Meaningful Use (Mu) - Chima

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5/6/2016MEANINGFUL USE (MU)One Journeya y Pathsat sManyEligible Providers (EPs)Kathy Flesher, BS,RHITBeka Luksik, BSHINATIONAL JEWISH HEALTHOrigins of MU The American Reinvestment & RecoveryAct (ARRA) Legislation Enacted 2/27/2009: ONE FEATURE: Health Information Technology forEconomic and Clinical Health(HITECH): Supports theUse Electronic Health Records Under Centers of Medicare and Medicaid (CMS)1

5/6/2016Goals Of MU Improve Quality, Safety, Efficiency andReduce Health Disparities. Engage patients and family’s in decisions Improve care coordination Improve Public Health Ensure Privacy and Security (Ransomware)for PHI Clinical EffectivenessCAPTURE & SHARE DATAIMPROVE CLINICAL PROCESSIMPROVE OUTCOMESCARROT BEFORE THE STICK Incentives for Adoption Three years of incentives Core Measures CQM-Clinical Quality Measures Then the Stick-Penalized 3% and upward2

5/6/2016High Risk Medications in ElderlyDocumentation of Current Medications in the medical record (Up to date med list)Documentation of tobacco useDocumentation of Influenza immunizationBMI screeningCLINICAL QUALITY MEASURESPneumonia vaccineMU GETTING STARTEDHealth Information ManagementOrganize Engagement With DepartmentsMeeting WeeklyAT THE TABLEMD(CMIO), HIM, Quality Improvement,Nursing-Informatics, Admissions, IST,Marketing, Physician ProfessionalDDevelopment.lt3

5/6/20162014Aligning the EHR with MU measuresg PackagegMU Reporting Challenges Provider Buy In “Why are we doing this?” Department Buy In Eduction on participation Learningg the Technologygy Trainingg andEducation on the EHROther Concerns: Responsibility vs.vs Accountability Meeting measures with a click vs actually doingthe requirement to help improve patient care. Ex:CCDA Summary-(Consolidated Clinical Document Architecture)One clinic was printing them to the wastebasket-not handing to the patient Medication Reconciliation – MA starts theprocess (responsibility) but the physician isultimately Accountable.4

5/6/2016RECOMMENDATIONSDesignate a person at each site to hold providersaccountable for compliance.STIMULUS REPORT: Run attestation reports prior to the qualifyingperiod by provider; identify problem areas andremediate Run the attestation reports weekly during theattestation period5

5/6/2016RECOMMENDATIONS CONT.CYA AUDITS: Maintain attestation reports and supportingdocumentation, for six years in preparation forpotential CMS auditEDUCATION: (Net-Learning, CBTs, Hands On) Reinforcement/Educate Eligible Providers (EPs)2015 Meaningful Use Coordinator hired 7/2015still waiting for the final rule from CMS. Studieddi d eachh rulel anddddove iinto theh measurelogic from Allscripts Final Rule was published 10/2015 Finally able to focus on EP performance andaddress issues Determine Attesting Providers Total Medicare charges vsvs. the cost to attest Final decision 73 EPs of 110 EPs6

5/6/2016Measures Included:1.Protect Patient Health information (securityrisk analysis performed)- yes/no attestation2. CLINICAL DECISION SUPPORT Computerized Alerts for Physicians and PatientsCondition Specific Order SetsDiagnostic Support (Ex: Labs flagged in red)A tool to assist care teams2015 Implemented 1 CDS tool2016- Implemented 5 CDS toolsMEASURES CONT.3.Computerized Provider Order Entry(CPOE) Medication orders, lab ordersand radiology orders.4.e-Prescribing (eRx)7

5/6/20165.Health information exchange (Directmessaging)g g) Exclusion for 20156.Patient-specific education- Exclusionfor 20157.Medication reconciliation- "menumeasure" Completed8.Patient electronic access (portal)- wetook exclusion for 20159.Secure electronic messaging-2015Exclusion10. Public Health Reporting(Immunization, SyndromicSurveillance or Specialized registry)attested for Immunization registry for2015. 2016- Immunization and CDCfor specialized registry.8

5/6/2016Developing/Altering workflows Workflows have been technically builtaround MU ex: CPOE. Providers do nothave an alternative but to use. Other workflows were modified to meetMU ex: eRx, Medication Reconciliationand Patient Education9

5/6/2016Improving Performance/QualityMeeting MU Requirements ThThroughh EHR reportingtiportalt l IdIdentifiedtifi dEPs not meeting to reflect the final rule. One Measure: Medication Reconciliation.Not meeting due to in consistencies:Workflow breakdowns-Workflow- “I need to click WHAT?”DIRECT MESSAGING DIRECT WHAT? Sending a message directly from oneEMR to another EMR. Similar to email, but more secure anddirect Potentiallyy flows directlyy into ppatientchart10

5/6/2016DIRECT MESSAGING CONT. Every AttestingiProviderid ReceivesiDirect Message Address Improves coordination of care Quickly share patient informationDIRECT MESSAGING Establishing communication directly with othersystems.“Let’s Talk” Developing Workflow: Sending Out:Off ground referral process (consults, tests,and procedures) so we can send directmessages. Incoming Information-From Inpatient Stays Releasing Information to our DM Partners Incorporates systems, people, process. This has been a very challenging process!11

5/6/2016CHALLENGES INCLUDE: Technology: Unable to attach to outgoing Unable to receive incomingattachments Communicating with other providersy theyy can receive.to verify TestingDirect messaging/HIE/MU Objective 5PROCESS: Simple process adding direct messages toour order.order We were WRONG! We met monthly or every 2 weeks for a year. Involved Admissions, Scheduling andMarketing, to help finalize workflow andbuilding orders. Establish relationshipsp with pproviders to testif our redesigned workflow actually worked!(How is it going?)12

5/6/2016Direct Message HIM Off Site ReferralMU FUTURE CONSIDERATIONS: Managing Attestation on the providerlevel. Provider fails MU and moves to anotherfacility? Payment adjustment followsthem!h!13

5/6/2016MU FUTURE CONSIDERATIONS: Hiring- Soon facilities will need to askabout a provider’s MU success whenhiring, will they be bringing a penaltywith them? Audits- EP gets audited and fails, whogives money back?November 1st is the deadline for the final measures andpolicies of MIPSMU Future MACRA-(Medicare Access and CHIP ReauthorizationAct of 2015) Streamlines multiple quality programsunder the new MIPS (Merit-Based IncentivePayments Systems) programConsolidates MU, PQRS (Physician QualityReporting System) and Value-Based PaymentModifier into a combined performancescore.14

5/6/2016**Breaking News** CMS blog post on 4/27/2016 (900 pageproposed rule) Proposed rule will change the name ofMU to “Advancing Care Information” Choose measures?Eliminate all or nothing measurement?Reduce measures to 11?Report as a group insteadid off EPs?Eliminate CDS and CPOE measures?MIPS Include 4 performance categories withweighted values: 50% Quality- 6 PQRS measures 10% Resource Use- Based on claims data,no reporting requirement 15% ClinicalCli i l PracticePti ImprovementItActivites- NEW 25% Advancing Care Information- AKAMeaningful Use!15

5/6/2016November 1st is the deadline for the final measures andpolicies of MIPSMU FUTURE CONT. Payment adjustments can be positive,negativeior neutral.l AmountAstarts at 4%and will go up to 9%. Score will be compared to a threshold determinedby CMS, so providers can tell if they are passing orfailing right away. Will include MDs, PAs, NPs, Clinical NurseSpecialists and Nurse Anesthetists. (Maybenot for 1st year?) **MIPS will not apply to hospitals orfacilities, EPs only.Questions/Comments/Experiences Comment on CMS Proposed Rule PLEASE!! https://go.cms.gov/QualityPaymentProgram Start a blog/group to share experiences? Make connections and learn from eachother.16

5/6/2016Email gCMS Websites: http://www.cms.gov/EHRIncentivePrograms/ ation/EHRIncentivePrograms/downloads/EP Attestation User Guide.pdf SListeningSession.pdf izing-how-medicarepays-physicians.html http://go.cms.gov/QualityPaymentProgram17

Testing Direct messaging/HIE/MU Objective 5 PROCESS: Simple process adding direct messages to our order our order. We were WRONG! We met monthly or every 2 weeks for a year. Involved Admissions, Scheduling and Marketing, to help finalize workflow and building orders. Establish relationshippps with providers to test

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