The Future of Meaningful Use (MU) of EHR Systems

The Healthcare industry is moving at a fast pace via Healthcare Information Technology (HIT). Everybody knows that electronic healthcare records (EHRs) are the most advanced practice of innovation in the healthcare industry. The meaningful use of EHRs (MU) is not limited to a certain sector of healthcare, which is capable of heavy investment. In fact, it is widely accepted by physicians of every scale and expertise.

Healthcare Chief Information Officers (CIOs) are making sure that their organizations maintain a certain standard of interoperability. Only this way, the actual progression in the industry will be observed.

HIT leaders’ investments in EHRs are not substantial only for today’s use, but they have an eye on the future of meaningful use of EHRs. EHRs are already an advanced form of technology, making patients and physicians empowered.

So what is the Future of Electronic Healthcare Records (EHRs)?

According to the officers of Healthcare IT and the leading EHRs vendors, automation, telemedicine, and advanced analytical tools will have a huge impact on EHR technology.

Impact of Automation and the Advanced Analytical Tools

The automation in the care services in diagnostic, treatment procedures, and in administrative processes has cut down costs. It helps physicians to focus their attention towards the work of their expertise, rather on managerial issues.

The same is the case with Genomics – Informed Medicines which require the genomic information of a patient for his treatment. This approach is quite useful in understanding the diseases’ causes and their impact on patient’s health. This type of medicine also facilitates preventive medicines. Thus, the dimension of reporting of medical records will change drastically.

Telemedicine is the discipline, in which patients and physicians are not present in front of each other. As this technology will strengthen its place in the near future, the way one access, and views EHR will be changed. The virtual delivery of healthcare services has transformed, and this will affect the outcomes of the interoperability measures.

In short, there are different ways to leverage healthcare services. Thus, the devices and algorithms to process or detect illnesses will require a different recording method.

For Example,

How EHR will react towards diagnostic procedures conducted in a home setting, but the tests result been given back to the medical organization, especially, when they are to be given to an algorithm or machine as well.

How Increased Interaction Influences Meaningful Use of EHR?

With technology advancement, the virtual diagnosis will move towards increased interaction and user satisfaction. In addition, it will reduce unnecessary cost expenses.

The accommodation of innovation techniques will be difficult to manage as tangible results. Thus, Meaningful Use of EHR in the future will be helpful in recognizing serious health areas, and it will be using machine learning and predictive models to support the latest technology.

Developing such, intelligent EHRs will be challenging when there is a big issue that is the complexity of the EHR system to handle a large amount of data.

Health IT leaders predict that human-centered designs will resolve this problem. Cloud-based service and aligning work operations to support mobile services will increase the efficiency of electronic healthcare records (EHRs).

With a cloud-based EHR platform, interoperability will also increase via improved security features and the HIPAA-Compliance will be possible to a greater extent.

Mobile-Based EHR Systems

Even today, many professional EHR vendors have developed systems that offer specific functionality of EHRs on smartphones. Everybody knows the accessibility and the scalability of mobile-based systems. By completely incorporating this method into reality, medical records will be at fingertips and the physicians-patients engagement will be easy.

The main purpose of EHR technology is to support a large population of data without any redundancy. The second purpose is to streamline artificial intelligence to increase a better understanding of healthcare data and remove vulnerabilities in the healthcare system.

Get Ready for the Highest Level of Interoperability via Meaningful Use EHRs

Cloud-based APIs will have a great say in the progressive healthcare system. Smart applications and the additional medical components will form the base of a more secure healthcare system.  The only need is to accept change with open arms.

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MIPS and MACRA, EHR technology, healthcare industry, healthcare provider, Healthcare clinical process, Medicare and Medicaid Services, value based healthcare

The Role Of Clinical Quality Measures For Physicians

Since the healthcare industry has taken serious measures to revamp healthcare services, the emphasis on incentive payment programs has increased. MIPS and MACRA, and more offer facilities to physicians that regular payment method can never provide.

Such incentive payment programs come with various quality measures against which clinical data is needed to report. The number of clinical quality measures is so large that it is difficult to manage them for each healthcare provider. Moreover, the requirements for each program be it Meaningful Use (MU), MIPS or others and the implementation of reporting criteria can be quite confusing.

The Center for Medicare and Medicaid Services (CMS) states Clinical Quality Measures (CQMs) for incentive payment programs. The result is not just to pay physicians but the value-based healthcare improvement efforts. These clinical quality measures also put their part in various government or private development projects.

Need of CQMs

Eligible physicians and hospitals submit data to CMS as in MIPS. In return, CMS estimates their performance and reward accordingly while checking that patients are getting the deserved attention from physicians. In addition, it works in favor of the healthcare industry to improve performance categories, falling short in terms of efficiency and quality.

What factors determine success in Clinical Quality Measures Submission?

As per the CMS website, it checks the following parameters to score CQMs.

  1. Use of available resources
  2. Compatibility to healthcare standards
  3. Healthcare outcomes
  4. Patient’s safety and welfare
  5. Coordination among physicians
  6. Patient’s engagement level
  7. Population & overall health standard
  8. Healthcare clinical processes

To maintain the accuracy and transparency in the healthcare system, ONC, Office of the National Coordinator for Health Information Technology (US Government Health and Human Services), monitors the use of EHR and other technologies.

The Development Process of Clinical Quality Measures (CQMs)

MIPS and MACRA, EHR technology, healthcare industry, healthcare provider, Healthcare clinical process, Medicare and Medicaid Services, value based healthcare

National Quality Forum

Many healthcare industry leaders and stakeholders take part in developing CQMs. However, measures standardized by the National Quality Forum (NQF) are considered as the top priority. Most of the incentive payment programs use their measures because their development process involves extensive research.

Another reason for adopting NQF quality measures is their work and objectives that match with that of CMS. Moreover, their initiative boosts the use of electronic healthcare records (EHRs).

Development Process via CMS

CMS also has its own measure development project known as The Measures Management system. This system is always in its evolution stage and sets values for business processes. The deduced measures also support MIPS and other incentive payment programs and provide an opportunity for their growth.

Real-Life Implementation of Quality Measures

Clinical quality measure reporting accounts for many uses, but its major reliance is on EHR technology usage or Meaningful Use. However, many healthcare providers deem Meaningful Use to be stressful and demanding. Moreover, not every quality measure is for everyone. Thus, there should be some flexibility in the reporting criteria.

CMS has gone to great lengths to overcome reporting issues and streamlined measures under seven categories.  When physicians are reimbursed and incentivize, it becomes obligatory for them to maintain their performance instead of giving quality as a onetime shot.

Clinical quality measures are also a great aspect of Physicians’ Quality Reporting System. Physicians are met with penalties when they don’t report according to the standards.

Thus, MIPS, MACRA, and other payment incentive programs can’t perform their actual functions without efficient marking of clinical quality measures. The key to success is the selection of accurate measures according to the practice and the value-based approach of practicing physicians towards patients.

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Looking Back At EHR Meaningful Use From A New Perspective

ARRA – The American Reinvestment & Recovery Act was legalized on February 17th, 2009. It aimed to revolutionize many economic and social sectors including healthcare. Health Information Technology for Economic and Clinical Health (HITECH) Act was also one of its considerations. This act was in great support of the meaningful use of the electronic healthcare records (EHRs), an initiative by the Centers for Medicare and Medicaid (CMS) and the Office of National Coordinator for Health IT (ONC).

Its emphasis on the implementation of EHR technology throughout the USA. Moreover, it is also in accordance with the MIPS quality measure Promoting Interoperability (PI) in which physicians use innovative methods to improve the quality of care services. It requires the use of certified EHR technology to provide a secure exchange of healthcare information.

Plays an Important Role in MIPS Data Submission

The meaningful use of EHR technology also helps physicians to efficiently submit MIPS data to CMS. On the other hand, physicians using this technology can also report measures regarding value-based services to the Secretary of Health & Human Services (HHS) and get incentives.

The Need for Meaningful Use (MU) Act

This act is helpful in generating five possible outcomes for the betterment of the healthcare industry.

  • Improvement in public health
  • Improved coordination in healthcare sectors
  • Increased engagement of physicians and patients
  • Protect patient’s private data from unauthorized use
  • Improved services, safety, and efficiency of the healthcare system

What benefits physicians have for meaningfully using EHR technology?

Meaningful use of EHR

The incentive payment ranges from $44,000 for 5 years to $63,750 for 6 years (Starting from 2011).   Eligible physicians (EPs) and eligible hospitals (EHs) demonstrating adaptation and efficient use of EHR, get valuable rewards. To encourage physicians to go for EHR meaningful use and reduce the burden for healthcare providers, it is classified into three stages.

Stage 1 of Meaningful Use

The requirements of this stage are divided into the 15 core set and 10 menu set objectives. There is an option of choosing 5 out of 10 menu set objectives with the compulsion of at least one population/public health measure.

Stage 2 of Meaningful Use

CMS and ONC have also set standards for the second stage of meaningful use (MU). It released the final rule for incentive programs of Medicare, Medicaid and EHR technology in August 2012.

For this stage, eligible physicians are required to meet for the exclusion to 17 core objectives and 3 out of 6 menu set objectives.

Whereas, it was a must for eligible hospitals and Critical Access Hospitals (CAHs) to qualify for an exclusion to 16 core objectives and 3 out of 6 menu objectives.

Stage 3 of Meaningful Use

In the modified version of stage 2 meaningful use for 2015-2017, clinicians attest to any combination of 2 measures out of 3, while EHs and CAHs attest for any combination of 3 measures out of 4. For stage 3, submitting data for meaningful use was obligatory in 2018.

ONC along with HHS (Department of Human Health & Services) released a final rule in the context of meaningful use and gave certification to the 2015 edition of electronic healthcare records (EHRs). This initiative allowed diverse types of healthcare organizations to get access to healthcare IT.

Thus, medical practices that adopted EHR technology in previous years are now in benefit and can target more incentives, as they have completely understood this method. To get incentives and adopt healthcare IT, physicians should invest their efforts in this system respectively.

HITECH provides high opportunities for healthcare providers to improve their medical practice. The phased approach of three stages allows room for improvement in the public health sector. Moreover, it sets the base of the healthcare system with fewer discrepancies and controls chronic diseases.

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3 Types Of Payment Models, Physicians Probably Don’t Know!

Value-based healthcare services have not only changed the patients’ healthcare standards but also the physicians’ payment model. Value-based reimbursement models encourage clinicians to adopt methods that make healthcare easy and efficient. Programs like MIPS & MACRA and more depict a value-based care system and allow physicians to achieve rewards and bonuses. The purpose is value-based reimbursement models are too.

  • Straighten up physicians’ revenue cycle management
  • Make patients empower the healthcare system where they choose their desired service

We have heard many of the benefits and the need for value-based healthcare models, but the proper information about the available models is not very common. Let’s review that.

What are the Available Value-Based Care Models?

There are a few types of value-based payment models with a variety of risks attached and the benefits.

1. Accountable Care Organizations (ACO)

It is a system of hospitals, clinicians, and other healthcare providers to provide organized and high-quality services to Medicare beneficiaries. It was started to help patients receive up-to-the-mark services at the most appropriate time. It means that in case of emergencies or other scenarios, patients don’t have to wait to get to the relevant doctor.

This organization ensures that patient only bears expenses for those services that are absolutely necessary to treat an illness. Redundant medical services are reduced by eliminating medical errors that occur while diagnosis or treatment.

Healthcare providers volunteer in this program to get shared savings if the ACO fulfills the standardized healthcare criteria with reduced expenditure.

Risk Factor Involved in ACO

It is not like ACO volunteers always end up adding a bonus to their revenue cycle, but the financial risk is also involved. When able to meet the requirement, physicians have a jackpot, but on the other side, they also have to bear shared losses if any.

For shared loss, healthcare providers have to pay Medicare as compensation for not delivering value-based care to patients.

This value-based reimbursement model is not just about value-based medical procedures but also supports volume-based services. However, the evaluation is based on quality, safety, and experience.

2. Bundled Payment for Rendered Services

This payment model pays physicians not for each service but as a whole series of services. Clinicians receive collective reimbursement for treating a medical condition, including all the charges for physicians and the types of rendered procedures.

For Instance,

If a patient undergoes a surgical procedure, CMS (The Centers for Medicare and Medicaid Services) sets a collective payment for surgeons, an anesthesiologist. It then pays a total amount rather than paying separately to each clinician.

Risks Attached with Bundled Payment Model

A certain level of risk is also involved with this type of payment model same as the ACO. Physicians get to full their pockets when they collectively reduce the incurred cost. Otherwise, they get will have to bear the loss.

Thus, this practice requires standardized procedures so that, all stakeholders get the rightful reimbursements.

3. Patient-Centered Medical Homes (PCMH)

It represents the healthcare payment model in which a primary care physician coordinates the patients’ healthcare. This payment model manages and handles all the needs of the patient in a centralized setting.

It’s certification highlights that the physicians are capable of providing healthcare in a patient-centered setting with team-based methods. Moreover, it also ensures consistent care quality for patients.

Patients are allowed to develop a one-to-one relationship with their physicians, and it governs the medical and environmental factors.

This payment system has shown great potential in reducing the unnecessary cost expenditure. According to a Maryland – based PCMH, via the efficient practice of this reimbursement model, they were able to save up to $98 million and enhance their quality standards by 10%.

Alternative payment methods other than the fee-per-service are not very popular practices. However, physicians are unable to meet their financial requirements. Thus, they are devising ways to incorporate new technologies into their system to speed up the workflow.

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Highlighted Aspects Of Medicare Usage Of EHR Technology For Hospitals!

The healthcare industry emphasizes on value-based medical services to patients with the correct use of technology and innovation. The purpose is to empower physicians’ RCM and patients with the right to choose quality care services. MIPS is a great addition in this context. It allows physicians to take small steps towards a better healthcare system. However, along with MIPS, the Medicare EHR incentive program also shares the responsibility with the same approach.

Since many hospitals don’t use EHR technology until now. However, the healthcare industry will only progress forward in a secure environment when using the latest technologies. For encouraging physicians and boosting their RCM, The American Recovery and Reinvestment Act of 2009 (ARRA) initiated a program under Medicare. It was to facilitate eligible physicians to use the Certified Electronic Health Record (CEHR) technology meaningfully.

CMS named this program as Medicare Promoting Interoperability (PI) since last year. MIPS also contains this category featuring the benefits of this program, ensuring advancement in healthcare services with the appropriate use of EHRs. This measure appreciates interoperability efforts and applauses for allowing reasonable access of patients to information.

What if Clinicians don’t meet the Promoting Interoperability (PI) criteria!

Healthcare organizations that don’t illustrate the correct depiction of PI will not get payment adjustment for the respective year.
Healthcare, which participates in both incentive programs i.e; Medicare and Medicaid EHR programs can subject to payment adjustments only when it demonstrates the true value in its reporting.

Reporting Criteria for EHR Incentive Program

Prior to 2018, physicians demonstrated EHR use via either CMS Medicare EHR Incentive Programs Attestation System or the state’s attestation system. Now, QNet System confirms the EHR meaningful use and payment adjustments are calculated via a formula specified by the CMS.

What Expectations Should clinicians have for payment adjustments for 2019?

Eligible healthcare organizations, which are not meaningful EHR users, get payment adjustment as a reduction to the applicable percentage proportional to the Inpatient Prospective Program System (IPPS). Thus, it reduces the IPPS standardized amount of healthcare centers.

What are the hardship exceptions?

MIPS and the EHR meaningful uses

Eligible hospitals can avoid negative payment adjustments through hardship exceptions on day-to-day scenarios. Sometimes, CMS itself determines that eligible healthcare falls in an exceptional case.

To apply as an exception, clinicians or hospitals can get information on the official CMS website.

https://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/PaymentAdj_Hardship.html

Given below are the categories for hardship exception cases.

1. New Eligible Healthcare Organizations

Healthcare organizations having new CMS Certification Numbers (CCNs) and insufficient time to submit data can get relaxation for 1 year.

2. Infrastructure Liabilities

Eligible hospitals having no Internet access in their operating area or with insufficient resources to meet the threshold of EHR meaningful use.

3. Unexpected Circumstances

In the case of natural disasters or unforeseen conditions.

4. Vendor Related Issues

Hospitals can apply for this category when they encounter EHR vendor issues to obtain a certification or due to related delays.

What will physicians get in return for their efforts?

  • The foremost purpose is to avoid negative Medicare payment adjustment, and thus revenue cycle management becomes efficient, supporting all the financial matters.
  • The healthcare system improves, and the transparency travels across the board from a higher level to a lower level.

Thus, EHR technology is not just about technology incorporation but a way to fill gaps between patient and physician. Moreover, the advancement in its context helps in successfully submitting clinical data for MIPS as well. Consequently, the healthcare industry flourishes.

Consult the official CMS website for further information https://www.cms.gov EHRIncentivePrograms

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Key Points:

  • EHR incentive program
  • The result when not submit data for this program
  • Payment adjustment criteria
  • Hardship exceptional cases
  • Advantages

MIPS Quality Measures 2017 Applicable To LTPAC Medicine

The following article looks at CMS MIPS quality measures for LPTAC medicine. However, before we go towards the MIPS quality details, we need to look at the underlying purpose and objectives.

Purpose

CMS (Centers for Medicare and Medicaid Services) is always working on improving the policy to provide better healthcare facilities. Therefore, the new measures are aimed to help improve the overall care delivery and also reward clinicians who are better engaging patients, families, and caregivers.

Here is how CMS looks at MIPS.

“To these ends, and to ensure the Quality Payment Program works for all stakeholders, we further recognize that we must provide ongoing education, support, and technical assistance so that clinicians can understand requirements, use available tools to enhance their practices, and improve quality and progress toward participation in APMs if that is the best choice for their practice.” healthcare facilities

Key Strategic ObjectivesMedicare and Medicaid Services

Let us have a look at the strategic objectives set by CMS.

  • The engagement of patients and the improvement of beneficiary outcomes.
  • To further the clinical experiences that offer flexible yet transparent programs.
  • Ensure meeting of diverse needs of the physician practices typically those with small practices.
  • Further the capabilities of the IT systems that meet various data needs of the end-user including reporting and submission.
  • Work on improving information and data sharing to ensure its timely availability.
  • Enable customized communication while keeping MIPS quality measures specifications into perspective.

Caveats for Individuals and Groups

The new MIPS quality measures take into consideration two LTPAC setting codes. These codes are the basis for the MIPS quality measures specifications. These MIPS quality measures are for application on individuals as well as groups.

Eligibility Criteria

Here are some considerations to undertake.

To qualify for the MIPS incentive payments you need to report on the following.

  • There are 6 measures with at least one of them as an outcome measure relating to poor diabetes control. The new quality measures mark high specialty and ambulatory practices.
  • Each measure’s applicability should be up to 90 days.
  • Around 50 percent of your patients have to qualify for one of those 6 measures.
  • The minimum number acceptable for the incentive payments stands at 20 patients.
  • The health practitioner can only report some measures after a specific diagnosis. Therefore, health clinicians have to be careful when selecting these measures.

Avenues for Submission

You can submit your measures to multiple avenues including EHR, claims, QCDR, and Registry. Registry seems to be the most suitable option for groups that aim to report when using the individual measures.

Why Consider Registry for Submission?

Here are the reasons why you must consider submission via Registry.

  • Since you can submit all 2017 QMs via Registry, you do not rely on any other methods.
  • Claims Reporting for 2017 QMs only supports a subset. Therefore, be careful to see the claims if the Claims Reporting offers support for it or you need to use Registry instead.
  • The group gets a measure of review or control when using Registry before you submit the data. Therefore, it gives a buffer, allowing you to remove any errors that you may find.

Avoiding Penalties is Critical

Make sure to always keep the benchmarks in perspective. By following them you can reduce your chances of getting a penalty. It will also help you satisfy base reporting requirements for MIPS.

Make sure that the data you submit for one patient satisfies that particular measure. If you are able to satisfy all six measures, the data would become a prime example for others to follow. In that case, you may be able to find your data published on CMS’s site for Physician Compare.

How 2017 MIPS Quality Measures Differ?

Previously, there was not much detail available. However, 2017 MIPS by CMS offers detailed benchmarking, relying upon the methodology which involves different performance points.

These individual performance points add to make a total score. Therefore, in 2017, you need to focus on performance as it is a critical year for it. Physicians should know the way they are graded to their performance, comparing it with the past year. It is vital to carefully select QMs which would help you score above-average performance.

Here is how CMS elaborates on this concept.

“By developing a program that is flexible instead of one-size-fits-all, we’re trying to meet clinicians where they are so that they can make the choice about how to participate in a way that is best for them, their practice, and their patients. Reducing burden, ensuring flexible program design, and improving how we measure cost and quality performance supports clinicians in doing what they do best – making their patients healthy.”

Fake Meaningful Use May Cost EHR $1 Billion In Lawsuits

An estate of a cancer patient, Stjepan Tot, filed a class-action lawsuit against eClinicalWorks. The estate maintains the patient could not refer to earlier cancer symptoms due to faulty meaningful use software.

eClinicalWorks is hit with a class-action lawsuit since the patients can no longer trust the accuracy of their medical records. The lawsuit point towards the flaws in the software clearly, defying the meaningful use core objectives.

Lawsuit Adds to eClinicalWorks Financial Struggles

eClinicalWorks had to deal with a huge settlement claim of $155 million only six months ago. The False Claim Act alleged that eClinicalWorks incentivized its customers to promote its products.

Details of the $1 Billion Lawsuit Against EHR Vendor

Kristina Tot, who represents Stjepan Tot estate, filed the lawsuit in New York’s Southern District. She claimed $999 million in monetary damages for gross negligence. Furthermore, the lawsuit also states that Stjepan Tot died because of cancer.

He could not search his electronic medical records to ascertain when he was first diagnosed with cancer. As there was no accuracy in the display of the medical records.

The lawsuit also alleges that millions of patients relying on eClinicalWorks cannot sort out their medical history. Thus, the software provided by eClinicalWorks fails to meet the meaningful use core objectives. Therefore, eClinicalWorks software does not meet the necessary requirements.

eClinicalWorks Lawsuit Reminds of the Report by HHS-OIG

The US Department of Health and Human Services or HHS-OIG released a report this June. The report samples 100 electronic health record providers getting payments from CMS for meaningful use. This report points to the failure of meeting meaningful use requirements of these health care providers, using incentive payments to the tune of $729 million. HHS-OIG found many of these healthcare providers not qualifying for these meaningful use incentives.

Large Scale Implications of eClinicalWorks Lawsuit

This lawsuit would have widespread implications for eClinicalWorks customers. The lawsuit indicates over 850,000 health service providers relying on this software. These new findings clearly reflect the need for better checks on software development companies offering health care provides with the EHR software.