After run intoing Stage 1 for the two old ages, Fletcher Allen Partners will necessitate to run into meaningful usage Phase 2 standards get downing in 2014 ( Figure 1 ) . With this following phase, EHRs will farther salvage Fletcher Allen Partners money, save clip for physicians and infirmaries, and salvage lives.The Stage 2 standards includes new aims to better patient attention through better clinical determination support, attention coordination and patient battle ( cms.com ) . The phase 2 ends would spread out the Phase 1 standards and concentrate on the meaningful usage of electronic wellness records ( EHRs ) to back up the purposes and precedences of the National Quality Strategy ( NQS ) . The Phase 2 standards encourages the usage of wellness IT for uninterrupted attention and information quality betterment.
The proposed Phase 2 meaningful usage demands include strict outlooks for wellness information exchange and include: more demanding demands for eprescribing ; integrating structured laboratory consequences ; and the outlook that suppliers will electronically convey patient attention sum-ups with each other and with the patient to back up passages in attention. Phase 2 focal points on existent usage instances of electronic information exchange and requires that a supplier direct a sum-up of attention record for more than 50 % of passages of attention and referrals. The regulation besides requires that a supplier electronically transmit a sum-up of attention for more than 10 % of passages of attention and referrals. Increasingly robust outlooks for wellness information exchange in Stage 2 and Stage 3 would back up the end that information follows the patient ( Federal Register, 2012 ) . To let suppliers clip to follow 2014 certified EHR engineering and fix for Stage 2, all participants will hold a three-month coverage period in 2014.
Figure 1: Phases of Meaningful Use
Beginning: NeHC University ( 2012 )
REQUIREMENTS FOR STAGE 2 IMPLEMENTATION
Core Aims and Menu Aims
Fletcher Allen Partners must run into certain demands for a successful Phase 2 execution. The figure of Stage 1 and Stage 2 entire aims remains the same, EPs are must run into the the step of 20 entire aims and CAHs must run into the step of 19 entire aims. However, the combination of aims has changed. Under Phase 2, eligible professionals ( EPs ) must run into the step or measure up for an exclusion to 17 nucleus aims and 3 of 6 bill of fare aims and eligible infirmaries ( EHs ) and CAHs must run into the step or measure up for an exclusion to 16 nucleus aims and 3 of 6 bill of fare aims ( Figure 2 ) . This is a alteration from EP ‘s holding to run into 15 nucleus aims and EHs holding 14 nucleus aims and 5 bill of fare aims severally. About all of the Stage 1 nucleus and bill of fare aims are retained for Stage 2.
Figure 2: Changes from Phase 1 to Stage 2
15 nucleus aims
17 nucleus aims
5 of 10 bill of fare aims
3 of 6 bill of fare aims
20 entire aims
20 entire aims
Eligible Hospitals & A ; CAHs
14 nucleus aims
16 nucleus aims
5 of 10 bill of fare aims
3 of 6 bill of fare aims
19 entire aims
19 entire aims
Clinical Quality Measures needed to be captured by FAP
In add-on to run intoing the nucleus and bill of fare aims, eligible professionals, eligible infirmaries and CAHs are besides required to describe clinical quality measures.The clinical quality steps ( CQMs ) are tools used to mensurate and track the quality of health care services by eligible professionals ( EPs ) , eligible infirmaries ( EHs ) and critical entree infirmaries ( CAHs ) within the health care system. The CQMs step many facets of patient attention to include wellness results, clinical procedures, patient safety, efficient usage of healthcare resources, attention coordination, patient battles, population and public wellness, and clinical guidelines.The measuring and coverage of the CQMs guarantee that Fletcher Allen Partners deliver efficient, patient-centered, and safe quality care.A Eligible professionals must describe on 6 entire clinical quality steps: 3 required nucleus steps ( or 3 surrogate nucleus steps ) and 3 extra steps ( selected from a set of 38 clinical quality steps ) . Eligible infirmaries and CAHs must describe on all 15 of their clinical quality steps ( CQMS, cms.gov ) .
Centers for Medicare & A ; Medicaid Services ( CMS ) selected the recommended nucleus set of CQMs for EPs based on analysis of several factors:
Conditionss that contribute to the morbidity and mortality of the most Medicare and Medicaid donees
Conditionss that represent national public wellness precedences
Conditionss that are common to wellness disparities
Conditionss that disproportionately drive health care costs and could better with better quality measuring
Measures that would enable CMS, States, and the supplier community to mensurate quality of attention in new dimensions, with a stronger focal point on penurious measuring
Measures that include patient and/or health professional battle
Get downing in 2014, all Medicare-eligible suppliers in their 2nd twelvemonth and beyond of showing meaningful usage must electronically describe their CQM information to CMS. Medicaid suppliers will electronically describe their CQM information to their province. As Figure 3 shows, EPs must describe on 9 of the 64 approved CQMs. Selected CQMs must cover at least 3 of the National Quality Strategy domains Eligible Hospitals and CAHs must describe on 16 of 29 approved CQMs Selected CQMs must cover at least 3 of the National Quality Strategy domains. Get downing in 2014, all Medicare-eligible suppliers beyond their first twelvemonth of showing meaningful usage must electronically describe their CQM information to CMS informations to CMS.
Figure 3: Clinical Quality Measures ( CQMs )
Prior to 2014
2014 and Beyond*
Complete 6 out of 44
Complete 9 out of 64
aˆ?3 nucleus or 3 elevation. nucleus
Choose at least 1 step in 3 NQS spheres
aˆ?3 bill of fare
Recommended nucleus CQMs include:
aˆ?9 CQMs for the grownup population
aˆ?9 CQMs for the paediatric population
aˆ?Prioritize NQS spheres
Eligible Hospitals and CAHs
Complete 15 out of 15
Complete 16 out of 29
aˆ?Choose at least 1 step in 3 NQS spheres
For 2014, CMS is non necessitating the entry of a nucleus set of CQMs. A Alternatively we identify two recommended nucleus sets of CQMs, one for grownups and one for kids. A We encourage eligible professionals to describe from the recommended nucleus set to the extent those CQMs are applicable to your range of pattern and patient population. Figure 4 shows the recommended nucleus steps:
Figure 4: Recommended Core Measures
Adult Recommended Core Measures
Pediatric Recommended Core Measures
Controling High Blood Pressure
Appropriate Testing for Children with Pharyngitis
Use of High-Risk Medications in the Aged
Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents
Preventive Care and Screening: A Tobacco Use: A Screening and Cessation Intervention
Chlamydia Screening for Women
Use of Imaging Studies for Low Back Pain
Use of Appropriate Medications for Asthma
Preventive Care and Screening: A Screening for Clinical Depression and Follow-Up Plan
Childhood Immunization Status
Documentation of Current Medications in the Medical Record
Appropriate Treatment for Children with Upper Respiratory Infection ( URI )
Preventive Care and Screening: A Body Mass Index ( BMI ) Screening and Follow-Up
Attention deficit disorder: A Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder ( ADHD ) Medicine
Closing the referral cringle: reception of specialist study
Preventive Care and Screening: A Screening for Clinical Depression and Follow-Up PlanA
Childs who have dental decay or pits
Patient Care Improvements
Patient entree to their wellness information is an of import facet of patient attention and battle, and the capablenesss of CEHRT in 2014 and beyond will enable suppliers to do this information available online in a manner that does non enforce a important load on suppliers. Patient engagement – battle is an of import focal point of Stage 2. There are 26 Requirements for Patient Action: More than 5 % of patients must direct secure messages to their EP. More than 5 % of patients must entree their wellness information online.
Loss of future gross through authorities inducements
Changes to Medicare EHR Incentive Programs
The Medicare and Medicaid EHR Incentive Programs provide incentive payments to eligible professionals, eligible infirmaries and critical entree infirmaries ( CAHs ) as they adopt, implement, upgrade or show meaningful usage of certified EHR engineering. Eligible professionals can have up to $ 44,000 through the Medicare EHR Incentive Program and up to $ 63,750 through the Medicaid EHR Incentive Program. The Medicare and Medicaid EHR Incentive Programs provide fiscal inducements for the “ meaningful usage ” of certified EHR engineering to better patient attention. To have an EHR incentive payment, suppliers have to demo that they are “ meaningfully utilizing ” their EHRs by run intoing thresholds for a figure of aims. CMS has established the aims for “ meaningful usage ” that eligible professionals, eligible infirmaries, and critical entree infirmaries ( CAHs ) must run into in order to have an incentive payment. A The Medicare and Medicaid EHR Incentive Programs are staged in three stairss with increasing demands for engagement. All suppliers begin take parting by run intoing the Phase 1 demands for a 90-day period in their first twelvemonth of meaningful usage and a full twelvemonth in their 2nd twelvemonth of meaningful usage. After run intoing the Phase 1 demands, suppliers will so hold to run into Stage 2 demands for two full old ages. Eligible professionals participate in the plan on the calendar old ages, while eligible infirmaries and CAHs take part harmonizing to the federal financial twelvemonth beginnning on October 1st. ( EHR Incentive Program, cms.gov )
In order to successfully take part in the plan, EPs, EHs, and CAHs are required to subject CQMs to in order to have an incentive payment in the EHR Incentive Program.Beginning in 2014, the coverage of clinical quality steps ( CQMs ) will alter for all suppliers. EHR engineering that has been certified to the 2014 Edition criterions and enfranchisement standards will hold been tested for enhanced CQM-related capabilities.ELECTRONIC Coverage: In order to let participants to successfully describe CQMs electronically for 2014, CMS is supplying a set of electronic specifications for clinical quality steps ( eCQMs ) for eligible professionals and eligible infirmaries for usage in the EHR Incentive plan for electronic coverage. A These electronic specifications contain multiple parts which allow certified EHR engineering systems to be plan to accurately capture, calculate, and describe clinical quality steps electronically for the 2014 CQMs. A Each eCQM can be described in 3 different ways depending on the intended usage:
HTML A – A This is a human clear format so that the user can understand both how the elements are defined and the implicit in logic used to cipher the step.
XML – This is a computing machine clear format which enables the machine-controlled creative activity of questions against an EHR or other operational informations shop for quality coverage.
Value Sets – Value sets are the specific codifications used by developers to plan the system to accurately capture patient informations in the EHR system. A A
To have the maximal EHR inducement payment, Medicare eligible professionals must get down engagement by 2012.
Eligible professionals who demonstrate meaningful usage of certified EHR engineering can have up to $ 44,000 over 5 uninterrupted old ages under the Medicare EHR Incentive Program
Incentive payments for eligible professionals are higher under the Medicaid EHR Incentive Payments- up to $ 63,750 over 6 old ages under the Medicaid EHR inducement plan
Get downing in 2015, Medicare eligible professionals who do non successfully show meaningful usage will be capable to a payment accommodation. The payment decrease starts at 1 % and increases each twelvemonth that a Medicare eligible professional does non show meaningful usage, to a upper limit of 5 % .
The eligibility for the EHR inducement plan is determined by the HITECH Act. The lone eligibility alterations under Phase 2 are under the Medicaid EHR incentive plan. The Phase 2 eligibility. Meaningful usage way for Medicare eligible doctors ( EPs ) :
Meaningful usage way for Medicare infirmaries:
*Payments will diminish for infirmaries that start having payments in 2014 and subsequently.
The alterations from Phase 1 to Stage 2 are as follow:
Reporting Period Reduced to Three Months – to let suppliers clip to follow 2014 certified EHR engineering and fix for Stage 2, all participants will hold a three-month coverage period in 2014.
“ Phase 2 ends, consistent with other commissariats of Medicare and Medicaid jurisprudence, would spread out upon the Phase 1 standards with a focal point on guaranting that the meaningful usage of EHRs supports the purposes and precedences of the National Quality Strategy. Specifically, Stage 2 meaningful usage standards would promote the usage of wellness IT for uninterrupted quality betterment at the point of attention and the exchange of information in the most structured format possible. Our proposed Phase 2 meaningful usage demands included
strict outlooks for wellness information exchange including: more demanding demands for eprescribing ; integrating structured laboratory consequences ; and the outlook that suppliers will electronically convey patient attention sum-ups with each other and with the patient to back up passages in attention. Increasingly robust outlooks for wellness information exchange in Stage 2 and Stage 3 would back up the end that information follows the patient. ”
Hospitals- FY14 )