Meaningful Use: Timeline of Events

1. Regulatory context Objectives, stages and final rule Eligibility, incentive payments Regulatory context Objectives, stages and final rule Eligibility, incentive payments

4. Meaningful Use: Timeline of Events 2009 February 17, 2009 � Obama signs ARRA. HITECH (Health IT for Economic and Clinical Health) provisions include meaningful use (MU). January 13, 2009 - Draft rule on MU incentive payments 2010 March, 2010 - NACHC & CHCANYS submit official comments (over 2000 comments) February 23 & March 29, 2010 - New York State Medicaid solicits testimony from CHCANYS July 13, 2010 � Final Rule released 2011 Medicaid Incentive Program: Certification process and timeline to be published by NY State Medicaid Medicare Incentive Program: January, 2011 - begin the 90-day process of using a certified record per meaningful use requirements April, 2011 � Attestation for Meaningful Use May 2011 � CMS Payments begin

6. Sandy � is working on Payment Mechanism ok?Sandy � is working on Payment Mechanism ok?

18. Adopt, Implement, Upgrade (AIU) In their first year of participation in the Medicaid incentive payment program, EPs may qualify for an incentive payment by demonstrating any of the following: � that they have adopted (acquired), implemented (installed or commenced utilization, e.g. staff training, data entry, redesign of provider workflows, or establishing data exchange agreements), or upgraded (upgrade to a certified version or expanded functionality, e.g. CDSS, e-prescribing, or other features that facilitate meaningful use) This casts a wide net Final definition and documentation requirements to be announced by NYS Medicaid

21. Medical Home Tenets Adopted by AAFP, ACP, AAP, AOA: Personal physician Physician directed medical practice Whole person orientation Care is coordinated and/or integrated Quality and safety Enhanced access Payment www.medicalhomeinfo.org/Joint%20Statement.pdf. Accessed May 9, 2008. A. Personal physician�each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care. B. Physician directed medical practice� the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients. C. Whole person orientation�the personal physician is responsible for providing for all the patient�s health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life; acute care; chronic care; preventive services; and end of life care. D. Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient�s community (e.g., family, public and private community-based services). Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner. E. Quality and safety are hallmarks of the medical home: � Practices advocate for their patients to support the attainment of optimal, patient-centered outcomes that are defined by a care planning process driven by a compassionate, robust partnership between physicians, patients, and the patient�s family. � Evidence-based medicine and clinical decision support tools guide decision making. F. Enhanced access to care is available through systems such as open scheduling, expanded hours and new options for communication between patients, their personal physician, and practice staff. G. Payment appropriately recognizes the added value provided to patients who have a Patient-Centered Medical Home. The payment structure should be based on the following framework: � It should reflect the value of physician and non physician staff patient-centered care management work that falls outside of the face-to-face visit. � It should pay for services associated with coordination of care both within a given practice and between consultants, ancillary providers, and community resources. � It shouldA. Personal physician�each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care. B. Physician directed medical practice� the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients. C. Whole person orientation�the personal physician is responsible for providing for all the patient�s health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life; acute care; chronic care; preventive services; and end of life care. D. Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient�s community (e.g., family, public and private community-based services). Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner. E. Quality and safety are hallmarks of the medical home: � Practices advocate for their patients to support the attainment of optimal, patient-centered outcomes that are defined by a care planning process driven by a compassionate, robust partnership between physicians, patients, and the patient�s family. � Evidence-based medicine and clinical decision support tools guide decision making. F. Enhanced access to care is available through systems such as open scheduling, expanded hours and new options for communication between patients, their personal physician, and practice staff. G. Payment appropriately recognizes the added value provided to patients who have a Patient-Centered Medical Home. The payment structure should be based on the following framework: � It should reflect the value of physician and non physician staff patient-centered care management work that falls outside of the face-to-face visit. � It should pay for services associated with coordination of care both within a given practice and between consultants, ancillary providers, and community resources. � It should

22. National Committee for Quality Assurance (NCQA) and the PCMH NCQA developed a set of standards and a 3-tiered recognition process to assess the extent to which health care organizations are functioning as medical home Obtaining recognition requires completing an application and providing adequate documentation to show evidence that specific processes and policies are in place Recognition is offered at three levels: Level 1 Level 2 Level 3

23. NCQA Score Requirements The NCQA scoring guidelines for the PCMH has 3 levels of achievement There are 10 Must-Pass elements, of which a practice must pass at a 50% or greater score. A practice must pass 5 of the 10 must pass elements for Level 1 recognition, and 10 of the 10 elements for Level 2 or 3 recognition The NCQA scoring guidelines for the PCMH has 3 levels of achievement There are 10 Must-Pass elements, of which a practice must pass at a 50% or greater score. A practice must pass 5 of the 10 must pass elements for Level 1 recognition, and 10 of the 10 elements for Level 2 or 3 recognition

24. Benefits of PCMH

25. NY State PCMH Incentive Payment For claims coded with E&M and/or Preventive Medicine codes For fee-for-service claims $5.50 for Level 1 $11.25 for Level 2 $16.75 for Level 3 For Medicaid Managed Care & Family Health Plus claims Plans receive $2/$4/$6 PMPM for Levels 1/2/3 Payments must go to recognized practices; cannot be retained by Plans or rolled over to subsequent year Plans will provide details on payout method Payments for Level 1 will end after December 2012 to promote practices obtaining Levels 2 & 3 recognition

26. The NCQA PPC-PCMH Survey NCQA framework can be used as a framework for a systematic approach to ensuring we are actually doing what we intend to do. NCQA framework can be used as a framework for a systematic approach to ensuring we are actually doing what we intend to do.

27. Standards Standards are definitive statements about acceptable performance or results Each Standard includes a statement of an attribute or expectation has a designated number of points which is the sum of points from all elements assigned to the standard Has a statement of intent that describes the purpose of the standard Example: PPC1 (or Standard 1), Access and Communication [9 points] Statement: The practice has standards for access to care and communication with patients and monitors its performance to meet the standards Intent: The practice provides patients with access during & after regular business hours, and communicates with patients effectively

28. Elements There is at least one Element for each Standard Each Element has specific number of points describes a specific component of performance that is individually evaluated and scored Example: PPC 1A, Access & Communication Processes [4 points] & PPC 1B, Access & Communication Results [5 points] PPC 1A: The practice establishes in writing standards for the following processes to support patient access PPC 1B: The practice�s data show that it meets access & communication standards in PPC 1A

29. Must Pass Elements These are 10 of the 30 Elements that a practice must pass at a 50% or greater score in order to achieve any level of recognition (5 for Level 1; 10 for Level 2 or 3) They are considered to be the fundamental building blocks for a medical home that any practice must be able to demonstrate to be a medical home

31. Peter : Welcome Expectation: Not scholarly Developing a conversation about what people are struggling with and what needs they have Focsed on NYS Trying to engage in a conversations that produces an understanding of the needs in the community Housekeeping Introduce the Speakers/The Panel�.who you�ll hear from 2day Peter : Welcome Expectation: Not scholarly Developing a conversation about what people are struggling with and what needs they have Focsed on NYS Trying to engage in a conversations that produces an understanding of the needs in the community Housekeeping Introduce the Speakers/The Panel�.who you�ll hear from 2day

32. Criteria for Achieving Meaningful Use & PCMH Meaningful Use (MU) Improve quality, efficiency and reduce health disparities Engage patients & families Improve care coordination Improve population & public health Ensure privacy & security PCMH Access & communication Patient tracking & registry Care management Patient self-management Electronic prescribing Test tracking Referral tracking Performance reporting & improvement Advanced electronic communications Lisa PerryLisa Perry

33. Is this a good place to quantify the overlap? Your intro slide does ask �How much do they have in common?� I don�t remember the figures, but they were interesting and demonstrate how much overlap there is.Is this a good place to quantify the overlap? Your intro slide does ask �How much do they have in common?� I don�t remember the figures, but they were interesting and demonstrate how much overlap there is.

34. I don�t understand �Cut of PCMH Factors that could apply HIT� Are you saying these are the PCMH Factors that either require or will be significantly easier with HIT? An alternative subtitle could be �PCMH Factors that require or benefit from use of HIT�I don�t understand �Cut of PCMH Factors that could apply HIT� Are you saying these are the PCMH Factors that either require or will be significantly easier with HIT? An alternative subtitle could be �PCMH Factors that require or benefit from use of HIT�

37. PCMH Application Checklist Obtain free copy of NCQA PPC-PCMH Standards & Guidelines available at http://www.ncqa.org/tabid/629/Default.aspx#pcmh Purchase $80 NCQA PPC-PCMH Survey Tool available at http://www.ncqa.org/tabid/629/Default.aspx#pcmh Determine survey approach if part of multi-site network (multi-site or standard survey)

38. PCMH Application Checklist Complete NCQA PPC-PCMH Application Documents Compile PPC-PCMH submission Identify three clinically important conditions Develop system for labeling and organizing documentation required for submission (nomenclature should clearly identify relevant factor(s); if using multi-site option, should clearly indicate relevant site(s)) Compile documentation required for submission Identify 36 patients to include in chart review and conduct chart review for relevant elements (2C, 2D, 3D, 4B) (refer to NCQA�s Record Review Workbook for information regarding the methodology for selecting your sample and tool to use to conduct chart review) Upload documentation and complete on-line survey (including notes to reviewer) Application documents must be completed and returned to NCQA prior to uploading documentation and completing submission; should be completed at least 2-4 weeks prior to anticipated submission date to avoid delays to timeline. Agreement (includes Attestation, Data Release, NCQA Agreement and HIPAA Business Associate Agreement) Practice Background Information Worksheet Application, including submission date Multi-Site Group Survey Assessment Questionnaire (if interested in using multi-site survey option) Determine fee (refer to NCQA PPC-PCMH Fee Schedule available at http://www.ncqa.org/tabid/631/Default.aspx); NCQA accepts checks and credit cards Application documents must be completed and returned to NCQA prior to uploading documentation and completing submission; should be completed at least 2-4 weeks prior to anticipated submission date to avoid delays to timeline. Agreement (includes Attestation, Data Release, NCQA Agreement and HIPAA Business Associate Agreement) Practice Background Information Worksheet Application, including submission date Multi-Site Group Survey Assessment Questionnaire (if interested in using multi-site survey option) Determine fee (refer to NCQA PPC-PCMH Fee Schedule available at http://www.ncqa.org/tabid/631/Default.aspx); NCQA accepts checks and credit cards

40. MU Checklist: 2010 & 2011 Prepare for upgrade to certified version of your EHR Contact vendor to learn upgrade process and requirements (may include upgrade of related software and/or hardware) Schedule your upgrade Prepare for upgrade Develop a team Conduct communications campaign with Board, patients & staff Calculate your % �needy individuals� for CY 2010 to determine that your health center meets the 30% threshold Identify your Eligible Professionals Register them for 2011 MU incentives & assignment Stay tuned for further instructions from NY State Medicaid Attest for each provider that you have satisfied requirements of �Adopt, Implement, or Upgrade�

41. MU Checklist: Now - 2012 Conduct detailed self-assessment & gap analysis for Stage 1 MU Develop work plan Begin system configuration, workflow revision, training, report development & other activity required to achieve each MU objective Compile documentation of compliance with each MU Objective for 90-days in 2012 Attest for each provider

42. Regional Extension Centers (RECs) have been funded to provide technical assistance in achieving MU CHCANYS is an extension agent of the NYeC REC, serving all FQHCs in New York State except those in New York City New York City FQHCs are served by REACH, the NYC DOHMH REC Please contact us if you are interested in more information: Sandy Worden sworden@chcanys.org Lisa Perry lperry@chcanys.org

44. Additional Resources: Educational Materials For Patients Brochure in 14 languages Video by Emmi Solutions to explain the PCMH concept for patients is available at: http://www.emmisolutions.com/medicalhome/transformed/ For Providers Educational brochure Three part series of presentations on PCMH can be viewed and downloaded at: http://www.acponline.org/running_practice/pcmh/ � See the right hand column: �What is the PCMH?� and �Common Questions About the PCMH.� Provider PowerPoint, above brochures and more available at: http://www.ehealth4ny.org/resources.html FAQs on Meaningful Use and additional resources available at http://www.nyecrec.org/index.php/education-a-resources

56. Standards & Certification: Timeline of Events 2010 January 13, 2010 - Official publication in Federal Register of Initial Set of Standards, Implementation Specifications & Certification Criteria for Electronic Health Record Technology; effective 30 days after publication 60-day comment period June 24, 2010 � Official publication in Federal Register of Final Rule re: temporary certification program July 13, 2010 � Release of Final Rule on Standards & Certification Criteria August � September, 2010 � First Authorized Testing & Certification Bodies to be named Fall, 2010 � Anticipated time for certified products to be available on market

57. Key Definitions Standard - a technical, functional, or performance-based rule, condition, requirement, or specification that stipulates instructions, fields, codes, data, materials, characteristics, or actions. (e.g. HIPAA codes, HL7, CCD) Implementation Specification - specific requirements or instructions for putting a standard into operation Certification Criteria � to establish that health IT meets applicable standards and implementation specifications adopted by the Secretary; to test and certify that health IT includes required capabilities.

58. Standards, Implementation & Certification: Relationship to MU Relationship to Meaningful Use: The HITECH Act fundamentally ties the standards, implementation specifications, and certification criteria adopted in this IFR to the incentives available under the Medicare and Medicaid EHR Incentive Programs by requiring the meaningful use of Certified EHR Technology. Certification criteria described in the IFR: establish the capabilities and standards that certified EHR technology will need, at a minimum, to support the achievement of proposed meaningful use Stage 1 by EPs and hospitals.