Transcription
Maryland Medicaid EHRIncentive ProgramUpdates to and Implications ofMeaningful UsePaul Messino, MPPChief, Health IT Policy, Maryland Medicaid
OutlineI. Program OverviewII. Program Status, By the NumbersIII. Program ImplementationA. AIUB. Meaningful Use: Stages I and IIIV. Proposed ChangesV. EHR Acquisition ProcessJuly 22, 20152 of 19
The Basics Financial incentives for adoption andmeaningful use of certified EHRsMedicareMedicaidEligible Providers (EP)Eligible Hospitals (EH)Either, but not both.Both.** Generally, hospitals are eligible to participate in both programs.July 22, 20153 of 19
EligibilityMedicaidMedicarePhysician (MD, OD)*Physician (MD, OD)Nurse PractitionersDoctor of dental surgery or dentalmedicineNurse MidwivesDoctor of podiatryDentistsDoctor of optometryPAs**ChiropractorCertain HospitalsCertain Hospitals* Includes optometrists for MD.** In certain situations, unlikely in MD.4 of 19
Eligibility Requirements Patient Volume (Medicaid) Adoption (Medicaid) and “Meaningful Use”(Medicaid and Medicare) of EHRsJuly 22, 20155 of 19
Medicaid PV RequirementsEntityMinimum MedicaidPatient VolumePhysicians30%- Pediatrician20%*Dentist30%CNMs30%PAs when practicingat an FQHC/RHC thatis so led by a PA30%NPs30%Acute Care Hospitals10%Children’s HospitalsNo requirement* Receives 2/3 of a Physician’s incentive amountOr EP practicespredominately inFQHC or RHC with30% needy individualpatient volume
How to Calculate Patient Volume Individually– All FFS and MCO encounters in 90 day periodin previous CY divided by all encounters Group Proxy– All FFS and MCO encounters in 90 day periodfor the whole group (NPI-based) in previousCY divided by all encountersJuly 22, 20157 of 19
How Much is Available?EPs*MedicaidEPs**MedicareYear 1 21,250 18,000 - 12,000Year 2 8,500Year 3 8,500Year 4 8,500Year 5 8,500 12,000 - 8,000LastYear- 4,000to Begin 8,000Participation: 2014 - 4 Years 4,000 - 2,000- Single calc.- 2M 2,000 - 0Year 6 8,500Total 63,750 44,000EHMedicaidEHMedicare- 3-4 Years- Mult. calc.- 2M
Program StatusStatewide Payments: 146,825,633 (2,490 EP; 38 EH) Enrollment: 7,816 Adoption rate* (non-hospital-based):– 2010: 20%– 2013: 73%Sources: DHMH Environmental Scan, 2010, 2013 and Charles, Dustin et al (2014). “Adoption of Electronic Health RecordSystems among U.S. Non-federal Acute Care Hospitals: 2008-2013.” ONC Data Brief (16), May.July 22, 20159 of 19
EP Registration RatesData from 2013; mixed-methods for percent eligible by county.July 22, 201510 of 19
Percent EPs PaidData from 2013, NLR Repository.July 22, 201511 of 19
Program Implementation Two-stage enrollment process– CMS: Registration and Attestation testation.html– Maryland: Electronic Medicaid IncentivePayment Program (eMIPP)https://emipp.dhmh.maryland.gov/July 22, 201512 of 19
Adopt, Implement, Upgrade Adopt: Acquire and install system Implement: Training, data migration,commence utilization Upgrade: Expand and improve existingsystem to meet definition of certified EHRtechnologyJuly 22, 201513 of 19
Meaningful Use MU Periods (90, 365) Staged approach For Stage 1 Meaningful Use (2014 CEHRT), samecore and menu set as Medicare*– Eligible Professions: Must meet 18 of 22 objectives, all 13 coreobjectives and 5 of 9 menu set objectives (plus CQMs).– Eligible Hospitals: Must meet 16 of 21 objectives, all 11 core and5 of 10 menu set objectives (plus CQMs).*As of Stage 2 ruling.July 22, 201514 of 19
MU Stage 1 ExamplesCORE SETMENU SETDrug-drug and drug-allergychecksSummary of Care recordClinical Quality MeasuresPublic health data submission*E-PrescribingMedication reconciliation(new patients)CPOEIdentify and supply patient-specificcare informationUp-to-date problem list of currentand active diagnosesGenerate lists of patients by conditionSource: ation/EHRIncentivePrograms/Downloads/EP MU TableOfContents.pdfJuly 22, 201515 of 19
Meaningful Use – Stage 2 For Stage 2 Meaningful Use, same core andmenu set as Medicare– Eligible Professions: Must meet 20 of 23 objectives, all 17 coreobjectives and 3 of 6 menu set objectives (plus CQM).– Eligible Hospitals: Must meet 19 of 22 objectives, all 16 core and3 of 6 menu set objectives.July 22, 201516 of 19
MU Stage 2 ExamplesCORE SETMENU SETPublic Health reporting(EP: Imm; EH:All)Record electronic notes.Send reminders to patients forfollow up.Imaging results, with notes.Summary of care record.Patient family history as structured data.Use secure electronic messagesto communicate with patients.Special public health reporting (e.g.cancer)Protect e-Health InformationSpecialized registry reportingSource: ation/EHRIncentivePrograms/Downloads/Stage2 MeaningfulUseSpecSheet TableContents EPs.pdfJuly 22, 201517 of 19
Proposed Changes Proposed Rules– Stage 3 (March 30, 2015)– 2015-2017 Modification (April 15, 2015) Significant Programmatic Changes– Flexibility (2015-2017)– Break the “core” and “menu” structure– 2018 Stage 3 reporting onlyJuly 22, 201518 of 19
Questions? DHMH Informational WebsiteMaryland me.aspxCRISP MU Supporthttps://meaningfuluse.crisphealth.org/ ContactsDHMH: dhmh.MarylandEHR@maryland.govCRISP: 1-877-952-7477; support@crisphealth.orgJuly 22, 201519 of 19
Maryland Medicaid EHRIncentive ProgramUpdates to and Implications ofMeaningful UsePaul Messino, MPPChief, Health IT Policy, Maryland Medicaid
OutlineI. Program OverviewII. Program Status, By the NumbersIII. Program ImplementationA. AIUB. Meaningful Use: Stages I and IIIV. Proposed ChangesV. EHR Acquisition ProcessJuly 22, 20152 of 19
The Basics Financial incentives for adoption andmeaningful use of certified EHRsMedicareMedicaidEligible Providers (EP)Eligible Hospitals (EH)Either, but not both.Both.** Generally, hospitals are eligible to participate in both programs.July 22, 20153 of 19
EligibilityMedicaidMedicarePhysician (MD, OD)*Physician (MD, OD)Nurse PractitionersDoctor of dental surgery or dentalmedicineNurse MidwivesDoctor of podiatryDentistsDoctor of optometryPAs**ChiropractorCertain HospitalsCertain Hospitals* Includes optometrists for MD.** In certain situations, unlikely in MD.4 of 19
Eligibility Requirements Patient Volume (Medicaid) Adoption (Medicaid) and “Meaningful Use”(Medicaid and Medicare) of EHRsJuly 22, 20155 of 19
Medicaid PV RequirementsEntityMinimum MedicaidPatient VolumePhysicians30%- Pediatrician20%*Dentist30%CNMs30%PAs when practicingat an FQHC/RHC thatis so led by a PA30%NPs30%Acute Care Hospitals10%Children’s HospitalsNo requirement* Receives 2/3 of a Physician’s incentive amountOr EP practicespredominately inFQHC or RHC with30% needy individualpatient volume
How to Calculate Patient Volume Individually– All FFS and MCO encounters in 90 day periodin previous CY divided by all encounters Group Proxy– All FFS and MCO encounters in 90 day periodfor the whole group (NPI-based) in previousCY divided by all encountersJuly 22, 20157 of 19
How Much is Available?EPs*MedicaidEPs**MedicareYear 1 21,250 18,000 - 12,000Year 2 8,500Year 3 8,500Year 4 8,500Year 5 8,500 12,000 - 8,000LastYear- 4,000to Begin 8,000Participation: 2014 - 4 Years 4,000 - 2,000- Single calc.- 2M 2,000 - 0Year 6 8,500Total 63,750 44,000EHMedicaidEHMedicare- 3-4 Years- Mult. calc.- 2M
Program StatusStatewide Payments: 146,825,633 (2,490 EP; 38 EH) Enrollment: 7,816 Adoption rate* (non-hospital-based):– 2010: 20%– 2013: 73%Sources: DHMH Environmental Scan, 2010, 2013 and Charles, Dustin et al (2014). “Adoption of Electronic Health RecordSystems among U.S. Non-federal Acute Care Hospitals: 2008-2013.” ONC Data Brief (16), May.July 22, 20159 of 19
EP Registration RatesData from 2013; mixed-methods for percent eligible by county.July 22, 201510 of 19
Percent EPs PaidData from 2013, NLR Repository.July 22, 201511 of 19
Program Implementation Two-stage enrollment process– CMS: Registration and Attestation testation.html– Maryland: Electronic Medicaid IncentivePayment Program (eMIPP)https://emipp.dhmh.maryland.gov/July 22, 201512 of 19
Adopt, Implement, Upgrade Adopt: Acquire and install system Implement: Training, data migration,commence utilization Upgrade: Expand and improve existingsystem to meet definition of certified EHRtechnologyJuly 22, 201513 of 19
Meaningful Use MU Periods (90, 365) Staged approach For Stage 1 Meaningful Use (2014 CEHRT), samecore and menu set as Medicare*– Eligible Professions: Must meet 18 of 22 objectives, all 13 coreobjectives and 5 of 9 menu set objectives (plus CQMs).– Eligible Hospitals: Must meet 16 of 21 objectives, all 11 core and5 of 10 menu set objectives (plus CQMs).*As of Stage 2 ruling.July 22, 201514 of 19
MU Stage 1 ExamplesCORE SETMENU SETDrug-drug and drug-allergychecksSummary of Care recordClinical Quality MeasuresPublic health data submission*E-PrescribingMedication reconciliation(new patients)CPOEIdentify and supply patient-specificcare informationUp-to-date problem list of currentand active diagnosesGenerate lists of patients by conditionSource: ation/EHRIncentivePrograms/Downloads/EP MU TableOfContents.pdfJuly 22, 201515 of 19
Meaningful Use – Stage 2 For Stage 2 Meaningful Use, same core andmenu set as Medicare– Eligible Professions: Must meet 20 of 23 objectives, all 17 coreobjectives and 3 of 6 menu set objectives (plus CQM).– Eligible Hospitals: Must meet 19 of 22 objectives, all 16 core and3 of 6 menu set objectives.July 22, 201516 of 19
MU Stage 2 ExamplesCORE SETMENU SETPublic Health reporting(EP: Imm; EH:All)Record electronic notes.Send reminders to patients forfollow up.Imaging results, with notes.Summary of care record.Patient family history as structured data.Use secure electronic messagesto communicate with patients.Special public health reporting (e.g.cancer)Protect e-Health InformationSpecialized registry reportingSource: ation/EHRIncentivePrograms/Downloads/Stage2 MeaningfulUseSpecSheet TableContents EPs.pdfJuly 22, 201517 of 19
Proposed Changes Proposed Rules– Stage 3 (March 30, 2015)– 2015-2017 Modification (April 15, 2015) Significant Programmatic Changes– Flexibility (2015-2017)– Break the “core” and “menu” structure– 2018 Stage 3 reporting onlyJuly 22, 201518 of 19
Questions? DHMH Informational WebsiteMaryland me.aspxCRISP MU Supporthttps://meaningfuluse.crisphealth.org/ ContactsDHMH: dhmh.MarylandEHR@maryland.govCRISP: 1-877-952-7477; support@crisphealth.orgJuly 22, 201519 of 19
Maryland Medicaid EHR Incentive Program Paul Messino, MPP Chief, Health IT Policy, Maryland Medicaid. Outline I. Program Overview II. . "Adoption of Electronic Health Record Systems among U.S. Non-federal Acute Care Hospitals: 2008-2013." ONC Data Brief (16), May. EP Registration Rates July 22, 2015 10 of 19 Data from 2013; mixed-methods .
