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Medi-Cal Electronic Health Records (EHR) Incentive Program

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Medi-Cal Electronic Health Records (EHR) Incentive Program Larry Dickey, MD, MPH Medical Director Office of Health Information Technology California Department of ... – PowerPoint PPT presentation

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Title: Medi-Cal Electronic Health Records (EHR) Incentive Program


1
Medi-Cal Electronic Health Records (EHR)
Incentive Program
Larry Dickey, MD, MPH Medical Director Office of
Health Information Technology California
Department of Health Care Services
2
Medi-Cal EHR Incentive Program
  • Program Overview
  • History-Where have we been?
  • Current Activities-Where are we going?
  • Forward-Ongoing Activities

3
Medi-Cal EHR Incentive Program
  • Cornerstone of ARRA Hi-Tech Program
  • Companion to the Medicare EHR Incentive Program
    administered by CMS
  • Medi-Cal EHR Incentive Program administered by
    DHCS with CMS funding
  • 1.4 billion dollars to California providers
    (practitioners and hospitals) over 10 year period
    beginning in 2011. Currently have paid 750
    million to over 13,000 providers and 388
    hospitals.
  • EHR Incentive programs complement health
    information exchange (HIE) and regional extension
    center (REC) programs funded by federal DHHS.

4
Medi-Cal EHR Incentive Program
  • Purpose to encourage providers to
  • Adopt, install, or upgrade high quality EHRs
    certified by the Office of the National
    Coordinator
  • Use EHRs to meaningfully improve clinical
    practice and public health
  • Ensure quality and continuity of care
  • Permit greater access to care
  • Reduce costs

5
Medi-Cal EHR Incentive Program Practitioner
Eligibility
  • Who are eligible providers
  • Physicians
  • Dentists
  • Nurse Practitioners
  • Midwifes
  • Physician assistants practicing in a PA-led
    Federal Qualified Health Center (FQHC) or Rural
    Health Clinic (RHC)
  • Optometrists

6
Medi-Cal EHR Incentive Program Practitioner
Eligibility
  • Patient Volume Requirement
  • 30 Medi-Cal patient volume, except for
    pediatricians who can qualify with 20 but
    receive 2/3 of incentive payments
  • Providers in groups all qualify if the group as a
    whole qualifies. 75 of participants currently.
  • Practitioners in FQHCs or RHCs are eligible with
    30 needy volume Medi-Cal Healthy Families,
    uninsured and partial-pay patients
  • Most Indian health centers in California are
    Tribal Health Program (THP) Clinics, not FQHCs.
    Many will not qualify for incentive payments
    unless able to count needy patients.

7
Medicaid Eligible Hospitals
Acute care hospital (includes CAHs) gt 10 Medicaid share, Avg length of stay lt 25 days, Last 4-digits of Medicare CCN 0001-0879 and 1300-1399
Childrens hospital All
  • Hospitals eligible for incentive under Medicare
    and Medicaid may receive both payments.
  • Final Rule added all Critical Access Hospitals
    (CAHs) by definition to be eligible under
    Medicaid.

8
Medi-Cal EHR Incentive Program
  • Incentives (carrots)
  • Practitioners 63,750 over 6 years
  • Hospitals 2-6 million over 4 years
  • Withholds (stick)
  • Beginning in 2015 Medicare withholds (1 to 5
    progressive) for providers not attaining
    meaningful use.
  • Timeline
  • Enrollment October 2011
  • Program ends December 2021

9
Potential Medicaid Provider Incentives
Year 1 21,250
Year 2 8,500
Year 3 8,500
Year 4 8,500
Year 5 8,500
Year 6 8,500
Total 63,750
  • Year 1 payment for adoption, implementation, or
    upgrade of certified EHR technology. Purchase
    not necessary. Some are free.
  • Year 2-6 payments contingent on provider
    demonstrating meaningful use of the EHR -- Does
    not need to be consecutive years
  • Year 1 payment does not need to be in 2011, but
    cannot be later than 2016.
  • One time switch to Medicare incentive program if
    before CY2015.
  • No penalties for failure to actually use the
    certified EHRs.
  • available to each eligible provider

10
What is a Certified EHR?
  • Certified by the Office of the National
    Coordinator for Health Information Technology
  • Must meet national standards for content,
    functionality and interoperability. All
    certified EHRs should be able to attain
    meaningful use.
  • Certified separately for Stage 1 (2011-2013) and
    Stage 2 (2014-2016) meaningful use. Stage 3 is
    being planned.

11
Steps for Meaningful Use
  • When providers use CEHRT in a meaningful way, it
    builds a broader HIT infrastructure to help
    reform and improve the healthcare system by
    ensuring quality, efficiency, and patient safety.

The MU criteria are being implemented in three
stages and will continue to evolve over the next
five years.
The requirements for each stage become
progressively more demanding
12
Stage 1 MU Requirements
  • There are different MU objectives (core and menu)
    for eligible professionals (EPs) and eligible
    hospitals (EHs).
  • EPs must meet 20 out of 25 objectives to qualify
    (15 core 5 menu objectives).
  • EHs must meet 19 out of 24 objectives to qualify
    (14 core 5 menu objectives).
  • Both EPs and EHs must meet all core objectives
    and select five out of ten menu objectives.

Providers must attest at the state website
www.medi-cal.ehr.ca.gov and receive verification
that they met the MU objectives and measures.
13
Stage 1 Meaningful Use Core Objectives for EPs
Eligible Professionals 15 Core Objectives (EPs must meet all core objectives.) Eligible Professionals 15 Core Objectives (EPs must meet all core objectives.)
1 Use a computerized physician order entry (CPOE) for medication orders.
2 Implement drug-drug and drug-allergy interaction checks.
3 Maintain an up-to-date problem list of current and active diagnoses.
4 Generate and transmit permissible prescriptions electronically (e-prescribing eRx).
5 Maintain an active medication list.
6 Maintain an active medication allergy list.
7 Record demographics (e.g., preferred language, gender, race, ethnicity, and date of birth).
8 Record and chart changes in vital signs (e.g., height, weight, blood pressure, body mass index, and growth charts).
9 Record smoking status for patients 13 years old or older.
10 Report ambulatory Clinical Quality Measures (CQM) to CMS or the States.
11 Implement one clinical decision support rule.
12 Provide patients with an electronic copy of their health information, upon request.
13 Provide clinical summaries for patients for each office visit.
14 Exchange key electronic clinical information among providers of care and patient-authorized entities.
15 Protect electronic health information.
14
Stage 1 of Meaningful Use Menu Objectives for
EPs
Eligible Professionals 10 Menu Objectives (EPs must meet 5 of 10 menu objectives.) Eligible Professionals 10 Menu Objectives (EPs must meet 5 of 10 menu objectives.)
1 Implement drug formulary checks.
2 Incorporate clinical lab test results as structured data.
3 Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.
4 Send patient reminders per patient preference for preventive/follow-up care.
5 Provide patients with timely electronic access to their health information.
6 Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient, if appropriate.
7 Perform medication reconciliation (coordination of medications between levels of care and providers).
8 Provide a summary of care record for each transition of care or referral.
9 Submit electronic data to immunization registries or immunization information systems.
10 Submit electronic syndromic surveillance data to public health agencies.
Public health objective At least one public health objective must be selected by the provider. Public health objective At least one public health objective must be selected by the provider.
15
Clinical Quality Measures
  • 3 Core CQMs
  • Adult weight screening and follow-up
  • Blood pressure measurement 18 and over
  • Tobacco assessment and intervention
  • 3 Alternate Core (if exclude any core)
  • Childhood immunization status
  • Weight assessment and counseling (children and
    adolescents)
  • Influenza immunization (50 and older)

16
Clinical Quality Measures (Stage 1)
  • 3 of 39 Additional Measures
  • MCAH Related
  • Strep throat testing and treatment 2-18 years
  • Drug and alcohol interventionadolescents and
    adults
  • Asthma assessment
  • Asthma medications
  • HIV screening (prenatal)
  • Anti-D Immune Globulin at 26-30 weeks
  • Chlamydia screening

17
Clinical Quality Measures (beginning in 2014)
  • Report 9 of 64 in 3 of 6 domains
  • Patient and Family Engagement
  • Patient Safety
  • Care Coordination
  • Population/Public Health
  • Efficient Use of Healthcare Resources
  • Clinical Process/Effectiveness

18
Clinical Quality Measures (beginning in 2014)
  • Report 9 in 3 of 6 domains
  • Patient and Family Engagement
  • Patient Safety
  • Care Coordination
  • Population/Public Health
  • Efficient Use of Healthcare Resources
  • Clinical Process/Effectiveness

19
Clinical Quality Measures (beginning in 2014)
  • MCAH Related
  • Same as previous but have added
  • URI treatment
  • ADHD follow-up care
  • Depression screening (12 and over)
  • HBsAg prenatal testing
  • Maternal depression screening
  • Dental decay

20
A California Certified EHR?
  • Several California state programs require
    retention of forms in medical recordssuch as
    CPSP
  • For state to promote EHRs while continuing to
    require paper forms is contradictory
  • Programs and provider groups have requested these
    forms be incorporated into EHRs
  • DHCS Directors Office very supportive of this

21
A California Certified EHR?
  • First steps
  • A survey has been sent out to all DHCS programs
    as well as to CHHS departments. Results pending
  • A meeting of concerned programs will be convened
    based on the survey.
  • Will forms simply be scanned into the EHRs?
  • Will it be possible to use data entered elsewhere
    in the EHR?
  • Will vendors be willing to adopt standards?
  • Will programs be willing to review vendor
    products for compliance?
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