Alaska Medicaid Electronic Health Record (EHR) Incentive Pr - PowerPoint Presentation

Slide1

Alaska Medicaid Electronic Health Record (EHR) Incentive ProgramSlide2

A federal program that provides major financial support to incent providers to adopt, implement, or upgrade to certified EHR technology and to meet meaningful use standards

Goals:Enhance care coordination and patient safetyReduce paperwork and improve efficienciesFacilitate information sharing across providers, payers, and state linesEnable sharing using state Health Information Exchanges (HIE) and the National Health Information Network (NHIN) Purpose:Improve outcomes, facilitate access, simplify care, and reducecosts of health care nationwide

EHR Incentive ProgramSlide3

Incentive Requirements

Adopt, Implement or Upgrade “certified” EHR technologyMeet the “meaningful use” criteria in the employment of the certified EHR technologyBe an

“

eligible” professional (EP) or hospital (EH)Meet EP or EH Medicaid Patient Volume Criteria

EHR Incentive Program RequirementsSlide4

Adopt

– Acquire, purchase, or secure access to certified EHR technologyImplement – Install or commence utilization of certified EHR technology capable of meeting meaningful use requirementsUpgrade – Expand the availability functionality of certified EHR technology capable of meeting meaningful use requirements at the practice site, including staffing, maintenance, and training, or upgrade from existing EHR technology to certified EHR technology per the Office of the National Coordinator (ONC) EHR certification criteriaUse Certified EHR TechnologySlide5

Use Certified EHR Technology

In a meaningful manner - have certain electronic capabilities, such as e-prescribingFor electronic exchange of health information - to improve quality/coordination of health care, reduce costsTo submit clinical quality and other measures - measures change over time to show progressMeaningful Use CriteriaSet of measuresQuality (outcomes)Process ( use of best practices/data capture)Capabilities (computerized functions)Providers must submit and attest to these quality measures to receive fundsMust use Federal Meaningful Use definition as a floor

Meaningful UseSlide6

Eligible Professionals (EPs)

Must choose to participate in Medicare or Medicaid ProgramBefore 2015, EPs may switch programs once after the first incentive paymentFor Medicaid: Potentially as high as $63,750 over 6 yrsFor Medicare: Potentially as high as $48,000Medicare or Medicaid EligibilitySlide7

Medicaid Eligible Professionals or Eligible Hospitals may be eligible for the program if they:

adopt, implement or upgrade to a certified EHR technology or successfully demonstrate meaningful use of certified EHR technology Medicare Eligible Professionals or Eligible Hospitals may be eligible for the program if they:successfully demonstrate meaningful use of certified EHR technology Medicare or Medicaid EligibilitySlide8

Medicaid Eligible Professionals

Physician (MD,DO)DentistCertified Nurse Mid-Wife Nurse Practitioner, andPhysician Assistant if practicing in a Rural Health Clinic or a Federally Qualified Health Center led by a physician assistant Non-Hospital BasedHospital-based EPs are not eligible for incentive payments An EP is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (POS 21) or emergency room (POS 23) setting

Medicaid EHR Incentive Program

Eligible Provider TypesSlide9

Medicaid Patient Volume Criteria

For Eligible Professionals (EPs)

Provider Type

Minimum Medicaid Patient Volume Threshold

Physicians

30%

-Pediatrician

20%

Dentists

30%

Certified Nurse Midwife

30%

Nurse

Practitioners

30%

PA's when practicing at an FQHC/RHC that is led by a PA

30%

**

Or the Medicaid EP practices predominantly in an FQHC or RHC-30% needy individuals patient volume threshold

For Eligible

Hospitals (EHs)

Acute

Care Hospital and

Critical Access Hospital

s

10%

Children’s

Hospital

No

Medicaid volume requirementSlide10

Needy Individual encounters can be used by Eligible Professionals (EPs) who practice predominately in an FQHC or RHC.

Needy Individual encounters include:Services paid by TXIX Medicaid Services paid by TXXI Children’s Health Insurance Program (CHIP)Furnished by the provider as uncompensated careFurnished at either no cost or reduced cost based on a sliding scaleNeedy Individual Patient VolumeSlide11

Potential EP Payment Timeline

(for Medicaid EHR Incentive Program)Slide12

EH payments are based on a number of factors, beginning with a $2 million base payment.

Hospitals cannot initiate payments after 2016 and payment years must be consecutive after 2016Potential EH PaymentSlide13

To enroll in the incentive program EPs and EHs must:

Register at the CMS EHR Incentive Program Registration siteRegister and attest at the Alaska Medicaid State Level Registry (SLR)EHR Incentive Program EnrollmentSlide14

Alaska Medicaid

Provider Outreach PageCentralized “one stop” launching pad of available tools for Providers to manage their EHR Incentive Program InformationThe Provider Outreach portal provides:A link "Want to get a jump start?" with step-by-step instructions on how to complete the registration process by role (individual eligible professional, eligible hospital or group administrator) Attestation workbooks for Eligibility and Adopt / Implement / Upgrade to  help gather all the necessary information to register for the programAbility to access the CMS EHR Incentive Registration siteAbility to create an account with the Alaska Medicaid SLR

Ability for Eligible Professionals and Eligible Hospitals to attest to information submittedSlide15

Alaska Medicaid SLRSlide16

Getting StartedSlide17

Step by

Step InstructionsSlide18

To register in the SLR you must be:

An eligible professional, eligible hospital or a group administratorEnrolled in Alaska MedicaidHave your National Provider Identifier (NPI) and Tax Identifier Number (TIN) The NPI and TIN used in the SLR needs to be the same as what was entered for the CMS EHR Incentive RegistrationAlaska Medicaid SLR RegistrationSlide19

Determine which method of Certified EHR technology you will be attesting to —  adopt, implement, or upgrade

Verify that your EHR is on the list from ONC as certified EHR technologyObtain a copy of your signed contract with a vendor for the purchase, implementation or upgrade of a certified EHR systemSelect the 90 day period to determine the Medicaid or needy individual patient volume you will be reporting using the number of encountersObtain your active Alaska Medicaid Provider numberObtain your medical license number, licensing board name and state in which it was issuedEligible Hospitals (EHs) need to have four (4) years worth of cost reports in order to complete the attestation processAttestation PreparationSlide20

Where do I go to log into the SLR?Slide21

SLR Create AccountSlide22

SLR Create Login

Must be between 8 – 20 charactersNo spaces / special characters allowed

Must have between 8 - 20 characters,

at least 1 upper and 1 lower case letter, 1 number, 1 special character (@ or # or !), not your User ID and not an old passwordSlide23

SLR Login

Enter User ID and Password you createdSlide24

SLR – End User License Agreement

Legalese

User agrees and proceeds; user disagrees and cannot complete registrationSlide25

SLR Home Page

Steps guide users through Attestation workflowSlide26

SLR Step 1 – Eligible Professional (EP) About YouSlide27

SLR Step 1 – EP About You Slide28

SLR Step 1 – Eligible Hospital (EH)

About YouSlide29

SLR Step 2 – EP Confirm EligibilitySlide30

SLR Step 2 – EH Confirm EligibilitySlide31

SLR Step 2 – EH Hospital DemographicsSlide32

SLR Step 3 – Attestation MethodSlide33

SLR Step 3 – AIU MethodSlide34
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SLR Step 3 – EHR CertificationSlide36

ONC CHPLSlide37

ONC CHPLSlide38

ONC CHPL

Add to SLR EHR Certification ID fieldSlide39

SLR Step 3 – Meaningful Use (MU)

EHR Reporting PeriodSlide40

EP will have to attest to each of the 15 Meaningful Use Core Objectives

The 15 Meaningful Use Core Objectives are:Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelinesImplement drug-drug and drug-allergy interaction checksMaintain an up-to-date problem list of current and active diagnosesGenerate and transmit permissible prescriptions electronically (eRx)Maintain active medication list.Maintain active medication allergy listRecord all the demographicsRecord and chart changes in vital signs

SLR Step 3 – EP MU Core ObjectivesSlide41

Record smoking status for patients 13 years old or older

Report ambulatory clinical quality measures to the StateImplement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance to that ruleProvide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies), upon requestProvide clinical summaries for patients for each office visitCapability to exchange key clinical information (for example, problem list, medication list, allergies, diagnostic test results), among providers of care and patient authorized entities electronicallyProtect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities

SLR Step 3 – EP MU Core Objectives Slide42

SLR Step 3 – EP MU Core Objectives Slide43

EH will have to attest to each of the 14 Meaningful Use Core Objectives

Use computerized physician order entry (CPOE)Implement drug-drug and drug-allergy interaction checksMaintain an up-to-date problem list of current and active diagnosesMaintain active medication listMaintain active medication allergy listRecord all of the demographics: preferred language, gender, race, ethnicity, date of birth, date and preliminary cause of death in event of mortality Record and chart changes in vital signsRecord smoking status for patients 13 years or olderReport hospital clinical decision support rule related to a high priority hospital conditionProvide patients with an electronic copy of their health informationProvide patients with an electronic copy of their discharge instructions

Capability to exchange key clinical information

Protect electronic health information created or maintained by certified EHR technology through the implementation of appropriate technical capabilities

SLR Step 3 – EH MU Core ObjectivesSlide44

SLR Step 3 – EH MU Core ObjectivesSlide45

EP has to attest to at least one menu objective from the public health list, even if the exclusion applies to both:

Capability to submit electronic data to immunization registry or immunization information systemCapability to submit electronic syndromic surveillance data to public health agenciesEP must attest to additional menu objectives until a total of 5 MU Menu Objectives have been selected:Implement drug formulary checksIncorporate clinical lab-test results into EHR as structured dataGenerate lists of patients by specific conditionsSend reminders to patientsProvide patients with timely electronic access to their health informationUse certified EHR technology to identify patient-specific education resourcesPerform medication reconciliation if patient is received from another care setting or provider

Provide summary of care record for any transition of care or referral

SLR Step 3 – EP MU Menu ObjectivesSlide46

SLR Step 3 – EP MU Menu ObjectivesSlide47

EH has to attest to at least one menu objective from the public health list, even if the exclusion applies to both:

Capability to submit electronic data to immunization registry or immunization information systemCapability to submit electronic syndromic surveillance data to public health agenciesCapability to submit electronic data on reportable lab results to public health agenciesEP must attest to additional menu objectives until a total of 5 MU Menu Objectives have been selected:Implement drug formulary checksRecord advance directives for patients 65 years or olderIncorporate clinical lab-test results into certified EHR as structured dataGenerate lists of patients by specific conditionsUse certified EHR technology to identify patient-specific education resourcesPerform medication reconciliation if patient is received from another care setting or provider

Provide summary of care record for any transition of care or referral

SLR Step 3 – EH MU Menu Objectives Slide48

SLR Step 3 – EH MU Menu ObjectivesSlide49

EP must attest to all three (3) Core Clinical Quality Measures

If any of the Core Clinical Quality Measures have a denominator of zero (0) an Alternative Core Clinical Quality Measure must also be submittedCore Clinical Quality Measures:Hypertension: Blood Pressure MeasurementPreventive Care and Screening Measure PairAdult Weight Screening and Follow-upAlternate Clinical Quality Measures:Weight Assessment and Counseling for Children and AdolescentsPreventive Care and Screening: Influenza Immunization for Patients > or = 50 years oldChildhood Immunization Status

SLR Step 3 – EP Core Clinical

Quality MeasuresSlide50

SLR Step 3 – EP Core Clinical

Quality MeasuresSlide51

SLR Step 3 – EP Alternate Clinical

Quality MeasuresSlide52

EP must select three (3) Additional Clinical Quality Measures from list:

Asthma assessmentAppropriate testing for children with pharyngitisInitiation and engagement of alcohol and other drug dependence treatmentPrenatal care: screening for HIVPrenatal care: anti-D immune globulinControlling high blood pressureSmoking and tobacco use cessationBreast cancer screeningCervical cancer screeningChlamydia screening for womenColorectal cancer screeningUse of appropriate medications for asthmaPneumonia vaccination status for older adults

Asthma pharmacologic therapy

Low back pain: use of imaging studiesDiabetes: eye examDiabetes: foot examDiabetes: hemoglobin A1c poor controlDiabetes: blood pressure management

SLR Step 3 – EP Additional

Clinical Quality Measures Slide53

Additional clinical quality measures continued:

Diabetes: urine screeningDiabetes: low density lipoprotein (LDL) management and controlCoronary artery disease: oral antiplatelet therapy prescribed Ischemic vascular disease: use of aspirin or another antithromboticCoronary artery disease: beta-blocker therapyIschemic vascular disease: blood pressure managementCoronary artery disease: drug therapy for lowering LDL-cholesterolIschemic vascular disease: complete lipid panel and LDL controlHeart failure: angiotenseinHeart failure: beta-blocker therapy for LVSDHeart failure: Waifarin therapy for patients with atrial fibrillationPrimary open angle glaucoma: optic nerve evaluation

Diabetic retinopathy: documentation of presence or absences of macular edema and level of severity

Diabetic retinopathy: communication with the physician mapping ongoing diabetes careAnti-depressant medication managementOncology colon cancer: chemotherapy for stage III colon cancer patientsOncology breast cancer: hormonal therapy for stage IC-IIIC estrogen receptor/progesterone receptor positive breast

cncer

Prostate cancer: avoidance of overuse of bone scan for staging low risk prostate cancer patients

Diabetes: hemoglobin A1c control

SLR Step 3 – EP Additional

Clinical Quality Measures Slide54

EP must attest to all fifteen (15) Core Clinical Quality Measures

Emergency department (ED): median time from ED arrival to time of departure from EDED: median time from admit decision time to time of departure from EDIschemic stroke: discharge on anti-thromboticsIschemic stroke: anticoagulation for A-fib/flutterIschemic stroke: thrombolytic therapy for patients arriving within 2 hours of symptom onsetIschemic or hemorrhagic stroke: antithrombotic therapy by day 2Ischemic stroke: discharge on statins

SLR Step 3 – EH Core Clinical

Quality MeasuresSlide55

Ischemic or hemorrhagic stroke: stroke education

Ischemic or hemorrhagic stroke: rehabilitation assessmentVTE prophylaxis within 24 hours of arrivalIntensive care unit VTE prophylaxisAnticoagulation overlap therapyPlatelet monitoring on unfractionated heparinVTE discharge instructionsIncidence of potentially preventable VTESLR Step 3 – EH Core Clinical Quality MeasuresSlide56

SLR Step 4 - Attestation

Need to download Attestation, review for accuracy, sign and upload to SLR. Original signed Attestation must be mailed to SOA EHR Incentive Program OfficeSlide57

SLR Step 5 – Submit AttestationSlide58

Don’t Forget To

Mail original signed EHR Incentive Program Attestation Agreement Form, Substitute Form - W9 and EDI Payment Agreement Form (if applicable) to: State of AlaskaDepartment of Health and Social ServicesDivision of Health Care ServicesEHR Incentive Program Office1835 South Bragaw St., Suite 300

Anchorage, AK 99508-3469

Your attestation is not complete until the signed Attestation Agreement has been received by the State of Alaska.Slide59

SLR – EP Payment Calculation ReportSlide60

SLR – EH Payment Calculation ReportSlide61

DHSS HIT

http://www.hss.state.ak.us/hit/ Preparation ChecklistCenters for Medicare & Medicaid (CMS) EHR Incentive Program http://www.cms.gov/EHRIncentiveProgramsProgram overview, eligibility, FAQsCMS EHR Incentive Program Registration https://ehrincentives.cms.gov/hitech/login.action ONC Certified Health IT Product List (CHPL) http://onc-chpl.force.com/ehrcert Alaska Medicaid SLR Provider Outreach Portal / EHR Incentive Program Registration

http://ak.arraincentive.com/default.aspx

Centralized “one stop” launching pad of available tools for Providers to manage their EHR Incentive Program Information

Where to Find Information?Slide62

Paul Cartland, State HIT Coordinator

State of AK, DHSSHITInfo@alaska.gov

907-269-6097

Beth Davidson, HIT Deputy Coordinator

State of AK, DHSS

HITInfo@alaska.gov

907-375-7725

JoLynn Cagle, EHR Program Manager

State of AK, DHSS

HITInfo@alaska.gov

907-334-4489

Contact Information