ONC Issues Guide on HIPAA Privacy and Security and Meaningful Use

May 8, 2012 By Leave a Comment

ONC has recently released a new “Guide to Privacy and Security of Health Information” which incorporates tips on complying with HIPAA Privacy and Security as well as meeting related meaningful use measures.  The guide is designed for clinical providers and focuses on the following:

  • Privacy & Security and Meaningful Use
  • Security Risk Analysis and Management Tips
  • Working with EHR and Health IT Vendors
  • A Privacy & Security 10-Step Plan
  • Health IT Privacy and Security Resources

Specifically, with regard to Meaningful Use, the guide describes Meaningful Use measures 12 and 15:

#12. Provide patients with an electronic copy of their health information (including diag­nostics test results, problem
list, medication lists, medica­tion allergies) upon request.  To learn more about this measure click here.

#15. Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.  To learn more about this measure click here.

If you have questions regarding HIPAA Privacy and Security or Meaningful Use please contact Elana Zana.

 

Filed Under: HIPAA, HITECH, Meaningful Use Tagged With: , ,

CMS Releases Proposed Rule On Meaningful Use Stage 2

February 23, 2012 By Leave a Comment

CMS announced today its proposed rule (NPRM) on Stage 2 of the EHR Incentive Program Meaningful Use requirements.  These requirements apply to both eligible professionals and hospitals participating in the Medicare and Medicaid EHR Incentive Program.  As previously announced, and proposed within this NPRM, the onset of the Stage 2 meaningful use requirements will not begin until 2014.

The Stage 2 requirements include greater applicability to specialists, changes to the clinical quality measures, and modifications to the core and menu measures.  CMS has issued a fact sheet that briefly summarizes the Stage 2 requirements.

The NPRM will be published in the Federal Register on March 7, 2012.

For questions regarding the Stage 2 proposed requirements or for assistance related to the Medicare or Medicaid EHR Incentive Program please contact Elana Zana.

Filed Under: HITECH, Incentive Payments, Meaningful Use, Medicare

EHR Contracting Tip: Attestation for AIU

January 28, 2012 By

Now that most states have their Medicaid EHR Incentive Program in full swing we have gotten a glimpse of what they are requiring for attesting to “adopt, implement and upgrade” aka “AIU”.  As described in the CMS rules themselves, practices need to show that they have some skin in the game and have actually invested in an EHR product.  Many states are asking that an EP (or group practice) upload the actual EHR software contract (or a redacted version).  Some states (such as California) are requesting a signed vendor statement in lieu of the full contract.  

If you are a practice in the process of negotiating an EHR contract, you may want to consider including a provision in the contract specific to the AIU attestation requirements of the state your practice is in.  For example, requiring in the contract itself that the software vendor execute any documents required by the state to attest to AIU or that the vendor provide a letter acknowledging the practice’s EHR license (if such a letter is acceptable in your state). Similar provisions are recommended in situations where the practice is involved with a Stark donation arrangement or other type of third party contract. 

Setting expectations up front and creating a contractual obligation will help ensure that the software vendor or other third party contractor does not stand in the way of your practice receiving EHR incentive dollars.

For assistance in drafting and negotiating EHR software contracts or the Medicaid EHR Incentive Program in general please contact Elana Zana or Dave Schoolcraft.            

Filed Under: Anti-Kickback/Stark, HITECH, Incentive Payments, Meaningful Use

ACO Final Rule – Drastically Reduces Quality Measure Requirements

December 8, 2011 By

The Accountable Care Organization (“ACO”) final rules show that comments to CMS really do make a difference.  The public outcry against the 65 quality measures proposed in the spring led to CMS’ 50% cut of the number quality measures.  Along with the large cut, CMS explained its plan for allowing ACOs to meet the measure requirements by reporting on the measures in the first year and receiving “pay for performance” in the following years based on the weighted scores received in each quality measure.

Quality Measures

The revised list of quality measures are broken out into 33 different measures (predominately with NQF measure numbers) with four umbrella categories and five subcategories as follows:

  1. Patient/Caregiver Experience (7 measures)
  2. Care Coordination/Patient Safety (6 measures, includes the EHR Incentive Program)
  3. Preventative Health (8 measures)
  4. At Risk Population (12 measures)
    1. Diabetes (6 measures)
    2. Hypertension (1 measure)
    3. Ischemic vascular disease (2 measures)
    4. Heart failure (1 measure)
    5. Coronary Artery Disease (2 measures)

The tables provided in the final rule at pages 67889-90 are particularly helpful in visually identifying the measures, the method of data submission and whether the particular measure is pay for reporting or pay for performance.  The measures will be submitted to CMS through either surveys (for patient/caregiver experience measures), claims, the EHR Incentive Program, or the Group Practice Reporting Option (“GPRO”) Web Interface.  The surveys will be conducted using the Consumer Assessment of Healthcare Providers and System (“CAHPS”) surveys for 2012 and 2013, in future years, ACOs will have to select a CMS approved vendor to administer the surveys.

EHR Incentive Program

One of the significant changes to the quality measures was the expansion of the EHR incentive program related measure.  The quality measure no longer requires that 50% of the primary care providers to achieve meaningful use in order for the ACO to participate.  The EHR quality measure now recognizes those participating in the Medicaid EHR Incentive Program do not have to meet meaningful use requirements in their first year of participation.  As such, the new measure now includes primary care providers that successfully qualify for the EHR Incentive Program under either Medicare or Medicaid.  In addition, CMS cut previously proposed measures that were redundant with the EHR Incentive Program such as the measure concerning clinical decision support and electronic prescribing.

CMS still emphasizes the importance of the usage of the EHR technology by giving the EHR quality measure a higher weight.  Eligible professionals participating in ACOs are still eligible to separately participate in the EHR Incentive Programs or the e-prescribing incentive program.

Pay for Reporting vs. Pay for Performance

In the first year of participation, all of the quality measures may be satisfied by merely reporting on the quality measures.  For pay for reporting, ACOs will earn the maximum sharing rate for complete and accurate reporting of 100% of the required data, and no quality threshold must be met.  In the second year, 25 of the quality measures will be pay for performance, and eight will continue to be pay for reporting.  In the third year, all but one quality measure will be on a pay for performance basis.

In the pay for performance years, each domain will be given equal weight of 25% in the calculation of the ACOs overall quality performance score.  Each of the individual measures will be equally weighted within the domains, except for the EHR Incentive Program quality measure which is double weighted.  ACOs must minimally attain 30% (or be in the national 30th percentile) for that quality measure.  Subregulatory guidance will indicate the quality performance rates an ACO needs to achieve in order to earn the maximum quality points in a domain.

Recognizing that meeting all 33 measures in a given year may be difficult, CMS is requiring that ACOs achieve the quality performance standards on 70% of the measures in each domain.  Failure to achieve the 70% standard will result in a corrective action plan and re-evaluation in the final year.  However, if an ACO scores a zero for an entire measure, it will not be able to share in the savings generated.  Due to the double weight of the EHR measure, failure to meet the EHR measure in the Care Coordination domain would cause the ACO to miss the 70% cut-off.

Reporting Calendar & PQRS

ACOs are expected to report on the quality measures on a calendar year basis, beginning with the reporting period starting January 1, 2012 through December 31, 2012.  Even though a “performance year” in the regulations may begin in April or July of 2012 and end in December 2013, the quality performance for the first performance year will be based on reporting of the measures from January 1, 2013 through December 31, 2013.  Eligible professionals participating in an ACO that start the agreement in April or July of 2012 will also qualify for the 2012 PQRS incentive under the Shared Savings program by reporting the ACO GPRO measures for the full 2012 Physician Quality Reporting System (“PQRS”) calendar year reporting period.

Note that ACO participant entities that want to qualify for PQRS must participate as group practices and not separately participate or earn a PQRS incentive outside of the Shared Savings Program.  Individual ACO providers may not seek to qualify for the individual PQRS incentive under the traditional PQRS plans.  CMS also relaxed its requirements regarding the PQRS incentives.  If an ACO fails to meet the Shared Savings Program quality performance measures and therefore is not eligible for shared savings, the participating entities may still be eligible to receive the PQRS incentive under the Shared Savings Program.   

More Updates Coming

ACO participants should keep an eye out for subregulatory guidance which will detail the annual measure specifications.  CMS plans on releasing specifications in December and in the first quarter of 2012.

For more information regarding the ACO quality measures or ACOs in general, please contact Elana Zana.

Filed Under: Accountable Care Organizations, Health Reform, Incentive Payments, Meaningful Use, Medicare

Stage 2 Meaningful Use – Delayed to 2014

November 30, 2011 By

HHS announced today that eligible professionals (“EPs”) and hospitals who begin participating in the EHR Incentive Program in 2011 will not have to meet the Stage 2 Meaningful Use standards until 2014.  Therefore, those EPs and hospitals  participating in the Medicare EHR Incentive Program in 2011 will be able to show Stage 1 meaningful use in 2011, 2012, and 2013.  Those participating in the Medicaid EHR Incentive Program in 2011 will show Adopt, Implement or Upgrade in 2011, and Stage 1 meaningful use 2012 and 2013.

If you have questions on achieving meaningful use or the Medicare and Medicaid EHR Incentive Programs please contact Elana Zana.

Filed Under: HITECH, Incentive Payments, Meaningful Use

CMS Issues Info Sheets on Meaningful Use

August 12, 2011 By

CMS has issued information sheets on the meaningful use requirements.  Releasing one sheet for eligible professionals and another for eligible hospitals, these sheets are designed to explain each meaningful use objective and its respective measure.  The sheets provide links to each meaningful use objective and then explains the numerator and denominator requirements, attestation requirements and relevant additional information.  To access the information sheets click on the links below:

Stage 1 EHR Meaningful Use Specification Sheets for Eligible Professionals

Stage 1 EHR Meaningful Use Specification Sheets for Eligible Hospitals

CMS is also offering a National Provider call regarding meaningful use on August 18th.  To register for the call click here.

Understanding the meaningful use measures and objectives is sometimes complicated.  For assistance with meaningful use or the EHR Incentive Programs in general contact Elana Zana.

Filed Under: HITECH, Incentive Payments, Meaningful Use, Medicare