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2013 EHR INCENTIVE
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2013 EHR Incentive Program Manual
Table of Contents
INTRODUCTION TO EHR & MEANINGFUL USE .............................................................................1
CMS’ EHR INCENTIVE PROGRAM - PARTICIPATION .....................................................................3
COMPARISON - MEDICARE & MEDICAID PROGRAMS .................................................................5
THE 2013 MEDICARE EHR INCENTIVE PROGRAM ........................................................................5
INCENTIVE P
PAYMENTS & PENALTY ADJUSTMENTS ....................................................................7
HARDSHIP EXEMPTIONS ...........................................................................................................8
2013 REQUIREMENTS FOR REPORTING MEANINGFUL USE ........................................................ 9
EHR SYSTEM CERTIFICATION ....................................................................................................9
STAGE 1 OBJECTIVE REQUIREMENTS ....................................................................................10
ST
CLINICAL QUALITY MEASURES ................................................................................................ 12
EHR PROGRAM REGISTRA
REGISTRATION & ATTESTATION ........................................................................ 15
2014 ST
STAGE 2 REQUIREMENTS ..................................................................................................... 17
ADDENDUM 1 – ST
STAGE 2 OBJECTIVES ......................................................................................... 18
21
ADDENDUM 2 – 2014 CLINICAL QUALITY MEASURES ................................................................
EHR INCENTIVE PROGRAM MANUAL
Thismanualcontainsinformationforthe2013EHRIncentiveProgramforphysiciansandclinicians,referredtobyCMSaseligibleprofessionalsorEPs.(Hospitalsparticipateintheirownversionoftheprogram)UpdatestoStage1,handeddownintheStage2rulingonAugust23,2012,
areincludedinthismanual.
Stage2oftheprogramdoesnotbeginuntilJanuary1,2014.Wehaveincludedsomeinformation
onStage2attheendofthemanual.However,thismanualisprimarilydesignedforEPsparticipatingintheprogramin2013.
INTRODUCTION TO EHR (ELECTRONIC HEALTH RECORDS) & MEANINGFUL USE (MU)
TheAmericanRecoveryandReinvestmentActof2009(RecoveryAct)(ARRA)wassignedintolaw
byPresidentObamaonFebruary17,2009.ThelawincludestheHealthInformationTechnology
forEconomicandClinicalHealthAct,orthe“HITECHAct,”whichestablishedprogramsunder
MedicareandMedicaidtoprovideincentivepaymentsforthe“meaningfuluse”or“MU”ofcertifiedelectronichealthrecords(EHR)technology.
OnDecember20,2009,CMS(TheCentersforMedicareandMedicaid)and ONC(OfficeoftheNa1
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tionalCoordinatorforHealthInformationTechnology)issuedtworegulationsthatlaidthefoundationforimprovingquality,efficiencyandsafetythrough“meaningfuluse”ofcertifiedelectronic
healthrecords(EHR)technology.
TheCMS’ regulation:
•DefinesandspecifieshowtodemonstrateMUofEHRtechnology,whichisapre-requisiteforreceivingtheMedicareorMedicaidincentivepayments.
•OutlinestheproposedpaymentmethodologiesforboththeMedicareandMedicaidincentiveprograms.
TheONC regulation:
•Setsinitialstandards,
•Implementsspecificationsand
•CreatescertificationcriteriaforEHRtechnologythatshouldenhancetheinteroperability,functionality,utilityandsecurityofhealthinformationtechnology.
The Recovery Act specifies the following 3 components of Meaningful Use:
1.UseofcertifiedEHRinameaningfulmannerwhichincludes:
a.theabilitytoelectronicallycapturehealthinformationinacodedformat,
b.usageofthatinformationtotrackkeyclinicalconditions,
c.implementationofclinicaldecisionsupporttoolstofacilitatediseaseandmedicationmanagement,and
d.theabilitytoreportclinicalqualitymeasuresandpublichealthinformation
2.UseofcertifiedEHRtechnologyforelectronicexchangeofhealthinformationtoimprovequalityofhealthcarewhichincludes:
a. exchanginghealthdataamongproviders,
b.providingsecurityofthatdata
3. UseofcertifiedEHRtechnologytosubmitclinicalqualitymeasures(CQM)andother
suchselectedmeasureswhichincludes:
a.usingstandardformatsforclinicalsummariesandprescriptionsandstandard
termstodescribeclinicalproblems,proceduresandtests
EHR IMPLEMENTATION STAGES
InJuly2010,CMSissuedafinalrulefortheElectronicHealthRecordsIncentiveProgramfor
Medicare and Medicaid, establishing a three-phase approach to implementing the requireahsrcm.com | 908-279-8120
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2013 EHR Incentive Program Manual
mentsfordemonstratingmeaningfuluse.Stage1wouldbeginonJanuary1,2011andthrough
arecentrulingwas extendedthrough2013. Stage 2was finalized by both CMSand ONCon
August23,2012tobeginonJanuary1,2014.Stage3isnowinthedesignstageandisslatedto
befinalizedin2016.
• Stage 1-meaningfulusecriteriafocusesonelectronicallycapturinghealthinformation
inacodedformat,usingthatinformationtotrackkeyclinicalconditionsandcommunicatingthatinformationforcarecoordinationpurposes.Italsocallsforimplementing
clinical decision support tools to facilitate disease and medication management and
reportingclinicalqualitymeasuresandpublichealthinformation.
•Stage 2 -expandsupontheStage1criteriatoencouragetheuseofhealthITforcontinuous quality improvement at the point of care and the exchange of information in
themoststructuredformatpossible,suchastheelectronictransmissionofordersenteredusingcomputerizedproviderorderentry(CPOE)andtheelectronictransmission
ofdiagnostictestresults(suchasbloodtests,microbiology,urinalysis,pathologytests,
radiology,cardiacimaging,nuclearmedicinetests,pulmonaryfunctiontestsandother
suchdataneededtodiagnoseandtreatdisease).Additionallytheymayconsiderapplyingthecriteriamorebroadlytoboththeinpatientandoutpatientsettings.
•Stage 3-focusesonpromotingimprovementsinquality,safetyandefficiencyandon
decisionsupportfornationalhighpriorityconditions,patientaccesstoselfmanagementtools,accesstocomprehensivepatientdataandimprovingpopulationhealth.
THE 2013 EHR INCENTIVE PROGRAM - PARTICIPATION
InordertoencouragetheuseofEHRsystemsinthemedicalcommunity,Medicare&Medicaid
will provide incentive payments to eligible professionals that are meaningful users of certified
EHRsystemsinordertohelpdefraythecostofinstitutingacceptableEHRsystems.TheparticipationregulationsforEPsintheMedicareandMedicaidprogramsare:
1.AnEPcanonlyparticipateineithertheMedicareorMedicaidprogram–notboth.However,aftertheinitialdesignationtoapplyforeithertheMedicareorMedicaidincentive,
EPsareallowedtochangetheirselectiononceduringpaymentyears2012-2014.
2.MedicareEligibleProfessionals’Criteria
a.Physicians-DoctorsofMedicineorOsteopathy,DentalSurgery/Medicine,PodiatristsMedicine,Optometry&Chiropractors
b.HospitalbasedEPsdoNOTqualifyforMedicareEHRincentivepayments.A
hospitalbasedEPisonewhofurnishes90%ormoreoftheirservicesinan
inpatientoremergencyroomhospitalsetting.
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c.Toreceivethemaximumincentive,anEPmustbeginparticipationby2012
3. MedicaidEligibleProfessionals’Criteria
a.Physicians – primarily medicine and osteopathy (Pediatricians have special
eligibility&paymentrules)
b.NursePractitioners(NPs),CertifiedNurse-Midwives,Dentists,
c. PhysicianAssistantswhopracticeinaFederallyQualifiedHealthCenter(FQHC)
orRuralHealthCenter(RHC)thatisledbyaPhysicianAssistant.
d. M
edicaid population must be 30% of an EPs total patient volume (billed en-
counters)toqualifyfortheMedicaidincentiveprogram(20%forpediatricians)
e.AnEPthatpracticespredominantlyinanFQHCorRHCandhavea30%patient
volumeattributabletoneedyindividuals
f.Children’s’HealthInsurancePrograms(CHIP)donotcounttowardstheMedicaidpatientvolume
4. MedicareAdvantage(MA)IncentiveCriteria
a.PaymentsmaybemadetoqualifyingMAorganizations(MAO)fortheiraffiliated
EPswhoaremeaningfulusersofcertifiedEHRtechnology.SpecificallyanMA
EPmusteither:
i.Furnish, on average, at least 20 hours/week of patient-care services
andbeemployedbythequalifyingMAO,or
ii.Beemployedby,orbeapartnerof,anentitythatthroughcontractwith
thequalifyingMAOfurnishesatleast80percentoftheentity’sMedicarepatientcareservicestoenrolleesofthequalifyingMAO
5.IfanEPprovidesservicesinmorethanonepracticeorlocation,50%ormoreofthe
EP’spatientencountersmustbeinapractice(s)orlocation(s)equippedwithcertified
EHRtechnology.
Example: If an EP works in 3 practices/locations and 2 of the 3 have certified EHR
technology,50%ormoreoftheEP’spatientencountersmustoccuratthe2locations
thathavecertifiedEHRtechnology.
6.EPswhoseepatientsinbothinpatient/ERandoutpatientsettingsandcertifiedEHR
technologyisavailableateachlocation,theEPsmustbasetheirmeaningfulusecalculationsonpatientsinonlytheoutpatientsetting(s).
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COMPARISONS OF MEDICARE & MEDICAID EHR PROGRAMS
NOTABLE DIFFERENCES BETWEEN THE MEDICARE & MEDICAID EHR PROGRAMS
MEDICARE
MEDICAID
Run by CMS
Run by Your State Medicaid Agency
$44,000 Maximum Incentive Payment per EP - Payments
over 5 consecutive years (2011 & 2012), reduced payments over less years for 2013 - 2016
$63,750 Incentive Payment per EP - Payments over 6
years, does not have to be consecutive
Payment adjustments will begin in 2015 for providers
who are eligible but decide not to participate
No Medicaid payment adjustments
Providers must demonstrate meaningful use every year
to receive incentive payments.
In the first year providers can receive an incentive payment for adopting, implementing, or upgrading EHR
technology. Providers must demonstrate meaningful use
in the remaining years to receive incentive payments
Last year EP can initiate program is 2014
Last year EP can initiate program is 2016
Last payment year in program is 2016
Last payment year in program is 2021
Payment adjustments begin in 2015
No Payment adjustments
Only Physicians
5 Types of EPs
LIMITATIONS OF PARTICIPATION IN MULTIPLE INCENTIVE PROGRAMS
PARTICIPATION IN HITECH AND OTHER MEDICARE INCENTIVE PROGRAMS
OTHER EHR MEDICARE INCENTIVE PROGRAM
ELIGIBLE FOR HITECH?
PQRS
Yes, EPs can participate in both if eligible
eRx (E-prescribe)
No - if the EP chooses to participate in the MEDICARE
EHR Incentive Program, they cannot participate in the
eRx program simultaneously
eRx (E-prescribe)
Yes - If the EP chooses to participate in the MEDICAID
EHR Incentive program
THE MEDICARE EHR INCENTIVE PLAN
NOTE:AsmostofourclientswillnotparticipateintheMedicaidIncentiveProgram,theremainderofthismanualwillfocusonlyontheMedicareIncentiveProgram.Thoseinterestedinthe
Medicaid Incentive Program should visit CMS’ EHR Incentive Program website and review the
EHR BasicsandMedicaid State Informationsubcategories.
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ToqualifyforMedicareincentivepayments,theEPmustmeaningfullyusecertifiedEHRtechnologyforthedurationoftheEHRreportingperiodoftherelevantpaymentyear.Thereporting
periodmaybeanycontinuous90-dayperiodormorewithinthefirstpaymentyear,andtheentire
calendaryearforallsubsequentyears.Example:IftheEPwantedtoreportfortheyear2013,the
lastreportingperiodfor2013wouldbeginonOctober1,2013.
Intheoriginalfinalrule,CMShadestablishedatimelinethatrequiredproviderstoprogressto
Stage2criteriaaftertwoprogramyearsundertheStage1criteria.Thisoriginaltimelinewould
haverequiredMedicareproviders who first demonstrated meaningful use in 2011 to meet the
Stage2criteriain2013.
UndertherecentStage2FinalRule,CMSdelayedtheonsetofStage2criteriaforEPsuntilfiscal
year2014.ThisallowsproviderswhofirstdemonstratedMUin2011tohavethreeconsecutive
yearsofMUundertheStage1criteriabeforeadvancingtoStage2criteria.Allotherproviders
wouldmeettwoyearsofmeaningfuluseundertheStage1criteriabeforeadvancingtotheStage
2criteriaintheirthirdyear.
•FirstYearofparticipation–providersmustdemonstrateMUfora90-DayEHRreportingperiod.
•Subsequentyears-fullyearreportingperiod(entirecalendaryear),exceptfor2014
In the Stage 2 ruling, CMS made an exception for the year 2014 requiring only a three-month
reportingperiodforthatyearinorderforEPstomakethenecessarychangestotheirsystems,
regardlessoftheirstageofMU.Thethree-monthEHRreportingperiodisfixedtocalendaryear
quartersinordertoalignwithexistingCMSqualitymeasurementprogramssuchasPQRS.2014is
theonlytimeCMSwillpermitthisthree-monthreportingperiod.Thefollowingtableillustratesthe
progressionofMUstagesfromwhenaMedicareproviderbeginsparticipationwiththeprogram.
STAGE OF MEANINGFUL USE BY FIRST MEDICARE PAYMENT YEAR
1st Year
2011
2012
STAGE OF MEANINGFUL USE BY FIRST MEDICARE PAYMENT YEAR
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2013
1
1
1
2
2
3
3
TBD
TBD
TBD
TBD
1
1
2
2
3
3
TBD
TBD
TBD
TBD
1
1
2
2
3
3
TBD
TBD
TBD
1
1
2
2
3
3
TBD
TBD
1
1
2
2
3
3
TBD
1
1
2
2
3
3
1
1
2
2
3
2013
2014
2015
2016
2017
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PAYMENT & ADJUSTMENT PROVISIONS OF THE EHR INCENTIVE PLAN
MEDICARE PAYMENT INCENTIVES
Paymentprovisionsforqualifiedprovidersareasfollows:
•Providersmayearnincentivepaymentequalto75%oftheirMedicareallowedcharges
forcoveredservicesfurnishedbytheproviderinayear,subjecttothemaximumpaymentasstatedinthefollowingchart.
•ThoseEPswhoattestandsuccessfullyadoptMUin2011and2012aretheonlyEPswho
willreapthehighestincentiveof$44,000perEP.ProvidershaduntilOctober1,2012to
demonstrate90daysofMUwiththeirEHRtoqualifyforthefull$44,000per-provider
Medicarebonus.
•Thosewhobegintheprocessin2013canearnamaximumof$39,000andin2014,$24,000.
•TherewillbenoincentivepaymentstoEPswhofirstbecomemeaningfulEHRusersin
2015orthereafter.
MEDICARE & MAO
FIRST CALENDAR YEAR IN WHICH EP RECEIVES INCENTIVE PAYMENT
CALENDAR YEAR
2011
2011
$18,000
2012
$12,000
$18,000
2013
$8,000
$12,000
$15,000
2014
$4,000
$8,000
$12,000
$12,000
2015
$2,000
$4,000
$8,000
$8,000
$0
$2,000
$4,000
$4,000
$0
$44,000
$39,000
$24,000
$0
2016
TOTAL
$44,000
2012
2013
2014
2015 & later
Additional incentives are made for Medicare EPs practicing in HPSAs. (Health Professional
ShortageArea)
MEDICARE PAYMENT ADJUSTMENTS (PENALTIES)
For2015andlater,MedicareEPswhoarenotmeaningfulusersofCertifiedEHRtechnologyby
2014willfaceMedicarepaymentreductionsin2015.(unlesstheEPissuccessfullyparticipating
intheMedicaidEHRIncentiveProgram)
EPswhofirstdemonstratedMUin2011or2012mustdemonstrateMUforafullyearin2013to
avoidpaymentadjustmentsin2015andmustcontinuetodemonstrateMUeveryyeartoavoid
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paymentadjustmentsinsubsequentyears.
ThepaymentadjustmentswillbeappliedtotheMedicarephysicianfeeschedule(PFS)amount
forcoveredprofessionalservicesfurnishedbytheEPduringtheyear.Thepaymentadjustment
is1%peryearandiscumulativeforeveryyearanEPisnotameaningfuluser.For2018and
thereafter,ifitisfoundthattheproportionofproviderswhoareMedicareEHRusersislessthan
75%,thenreductionswillincreaseby1%eachyearbutnotbymorethan5%overall.Payment
adjustmentswillbeasfollows:
•1%in2015,
•2%in2016,
•3%in2017,
•4%in2018,and
•between3-5%insubsequentyears.
HARDSHIP EXEMPTIONS
Inthe“proposed“Stage2period,inadditiontothoseEPswhopetitionedCMSandONCtonot
penalizeEPsinunusualcircumstances,manyspecialtyorganizationspetitionedCMSandONC,
torefocustheEHRobjectivesorexemptthemfromtheprogramastheprogram’sobjectives
favoredprimarycareanddidnotmatchtheirspecialties’environment.TheresultofbothrequestswasthecreationoffourhardshipexemptionsinthefinalStage2ruling.Thesehardship
exemptionswillbegrantedonlyunderspecificcircumstancesandonlyifCMSdeterminesthat
providershavedemonstratedthatthosecircumstancesposeasignificantbarriertotheirachievingMU.Thefourexemptionsare:
• Infrastructure: Clinicians must prove that they practice in an area with inadequate
internetaccessor“insurmountablebarriers”toobtainingit
• New Practitioners:Clinicianswhobeginpracticingin2015wouldbeexemptfromthe
MUpenaltyin2015and2016,butwouldhavetodemonstrateMUin2016toavoidthe
penaltyin2017.
• Unforeseen Circumstances:NaturaldisasterorsomeotherunforeseeableeventthatpreventsmeetingEHRMUcriteria.CMSwillconsiderthisexceptiononacase-by-casebasis.
• Scope of Practice: EPswhodonotseepatientsface-to-faceorwhopracticeinmultiple
locationswheretheyhavenocontrolovertheavailabilityofEHRtechnology.
>The face-to-face exemption is directed towards Anesthesiologists, Pathologists,andRadiologistsandtheseEPsmustberegisteredinMedicare’sPro-
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viderEnrollmentChainandOwnershipSystem(PECOS)withaprimaryspecialtyofanesthesiology,pathologyorradiology.
>ThemultiplelocationsexemptioncoversEPswhoseepatientsinmultiplelocationssuchasASCsornursinghomeswheretheEPhasnointerestorsay
inwhetherthefacilitiesinstallcertifiedEHRsystemsfortheiruse.Asthese
facilities are not required under the EHR Programs to be EHR certified, the
EPswouldbeartheentireimpactofanypaymentadjustment.
>TherulingstatesthattheScopeofPracticeexemptionsmaynotbeawarded
formorethan5years.CMSwillregularlyassessmeaningfulusecompliance
levelsandtheoverallstateofhealthinformationexchangeandmaymakeregulatory changes or develop new guidance that would eliminate the need for
thisexception.Newlegislationmustbepassedinordertomakethisexemptionpermanent.
Thedeadlinetoapplyfortheexemptionfromthe2015paymentadjustmentisJuly1,2014.However,CMShasnotyetpublishedtheapplicationprocess.
THE REQUIREMENTS FOR REPORTING MEANINGFUL USE
EHR SYSTEMS MUST BE CERTIFIED FOR CMS REGULATIONS
EPsmustuseEHRsystemsthathavebeencertifiedtomeettheCMSregulationsinordertoreceiveincentivemoney.CMShasapproved6organizationstoperformCompleteEHRand/orEHR
Moduletestingandcertification.TheseONC-AuthorizedTestingandCertificationBodies(ATCBs)
arerequiredtotestandcertifyEHRstotheapplicablecertificationcriteriaadoptedbytheSecretaryundersubpartCofPart170PartIIandPartIIIasstipulatedintheStandards and Certification
Criteria Final Rule
ThefollowingorganizationshavebeenselectedasONC-(ATCBs):
• Surescripts LLC-Arlington,VA
Dateofauthorization:December23,2010.
Scopeofauthorization:EHRModules:E-Prescribing,PrivacyandSecurity.
• ICSA Labs-Mechanicsburg,PA
Dateofauthorization:December10,2010.
Scopeofauthorization:CompleteEHRandEHRModules.
• SLI Global Solutions-Denver,CO
Dateofauthorization:December10,2010.
Scopeofauthorization:CompleteEHRandEHRModules.
• InfoGard Laboratories, Inc.–SanLuisObispo,CA
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Dateofauthorization:September24,2010.
Scopeofauthorization:CompleteEHRandEHRModules.
•Certification Commission for Health Information Technology (CCHIT)-Chicago,IL
Dateofauthorization:September3,2010.
Scopeofauthorization:CompleteEHRandEHRModules.
•Drummond Group, Inc. (DGI)-Austin,TX
Dateofauthorization:September3,2010.
Scopeofauthorization:CompleteEHRandEHRModules.
TheCertified Health IT Product ListlistsallEHRsystemsthathavebeencertifiedfortheEHR
IncentiveProgram.Thisonlinelistofcertifiedelectronichealthrecordtechnologyisupdatedas
ONC-ATCBscertifynewproducts.
2013 REQUIREMENTS FOR STAGE 1 OF MEANINGFUL USE
1.Thereareatotalof25meaningfuluseobjectives(CoreandMenu-set)forEPs.Theseobjectives
werecreatedtoshowhowwellaproviderisusingEHRbyensuringbasicpatientinformation
iscapturedinthemedicalrecordandenteredintotheEHRsystem.Toqualifyforanincentive
payment,20ofthese25objectivesmustbemet.
2.EPsmustalsoreportonatotalof6quality measures:3requiredcoremeasures(substituting
alternatecoremeasureswherenecessary)and3additionalmeasures.Amaximumof9measureswouldbereportediftheEPneededtoattesttothe3requiredcore,the3alternatecore
andthe3additionalmeasures
CORE & MENU-SET OBJECTIVES
InordertobeameaningfuluserinStage1,anEPmustreportboththerequired15“coreset”and
5“menuset”objectives(outof10)thatarespecifictoeligibleprofessionals(EPs).TheStage2
RulingmadesomechangestothecurrentStage1objectiveswhichwillbecomeeffective January
1, 2013. Thechangesarelistednexttotheapplicableobjective.
CORE OBJECTIVES - EPS ARE REQUIRED TO REPORT THE FOLLOWING 15 EHR OBJECTIVES
1.ComputerizedProviderorderentry(CPOE)-CMSisaddinganoptionalalternatemeasure.The
currentmeasureisbasedonthenumberofuniquepatientswithamedicationintheirmedicationlistthatwasenteredusingCPOE.ThenewmeasureisbasedonthetotalnumberofmedicationorderscreatedduringtheEHRreportingperiods.
2.Drug-druganddrug-allergyinteractionchecks
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3.Maintainanup-to-dateproblemlistofcurrentandactivediagnoses
4.Electonic-prescribing-CMSisaddinganadditionalexclusionforproviderswhoarenotwithin
a10mileradiusofapharmacythatacceptselectronicprescriptions.
5.Maintainactivemedicationlist
6.Maintainactivemedicationallergylist
7.Recorddemographics
8.Recordandchartchangesinvitalsigns(optional in 2013) -Thecurrentmeasurespecifiesthat
vitalsignsmustberecordedformorethan50percentofalluniquepatientsages2andover.The
newmeasureamendsthatagelimittorecordingbloodpressureforpatientsages3andover
andheightandweightforpatientsofallages.Theexclusionsarealsochanging.
9.Recordsmokingstatusforpatients13yearsandolder
10.ReportambulatoryclinicalqualitymeasurestoCMS/States- Therewillnolongerbeasepa-
rate objective for reporting ambulatory CQMs as part of MU. The objective is incorporated
directlyintothedefinitionofameaningfulEHRuser.
11.Implementoneclinicaldecisionsupportrule
12.Providepatientswithanelectroniccopyoftheirhealthinformation,uponrequest
13.Provideclinicalsummariesforpatientsforeachofficevisit
14.Capabilitytoexchangekeyclinicalinformationamongprovidersofcareandpatient-authorized
entitieselectronically-TheobjectivewillnolongerberequiredforStage1.
15.Protectelectronichealthinformation
MENU-SET OBJECTIVES - Providers must choose 5 EHR objectives from the following menu:
1.Drug-formularychecks
2.Incorporateclinicallabtestresultsasstructureddata
3.Generallistsofpatientsbyspecificconditions
4.Sendreminderstopatientsperpatientpreferenceforpreventive/followupcare
5.Providepatientswithtimelyelectronicaccesstotheirhealthinformation
6.Use certified EHR technology to identify patient-specific education resources and provide to
patient,ifappropriate
7.Medicarereconciliation
8.Summaryofcarerecordforeachtransitionofcare/referrals
9.Capabilitytosubmitelectronicdatatoimmunizationregistries/systems*
10.Capabilitytoprovideelectronicsyndromicsurveillancedatatopublichealthagencies*
*AlloftheStage1publichealthobjectiveswillrequirethatprovidersperformatleastonetestof
theircertifiedEHRTechnology’scapabilitytosenddatatopublichealthagencies,exceptwhere
prohibited.
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Core and Menu Set Exclusions
IfanEPcannotmeetaspecificMUobjectivebecauseitisoutsidethescopeoftheirpracticethey
maypossiblybeallowedtoexemptthatobjective.Forthe13ofthe25criteriathathaveexclusions,
CMSdesignatesnarrowwindowsforphysicianstoreportthattheobjectiveormeasuredoesnot
applytothembecausetheyhavenopatients,ornoorinsufficientnumberofactionsthatwould
allowcalculationofthemeaningfulusemeasure.Twoexamplesare
•Aphysicianwhohasnopatientsage65orolderorage5oryoungerwouldnothaveto
meettherequirementtosendanappropriatereminderto20percentormoreofallpatientsinthoseagegroupsduringtheEHRreportingperiod.
•AnEPmustwriteatleast100prescriptionstobeeligibleforthee-prescribingobjective.
IfanEPdoesnotwrite100prescriptions,he/shecanbeexemptfromthatobjective.
Notall objectivescanbeexcludedbutifanobjectiveisexempt,itcancountthesameasifthat
objectivewasmet.Intheaforementionedexamples,theEPmaygivetheobjectivea“0”andthen
reportontheremaining19objectives.
Detaileddescriptionsofallthecoreandmenu-setobjectivesincludingthenumerators,denominators,thresholdsandexclusionscanbefoundatEHRIncentivePrograms.Attestationrequirementsarealsolisted.
CLINICAL QUALITY MEASURES (CQMs)
SimilartoPQRS,aspartofthecriteriaforsatisfyingmeaningfuluse,clinicalqualitymeasures
resultsmustalsobereportedtoCMSinadditiontotheCoreandMenuobjectives..
InordertoreportqualitymeasuresfromanEHR,electronicspecificationsweredevelopedthat
includethedataelements,logic,anddefinitionsforthatmeasureinaformatthatcanbecaptured
orstoredintheEHRsothatthedatacanbesentorsharedelectronicallywithotherentitiesina
structured,standardized,andunalteredformat.
Eachelectronicspecificationcontainsthefollowing4maincomponents
•MeasureOverview/Description–Measuretitle,description,number,measurementperiod,measuresteward,andotherrelevantinformationtothemeasure.
•MeasureLogic–populationcriteriaandmeasurelogicforthenumerator,denominator
andexclusioncategoriesandthealgorithmusedtocalculateperformance
•MeasureCodelists
•QDS(QualityDataSets)Elements–listsanddescribeseachQualityDataSet(QDS)data
elementassociatewiththemeasure.
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TheGuide for Reading EP measures andeachmeasureanditscomponentscanbeviewedinthe
downloadsectionofthe Quality Measure Specifications site.Bothofthefollowingtwodocuments
shouldbeviewedtounderstandtheelectronicmeasuresapplicabletoyourpractice.(Thexxxbelowisthemeasurenumber)
1. NQF_HQMF_HumanReadable_xxx.pdf-ThisfilecontainstheeMeasurespecifications
includingmeasurebackgroundinformation,requireddataelements,measurelogicand
measurecalculationinstructions.
2. NQF_Retooled_Measure_xxx.xls–Thisfilecontainsallofthecodelists(asynonymfor
valuesets)referencedbyallQDSdataelementsintheeMeasures.
Reporting Quality Measures
EPsmustreporton3requiredCoreQualityMeasures(CQMs),andifthedenominatorofoneor
moreoftherequiredcoremeasuresis0,thentheEPsarerequiredtoreportresultsforupto3
alternatecoremeasures(ACMs).
Inaddition,EPsmustalsoselect3additionalCQMsfromasetof38CQMs(excludingthecore/
alternatecoremeasures.)Itisacceptabletohave‘0’denominatorsprovidedtheEPdoesnothave
anapplicablepopulation.
Core Quality Measures-NQF(NationalQualityForum)MeasureNumber&PQRSImplementationNumber/ClinicalMeasureTitle)
1.NQF0013-HypertensionBloodPressureMeasurement
2.NQF0028–PreventiveCareandScreeningMeasurePair
a.TobaccoUseAsessment
b. TobaccoCessationIntervention
3.NQF0421,PQRS128–AdultWeightScreeningandFollow-up
Alternate Core Quality Measures - (NQF Measure Number & PQRS Implementation Number/
ClinicalMeasureTitle)
1. NQF0024–WeightAsssessmentandCounselingforChildrenandAdolescents
2.NQF0041–PQRI110–PreventiveCare&Screening;InfluenzaImmunizationforPatients50Yearsoldandolder
3. NQF0038–ChildhoodImmunizationStatus
CLINICAL QUALITY MEASURES – EPS MUST COMPLETE 3 OF THE 38 MEASURES
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1.Diabetes:HemoglobinA1cPoorControl
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2.Diabetes:LowDensityLipoprotein(LDL)ManagementandControl
3.Diabetes:BloodPressureManagement
4.HeartFailure(HF):Angiotensin-ConvertingEnzyme(ACE)InhibitororAngiotensinReceptorBlocker(ARB)TherapyforLeftVentricularSystolicDysfunction(LVSD)
5.CoronaryArteryDisease(CAD):Beta-BlockerTherapyforCADPatientswithPriorMyocardialInfarction(MI)
6.PneumoniaVaccinationStatusforOlderAdults
7.BreastCancerScreening
8.ColorectalCancerScreening
9.CoronaryArteryDisease(CAD):OralAntiplateletTherapyPrescribedforPatientswithCAD
10.HeartFailure(HF):Beta-BlockerTherapyforLeftVentricularSystolicDysfunction
11.Anti-depressantmedicationmanagement:
(a)EffectiveAcutePhaseTreatment,
(b)EffectiveContinuationPhaseTreatment
12.PrimaryOpenAngleGlaucoma(POAG):OpticNerveEvaluation
13.DiabeticRetinopathy:DocumentationofPresenceorAbsenceofMacularEdemaand
LevelofSeverityofRetinopathy
14.DiabeticRetinopathy:CommunicationwiththePhysicianManagingOngoingDiabetesCare
15.AsthmaPharmacologicTherapy
16.AsthmaAssessment
17.AppropriateTestingforChildrenwithPharyngitis
18.OncologyBreastCancer:HormonalTherapyforStageIC-IIICEstrogenReceptor/ProgesteroneReceptor(ER/PR)PositiveBreastCancer
19.OncologyColonCancer:ChemotherapyforStageIIIColonCancerPatients
20.SmokingandTobaccoUseCessation,MedicalAssistance:
a)AdvisingSmokersandTobaccoUserstoQuit,
b)DiscussingSmokingandTobaccoUseCessationMedications,
c)DiscussingSmokingandTobaccoUseCessationStrategies
21.Diabetes:EyeExam
22.Diabetes:UrineScreening
24.Diabetes:FootExam
25.CoronaryArteryDisease(CAD):DrugTherapyforLoweringLDL-Cholesterol
26.HeartFailure(HF):WarfarinTherapyPatientswithAtriaFibrillation
27.IschemicVascularDisease(IVD):BloodPressureManagement
28.IschemicVascularDisease(IVD):UseofAspirinorAnotherAntithrombotic
29.InitiationandEngagementofAlcoholandOtherDrugDependenceTreatment:
a)Initiation,
b)Engagement
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30.PrenatalCare:ScreeningforHumanImmunodeficiencyVirus(HIV)
31.PrenatalCare:Anti-DImmuneGlobulin
32.ControllingHighBloodPressure
33.CervicalCancerScreening
34.ChlamydiaScreeningforWomen
35.UseofAppropriateMedicationsforAsthma
36.LowBackPain:UseofImagingStudies
37.IschemicVascularDisease(IVD):CompleteLipidPanelandLDLControl
38.Diabetes:HemoglobinA1cControl(<8.0%)
Clinical Quality Measures Exclusions
Iftherequiredcore,alternatecore,orothermeasuresdonotencompassthetypeofpatientsthat
anEPtypicallysees,theEPmayassignazerovalue.CMS’guidancestates:“Aneligibleprofessional(EP)isnotexcludedfromreportingcoreclinicalqualitymeasures.However,zeroisanacceptablevaluetoreportforthedenominatorofaclinicalqualitymeasureifthereisnopatientpopulationwithintheEHRtowhomthatclinicalqualitymeasureapplies.Intheeventthatnoneofthe
44clinicalqualitymeasuresappliestoanEP’spatientpopulation,theEPisstillrequiredtoreport
azeroforthedenominatorsforallsixofthecoreandalternatecoreclinicalqualitymeasures.”..
REGISTRATION & ATTESTATION FOR THE MEDICARE EHR PROGRAM
REGISTRATION
CMSstatesallEPsshouldregisterfortheprogrameveniftheyarenotyetonanEHRsystem.An
EPmustberegisteredinPECOSbeforeregisteringfortheEHRIncentiveProgram.
ToregisterforEHR,thefollowinginformationisneededforeachEP
•NationalProviderIdentifier(NPI).
•NationalPlanandProviderEnumerationSystem(NPPES)UserIDandPassword.
•PayeeTaxIdentificationNumber(ifyouarereassigningyourbenefits).
•PayeeNationalProviderIdentifier(NPI)(ifyouarereassigningyourbenefits).
Ifyouhavenotyetregistered,seetheRegistration User Guide for Medicare Eligible Professionals
forstep-by-stepregistrationinstructions.
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ATTESTATION & eREPORTING
TherearetworeportingmethodsavailableforreportingtheStage1measures;Attestationand
eReportingPilots.
Attestation - EPs must be registered and have decided which objectives and quality measures
theywillperformbeforecanattestthattheyareusingacertifiedEHRproduct.AttestationrequirescompletingtheAttestationandPaymentform.CMSwillallowanEPtodesignateathird
partytoregisterandattestonhisorherbehalf.
ThiswillrequiretheappointedpartytohaveanIdentityandAccessManagementSystem(I&A)
webuseraccount(UserID/Password),andbeassociatedtotheEP’sNationalProviderIdentifier
(NPI).IftheappointedpersondoesnothaveanI&Awebuseraccount,visitthefollowingwebsite
tohaveonecreated.
https://nppes.cms.hhs.gov/NPPES/IASecurityCheck.do
CMSoffersthefollowingguidebooksofferingstep-by-stepinstructionstoassistEPstoregister
andattesttotheEHRIncentiveProgram.
Attestation User Guide for Medicare Eligible Professionals
For more information on webinar tutorials, attestation worksheets and calculators, visit CMS’
Registration & Attestation site.
eReporting Pilots–ParticipationintheeReportingPilotisvoluntaryandenablesEPstoreport
EHRMUandPQRSqualitymeasurestogetherandwouldsatisfyrequirementsofboththeMUand
PQRSprograms.ThekeydifferencesbetweenthepilotandreportingMUandPQRSseparately:
•Reportingperiodistheentireyear
•DataissubmittedonMedicareBpatientsonly
•ReportthequalitymeasuresrequiredforMU
ProvidersmustindicatetheirintenttoparticipateviatheMUattestationpage.
Tolearnmoreaboutthisreportingfeatures,clickbelow:
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/
downloads/2012PQRS_MedicareEHR-IncentPilot_Final508_1-13-2012.pdf
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STAGE 2 – JANUARY 1, 2014
Stage1criteriafocusesonelectronicallycapturinghealthinformationinacodedformatandusingthatinformationtotrackkeyclinicalconditionswhilecommunicatingthatinformationforcare
coordinationpurposes.Stage2expandsuponStage1toencouragetheuseofhealthITforcontinuous quality improvement at the point of care and the exchange of information in the most
structuredformatpossible.
Toaccomplishthis,Stage2willstillrequiremeeting20objectives.Theseobjectiveswillmake
mandatorysomeEHRmeasuresthatareoptionalforStage1aswellasupgradeStage1measurestohigherthresholds.
Thenumberofrequiredcoresetmeasuresisincreasedto17from15,withEPsreporting3outof
6additionalmenusetmeasures.
COREOBJECTIVES
•9ofthecurrentStageOne15CoreObjectivesremain
•7ofthe10currentmenuobjectiveswillbecomeCoreobjectives
•1newcoreobjectivewillbeadded
•6ofthecurrentCoreObjectiveswereeitherdeletedorincorporatedintootherobjectives
MENUOBJECTIVES
•1ofthecurrentmenuobjectiveswillremain
•5newobjectiveswillbeadded
Inaddition,EPsmustreporton9outof64totalclinicalqualitymeasures(CQMs),selectingthem
fromatleast3ofthe6keyhealthcarepolicydomains.
Formoreinformation,seethe Stage 1 vs. Stage 2 ComparisonchartofferedbyCMSandseethe
Stage2CoreandMenuObjectivesinAddendum1.
CLINICALQUALITYMEASURES(CQMs)
•In2014,EPsmustreporton9outof64totalclinicalqualitymeasures(CQMs),selecting
themfromatleast3ofthe6keyhealthcarepolicydomains.SeeAddendum2forthe
2014CQMs.
Other Stage 2 Changes
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• Electronically reporting CQMs-Beginningin2014,allMedicareEPsbeyondtheirfirst
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yearofdemonstratingMUmustelectronicallyreporttheirCQMdatatoCMS.
• Definition Change of Hospital-Based EP–EPswhocandemonstratethattheyfundthe
acquisition,implementation,andmaintenanceofCEHRT(certifiedelectronichealthrecordtechnology),includingsupportinghardwareandinterfacesneededformeaningful
usewithoutreimbursementfromaneligiblehospitalorCAH,inlieuofusingthehospital’sCEHRT,canbedeterminednon-hospital-basedandpotentiallyreceiveanincentive
payment.
• Adoption of 2014 Technology Criteria - All EHR Incentive Programs participants will
havetoadoptcertifiedEHRtechnologythatmeetsONC’sStandards&CertificationCriteria2014FinalRule
• Reporting Period Reduced to Three Months–toallowproviderstimetoadopt2014certifiedEHRtechnologyandprepareforStage2,allparticipantswillhaveathreemonth
reportingperiodin2014.Thiswillonlyoccurin2014.
• Menu Objective Exclusions–WhileEPsmaycontinuetoclaimexclusionsifapplicable
formenuobjectives,startingin2014,theseexclusionswillnolongercounttowardsthe
numberofmenuobjectivesneededifthereareothermenuobjectiveswhichtheycan
select.EPswillnotbepenalizedforselectingamenuobjectiveandclaimingtheexclusioniftheywouldalsoqualityfortheexclusionsforalltheremainingmenuobjectives.
• Batch Reporting-Startingin2014,groupswillbeallowedtosubmitattestationinformationforalloftheirindividualEPsinonefileforuploadtotheAttestationSystem,rather
thanhavingeachEPindividuallyenterdata.
ADDENDUM 1 - STAGE 2 EHR INCENTIVE PROGRAM
17 CORE OBJECTIVES (EPs must report on all)
Current Core Objectives Remaining in Stage 2
1.ComputerizedProviderOrderEntry(CPOE)(Morethan60%ofmedication,30%oflabs,
30%ofradiology)
2.E-prescribing(morethan50%ofprescriptions)
3.Recordpatientdemographicinformation(>80%uniquepatients(UP))
4.Recordandchartchangesinvitalsigns(>80%UP)
5.Recordsmokingstatusforpatients13yearsorolder(>80%UP)
6.Useclinicaldecisionsupport(5interventions&drug/drug,drug/allergy)
7.PatientElectronicAccesstotheirhealthinformation(>75%UPwith>5%accessing)
8.Provideclinicalsummariesforpatientsforeachofficevisit(>50%ofvisits)
9.Protectelectronichealthinformation
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Current Menu Objectives Upgraded to Core Objectives
10.IncorporateclinicallabtestresultsintoEHR(>55%)
11.Generatelistsofpatientsbyspecificconditions
12.Sendreminderstopatientsperpatientpreferenceforpreventive/followupcare(10%
w/2ormorevisits)
13.UsecertifiedEHRtechnologytoidentifypatient-specificeducationresources(>10%)
14.Medicationreconciliation(>50%)
15.Summaryofcarerecordforeachtransitionofcare/referral
16.Capabilitytosubmitelectronicdatatoimmunizationregistries/systems*
New Objective
17.Use Secure electronic messaging to communicate with patients on relevant health
information(>5%)
6 MENU OBJECTIVES (EPs must report on 3 of these objectives)
Current Menu Objective Remaining in Stage 2
1.Submitelectronicsyndromicsurveillancedatatopublichealthagencies
New Menu Objectives
2.Recordelectronicnotesinpatientrecords(>30%UP)
3.ImagingresultsaccessiblethroughCEHRT(>10%imagingresults)
4.Recordpatientfamilyhealthhistory(>20%UP)
5.IdentifyandreportcancercasestoaStatecancerregistry
6.Identifyandreportspecificcasestoaspecializedregistry(otherthanacancerregistry)
DELETED OBJECTIVES:
Thefollowingcurrentcoreobjectiveswereeitherdeletedorincorporatedintootherobjectives
forStage2.
1.Drug-druganddrug-allergyinteraction(IncorporatedintoCoreObjective#6)
2.Maintainanup-to-dateproblemlistofcurrentandactivediagnoses(Incorporatedinto
Stage2objective#15)
3.Maintainactivemedicationlist(IncorporatedintoCoreObjective#15)
4.Maintainanactivemedicationallergylist(incorporatedintoCoreObjective#15)
5.Report ambulatory clinical quality measures (CQMs) to CMS/States (Removed as an
objectivebutismandatedasageneralpartofEHR)
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authorizedentitieselectronically(EliminatedinbothStage1&2)
7.Implementdrug-formularychecks(Menu)–(IncorporatedintoCoreObjective2)
8.Providepatientswithtimelyelectronicaccesstotheirhealthinformationwithin4businessdaysofinformationbeingavailabletoEP(Menu)(EliminatedfromStage1in2014
andnolongeranobjectiveforStage2)
CLINICAL QUALITY MEASURES (CQMs) FOR 2014
The64final2014qualitymeasuresarelistedinAddendum2.
HEALTH CARE POLICY DOMAINS
Stage2willoffer64clinicalqualitymeasuresofwhichEPsmustreportonatleast9.The9measuresmustbeselectedfromatleast3ofthefollowing6healthcarepolicydomains.
1.PatientandFamilyEngagement
2.PatientSafety
3.CareCoordination
4.PopulationandPublicHealth
5.EfficientUseofHealthcareResources
6.ClinicalProcesses/Effectiveness
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ADDENDUM 2 – 2014 CLINICAL QUALITY MEASURES (CQMs)
Italicizes measures were either available or very similar to the measures introduced in Stage
1. The 4-digit number is the NQF (National Quality Forum) clinical measure number.
Detailed information such as the measure description, numerator and denominator statements,
and the measure steward may be found on the CMS website.
1.0002AppropriateTestingforChildrenwithPharyngitis
2.0004InitiationandEngagementofAlcoholandOtherDrugDependenceTreatment
3.0018ControllingHighBloodPressure
4.0022UseofHigh-RiskMedicationsintheElderly
5.0024WeightAssessmentandCounselingforNutritionandPhysicalActivityforChildrenandAdolescents
6.0028PreventiveCareandScreening:TobaccoUse:ScreeningandCessationIntervention
7.0031BreastCancerScreening
8.0032CervicalCancerScreening
9.0033ChlamydiaScreeningforWomen
10.0034ColorectalCancerScreening
11.0036UseofAppropriateMedicationsforAsthma
12.0038ChildhoodImmunizationStatus
13.0041PreventiveCareandScreening:InfluenzaImmunization
14.0043PneumoniaVaccinationStatusforOlderAdults
15.0052UseofImagingStudiesforLowBackPain
16.0055Diabetes:EyeExam
17.0056Diabetes:FootExam
18.0059Diabetes:HemoglobinA1cPoorControl
19.0060HemoglobinA1cTestforPediatricPatients
20.0062Diabetes:UrineProteinScreening
21.0064Diabetes:LowDensityLipoprotein(LDL)Management
22.0068IschemicVascularDisease(IVD):UseofAspirinorAnotherAntithrombotic
23.0069AppropriateTreatmentforChildrenwithUpperRespiratoryInfection(URI)
24.0070CoronaryArteryDisease(CAD):Beta-BlockerTherapy—PriorMyocardialInfarc-
tion(MI)orLeftVentricularSystolicDysfunction(LVEF<40%)
25.0075IschemicVascularDisease(IVD):CompleteLipidPanelandLDLControl
26.0081HeartFailure(HF):Angiotensin-ConvertingEnzyme(ACE)InhibitororAngio-
tensinReceptorBlocker(ARB)TherapyforLeftVentricularSystolicDysfunction(LVSD)
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27.0083HeartFailure(HF):BetaBlockerTherapyforLeftVentricularSystolicDysfunc-
tion(LVSD)
28.0086PrimaryOpenAngleGlaucoma(POAG):OpticNerveEvaluation
29.0088DiabeticRetinopathy:DocumentationofPresenceorAbsenceofMacularEdema
andLevelofSeverityofRetinopathy
30.0089Diabetic Retinopathy: Communication with the Physician Managing Ongoing
DiabetesCare
31.0101Falls:ScreeningforFutureFallRisk
32.0104MajorDepressiveDisorder(MDD):SuicideRiskAssessment
33.0105Anti-depressantMedicationManagement
34.0108A
DHD: Follow-Up Care for Children Prescribed Attention Deficit/Hyperactivity
Disorder(ADHD)Medication
35.0110BipolarDisorderandMajorDepression:Appraisalforalcoholorchemicalsubstanceuse
36.0384Oncology:MedicalandRadiation–PainIntensityQuantified
37.0385ColonCancer:ChemotherapyforAJCCStageIIIColonCancerPatients
38.0387BreastCancer:HormonalTherapyforStageIC-IIICEstrogenReceptor/Pro-
gesteroneReceptor(ER/PR)PositiveBreastCancer
39.0389ProstateCancer:AvoidanceofOveruseofBoneScanforStagingLowRiskProstateCancerPatients
40.0403HIV/AIDS:MedicalVisit
41.0405HIV/AIDS:Pneumocystisjirovecipneumonia(PCP)Prophylaxis
42.0418PreventiveCareandScreening:ScreeningforClinicalDepressionandFollow-UpPlan
43.0419DocumentationofCurrentMedicationsintheMedicalRecord
44.0421PreventiveCareandScreening:BodyMassIndex(BMI)ScreeningandFollow-Up
45.0564C
ataracts:Complicationswithin30DaysFollowingCataractSurgeryRequiring
AdditionalSurgicalProcedures
46.0565Cataracts:20/40orBetterVisualAcuitywithin90DaysFollowingCataractSurgery
47.0608PregnantwomenthathadHBsAgtesting
48.0710DepressionRemissionatTwelveMonths
49.0712DepressionUtilizationofthePHQ-9Tool
50.TBDChildrenwhohavedentaldecayorcavities
51.1365ChildandAdolescentMajorDepressiveDisorder:SuicideRiskAssessment
52.1401Maternaldepressionscreening
53.1401Maternaldepressionscreening
54.TBDPrimaryCariesPreventionInterventionasOfferedbyPrimaryCareProviders,
includingDentists
55.TBDPreventiveCareandScreening:Cholesterol–FastingLowDensityLipoprotein
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(LDL-C)TestPerformed
56.TBDPreventiveCareandScreening:Risk-StratifiedCholesterol–FastingLowDensityLipoprotein(LDL-C)
57.TBDDementia:CognitiveAssessment
58.TBDHypertension:Improvementinbloodpressure
59.TBDClosingthereferralloop:receiptofspecialistreport
60.TBDFunctionalstatusassessmentforkneereplacement
61.TBDFunctionalstatusassessmentforhipreplacement
62.TBDFunctionalstatusassessmentforcomplexchronicconditions
63.TBDADEPreventionandMonitoring:WarfarinTimeinTherapeuticRange
64.TBDPreventiveCareandScreening:ScreeningforHighBloodPressureandFollowUpDocumented
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