Lesson 10 Discussion
Discuss how meaningful use criteria tie back to goals for the healthcaresystem,giving specific examples.
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Component 1, Unit 10: Lecture b: Introduction to Health Care and Public Health in the U.S.: Meaningful Use Introduction to Health Care and Public Health in the U.S. Meaningful Use Lecture b This material (Comp 1 Unit 10) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0001. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/. Welcome to Introduction to Health Care and Public Health in the U.S.: Meaningful Use. This is lecture b. This component, Introduction to Health Care and Public Health in the U.S., is a survey of how health care and public health are organized and how services are delivered in the U.S. It covers public policy, relevant organizations and their interrelationships, professional roles, legal and regulatory issues, and payment systems. It also addresses health reform initiatives in the U.S. Health IT Workforce Curriculum Version 4.0 1 Meaningful Use Learning Objectives - 1 Define meaningful use (MU) of health information technology in the context of the Health Information Technology for Economic and Clinical Health (HITECH) Act (Lecture a) Describe the major goals of meaningful use (Lecture a) 2 The objectives for this unit, Meaningful Use, are to: Define meaningful use, or MU, of health information technology in the context of the Health Information Technology for Economic and Clinical Health, or HITECH, Act. Describe the major goals of meaningful use. Health IT Workforce Curriculum Version 4.0 2 Meaningful Use Learning Objectives - 2 Discuss the criteria for Stages 1-3 of meaningful use for eligible professionals and eligible hospitals, and critical access hospitals (Lecture b) Describe the standards specified for MU (Lectures b and c) Discuss the likely evolution of the MU program (Lecture c) 3 Discuss the criteria for Stages 1-3 of meaningful use for eligible professionals, eligible hospitals, and critical access hospitals Describe the standards specified for MU And, discuss the likely evolution of the MU program Health IT Workforce Curriculum Version 4.0 3 MU Operationalized - 1 (Warning: Information overload!) For EPs and EHs, there are three requirements to receive MU funds: Meet meaningful use objectives Stage 1 (two sets of objectives) Core objectives, all of which must be met Menu requirements, choose 5 of the 10 Stage 2 Originally had core and menu objectives but Modified Stage 2 announced in 2015 had only core objectives Draft criteria for Stage 3 also have only core objectives 4 In this lecture, we will continue our discussion of the HITECH Act and achieving meaningful use. We will discuss how the meaningful use program has been operationalized, with the warning that there is a great deal of detail included here. It's most important, though, to keep your eye on the big picture. In the meaningful use program, recall that there are eligible professionals, eligible hospitals, and critical access hospitals, and that they need to meet three requirements to receive reimbursement funds: One requirement is meeting the meaningful use objectives in the various stages. In the original Stages 1 and 2, each had two sets of objectives. The first set of objectives were the core objectives. All of the core objectives had to be met. For the second set of objectives, users could choose a required number from a larger menu of options. Recently, Stage 2 has been modified to have only core objectives. In addition, the criteria for Stage 3 have been released. In this new setup, those seeking remuneration via the meaningful use program must meet all of the objectives; there are no choices. 4 MU Operationalized - 2 (Warning: Information overload!) For EPs and EHs, there are three requirements to receive MU funds: Meet Clinical Quality Measures (CQMs) Original set in 2011, superseded by new set in 2014 for all stages of MU Meet standards designated by Office of the National Coordinator (ONC) 5 In addition to meeting the meaningful use objectives, there are clinical quality measures, or CQMs, that had to be met as part of the three requirements. In the 2011 release of the original CQMs, there was one set of CQMs for eligible hospitals and another for eligible providers. These were superseded in 2014 by expanded sets of clinical quality measures. No matter what stage an EP or EH was in, starting in 2014, all those seeking remuneration through the meaningful use program needed to meet the new clinical quality measures. The third requirement for qualifying to receive meaningful use reimbursement funds was meeting standards designated by ONC via certified electronic health records. 5 MU Stages 1-2 Stage 1 (Blumenthal & Tavenner, 2010) Objectives announced in 2010 Program began payments on January 1, 2011 for EPs October 1, 2010 for EHs Stage 2 (Metzger, 2012) Objectives announced in 2012 Start pushed back to 2014 Raised the bar, additional emphasis on patient engagement and health information exchange (HIE) 6 The original Stages 1 and 2 were announced in 2010 and 2012 respectively. The program started making payments for Stage 1 in October 2010 for eligible hospitals and in January 2011 for eligible professionals. Stage 2 was delayed a year from its original start date and began in 2014. The Stage 2 objectives were announced in 2012 and raised the bar on many of the objectives. There was also additional emphasis on patient engagement and health information exchange, or HIE. 6 MU Stages 1-2 Overview 10.1 Figure. MU stages 1-2 overview. 7 Here is another way of looking at Stages 1 and 2. Each of these stages had its specific objectives, the standards that needed to be used to achieve those objectives, and the clinical quality measures - both the original CQMs and the 2014 update. 7 MU Modified Stage 2 and Stage 3 Objectives finalized in 2015 Stages 1-2 combined into Modified Stage 2, required from 2015-2017 EPs and EHs can attest to Stage 3 starting in 2017 Uncertainty due to Medicare Access & CHIP Reauthorization Act (MACRA) of 2015 - combine all CMS quality programs, including MU, into a single program (O’Neill, 2015) 8 In 2015, the rules for Modified Stage 2 and for Stage 3 were released. Modified stage 2, in essence, combined the original Stages 1 and 2, so any EP or EH just starting down the meaningful use road, or still in Stage 1, now had to meet the objectives of Modified Stage 2, through 2017. Starting in 2017, eligible professionals and eligible hospitals can begin attesting to Stage 3. Today there is some uncertainty over the future of the meaningful use program due to the Medicare Access and CHIP Reauthorization Act, or MACRA, that was passed by Congress in 2015. MACRA calls for combining all CMS quality programs, including meaningful use, into a single program, so it's possible that meaningful use will change further in the year or two ahead. But for now, this is how the stages of meaningful use must be met to become eligible for or maintain eligibility in the meaningful use program. We will talk more about the future of the meaningful use program at the end of the last lecture. 8 Stages 2-3 Going Forward 10.1 Table. Stages 2-3 Going Forward. Table reprinted from Centers for Medicare & Medicaid Services, n.d., retrieved September 28, 2016, from https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html 9 As seen in the table on this slide, everyone already in meaningful use should be in Modified Stage 2. Those starting in 2016 and 2017 would start in Modified Stage 2. In 2017 they could actually start in Stage 3. By 2018, everyone should be in Stage 3, although this is all subject to any changes that might come from the MACRA legislation. 9 Original Stages 1-2 MU – 1 Stage 1 EPs must meet 15 core and 5 of 10 menu objectives EHs must meet 14 core and 5 of 10 menu objectives For EPs and EHs, one menu objective must be a public health measure Stage 2 EPs must meet 17 core and 3 of 6 menu objectives EHs must meet 16 core and 3 of 6 menu objectives (Blumenthal & Tavenner, 2010; Metzger, 2012) 10 Let's go back to the original Stages 1 and 2. In Stage 1, eligible professionals had to meet 15 core and 5 of 10 menu objectives. Eligible hospitals had to meet 14 core and 5 of 10 menu objectives. These were essentially the same, although hospitals were not required to carry out electronic prescribing, since they tended to prescribe within their hospital by their computerized provider order entry systems. It was also specified that for eligible professionals and eligible hospitals, one of the menu objectives needed to be a public health measure. In Stage 2, some of the measures were consolidated and some new ones were added. Now, eligible professionals had to meet 17 core and 3 of 6 menu objectives, and eligible hospitals had to meet 16 core and 3 of 6 menu objectives. 10 Original Stages 1-2 MU – 2 Most EPs and EHs met Stage 1 Stage 2 has proven more difficult (Blumenthal & Tavenner, 2010; Metzger, 2012) 11 Stage 1 requirements were achievable by most eligible professionals and eligible hospitals. Stage 2 requirements proved more difficult for many eligible professionals and eligible hospitals to meet. 11 Stage 1 MU – Core Objectives Computerized provider order entry (CPOE) E-Prescribing (eRx) Report ambulatory clinical quality measures to CMS/ States Implement one clinical decision support rule Provide patients with an electronic copy of their health information, upon request Provide clinical summaries for patients for each office visit Drug-drug and drug-allergy interaction checks Record demographics Maintain up-to-date problem list of current and active diagnoses Maintain active medication and medication allergy lists Record and chart changes in vital signs Record smoking status for patients 13 years or older Capability to exchange key clinical information among providers of care and patient-authorized entities electronically Protect electronic health information 12 This slide shows the original core objectives for Stage 1 of meaningful use. You can see the various objectives, such as recording demographics, problem lists, medication lists, and allergy lists. Also required was providing clinical summaries. Another requirement was using, to a certain level, computerized provider order entry, or CPOE, implementing clinical decision support, carrying out a security risk analysis, and reporting clinical quality measures. This was the Stage 1 of meaningful use that the early meaningful use program participants had to achieve to get their first payments under the HITECH Act. 12 Stage 1 MU – Menu Objectives - 1 For EPs and EHs Drug-formulary checks Incorporate clinical lab test results as structured data Generate lists of patients by specific conditions Medication reconciliation Summary of care record for each transition of care/referrals Use certified EHR technology to identify