Case Study, Stage 3: Meeting Meaningful Use Requirements Before you begin this assignment, be sure you have read the “UMUC Family Clinic Case Study”, the syllabus readings for Week 3, which discuss meaningful use and reporting requirements, and your graded work (with any feedback received) for the previous stages of this case study. Purpose of this Assignment This assignment gives you the opportunity to learn about the regulatory requirements governing meaningful use and the financial incentives that the government offers to providers and healthcare institutions that meet meaningful use in order to improve the quality of care in the United States. It will require you to do more external research beyond the textbook. Since your textbook is older than the information on the Centers for Medicaid and Medicare Services (CMS) website, your source of information will primarily be the CMS website. This assignment addresses the following course outcomes to enable you to: • • • Evaluate the organizational environment in the health care industry to recognize how technology solutions enable strategic outcomes Evaluate technology solutions in the health care industry to improve the quality of care, safety, and financial management decisions. Examine the implications of ethical, legal, and regulatory policy issues on health care information systems. Achieving Meaningful Use Stage 1 According to the statute, meaningful use (MU) will be defined in at least 3 stages. As of this date, MU Stage 1 and MU Stage 2 have been published. For the purpose of the case study, we will only focus on achieving MU Stage 1. For your Stage 2 Project, you proposed a certified EHR system to improve a business process at the UMUC Family Clinic. The implementation of a certified EHR system will help the Clinic achieve meaningful use in order to qualify for the financial incentives available. In this assignment, you will provide the Clinic with a report that will recommend which incentive program to apply for and help them understand the reporting requirements of meaningful use. As the EHR consultant, you realize that there is more than one EHR Incentive Program for meaningful use: at the federal level is the Medicare Incentive Program, and at the state-level are the Medicaid Incentive Programs. States and Territories participate on a voluntary basis. There is a restriction that a health care provider can apply for only one incentive program. To achieve meaningful use you will need to decide on which incentive program to pursue: the Medicaid or the Medicare Incentive program. You will need to do more external research on the CMS website at: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html The requirements to achieve meaningful use Stage 1 involve some attestation and some reporting requirements of core and menu objectives, which can be found at the URL above for “meaningful use”. In addition, to the core and menu objectives, eligible professionals will also need to report on clinical quality measures (CQM). Beginning in 2014, the reporting of clinical quality measures (CQMs) have changed for all providers. More information can be found at http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Downloads/EP_MeasuresTable_Posting_CQMs.pdf Furthermore, per CMS, eligible professionals must report on 9 of the 64 approved Clinical Quality 12/17/2014 IFSM 305 – Stage 3 Page | 1 Measures (CQMs), with a requirement that the selected CQM cover at least 3 of the national quality strategy domains. CMS promotes a list of Recommended Core CQMS, which are optional. Assignment Using the Complete EHR technology system you proposed in Stage 2, you should briefly explain it and then copy the 4 tables below and complete the remaining columns. For each area of the core objectives, menu objectives, and CQM, provide a brief explanation, a minimum of two sentences for each, to justify the selection. Explanations must provide enough information to convey the reasoning behind the selection. You may copy the objectives, measures, and other parts of the tables from the CMS source documents, but you must use your own words to demonstrate your understanding of the measure of the objective/CQM as you provide in your explanations. You must include at least one external source, a source other than the textbook and other materials provided in class. Remember to correctly cite and reference your sources with APA format. Use the Grading Rubric to be sure you have covered everything. Submit your paper with answers to parts 1 through 4 below via your Assignment Folder as a Microsoft Word document with your last name included in the filename (LASTNAME_Stage3). Part 1: Briefly explain which incentive program you recommend that the medical practice pursue and explain the possible payment adjustments the UMUC Family Clinic will incur in 2015 if meaningful use is not achieved. Provide a table similar to the below with the detailed expected incentives for the clinic for the duration of the program. Click on the upper left corner of the table to copy it into your paper. Table 1: Incentive Program and Amounts Payment Amounts If the practice – as aMedicare eligible Professional - Qualifies to Receive First Payment in 2014 Payment Amount will be in $12,000 2014 Payment Amount will be in $ 8,0000 2015 Payment Amount will be in ….. 2016 … Total Payment Amount will be $$$$$ Identify which incentive program you recommend for the practice, how much the practice is expected to receive – if it complies for the duration of the program - detailing individual year amounts, followed by the total. The table is an example if you were to recommend the Medicare Incentive program. Please adapt the table to the incentives program that you will recommend for the practice and include a short summary of the possible payment adjustments the UMUC Family Clinic will incur in 2015 if meaningful use is not achieved. Before you begin the following Part 2 and Part 3: Please review ONLY the core and menu objectives in the document “MU_Stage1_ReqOverview” posted in Content>Course Resources and available at the following URL: https://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Downloads/MU_Stage1_ReqOverview.pdf Do not use the above PDF for Part 4 of this assignment as the CQM information in it is not valid for 2014. In Part 4, the instructions provide you with the link to the updated 2014 CQM Reporting Guidelines. 12/17/2014 IFSM 305 – Stage 3 Page | 2 For the Clinic in this case study, you should use the sections of MU that apply to “eligible professionals” (EP) vs. hospitals. Part 2: Table detailing the Core Objectives that you recommend that the UMUC Family Clinic report. In the document above, you will find the list of 15 Core Objectives. These are followed by several pages showing the “Stage 1 Core Set Objectives.” You should select 15 Stage 1 Objectives and corresponding Stage 1 Measures that will be collected by the EHR you have selected in your Stage 2 project. Then, you should explain for each one how the objective will be met at the UMUC Family Clinic using the EHR you have proposed for them. 15 entries are required, and an example for one entry is provided below (it may or may not be included in your selected EHR system). Click on the upper left corner of the table to copy it into your paper. Count 1 Stage 1 Core Objective Record and chart vital signs: height, weight, blood pressure, calculate and display BMI, plot and display growth charts for children 2-20 years, including BMI Table 2 Measure For more than 50% of all unique patients age 2 and over seen, height, weight, and blood pressure are recorded as structured data Explanation of how the objective will be met at the UMUC Family Clinic using the selected EHR (minimum of 2 sentences each) Since the clinic is a family medical practice, this is information that is already being captured in the workflow and will be entered in the EHR during the visit. At reporting, the EHR system will automatically extract the percentage satisfying this measure. 2 .. 15 Part 3: Table detailing the recommended Menu Objectives that you recommend that the UMUC Family Clinic report. In the document referred to above, you will find the list of 10 Menu Objectives. These are followed by several pages showing the “Stage 1 Menu Set Objectives.” You should select 5 Stage 1 Objectives and corresponding Stage 1 Measures that will be collected by the EHR you have selected in your Stage 2 project. 5 entries are required, and an example for one entry is provided below (it may or may not apply to your selected EHR system). Click on the upper left corner of the table to copy it into your paper. Count 1 12/17/2014 Stage 1 Menu Objective Implement drug formulary checks. Table 3 Measure The Clinic has enabled this functionality and has access to at least one internal or external drug formulary for the entire EHR Explanation of how the objective will be met at the UMUC Family Clinic using the selected EHR (minimum of 2 sentences each) All that needs to be done is to ask the EHR vendor to enable this functionality and to have access to at least one internal or external formulary for the entire EHR reporting period. Then at reporting attest to “Yes” IFSM 305 – Stage 3 Page | 3 reporting period 2 .. 5 Before you begin the following Part 4: Please review the list of the clinical quality measures (CQM) in the document “EP_MeasureTables Posting CQMs” posted in Content>Course Resources and available at the following URL: http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Downloads/EP_MeasuresTable_Posting_CQMs.pdf Part 4: Table detailing the recommended Clinical Quality Measures (CQM) that you recommend that the UMUC Family Clinic report. In the document referred to above, you will find a list of the CQMs, including their eMeasure ID, Title and Domain. You should select 6 CQMs, one from each of the 6 domains listed on the first page of the document. 6 entries are required, and an example for one entry is provided below (it may or may not apply to the EHR system you selected). Click on the upper left corner of the table to copy it into your paper. Count CMS eMeasure ID CQM Measure Title 1 CMS117v1 Childhood Immunization Status Table 4 Domain Population/Public Health Explanation of how the objective will be met at the UMUC Family Clinic using the selected EHR (minimum of 2 sentences each) Using the EHR system to record the vaccines will capture the needed information. A report will be generated from the EHR at the end of the reporting period. 2 .. 6 GRADING RUBRIC: Attribute Full Points Partial Points No points Part I Incentive Program Selection Explanation of incentive program selected reflects critical thinking and is convincing. Table of incentives and explanation of payment adjustments is complete and accurate. Explanation of incentive program, payment adjustments and/or the table presented is adequate or may be incomplete. Incentive program, payment adjustments and Table 1 is not provided. 12/17/2014 IFSM 305 – Stage 3 Possible Points 18 Points Earned Page | 4 Core Objectives Selection of 15 core objectives is appropriate to the case study; explanations provided demonstrate understanding of course concepts, meaningful use reporting requirements, analysis and critical thinking. Menu Objectives with explanations 5 menu objectives are appropriate to the case study; explanations provided demonstrate understanding of course concepts, meaningful use reporting requirements, analysis and critical thinking. Clinical Quality Measures 6 CQMs, one from each domain, are appropriate to the case study; with explanation provided and demonstrates understanding of course concepts, meaningful use reporting requirements, analysis and critical thinking. Table Format Information is professionally presented; uses correct sentence structure, grammar, and spelling. 12/17/2014 Core objectives are adequately explained, or some selected core objectives are not linked to the case study, and/or may not demonstrate understanding of course concepts, meaningful use reporting requirements, analysis, and/or critical thinking. Menu objectives adequately explained, or some menu objectives are not linked to the case study, and/or may not demonstrate understanding of course concepts, meaningful use reporting requirements, analysis, and/or critical thinking. CQMs adequately explained, or some CQMs are not linked to the case study; may be duplicate domain, and/or may not demonstrate understanding of course concepts, meaningful use reporting requirements, analysis, and/or critical thinking. Information is adequately presented, or may not be professionally presented, and/or Table 2 not provided. 30 (2 points each) Table 3 not provided. Table 4 not provided 10 (2 points each) 12 (2 points each) Information is extremely poorly written and does not convey the IFSM 305 – Stage 3 15 Page | 5 External Research 12/17/2014 At least one source other than the textbook and the materials provided in class is incorporated and used effectively. Source(s) used are relevant and timely and contribute to the analysis and support conclusions. Correct APA format is used for citations and References. contains grammar and/or spelling errors. A source other than the textbook or class materials may be used, but is not properly incorporated or used to contribute to the analysis or support conclusions, and/or is not effective or appropriate and/or is not relevant or timely, and/or APA format for citations and references is not followed. information. No external research is incorporated 15 TOTAL Points 100 IFSM 305 – Stage 3 Page | 6 UMUC Family Clinic Case Study In 1980, the UMUC Family Clinic was opened in a growing family area near UMUC, Maryland, by Dr. Tom Martin, a University of Maryland graduate after he retired from the US Navy. It is a small internal medicine medical practice. Dr. Martin has been the owner and manager of the medical practice. He has two nurses, Vivian and Manuella, to help him. Usually, one nurse takes care of the front desk while the other nurse assists the doctor during the patient visits. They rotate duties each day. Front desk duties include all administrative work from answering the phone, scheduling appointments, taking prescription refill requests, billing, faxing, etc. So if on Monday Vivian is helping the doctor, then it is Manuella who takes care of the front desk and all office work. The two nurses are constantly busy and running around and patients are now accustomed to a minimum 1-2 hour wait before being seen. And if one nurse is absent, the situation is even worse in the clinic. The clinic has 3 examination rooms so the owner is now looking into bringing a new physician or nurse practitioner on board. This would help him grow his practice, provide better service to his patients, and maybe reduce the patients’ waiting time. Dr. Martin knows that this will increase the admin overhead and the 2 nurses will not be able to manage any additional admin work. He faces several challenges and cannot afford to hire any additional administrative staff so the owner has to optimize his admin and clinical operations. The practice is barely covering the expenses and salaries at the moment. Dr. Martin’s practice operation is all paper-based with paper medical records filling his front desk shelves. The only software the doctor has on his front office computer is an appointment scheduling software. Even insurance billing is done in a quasi-manual way. For billing insurance, the front office nurse has to fax all the needed documentation to a third party medical billing company at the end of the day. The medical billing company then submits the claim to the insurance company and bills the patient. The clinic checks the status of the claims by logging into the medical billing system, through a login that the medical billing company has provided the clinic to access its account. There is no billing software installed at the practice, but the nurses open Internet Explorer to the URL of the medical billing company and then use the login provided by the third party medical billing company. Of course, the medical billing company takes a percentage of the amount that the clinic is reimbursed by the insurance. The medical practice does not have a Web site, and essentially still operates the same as it did in 1980. One problem immediately noticed is that there is no quick way to check patients in and if the nurse is on the phone while a patient tries to check in, then the patient has to wait until she is done. The doctor could be also waiting for the patient to be checked in, wasting valuable doctor time. Also many patients experience long waits on the phone when they are trying to schedule an appointment, while the nurse is checking in patients or responding to another patient’s request in the office. Every year, the clinic requires its patients to fill their information and insurance information anew, rather than have them just verify what they have on file. This annoys some of the moms when they have to complete the paperwork and take care of their sick child in the lobby. All of the medical records, lab results and financial and payroll accounts are kept on paper, so there is not a quick way to look up a patient’s history or current prescriptions if the doctor gets a call while he is away from the office. At the beginning of each day, the nurses pull the files for all patients who have appointments scheduled for that day. But the clinic also accepts walk-in patients. At a recent medical conference Dr. Martin learned of the government’s financial incentives for Electronic Health Records (EHR) and meaningful use adoption. After attending several demonstrations by the different vendors, ClinicalWorks, AthenaHealth, etc., he realized how inefficiently his practice is running and all of the opportunities that EHR systems can provide. The owner recognizes the benefits of moving to electronic medical records but does not know where to begin and feels overwhelmed. He is also concerned about disruption to his practice which may negatively affect his patients’ care experience. Moreover, neither the doctor nor the nurses have any knowledge or experience when it comes to information technology. Upon the recommendation of a fellow doctor, Dr. Martin has decided to hire an independent EHR Consultant, to help him select the best EHR for his practice. His friend also advised him that he should not just buy any package from a vendor but have the EHR consultant analyze the workflow processes at the practice first, then optimize them, and then look at the EHR systems. The new 01/23/2014 IFSM 305 – Case Study Description Page | 1 EHR system needs to work with the optimized processes of his practice. Dr. Martin needs to get his staff’s buy-in and involvement in the process from Day 1, if the EHR adoption process is to succeed. Dr. Martin realizes that EHR adoption will add significant costs to his practice, which he cannot afford. Therefore, he will go for the EHR adoption at this point, only if he can expect to qualify for the financial incentives for achieving meaningful use1. This extra money will help reduce the burden of the cost on a clinic that is barely able to sustain any more costs at this time. Dr. Martin, the owner of the UMUC Family Clinic, has just learned that he will start being penalized in the form of payment adjustments in 2015 according to CMS. Based on his fellow doctor’s recommendation, Dr. Martin has contracted with an independent EHR consultant, who is not associated to any vendor, to advise him through this process. Throughout this course you will be the EHR consultant. Dr. Martin has several strategic goals in mind that he shares with you during your first consultation with him as his consultant. For one, he would like to see his medical practice operate more efficiently and make some financial profit that would allow him to reinvest into the clinic in order to upgrade and expand. In a few years, he will need to invest some funds in a major renovation, primarily in the examination rooms and the waiting area. If he had extra money, he could also rent the apartment next to his clinic and open up the space to make a larger clinic. If he did that, he could also expand the clinic into a 3-physician group practice and maybe rent out some space to a physical therapy physician and generate some additional income. After much discussion with fellow MDs, he realizes that it is in his best interest to actively start the process of EHR adoption and take advantage of the incentives provided through the meaningful use program1. So this has now become another strategic goal for the practice. By implementing an EHR system, he will be able to fulfill another strategic objective, which is to raise the level of IT-awareness among his staff. Dr. Martin also wants to use technology to improve the quality of care, safety, and financial management decisions of his practice, while also meeting the legal and regulatory requirements for health care and health care systems. Your task is to help Dr. Martin decide which of his clinical processes can benefit from an IT solution, which processes should be automated first, how an EHR system could help his practice, which incentive program to qualify for, how to achieve meaningful use by adopting a certified EHR system and how to meet meaningful use reporting requirements. You are not expected to solve all of the problems identified or address all improvements that could be made at the UMUC Family Clinic. Note: We’re looking for a technology solution. While installing a TV in the waiting room may attract new patients, it is not a technology solution. The following is an example of how you will identify a process and optimize it using an EHR system: Last year, the medical practice had no effective way to check its members in when they arrived. Sign-in sheets were used at the front desk, and the nurse had to check off the name on the sheet against existing medical records in the filing cabinet. Some of the patients were walk-ins, so the nurses had not pulled their files off the shelf when they started the day. The nurse had to leave the desktop go search for the file on the shelf. This caused patients a long wait at the front desk, and several had complained to Dr. Martin about this situation. To address the business need of quickly checking members in, the appointment scheduling system was modified to allow the clinic office to quickly lookup patients by last name and date-of-birth (DOB) on the computer as they sign in. Note: As you approach the case study assignments, you will find it helpful to think about your own experiences with a medical practice. Making a trip to a small medical practice may help you think about the processes, challenges, and opportunities. 1 From the CMS.gov website: “The Medicare and Medicaid EHR Incentive Programs provide financial incentives for the “meaningful use” of certified EHR technology to improve patient care. To receive an EHR incentive payment, providers have to show that they are “meaningfully using” their EHRs by meeting thresholds for a number of objectives. CMS has established the objectives for “meaningful use” that eligible professionals, eligible hospitals, and critical access hospitals (CAHs) must meet in order to receive an incentive payment.” Meaningful use will be covered in the course materials. 01/23/2014 IFSM 305 – Case Study Description Page | 2 STAGED ASSIGNMENTS The case study and assignments address the Course Outcomes to enable you to:  Evaluate the organizational environment in the health care industry to recognize how technology solutions enable strategic outcomes  Analyze the flow of data and information among disparate health information systems to support internal and external business processes  Evaluate technology solutions in the health care industry to improve the quality of care, safety, and financial management decisions  Examine the implications of ethical, legal, and regulatory policy issues on health care information systems. Upon completion of these assignments you will have performed an array of activities to demonstrate your ability to apply the course concepts to a “real world situation” to:     Analyze a clinical process and diagram the steps (Stage 1) Propose an appropriate EHR technology solution (Stage 2) Identify and explain the meaningful use reporting requirements (Stage 3) Identify and explain the considerations in implementing the solution proposed in Stage 2 (Stage 4) The staged assignments are designed to follow the relevant chapters of the textbook in the class schedule, and are due on the dates as assigned. Assignments for stages 2 and 3 require external research, outside of the textbook and other materials provided in the classroom. The grading rubric is included with each assignment. These assignments are designed to help you identify how to effectively analyze and interpret information to improve a medical practice using technology. This is an opportunity for you to apply critical thinking skills and think like a professional medical consultant. When you are writing a paper or developing a presentation, prepare it as if it is going to the owner, Dr. Martin, whom you want to impress with your knowledge and abilities. Don't just go through the mechanics of pulling together information -- think about what you are doing, why you're doing it, whether it make sense, whether the information seems realistic, and what the results show. It’s important that you identify relevant, timely resources that specifically support the points or information you provide in your assignment. You should read the source and assimilate the information first, and then put it into your own words and incorporate it into the flow of your writing (with an appropriate in-text APA citation and a list of references at the end of your paper). Direct quotes should be used very sparingly—only when the author’s own words uniquely present a concept that would be lost if paraphrased by you. One of the prerequisites for this course is that you have a fundamental working knowledge of word processing and presentation software. Detailed instructions for each Staged Project, 1 through 4, are posted in the Assignments area of the classroom. You are to prepare each assignment in the indicated format (i.e., table, outline, report, presentation or other specified format) and submit it as an attachment through your individual Assignments Folder in LEO. No credit will be given for assignments submitted in file formats other than those stated in the assignment instructions. Do not wait until the last minute to begin an activity. You should read through all the assignments in advance to ensure you (1) understand what is expected, and (2) allow enough time to effectively create the information being requested. 01/23/2014 IFSM 305 – Case Study Description Page | 3