Are You Ready for the Next Step?

The federal government’s initiative to encourage the deployment of meaningful use (MU) among health care providers has moved on to Stage 2. The bar has been raised for what’s demanded of physician practices. There are more core measures, new menu measures and higher reporting thresholds. In Stage 2, MU focuses on care coordination and patient engagement.

Meeting the deadline

Eligible providers who didn’t start the MU program and meet the March 20, 2015, attestation deadline will be penalized in 2015 the equivalent of 1% of their Medicare Part B reimbursement. The penalty increases to 2% in 2016, and providers won’t be eligible for Electronic Health Record (EHR) incentive payments.

If a practice hasn’t yet initiated its MU program, it should do so immediately because it must start by meeting Stage 1 standards. There are certain steps you’ll need to do, such as registering with the CMS (http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/RegistrationandAttestation.html). Then, select an EHR system that’s suited to your practice, certified to 2014 MU standards and compliant with the upcoming ICD-10 transition.

Next, designate a team that includes doctors to lead the effort. If you’re already behind schedule, consider hiring a consultant. From there, choose the Clinical Quality Measures (CQMs) for which your practice intends to demonstrate MU. Pick measures that are most relevant and beneficial to the practice. Last, deploy a patient portal, which is mandatory under both Stage 1 and Stage 2.

Moving on to Stage 2

If your practice is currently satisfying Stage 1 and is ready to move on to Stage 2, it can look forward to some new standards. Your practice must achieve 17 core objectives and its choice of three out of six menu objectives, for a total of 20 objectives. Here are a few of the core objectives:

·         Use computerized provider order entry for medication, laboratory and radiology orders.

·         Generate and transmit permissible prescriptions electronically.

·         Record demographic information.

·         Provide patients the ability to view, download and transmit their health information online.

·         Create clinical summaries for patients for each office visit.

·         Keep lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach.

·         Collect clinically relevant information to identify patients who should receive reminders for preventive/follow-up care.

·         Implement secure electronic messaging to communicate with patients on relevant health information.

The six menu objectives include submitting electronic syndromic surveillance data to public health agencies and recording electronic notes in patient records. Other objectives include making imaging results accessible through Certified Electronic Health Record Technology, recording patient family health history, identifying and reporting cancer cases to a state cancer registry, and identifying and reporting specific cases to a specialized registry.

Still another objective is to commit to nine CQMs out of a total of 64 options. Those nine must lie in at least three of the following domains:

·         Patient and family engagement,

·         Patient safety and care coordination,

·         Population and public health, and

·         Efficient use of health care resources.

The last objective aims to improve clinical process and effectiveness.

Testing the system

The performance of MU activities revolves around the practice’s EHR system, which must be tested and certified under the Office of the National Coordinator for Health Information Technology Certification Program. The original certification criteria expired last year and were replaced by a 2014 edition. All EHRs must be upgraded to that edition.

The transition to Stage 2 should be relatively seamless. The EHR vendor must insert Stage 2 thresholds into the EHR workflow to make sure the right person is doing the right work. Vendors also need to ensure delivery of critical information to physicians at the point of care. And all of this should be accompanied by support, training and coaching until the practice is comfortable with the new system.

Creating a portal

Stage 1 required that practices make an online portal available to their patients, without necessarily doing anything to ensure that they use it. Under Stage 2, the portal must be engaging and user-friendly, and must support patient-centered outcomes. The portal must be integrated into clinical encounters so that it can convey information, communicate with patients, and support self-care and decision-making. Finally, the practice must actively promote and facilitate portal use.

Meeting the requirements

Whether you’re just starting Stage 1 or ready to move on to Stage 2, make sure you work with your health care advisor on meeting these requirements. He or she can walk you through the process.

Sidebar: Upgrading your EHR system

When upgrading your Electronic Health Record (EHR) system, be sure that it has the following features:

·         Is certified to all of the 2014 certification criteria.

·         Takes into account the ICD-10 compliance date of Oct. 1, 2015.

·         System software is updated to include new meaningful use standards and related workflow changes.

·         Meaningful use objectives and measures are incorporated into the workflow so they can be easily recorded.

·         Training and support are provided on how to satisfy the objectives and measures, with the results documented.

·         Further support and guidance are available when the practice needs to attest to what it has achieved.

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