EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Modifications to Meaningful Use for 2015 through 2017

Modifications to Meaningful Use for 2015 through 2017 | EHR and Health IT Consulting | Scoop.it

On April 10, 2015, the Centers for Medicare & Medicaid Services issued a new proposed rule for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs to align Stage 1 and Stage 2 objectives and measures with the long-term proposals for Stage 3, to build progress toward program milestones, to reduce complexity, and to simplify providers’ reporting. These modifications would allow providers to focus more closely on the advanced use of certified EHR technology to support health information exchange and quality improvement.

Better Care, Smarter Spending and Healthier People
The proposed rule is just one part of a larger effort across HHS to deliver better care, spend health dollars more wisely, and have healthier people and communities by working in three core areas: improving the way providers are paid, improving the way care is delivered, and improving the way information is shared to support transparency for consumers, health care providers, and researchers and to strengthen decision-making.


Vision for the Future


The proposed rule issued today is a critical step forward in helping to support the long-term goals of delivery system reform; especially those goals of a nationwide interoperable learning health system and patient-centered care. CMS is also simplifying the structure and reducing the reporting requirements for providers participating in the program by removing measures which have become duplicative, redundant, and reached wide-spread adoption (i.e., are “topped out”). This will allow providers to refocus on the advanced use objectives and measures. These advanced measures are at the core of health IT supported health care which drives toward improving the way electronic health information is shared among providers and with their patients, enhancing the ability to measure quality and set improvement goals, and ultimately improving the way health care is delivered and experienced.


Simplifying and Streamlining


The proposed rule would streamline reporting requirements. To accomplish these goals, the NPRM proposes:

  • Reducing the overall number of objectives to focus on advanced use of EHRs;
  • Removing measures that have become redundant, duplicative or have reached wide-spread adoption;
  • Realigning the reporting period beginning in 2015, so hospitals would participate on the calendar year instead of the fiscal year; and
  • Allowing a 90 day reporting period in 2015 to accommodate the implementation of these proposed changes in 2015.


Supporting Interoperability and the Adoption of Electronic Health Records


The EHR Incentive Programs support the adoption and meaningful use of certified EHR technology to allow providers and patients to exchange and access health information electronically and support interoperability broadly. The program supports interoperability by requiring the capture of data in structured formats as well as the exchange of data in standardized form as well as the sharing of this data electronically with other providers and with patients.

The proposed rule would reduce required reporting, allowing providers to focus on objectives which support advanced use of EHR technology and quality improvement, including health information exchange.


Improving Outcomes for Patients


The rule would support improved outcomes and measurement of those outcomes. By proposing to simplify the reporting requirements, the proposed rule would allow providers to focus on objectives that support advanced use of EHR technology, including quality measurement and quality improvement. The rule supports providers leveraging their resources and health IT to coordinate care for patients, to provide patients with access to their health information, and to support data collection in a format that can be shared across multiple health care organizations.


Program Registration and Participation Milestones


As of March 1, 2015, more than 525,000 providers have registered to participate in the Medicare and Medicaid EHR Incentive Programs. In addition, more than 438, 000 eligible professionals, eligible hospitals, and CAHs have received an EHR incentive payment. As of the end of 2014, 95% of eligible hospitals and CAHs, and more than 62% of eligible professionals have successfully demonstrated meaningful use of certified EHR technology.


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Why Providers Seek EHR Flexibility Standards From CMS

Why Providers Seek EHR Flexibility Standards From CMS | EHR and Health IT Consulting | Scoop.it

Over the last several years, a multitude of providers have found meaningful use requirements too complex and advanced to reach as quickly as the Centers for Medicare & Medicaid Services (CMS) mandates. Specifically, the healthcare industry is calling for more EHR flexibility when integrating these systems.


Due to the large volume of concerns from stakeholders and healthcare providers, CMS did move forward with revising some aspects of the meaningful use requirements. For example, instead of reporting on EHR use in a full calendar year, CMS decided to implement a 90-day reporting period instead.


“We continue to support the long-term goals of the meaningful use program and share the Department of Health and Human Services’ commitment to elevating patient-centered care and improving health outcomes, but greater flexibility is needed to support the providers and make participation less daunting,” American Academy of Family Physicians President Dr. Robert Wergin said in a public statement.

Along with concerns over meaningful use requirements, the lack of sharing capabilities among EHR systems is also causing providers to worry. The lack of EHR flexibility and interoperability is a significant concern, which the Office of the National Coordinator for Health IT (ONC) recently addressed by releasing a 10-year roadmap.


While approximately half of providers and 59 percent of hospitals have implemented EHR technology, not nearly as many physicians have the EHR flexibility necessary to communicate with doctors at other establishments. The Department of Health and Human Services (HHS) reported that, in 2013, only 14 percent of physicians electronically shared data with ambulatory care providers or hospitals that were outside of their facility.


Additionally, that same year only 10 percent of hospitals were offering their patients online access to view, download, and distribute their personal health records based on their hospital stay.

On March 18, the American Hospital Association (AHA) advised Congress to allow providers more EHR flexibility when implementing these systems. With the ICD-10 transition taking place on October 1, providers will need more secure and flexible products when adopting the new coding set.


Additionally, the recent release of the Stage 3 Meaningful Use proposed rule sets 2018 as the anticipated year for meeting the requirements. This may be difficult to achieve for providers that are still struggling to attain Stage 2 Meaningful Use regulations.

In a statement by AHA to the Senate Committee on Health, Education, Labor and Pensions, the organization commented on how health IT tools do not support a high level of health information sharing. AHA asks for the development of policy that supports EHR flexibility and the designing of systems to securely adapt to the ICD-10 coding set.

AHA also highlights the importance of delivering health IT products that promote patient safety and quality improvements. The various EHR issues including data exchange concerns will need to be addressed by the federal government over the coming months, as the ICD-10 transition is currently set to take place on October 1, 2015.


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Strategies for Dealing with Value-Based Modifiers

Strategies for Dealing with Value-Based Modifiers | EHR and Health IT Consulting | Scoop.it

As we know many payers are implementing various approaches to pay-for-performance reimbursement or value-based reimbursement programs. Medicare has announced significant goals in modifying payment models; rolling out value-based payment modifiers (VBPM) this year. Patient care activity in 2015 will impact every Medicare payment in 2017. Physician groups of 100 or more will have payments affected this year, groups of 10 or more in 2016, and all groups in 2017. Medicare will determine the amount of payment incentive or adjustment based on the information noted below. The range is from - 4 percent to + 4 percent of Medicare payments.

Below are some thoughts on how you can respond to VBPMs and optimize the care provided patients and maintain or gain financial viability.


1. Continue to participate in PQRS which is the basis for the Medicare Value-Based Payment Modifier program. Understand how your profile fits within the six domains (check meaningful use): clinical process/effectiveness; patient and family engagement; population/public health; patient safety; care coordination; and efficient use of healthcare resources.


2. Access your practice Quality and Resource Use Report, QRUR, by obtaining an IACS number from CMS. This report was published by CMS last fall and compares your practice to peers on both quality and cost measures. This can be downloaded in both PDF and excel formats. It's complex but worth spending time on to both understand and identify your practice profile.


3. Monitor your entire provider panel in key measures:

Quality:

a. Preventable hospital admissions:

• Patients with acute episodes of dehydration, UTI, and bacterial pneumonia

• Chronic patients with heart failure, COPD, and diabetes

b. All cause hospital readmissions

Cost — your practice status:

a. All Part A and Part B payments (Part D excluded)

b. For disease categories: COPD, heart failure, coronary artery disease, and diabetes

c. Medicare Spend Per Beneficiary, MSPB, for three days prior to and 30 days post discharge

d. Total Medicare Allowable per applicable CPT code

4. Report monthly on what is occurring.

a. Your practice will not know the Medicare ranking until the end of period.

b. Rankings are determined by the eligible provider (EP) who has a "plurality" of primary-care codes assigned and the Medicare allowable charge amount assigned. Primary-care providers will be considered first, but any specialist may qualify.

c. A minimum of 20 episodes per measure (see quality above) hence the need to monitor your practice. If insufficient numbers are there, you may not see either the incentive or adjustment.


5. Regular review and reporting will help lead the practice toward a more "quality" impact and focus. When all staff, not just providers, work together, the cumbersome nature of reporting will become easier and part of everyday practice life — since in many cases the impact is not significant this year. It will however become more impactful in the years to come, as not only VBPM programs come into play, but overall payment model reforms are implemented. There will be an eventual culture change!


Long term outcomes for practices should be improved patient care, compliance with the new paradigm, and an improved financial picture. How you approach it now may determine the long-term success and viability of your practice in the future.


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