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Make Meaningful Use of Your Time, Less Than 1% of Anesthesiologists Have Qualified1

 As many in the anesthesia community have known for quite some time, it is very difficult for the vast majority of anesthesiologists to meet the requirements for meaningful use under the Medicare EHR Incentive Program and thus, receive an incentive payment of up to $44,000. Some of the Program’s meaningful use criteria simply are not applicable to anesthesia.  ASA provides a rundown of the “… many hurdles you face when attempting to become a meaningful user of electronic health records.”2

It’s important to note a few key comments from the ASA Newsletter article “The Meaningful Use Hurdle” written by Grant Couch, Federal Affairs Associate for ASA.

1. “… only 422 anesthesiologists in the entire country have received incentives through the EHR Incentive Program as of June 19, 2012.Roughly, this is less than 1 percent of physicians who identify their specialty as anesthesiology.”1

2. “…most anesthesiologists are eligible [professionals] and could be subject to eventual payment reductions that could total 5 percent annually.”2

3. “…anesthesiologists do not have a meaningful set of criteria to participate in the incentives.”2

In its Final Rules on Stage 2, CMS acknowledged anesthesiologists’ difficulty in satisfying the meaningful use criteria by establishing a hardship exception, which would exempt an anesthesiologist from the payment penalty, where achieving meaningful use would result in a hardship for them. Otherwise, the payment penalty would apply to many anesthesiologists, beginning in 2015. In the Final Rules, CMS pointed, in part to, “…lack of face-to-face interactions and need to follow up with patients…” as justifications for the hardship exception. CMS went on to note that “…anesthesiologists do interact with patients, but not in a manner that is conducive to collecting the information needed for many aspects of meaningful use.” 5

If you have not done so, make meaningful use of your time by reading the full ASA article “The Meaningful Use Hurdle” and reviewing the Medicare EHR Incentive Program’s meaningful use criteria for Stage 1 to better understand what it takes to qualify.

Meaningful Use & Hurdling EHR CriteriaIf you have questions regarding this article, contact us at info@abeo.com.

 

What are the requirements for Meaningful Use in Stage 1 of the Medicare EHR Incentive Program?

To demonstrate meaningful use and qualify for a Medicare EHR Incentive Program incentive payment, eligible professionals must meet 20 of the 25 meaningful use objectives and report on 6 clinical quality measures.

The 15 core objectives are:

  1. Computerized provider order entry (CPOE)
  2.  Drug-drug and drug-allergy checks
  3. Maintain an up-to-date problem list of current and active diagnoses
  4. E-Prescribing (eRx)
  5. Maintain active medication list
  6. Maintain active medication allergy list
  7. Record demographics
  8. Record and chart changes in vital signs
  9. Record smoking status for patients 13 years or older
  10. Report ambulatory clinical quality measures to CMS/States
  11. Implement clinical decision support
  12. Provide patients with an electronic copy of their health information, upon request
  13. Provide clinical summaries for patients for each office visit
  14. Capability to exchange key clinical information
  15. Protect electronic health information

The menu set objectives are:

  1. Submit electronic data to immunization registries*
  2. Submit electronic syndromic surveillance data to public health agencies*
  3. Drug formulary checks
  4. Incorporate clinical lab-test results
  5. Generate lists of patients by specific conditions
  6. Send reminders to patients for preventive/follow-up care
  7. Patient-specific education resources
  8. Electronic access to health information for patients
  9. Medication reconciliation
  10. Summary of care record for transitions of care

*When selecting 5 menu objectives (from the 10 listed above), at least one must come from the Public Health list, which are items 1 and 2 on the list above.

In addition to meeting the core and menu objectives, eligible professionals are also required to report on 6 total clinical quality measures, as follows: 3 required core measures (or 3 alternate core measures); and 3 additional measures (selected from a set of 38).

The 3 required core measures** are:

  1. Hypertension: Blood Pressure Measurement
  2. Preventive Care and Screening Measure Pair:
    a) Tobacco Use Assessment
    b) Tobacco Cessation Intervention
  3. Adult Weight Screening and Follow-up

**If the eligible professional’s EHR data indicates a zero for the denominator of one or more of the core clinical quality measures, then they must choose one or more alternate core clinical quality measures from the alternate core measures list.

The 3 alternate core measures are:

  1. Weight Assessment and Counseling for Children and Adolescents
  2. Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or Older
  3. Childhood Immunization Status

The additional clinical quality measures are:

  1. Diabetes: Hemoglobin A1c Poor Control
  2. Diabetes: Low Density Lipoprotein (LDL) Management and Control
  3. Diabetes: Blood Pressure Management
  4. Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
  5. Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
  6. Pneumonia Vaccination Status for Older Adults
  7. Breast Cancer Screening
  8. Colorectal Cancer Screening
  9. Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD
  10. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
  11. Anti-depressant medication management:
    (a)  Effective Acute Phase Treatment,
    (b)  Effective Continuation Phase Treatment
  12. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation
  13. Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
  14. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
  15. Asthma Pharmacologic Therapy
  16. Asthma Assessment
  17. Appropriate Testing for Children with Pharyngitis
  18. Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer
  19. Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients
  20. Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
  21. Smoking and Tobacco Use Cessation, Medical assistance:
    a) Advising Smokers and Tobacco Users to Quit,
    b) Discussing Smoking and Tobacco Use Cessation Medications
    c) Discussing Smoking and Tobacco Use Cessation Strategies
  22. Diabetes: Eye Exam
  23. Diabetes: Urine Screening
  24. Diabetes: Foot Exam
  25. Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol
  26. Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation
  27. Ischemic Vascular Disease (IVD): Blood Pressure Management
  28. Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
  29. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment:
    a) Initiation,
    b) Engagement
  30. Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)
  31. Prenatal Care: Anti-D Immune Globulin
  32. Controlling High Blood Pressure
  33. Cervical Cancer Screening
  34. Chlamydia Screening for Women
  35. Use of Appropriate Medications for Asthma
  36. Low Back Pain: Use of Imaging Studies
  37. Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control
  38. Diabetes: Hemoglobin A1c Control (<8.0%)

Still looking for more information?  Review ASA’s analysis of the applicability and achievability of the Stage 1 requirements for surgical anesthesiologists, available as a PDF download at http://www.asahq.org/~/media/For%20Members/Advocacy/Electronic%20Health%20Records/ASA%20Analysis%20and%20Recommends%20for%20MU%20Requirements.ashx

REFERENCES

1 This percentage is derived by taking the 422 anesthesiologists that have received the inventive and divided by the 43,359 physicians that identify their specialty as anesthesiology. Physician Characteristics and Distribution in the US. American Medical Association. 2012.

2 American Society of Anesthesiologists Newsletter. September 2012. Volume 76. Number 9, at pp. 44-45.  See online version at: http://viewer.zmags.com/publication/153a4063#/153a4063/46

3 “CMS Medicare and Medicaid EHR Incentive Program, electronic health record products used for attestation” (Updated June 19, 2012 and accessed via data.go on June 28, 2012).

4  Letter from Jerry A. Cohen, M.D. to Marilyn Tavenner, Administrator and Chief Operating Officer – Centers for Medicare and Medicaid Services. May 7, 2012.  http://www.asahq.org/~/media/For%20Members/Advocacy/Electronic%20Health%20Records/ASA%20Stage%202%20letter%205%207%2012.ashx

5 77 Federal Register, 53968, at p. 54099 (September 4, 2012). http://www.gpo.gov/fdsys/pkg/FR-2012-09-04/html/2012-21050.htm

 

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abeo Management Corporation (abeo) serves as a leading source of revenue cycle management and practice management with a specialization in anesthesia. The company leverages its people, processes, and software to serve independent practices, surgery centers, hospitals and healthcare systems with a scope of services that include billing, coding, transcription, practice management, and business consulting.

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