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MU Adjustments Based on Two Years of Activity

Article written by Jim Tate

For years we have talked about the carrot and stick approach to the CMS EHR incentive program. First came those lovely front loaded incentives that drove EHR adoption. Then, almost as an afterthought, we vaguely mentioned the penalties (“fee adjustments”). Well the carrots are getting smaller and the sticks are coming. For many Medicare providers who have delayed jumping in with both feet, it may already be too late to avoid the penalties. Let’s look at the facts.

CMS states clearly: “If Medicare eligible professionals, or EPs, do not adopt and successfully demonstrate meaningful use of a certified electronic health record (EHR) technology by 2015, the EP’s Medicare physician fee schedule amount for covered professional services will be adjusted down by 1% each year. The adjustment schedule is as follows:

  • 2015-99% of Medicare physician fee schedule covered amount
  • 2016-98 % of Medicare physician fee schedule covered amount
  • 2017 and each subsequent year-97% of Medicare physician fee schedule covered amount

If less than 75% of EPs have become meaningful users of EHRs by 2018, the adjustment will change by 1% point each year to a maximum of 5% (95% of Medicare covered amount).”

That doesn’t sound too bad, right? Just get your act together by 2015 and all will be well. However, that is not the case. The penalties are based on activity two years prior. That’s right you pretty much have to have your act together in 2013 to duck those 2015 “fee adjustments”. Permit me to quote directly from CMS scripture: “EPs who first demonstrated meaningful use in 2011 or 2012 must demonstrate meaningful use for a full year in 2013 to avoid payment adjustments in 2015. They must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years……..EPs who first demonstrate meaningful use in 2013 must demonstrate meaningful use for a 90-day reporting period in 2013 to avoid payment adjustments in 2015. They must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years.”

Now for you Medicaid EPs there is a bit of a twist. In the Medicaid EHR Incentive program there are no penalties against Medicaid reimbursements but you will be penalized for those Medicare charges if you don’t reach meaningful use. Kind of a “damn if you do, damn if you don’t” situation.

I can hear the wheels turning out there. What if I practice where there is no broadband Internet access? What if my town is hit by an tornado/hurricane/firestorm/tsunami? What if I never actually see a patient in person? What if there in no way on Gods’s green earth I will ever achieve meaningful use? Funny you should ask. CMS has outline a process for hardship exceptions that should put your mind at ease for some of you. For the rest the stage is now being set for those who will begin receiving reduced payments in 15 months. A stitch in time save nine.

This article was originally published at www.hitechanswers.net is used here with permission

Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs

This July, the Centers for Medicare & Medicaid Services (CMS) announced that more than 300,000 providers have received payment for successfully participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.  We also recently released new data demonstrating how doctors and other health care providers have been able to use EHRs to increase efficiency in their practices while safeguarding privacy and improving care for millions of patients nationwide.
Our hope is to support all eligible providers with resources to help them join the hundreds of thousands who have successfully participated in the EHR Incentive Programs. This includes providers – such as pediatricians – who must select specific meaningful use measures and exemptions in order to participate.

Meaningful Use for Pediatricians 

Pediatricians are among the providers who are eligible to participate in the Medicaid EHR Incentive Program.  This means adopting EHRs and meeting the meaningful use criteria to earn incentive payments. We recognize that not every meaningful use measure applies to every provider. Over the past three years, CMS has worked with ONC to develop electronic clinical quality measures that address areas relevant to infants, children, and adolescents enrolled in Medicaid and CHIP. Pediatricians can select meaningful use measures that meet their individual practices’ needs and choose exemptions for measures that are not applicable. It is estimated that between 65% and 70% of pediatricians may be eligible to participate in the Medicaid EHR program and earn an incentive.

Pediatricians who see between 20% and 30% Medicaid patients based on their total number of patient encounters are eligible to receive up to $42,500 over 6 years through the Medicaid EHR Incentive Program.

EHR Systems for Pediatricians

Recognizing that pediatricians may encounter challenges finding certified EHR systems that meet their needs, CMS is working with stakeholder groups and other government agencies to ensure systems have the functionality for pediatric use.
Last February, CMS and the Agency for Healthcare Research and Quality released a children’s EHR format that defines functionality standards and data requirements essential to pediatric care. These efforts involved coordination with stakeholders, including the American Academy of Pediatrics and the American Academy of Family Physicians. CMS believes this format will better enable EHR developers to increase the range of products and design systems tailored to meet children’s health care needs.

Once adopted and integrated, pediatricians can use these certified EHR systems to become successful participants in the Medicaid EHR Incentive Program and provide their patients with improved outcomes through greater access to high quality care.

Resources for Pediatricians

In order to help pediatricians successfully navigate the Medicaid EHR Incentive Program, CMS has developed the Meaningful Use for Specialists Tipsheet. We encourage all eligible providers, regardless of practice specialty, to take advantage of this resource.

EHR Market Poised for Shakeout

The EHR landscape, many health care professionals are discovering, is littered with software programs that do not interoperate, integrate or even interface with each other. Critics cite a range of reasons — from technological challenges to proprietary and financially driven issues.

Mike Taylor, CIO at the Charleston, S.C.-based Roper St. Francis health network, says a fragmented marketplace creates some harsh realities for prospective EHR buyers. “It’s been extremely frustrating when you sit down to select one,” Taylor continued. “There’s not a one-size-fits-all vendor in the marketplace, nor do I think there ever will be, nor do I think that’s healthy. But the inability to take the best of each and pull them together to do what you’re trying to do for health care and the patient, that’s the frustrating piece.”

Indeed, the EHR marketplace is “agitated” and “unstable” according to a report published in late July by Black Book. This at a time when many health care organizations are either planning to or are already in the process of switching EHR vendors.

Black Book managing partner Doug Brown says the predictions of a great shakeout and consolidation in the EHR marketplace are “spot on.” He notes that many health care organizations are looking to switch EHRs and, in so doing, are considering a relatively small number of vendors, including athenahealth, Care360 Quest, ChartLogic, Cerner, GE Healthcare, Greenway, Practice Fusion and Vitera. Ultimately, industry observers are predicting that fewer EHR makers will survive, but that their products will be stronger — both more usable and interoperable — than what exists today.

In the meantime, Mike Taylor is hoping for change. “My hope is that there are several guys in a garage right now coding the next EHR. Hopefully something emerges in the next few years, or somebody puts the venture capital together and builds something much simpler, easier and more interoperable.”

For original article, click here.

Clinton Challenges Lawmakers to Address ACA Glitches

As the Affordable Care Act’s health insurance marketplaces prepare to open for business across the country, former President Bill Clinton is urging Congress and the states to fix some glaring glitches.

Speaking at his presidential library in Little Rock, Ark., Clinton touted the ACA’s early successes and future benefits, while pointing to some challenges he says still need to be addressed.

One of the law’s worst problems, he says, is an unintended consequence of the Supreme Court’s ruling upholding the health law but making the expansion of Medicaid optional for states. In about half of the states, governors and lawmakers have chosen not to expand Medicaid to low-income adults with incomes up to 138 percent of the federal poverty level.

In those states, Clinton explained, working people with incomes below the federal poverty level ($11,490 for an individual) will not be eligible for Medicaid or federal subsidies. “So you get the worst of all worlds,” he says. “You’re working 40 hours a week, but you’re too poor to get help. Not too rich, but too poor.”

Meanwhile, people in those same states who make higher incomes will get federal tax subsidies to help pay for health insurance.

“This is a problem that only states can fix,” Clinton says. While not offering a specific solution, he said states are “going to have to talk about it.” Besides leaving the poorest Americans without health coverage, he said, states’ decisions not to expand Medicaid will hurt the hospitals within their borders that end up caring for the poor.

Clinton spoke as part of what the White House has billed as a “celebrity outreach effort” to help Americans understand what the law has to offer them.

For original article,click here.

EHR Certification Guidance Offered for ‘”Ineligible’ Providers

While the Medicare/Medicaid meaningful use incentive program has driven significant EHR adoption by health care providers, there remains a broad swath of care providers who are ineligible for Medicare and Medicaid EHR incentive payments.

These include certain mental and behavioral health professionals, as well as other professionals who practice in long-term and post-acute care settings. Yet, these “ineligible” providers routinely interact with hospitals and physician practices that are eligible for EHR incentive payments.

Recognizing that these providers are equally important to the care continuum, the Office of the National Coordinator (ONC) has drawn up a certification guidance aimed at technology developers serving these specialized providers.

The five-page guidance, issued Sept. 9, specifically focuses on interoperability. Here, ONC says it is seeking to open critical communication lines between eligible and ineligible health care providers in order to support broad health care goals, such as care coordination and reduced hospital readmissions.

In practice, that could mean improved health information exchange among not just traditional care settings but even clinical laboratories, public health agencies and more.

For example, one section of the 2014 Edition EHR certification criteria specifically supports interoperable summary care record exchange — a fundamental capability necessary to enable care coordination across different health care settings.

ONC officials say the guidance is meant to serve as a building block for federal agencies and stakeholders as they work with different communities to achieve interoperable electronic health information exchange. They note that health care providers eligible to receive incentive payments under the Medicare and Medicaid EHR incentive programs will, depending on the stage of meaningful use they seek to achieve, need to have EHR technology certified to these criteria. “We encourage EHR technology developers serving ineligible health care providers to also seek certification to these criteria.”

For original article,click here.

Plan Ahead: Review Upcoming eHealth Milestones Using New eHealth Interactive Timeline

CMS posted a new interactive timeline that highlights key 2013 and 2014 milestones for its eHealth programs. The timeline helps you identify key program dates and corresponding required actions, as well as resources to help you complete each milestone.

Important dates for the following programs are outlined in the resource:

You can click on a date on the timeline, and the tool will take you directly to the information you need to prepare for the milestone.

The timeline is available on the Resources page of the eHealth website.

Source: CMS eHealth

National Learning Consortium (NLC) Resources: Secure Electronic Messaging

The NLC resources are examples of tools that are used in the field today, and that are recommended by “boots on the ground” professionals. The NLC, in partnership with HealthIT.gov, shares this collective EHR implementation knowledge and resources throughout this site. These FAQs address patient questions about secure electronic messaging.

FAQ About Secure Electronic Messaging

What is secure electronic messaging?

Secure messaging is a way to communicate with your health care providers using the Internet. It’s like email but has extra security to protect your health information.

How do I get started?

Ask your health care providers or clinic staff if secure messaging is available and how to sign up. It may be available through a patient portal, a secure online website that gives you access to your health information.

What are the benefits to me?

  • Relationship with your health care providers — Regular communication can improve your relationship with your health care providers and help them get to know you better.
  • Convenience — You can send messages at your convenience from your home, office, or anywhere you have Internet access.
  • Not rushed — You can take your time to think about what you want to say.
  • Feel more comfortable discussing sensitive topics — You may feel more comfortable discussing sensitive health issues using messaging rather than in person.
  • No phone messages or “telephone tag” — You won’t have to wait on hold or leave phone messages. And you will never miss a response because of “telephone tag.”
  • Messages are saved — Messages become part of your medical record. You can go back to messages later to recall important information.

Can I communicate about family members, too?

You may be able to use secure messaging to stay in touch with health care providers who are caring for your family members, such as an older parent or relative.

Who will read my messages?

Only your health care team, such as your health care providers and specific clinic staff, can read your messages.

You can use secure messaging to:

  • Ask questions you may have forgotten during your visit or that come up between visits
  • Let your health care team know how you’re doing or about any changes in your health.
  • Get help for minor health concerns that may not need an office visit
  • Request medication refills and referrals to specialists
  • Get help with billing and insurance issues


Attestation Deadlines Loom

What: Dec. 31 marks the end of the 2013 meaningful use program year for eligible professionals participating in the Medicare EHR Incentive Program. Eligible professionals then have until Feb. 28, 2014, to attest to meaningful use of the data collected during the 2013 reporting period.

Why: If you are participating in the Medicaid EHR Incentive Program, you must attest to demonstrating meaningful use every year to receive an incentive and avoid a payment adjustment.


Changes to Physician Quality Programs and the Value Modifier

What: A final rule from the Centers for Medicare & Medicaid Services (CMS) finalizes changes to several pay-for-reporting programs — including the Physician Quality Reporting System (PQRS) — and provides guidance for the continued phase-in of the Value Modifier.

Who: These changes will affect payments to certain groups of physicians based on the quality and cost of care they furnish to beneficiaries enrolled in the traditional Medicare Fee-for-Service program.


Medicare Physician Fee Schedule to Incentivize Care Coordination

What: CMS is establishing separate payments for managing a patient’s care outside of a face-to-face visit for practices equipped to provide these services, beginning in 2015.

Why: The care coordination policy recognizes the critical role that primary care plays in providing care to beneficiaries with multiple chronic conditions as well as the importance of care that occurs outside of a face-to-face visit.