The last mile of meaningful use — value

In this months post, we take a look at an article written by, Bob Cooke, Vice President, Marketing, National Decision Support Company.

The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator (ONC) for Health IT took a leap forward with their recent releases of the Stage 3 Proposed Rule and HIT certification criteria, respectively. At the highest level, a key requirement derived from these proposed program updates is that providers will need to comply with a revised set of requirements in order to receive future value-based reimbursements.

The Stage 3 Proposed Rule focuses on the exchange of data across episodes of care as opposed to whether or not providers “see patients,” “have office visits,” or fall under others terms that don’t really apply to radiologists. It’s not that radiologists don’t conduct “office visits,” or “see patients,” it’s just that to apply these definitions against a radiologist’s compliance with Meaningful Use, and more importantly, extracting value from participation by imaging is practically impossible. Collecting this data is not enough for radiology.

Take smoking status for example, a fairly simple piece of data. For most of the radiologists in the country, this simple piece of data is not available as part of the interpretation process. Collecting it when you see a patient is one thing, but for a radiologist to see it when they interpret an exam for the patient, it can mean everything, as Brigham and Women’s Hospital found out when a jury awarded a patient $16.7 million for a missed cancer diagnosis on a simple CXR for a patient. It turns out the radiologist did not have access to the patients history, which included a family history of lung cancer and a 30 year habit. The exchange of this kind of data is critical to healthcare providers and consumers alike.

Exchanging data across episodes of care (e.g. a radiology encounter) has tremendous benefits to radiology as it enables practices to capture relevant clinical information and apply it towards value-based workflows using widely available, and established, implementation standards. Furthermore, this same exchange mechanism transports coded radiology results, updated medications (for interventional exams) and vitals as appropriate, as the Stage 3 Proposed Rule formally defines the radiology report as part of the Clinical Document Architecture (CDA).

Another key component of Meaningful Use is Clinical Decision Support (CDS). And, the Stage 3 Proposed Rule encompasses the implementation of CDS for recording clinical quality measures and to align incentives with the Physician Quality Reporting System (PQRS). Furthermore, the Protecting Access to Medicare Act of 2014 (PAMA) requires physicians to consult CDS in order to receive payments for Medicare claims.

All in all, radiology has an opportunity to leverage these proposed program updates to deeply embed themselves into the patient care cycle and measure and improve their value in delivering more cost effective and higher quality patient care.

Ready to learn more, buy a book today! 

Go to http://www.theMUguide.com to learn more. Buy a book from the official e-store (http://buy.theMUguide.com) or Amazon.com (http://amazon.theMUguide.com).

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Incentives and Penalties for Radiology EPs

All eligible professionals (EPs) have an opportunity to receive up to $44,000 in incentive payments through the Medicare EHR Incentive Program if they begin meaningful use by October 3, 2012. If meaningful use begins by the end of 2013 the maximum incentive opportunity drops to $39,000 and by end of 2014 drops to $24,000. Starting in 2015 the incentive opportunity goes away and ultimately turns into penalties.

Meaningful Use Program Penalties

Under the Medicare version of the program, payment adjustments go into effect beginning in 2015 if an EP does not successfully demonstrate meaningful use of certified EHR technology. The non-trivial penalties could reach 5 percent by the end of this decade if the majority of EPs are not demonstrating meaningful use. For EPs, including radiologists, this comes in the form of an adjustment to the physician fee schedule amount for covered professional services.

Meaningful Use Incentive Payments

Upon successfully demonstrating meaningful use and attesting, EPs, including eligible radiologists, participating in the Medicare version of the incentive program will receive a single lump sum payment for each year that they continue to demonstrate meaningful use of certified EHR technology for a total incentive payment of up to $44,000 over five consecutive years. If an EP provides service in a Health Professional Shortage Area (HPSA), an additional payment bonus of 10 percent will be paid separately on an annual basis.

Ready to learn more, buy the book today!

Go to http://www.theMUguide.com to learn more. Buy the book from the official e-store (http://buy.theMUguide.com) or Amazon.com (http://amazon.theMUguide.com).

Stage 1 MU Objectives and Measures

Capturing electronic health information and using that data to track and communicate clinical conditions is the predominant focus of Stage 1 Meaningful Use. This first phase of meaningful use includes measures that are specific to EHs and EPs. Radiology EPs have a total of 15 core set objectives, 10 menu set objectives, and 44 clinical quality measures to report against. Each set has specific objectives that may be excluded. However, all EPs are still required to “possess” EHR technology that has been tested and certified against all 33 Certification Criteria.

15 Core Set Measures 

The core set includes six measures eligible for exclusion. For radiology EPs, three of the measures may potentially be excluded based on practice type and patient population. Of the remaining objectives, eight may be achievable with your current IT investments while the remaining measures will likely require your department to implement new, certified technology modules.

10 Menu Set Measures

The menu set includes eight measures eligible for exclusion and allows EPs to select five of 10 measures to report. For radiology EPs, three measures may potentially be excluded based on practice type and patient population. Based on menu set requirements, most radiology EPs would be responsible for reporting two of seven menu set measures. Like the core set measures, menu set measures will likely require implementation of new certified technology in order to comply with meaningful use objectives.

44 Clinical Quality Measures (CQMs)

One of the core set objectives, 42 CFR §495.6(d)(10), expands out to a set of 44 clinically-based measures of which EPs are required to report on six (three core or alternate core measures and three discretionary measures).

Ready to learn more, buy the book today!

Go to http://www.theMUguide.com to learn more. Buy the book from the official e-store (http://buy.theMUguide.com) or Amazon.com (http://amazon.theMUguide.com).

Meaningful Use Regulations and Legislation

It was more than three years ago that President Obama pledged a five year promise to computerize the nation’s health records in an attempt to lower costs, cut medical errors, and improve patient care. A number of significant events have unfolded since this bold statement was made during his first Weekly Presidential Address.

In early 2009, just four days after he took office, Congress passed the American Recovery and Reinvestment (ARRA) Act of 2009, a $787 billion piece of legislation that now tops $840 billion, which President Obama quickly signed into law. Out of this new legislation came a sizable carve out: the Health Information and Technology for Economic and Clinical Health (HITECH) Act, designed to promote the adoption and meaningful use of health information technology. From this, a significant amount of funds were set aside to modernize healthcare IT systems through the CMS EHR Incentive Programs.

Two federal agencies working together

CMS and the ONC, both under the Department of Health and Human Services (HHS), hold joint responsibility for the development and implementation of the incentive programs. Under regulations of the HITECH Act, both federal agencies were initially responsible for creating a set of complementary final rules to support the implementation of the EHR Incentive Programs. CMS and ONC released the final rules of Stage 1 Meaningful Use in July 2010. In the months following the final rule issue, HHS announced the initial set of EHR testing and certification groups—Certification Commission for Health IT (CCHIT), Drummond Group (DGI), InfoGard Laboratories, ICSA Labs, SLI Global Solutions and Surescripts – the groups responsible for certifying the technology that health care professionals are required to use for this government program.

Meaningful use ascension path

Meaningful use will follow an ascension path over time. In other words, each stage of meaningful use will affect subsequent stages through a multi-layered and interconnected approach to health care improvement. In effect, Stage 1 Meaningful Use forms the baseline of the program by promoting electronic data capture and information sharing. Stage 2 Meaningful Use focuses on advancing care processes while Stage 3 Meaningful Use emphasizes leveraging the information collected in the first two stages of meaningful use to improve outcomes. Stage 2 and 3 both build on the foundation of Stage 1 Meaningful Use and will be developed over the next few years through a series of future rulemakings.

Ready to learn more, buy the book today!

Go to http://www.theMUguide.com to learn more. Buy the book from the official e-store (http://buy.theMUguide.com) or Amazon.com (http://amazon.theMUguide.com).

The Goals of Meaningful Use and Stage 1

On January 24, 2009, during his first Weekly Address as 44th president of the United States, President Barack Obama said that the nation’s health records will be computerized within five years in order to lower health care costs, cut medical errors, and improve care.

Goals of Meaningful Use

By focusing on the effective use of EHRs with certain capabilities, the HITECH Act makes it clear that the adoption of records is not a goal in itself: it is the use of EHRs to achieve health and efficiency goals that matters. HITECH’s incentives and assistance programs seek to improve the health of Americans and the performance of their healthcare system through the meaningful use of EHRs to achieve five primary health care goals:

• Improve quality, safety, and efficiency while reducing health disparities.

• Engage patients and families in their health care.

• Promote and improve public and population health.

• Improve care coordination between providers.

• Ensure adequate privacy and security protections for personal health information.

Stage 1 Meaningful Use

Capturing electronic health information and using that data to track and communicate clinical conditions is the predominant focus of Stage 1 Meaningful Use. Under both the Medicare and Medicaid versions of the incentive programs, the first phase of meaningful use includes measures that are specific to eligible hospitals (EHs) and eligible professionals (EPs). Radiologists, most of whom qualify as EPs under the Medicare version, have a total of 15 core set objectives, 10 menu set objectives, and 44 clinical quality measures to report against. Each set has specific objectives that may be excluded, but all EPs are still required to “possess” EHR technology that has been tested and certified for all program criteria.

Ready to learn more, buy the book today! 

Go to http://www.theMUguide.com and learn more. Buy the book from the official e-store (http://buy.theMUguide.com) or Amazon.com (http://amazon.theMUguide.com).