three percent penalty also has not disappeared. The key requirements are:

  • Eight objectives with 21 measures including e-prescribing, clinical decision support, computerized physician order entry, and health information exchange
  • Incorporate either an online patient portal or application-program interface to provide patients with electronic access to their medical record (used by 25 percent of patients)
  • Use secure messaging with 25 percent of patients
  • Report meaningful use measures for a full year

Meaningful Use Audits

CMS has already started meaningful use audits, and the Office of Inspector General will also begin audits.

What Should You Be Doing?

  • If you haven’t moved to an EHR, start now and attest in 2015. Not only does attestation prevent penalties, but it creates the foundation for the data infrastructure required for the Medicare Merit-Based Incentive Payment System (“MIPS”) in 2019
  • Prepare for audits now: review your documentation for each measure, and ensure that it adequately documents your process, your measure calculation reporting, and dated screen shots that demonstrate meeting the measure
  • Begin moving to Stage 3 requirements

lucy_zielinski.pngMs. Zielinski is a vice president with The Camden Group, with over 20 years of experience in the healthcare industry. She specializes in helping private and hospital-owned medical practices achieve top financial performance by guiding physicians through practice development, strategic planning, coding and revenue cycle process optimization, and electronic health record system implementation. In her health system leadership roles, she has successfully managed the revenue cycle for over 2,000 physicians. Additionally, Lucy has led engagements with physician billing companies that involved restructuring operations and development of dashboard reports. She may be reached at lzielinski@thecamdengroup.com or 312-775-1700.

Topics: Meaningful Use, Lucy Zielinski, Stage 3 Meaningful Use, MACRA

The Next Phase of the Meaningful Use Journey: Stage 3 is On the Horizon

Posted by Matthew Smith on Apr 3, 2015 1:08:00 PM

By Cindy Barrett, LPN, Senior Consultant, and Leslie Madden, Consultant, The Camden Group

Stage3If achieving Meaningful Use is on your radar, the proposed rule for Stage 3 has been released and is open for public comment. For those who are already in the middle of their Meaningful Use (“MU”) journey, Stage 3 will hold its own share of challenges, as we’ve seen in the transition from Stage 1 to Stage 2. But if you’re looking at working toward attesting for the first time, consider the opportunity to do so sooner rather than later. Stage 3 builds upon the framework established in Stage1 and Stage 2, with further expansion proposed for Stage 3.

The Stage 3 objectives will eliminate some of the more easily attainable measures from Stage 1 and Stage 2, or increase the threshold requirements to meet those measures. Additionally, Stage 3 contains two major proposed reporting changes of note. First, in 2018, all providers must attest to Stage 3 Meaningful Use objectives, regardless of where they are on their MU journey. Secondly, everyone will attest for a 365-day reporting period in 2018, thus eliminating the 90-day reporting periods with which we are familiar for first time adopters. Expanded measure requirements for things such as patient engagement and data reporting will pose challenges for many providers and hospitals to meet all the objectives in Stage 3, and that includes many who have already completed successful attestations to MU Stages 1 and 2. And, if you are just starting on your MU journey, Stage 3 patient engagement, CPOE, and e-prescription requirements will be a drastic shift in process for you and/or your patient population.

The spirit of the proposed rule reportedly demonstrates an intended response to take into consideration the input received during Stages 1 and 2, while maintaining long term goals of the overall EHR incentive program like interoperability and enhanced use of EHR applications. The proposed Stage 3 rule is composed of 8 objectives- fewer in number than previous stages, but increasingly more difficult to achieve. Don’t let the lower number of objectives fool you. It’s a combination of higher thresholds for existing measures, enhanced system requirements, and increasing burdens for providers and hospitals to meet measures for patient engagement, care coordination and health information exchange. Once again, there will be challenges for vendors to meet timelines to comply with these requirements, and increasing costs to providers and hospitals in technology and resources to meet and sustain these objectives in your practice setting. 

While Stage 3 is expected to be the final stage of the Federal EHR Incentive Program, MU is not going away. Currently in an incentive phase, there are penalties phases in the coming years, and the expected standard is that everyone will meet and maintain these objectives to help achieve improved clinical outcomes and efficiencies, as well as cost reductions across the care continuum for years to come.

MU is truly a journey, with winding paths, bumpy roads and a course that promises hurdles and obstacles along the way. Whether the trip will result in the anticipated destination…..we’ll have to wait and see. What we do know is that the expectations for participation are not going away, and those who choose not to take the journey will find the price to pay only getting steeper with each passing year.


 

CindyBMs. Barrett is a senior consultant with The Camden Group, with over 30 years of clinical experience in the healthcare field. She specializes in collaborating with electronic medical record (“EMR”) implementation support teams to facilitate and build processes, workflows, post-implementation support, and optimization as it applies to EMR solutions. Ms. Barrett is recognized for her expertise in EMR clinical workflow analyses, technical EMR system builds, training oversight, and practice support during pre-implementation, implementation, go-live, and post go-live. Ms. Barrett has helped organizations achieve Meaningful Use and implement processes and care team models to support Patient-Centered Medical Home development. She may be reached at cbarrett@thecamdengroup.com or 512-795-5500.

 

lmaddenMs. Madden is a consultant with The Camden Group, with over 15 years of experience working with medical groups and physician practices. With strong knowledge of practice operations, Ms. Madden helps practices improve their billing/collections processes, assists with managed care contracting, establishes front office procedures, improves financial performance, and implements overall practice management approaches. She may be reached at lmadden@thecamdengroup.com or 512-795-5500.

 

Topics: Meaningful Use, CMS, Cindy Barrett, Stage 3 Meaningful Use, Leslie Madden

Meaningful Use Infographic | New Attestation Deadline Reminder

Posted by Matthew Smith on Mar 12, 2015 11:54:00 AM

EHR1.jpgEligible professionals now have until 11:59 pm ET on March 20, 2015, to attest to meaningful use for the Medicare Electronic Health Record ("EHR") Incentive Program 2014 reporting year.

The Centers for Medicaid and Medicare Services ("CMS") extended the deadline to allow providers extra time to submit their meaningful use data. CMS continues to urge providers to begin attesting for 2014 as soon as they can.

This extension also allows eligible professionals, who have not already used their one “switch”, to switch programs (from Medicare to Medicaid, or vice versa) for the 2014 payment year until 11:59 pm ET on March 20, 2015. After that time, eligible professionals will no longer be able to switch programs.

Medicare eligible professionals must attest to meaningful use every year to receive an incentive and avoid a payment adjustment. Providers who successfully attest for the 2014 program year will:

Note: The Medicare extension does not affect deadlines for the Medicaid EHR Incentive Program. Additionally, the EHR reporting option for PQRS has been extended until March 20, 2015. 

For help, call the EHR Information Center: 1-888-734-6433

__________________________________________

The following infographic from athenahealth, titled, "Meaningful Use: On the Road to Attestation," presents results from a survey of over 1,400 Epocrates members who shared their concerns and progress on their way to meaningful use success.

A full-sized version may be accessed here (click image to enlarge).

athenahealth_infographic-resized-600

 

Topics: EHR, EMR, Meaningful Use, CMS, Infographic, Electronic Health Record, Electronic Medical Record

Meaningful Use Stage 2 Attestations May Drastically Drop in 2015

Posted by Matthew Smith on Jan 8, 2015 4:39:00 PM

Meaningful Use, MU, Attestation, Medical Practice Insider polled nearly 2,000 physicians to reveal that 55% do not plan to attest for meaningful use Stage 2 in 2015.

The questioning was simple yes/no question: Do you plan to attest for Stage 2 in 2015?

The answer? Doctors are planning to forego Stage 2 by a margin of 994 to 822 participants.

Status check: MU participants
About 75% of office-based primary care physicians had some form of EHR system in 2012, according to the National Ambulatory Medical Care Survey, conducted by the National Center for Health Statistics.

Since the 2009 enactment of the HITECH Act, which established the Medicare and Medicaid EHR Incentive Programs for eligible professionals (EPs) and hospitals, nearly two-thirds of physicians who implemented health IT tools said financial incentives and penalties were a major influence to adopt such systems.

EPs have been paid nearly $10 billion by the Centers for Medicare and Medicaid Services under the meaningful use program to date. Only 3,655 unique Medicare EPs had received payments for Stage 2 attestation as of early December, however, compared to 268,686 EPs for Stage 1.

Individual comments from surveyed providers show a variety of reasons — some financially motivated, others not — for physicians deciding that they've had enough with the meaningful use program and will go no further.

"I did Stage 1 in years one and two, but it is almost impossible to do Stage 2. It requires patients to have emails and engage my EHR,” one cardiologist explained. “Well, I have a lot of patients in their 80s and 90s, and they don’t have computers, let alone email."

A family practitioner who CMS said was in the top 3 percent in terms of readiness and reporting is now at a crossroads.

"I’ve done Stage 1 three times now. I have the option to do either Stage 2 or Stage 1 for the fourth time. I would rather stay with Stage 1 for now because my patients are reluctant to use messaging and I personally do not like the interface for my portal,” the family practitioner noted. “I do not have too many Medicare patients even though I am participating in an ACO, so I am not concerned much about a penalty. I just want the software to be perfected and be more usable."

An internist echoed that last point about usability: "Every night there’s more chart work. I can’t find things in the patient chart easily, and it's hard to compare current and old EKS’s, current and old labs."

A rheumatologist, meanwhile, said that the administrative costs exceed any financial gains, meaningful use incentives and otherwise. “I am re-examining getting on an MU-certified EMR in 2015 as interoperability and eRx systems tend to mature and become more prevalent."

And then there’s the old-fashioned preference for paper.

"Because I don’t use an EMR, my work is easier, profits are better,” a gastroenterologist commented, “and I get my work done in 30 percent of the time it takes EMR-equipped hospital doctors."

It’s important to point out that the above comments are from specialists, a collective that often faces unique meaningful use challenges — particularly when it comes to core, menu and clinical quality measures engineered for providers with a broader swath of patients and services, making it easier to fulfill those requirements.

Topics: EHR, EMR, Meaningful Use, Electronic Health Records, Electronic Medical Records, Stage 2

Infographic: Is Meaningful Use Helping or Hurting EHR Adoption?

Posted by Matthew Smith on Dec 3, 2014 11:14:00 AM

Infographic, Meaningful Use, EHR, EMRWhen the Centers for Medicare and Medicaid Services (CMS) launched their EHR Incentive Programs back in January 2011, the main goal was to reward healthcare practitioners for adopting electronic health records and increasing efficiency within their practice. But one question everyone still finds themselves asking is whether or not the incentives have actually encouraged EHR adoption?

NueMD compiled research from the Department of Health and Human Services (HHS), CMS, and the American College of Physicians (ACP) looking to identify adoption trends and determine potential obstacles to successful implementation. Check out the findings below.

To view a larger version of the infographic, please click here and click on the image once it opens in your browser.

MU, Meaningful Use, Infographic, EHR, EMR, Electronic Health Record

 Infographic provided courtesy of NueMD. 

Topics: EHR, EMR, Meaningful Use, CMS, Infographic, Electronic Health Record, Electronic Medical Record, MU

New EHR Attestation Deadline for Eligible Hospitals: 12/31/14

Posted by Matthew Smith on Nov 24, 2014 3:01:00 PM
Courtesy of Centers for Medicare & Medicaid Services 

CMS, EHR, Meaningful UseCMS is extending the deadline for eligible hospitals and Critical Access Hospitals (CAHs) to attest to meaningful use for the Medicare Electronic Health Record (EHR) Incentive Program 2014 reporting year from 11:59 pm EST on November 30, 2014 to 11:59 pm EST on December 31, 2014.

This extension will allow more time for hospitals to submit their meaningful use data and receive an incentive payment for the 2014 program year, as well as avoid the 2016 Medicare payment adjustment.

CMS is also extending the deadline for eligible hospitals and CAHs that are electronically submitting clinical quality measures (CQMs) to meet that requirement of meaningful use and the Hospital Inpatient Quality Reporting (IQR) program. Hospitals now have until December 31, 2014 to submit their eCQM data via Quality Net.

Note: This extension does not impact the deadlines for the Medicaid EHR Incentive Program.

How to attest?
Medicare eligible hospitals and CAHs will use the Registration and Attestation System to submit their attestation for meaningful use for the 2014 reporting year. The system is open and fully operational, and includes the 2014 Certified EHR Technology (CEHRT) Flexibility Rule options. Medicare eligible hospitals and CAHs can attest any time to 2014 data until 11:59 pm EST on December 31, 2014 to meet the new 2014 program deadline.

Attestation Tips
Here are some steps to help make the attestation process easier:

  • Consider logging on to use the attestation system during non-peak hours, such as evenings and weekends
  • Log on to the registration and attestation system now and ensure that your information is up to date and begin entering your 2014 data  
  • If you experience attestation problems, call the EHR Incentive Program Help Desk and report the problem

Reminder: Medicare eligible hospitals must attest to demonstrating meaningful use every year to receive an incentive and avoid a payment adjustment.

2016 Payment Adjustments
Payment adjustments will be applied at the beginning of FY 2016 (October 1, 2015) for Medicare eligible hospitals that have not successfully demonstrated meaningful use in 2014. Read the eligible hospital payment adjustment tipsheet to learn more.

Note:  CAHs have a different payment adjustment schedule than Medicare eligible hospitals. Review the CAH Payment Adjustment and Hardship Exception Tipsheet.

Resources
The EHR Information Center is open to assist you with all of your registration and attestation system inquiries. Please call, 1-888-734-6433 (primary number) or 888-734-6563 (TTY number). The EHR Information Center is open Monday through Friday from 7:30 a.m. – 6:30 p.m. (Central Time), except federal holidays.

Attestation resources are available on the Educational Resources webpage of the EHR Incentives Programs website.

Topics: EHR, EMR, Meaningful Use, Medicare, CMS, Medicaid, Attestation

Summary of Care Meaningful Use Requirements in Stage 2

Posted by Matthew Smith on Nov 18, 2014 10:42:00 AM

EHR, EMR, Electronic Medical Records, Meaningful UseIf you are an eligible provider participating in the EHR Incentive Programs, you will have the option of reporting the Summary of Care menu objective in Stage 1, but will be required to meet the core objective in Stage 2.

CMS wants to ensure providers are able to meet Measure #2 of the Summary of Care objective in Stage 2. Below is some additional guidance to help you meet the measure.

Guidance for Meeting Measure #2

For Measure #2 of the Stage 2 Summary of Care objective, an eligible professional, eligible hospital or critical access hospital (CAH) may count a transition of care or referral in its numerator for the measure if they electronically create and send a summary of care document when a third party organization is involved so long as:

  • The summary of care document is created using certified EHR technology (CEHRT);
  • The summary of care document electronically transmitted by the eligible professional, eligible hospital, or CAH to the third party organization is done so using EITHER:
    1. their CEHRT’s transport standard capability; or
    2. an exchange facilitated by an organization that is an eHealth Exchange participant.
  • The third party organization can confirm for the sending provider that the summary of care document was ultimately received by the next provider of care.

In instances where a “third party organization that plays a role in determining the next provider of care and ultimately delivers the summary of care document” is involved, the service the third party provides does not have to be certified for the transmission to be counted in the numerator for Measure #2. Nor are there any specific requirements around the technical standards or methods by which the third party delivers the summary of care document to the receiving provider (e.g., SOAP, secure email, fax).

For More Information

For more information, read the updated FAQ. For additional Stage 2 resources, visit the Stage 2 webpage of the EHR Incentive Programs website.

Topics: EHR, EMR, Meaningful Use, CMS, CEHRT, CAH, Critical Access Hospitals, Summary of Care

Hardship Exception Applications to Avoid the 2015 Medicare Payment Adjustment Due 11/30/14

Posted by Matthew Smith on Oct 7, 2014 3:46:00 PM

CMS, Meaningful UseCMS is announcing its intent to reopen the submission period for hardship exception applications for eligible professionals and eligible hospitals to avoid the 2015 Medicare payment adjustments for not demonstrating meaningful use of Certified Electronic Health Record Technology (CEHRT). The new deadline will be November 30, 2014. Previously, the hardship exception application deadline was April 1, 2014 for eligible hospitals and July 1, 2014 for eligible professionals.

As part of the American Recovery and Reinvestment Act of 2009 (Recovery Act), Congress mandated payment adjustments under Medicare for eligible hospitals, critical access hospitals, and eligible professionals that are not meaningful users of CEHRT. The Recovery Act allows the Secretary to consider, on a case-by-case basis, hardship exceptions for eligible hospitals, critical access hospitals, and eligible professionals to avoid the payment adjustments.

This reopened hardship exception application submission period is for eligible professionals and eligible hospitals that:

  • Have been unable to fully implement 2014 Edition CEHRT due to delays in 2014 Edition CEHRT availability; AND
  • Eligible professionals who were unable to attest by October 1, 2014 and eligible hospitals that were unable to attest by July 1, 2014 using the flexibility options provided in the CMS 2014 CEHRT Flexibility Rule.  

These are the only circumstances that will be considered for this reopened hardship exception application submission period. Applications must be submitted by 11:59 PM EST November 30, 2014.

More Information
More information about the application process will be shared soon. We intend to address this issue in upcoming rulemaking. Visit the Payment Adjustments and Hardship Exceptions webpage for more information about Medicare EHR Incentive Program payment adjustments.

Topics: Meaningful Use, Medicare, CMS, CEHRT

FREE CMS Webinar on CEHRT for Small Practices

Posted by Matthew Smith on Oct 6, 2014 4:58:00 PM

CMS, EHREvent: 

CMS 2014 Certified EHR Technology (CEHRT) Flexibility Rule Overview

 

Date: 

Wednesday, October 15, 2014
Time: 1:00 PM-2:00 PM Eastern Time

Registration:

https://attendee.gotowebinar.com/register/5020894920993673730

Agenda:

  • CMS 2014 CEHRT Flexibility Rule overview
  • Stage 2 extension
  • 2014 flexibility options
  • Attestation System updates
  • CMS responses to public comments
  • Resources
  • Q&A

Description:

This webinar provides PAHCOM members with an overview of the 2014 Certified EHR Technology (CEHRT) Flexibility Rule that went into effect on October 1, 2014. While directed at PAHCOM members, all are welcome and anyone focused on medical office management will benefit.

This presentation will cover guidance and instructions on how eligible professionals who have been unable to fully implement 2014 Edition CEHRT for an EHR reporting period in 2014 due to delays in 2014 Edition CEHRT availability can use the rule’s flexibility to report for 2014. The presentation also provides information about the extension of Stage 2 through 2016. A question and answer session will follow the presentation.

Speaker:

Vidya Sellappan, HIT Initiatives Group, Office of E-Health Standards and Services

Register now as space is limited - https://attendee.gotowebinar.com/register/5020894920993673730

Topics: Meaningful Use, CMS, CEHRT, PAHCOM, Stage 2

CMS Releases New and Updated FAQs for the EHR Incentive Programs

Posted by Matthew Smith on Sep 24, 2014 11:10:00 AM

EHR, EMR, CMS, Meaningful UseTo keep you updated with information on the Medicare and Medicaid EHR Incentive Programs, CMS recently added one new FAQ and updated seven FAQs to the CMS FAQ system. We encourage you to stay informed by taking a few minutes to review the new information below.

 

New FAQ:

  1. For Measure 2 of the Stage 2 Summary of Care objective for the EHR Incentive Programs, may an eligible professional,  eligible hospital, or critical access hospital count a transition of care or referral in its numerator for the measure if they electronically create and send a summary of care document using their CEHRT to a third party organization that plays a role in determining the next provider of care and ultimately delivers the summary of care document? Read the answer.

Updated FAQs:

  1. If my practice does not typically collect information on any of the core, alternate core, and additional clinical quality measures (CQMs) listed in the Final Rule on the Medicare and Medicaid EHR Incentive Programs, do I need to report on CQMs for which I do not have any data? Read the answer.
  2. Can eligible professionals use CQMs from the alternate core set to meet the requirement of reporting three additional measures for the Medicare and Medicaid EHR Incentive Programs? Read the answer.
  3. If one of the measures for the core set of CQMs for eligible professionals is not applicable for my patient population, am I excluded from reporting that measure for the Medicare or Medicaid EHR Incentive Programs? Read the answer.
  4. If none of the core, alternate core, or additional clinical quality measures adopted for the Medicare and Medicaid EHR incentive programs apply, am I exempt from reporting on all CQMs? Read the answer.
  5. If the denominators for all three of the core CQM are zero, do I have to report on the additional CQMs for eligible professionals under the Medicare and Medicaid EHR Incentive Programs? Read the answer.
  6. For the Medicare and Medicaid EHR Incentive Programs, if the certified EHR technology possessed by an eligible professional generates zero denominators for all CQMs in the additional set that it can calculate, is the eligible professional responsible for determining whether they have zero denominators or data for any remaining CQMs in the additional set that their certified EHR technology is not capable of calculating? Read the answer.
  7. I am an eligible professional who has successfully attested for the Medicare EHR Incentive Program, so why haven't I received my incentive payment yet? Read the answer.
Want more information about the EHR Incentive Programs?
Make sure to visit the Medicare and Medicaid EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

Topics: EHR, EMR, Meaningful Use, Electronic Health Records, CMS, HIT, Health IT

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