Healthcare Quality, Electronic Health Records Important Issues for Providers

New Orleans—As part of the Patient Protection and Affordable Care Act (HR 3590), healthcare providers will be held more responsible for their quality of care and adherence to information technology initiatives such as quality reporting and electronic health records (EHRs). Providers who adopt the rules before 2014 will receive a financial incentive, whereas those who do not adhere to the standards by 2014 will be penalized. At the AAD meeting, presenters provided an overview of the issues and quality and technological programs during a session titled Washington Update. Alison Shippy, MPH, discussed the Physician Quality Reporting System (PQRS), which the Centers for Medicare & Medicaid Services (CMS) developed to provide financial incentives to physicians who voluntarily report on quality measures. To become eligible to receive 1% of the total allowed Medicare Part B charges for a reporting period, physicians have to report data on ≥3 quality measures. According to Ms. Shippy, participants can choose from >200 quality measures in 2011. In 2010, the AAD created an online resource guide (www.aad.org/qrs) called the Quality Reporting System where the organization provides dermatologists with tutorials and information on quality reporting as well as 2 modules through which they can submit data. Ms. Shippy said >800 dermatologists used the PQRS melanoma reporting tool, while >100 dermatologists used the electronic prescribing tool. The PQRS tool can be purchased from March through December, and participants must enter their quality reporting data for 2011 by January 31, 2012. The AAD will submit the data to CMS in March 2012, and physicians will receive checks by fall 2012. Ms. Shippy said that participants in the PQRS program in 2011 must have a >0% performance rate in all reported measures to qualify for the incentive, whereas they could have had a performance rate of 0% in all measures in 2010 and still received an incentive. Ms. Shippy discussed 3 measures that are part of the 2011 PQRS measures list and relevant for dermatologists. Measure 137, titled Melanoma: Continuity of Care–Recall System, asks for the percentage of patients with melanoma or a history of melanoma whose information was entered ≥1 time in 12 months into a recall system. The system must include a target date for the next complete physical skin exam as well as a process to follow up with patients who did not make or missed an appointment. Measure 138, titled Melanoma: Coordination of Care, asks for the percentage of patients who were diagnosed with melanoma and received a treatment plan communicated to physicians providing the care within 1 month of diagnosis. Measure 224, titled Melanoma: Overutilization of Imaging Studies in Stage 0-IA Melanoma, asks for the percentage of patients with stage 0 or IA melanoma without signs or symptoms who had not had diagnostic imaging studies ordered related to their diagnosis of melanoma. Rachna Chaudhari, MPH, followed by discussing the CMS’s EHR incentive programs, including Medicare, Medicaid, hospital, and Medicare Advantage plans. As part of the American Recovery and Reinvestment Act, in February 2009 the federal government pledged $19 billion in incentives to Medicare and Medicaid providers over a 10-year period to help influence their decision to use EHRs. To receive incentives, providers must use an EHR system certified by the Office of the National Coordinator for Health Information Technology, must be a “meaningful user,” and must submit clinical quality measures. Ms. Chaudhari said the Medicare EHR incentive program is for doctors of medicine, osteopathy, dental surgery, dental medicine, podiatric medicine, and optometry as well as chiropractors. She noted that Medicare providers cannot be based in hospitals (≥90% of a provider’s time being performed at a hospital inpatient or emergency department setting). Early adopters of EHRs will see the most benefits of the program. Participants who adopt EHRs in 2011 will receive a total of $44,000: $18,000 in 2011, $12,000 in 2012, $8000 in 2013, $4000 in 2014, and $2000 in 2015. Participants who adopt EHRs in 2012 will also receive a total of $44,000: $18,000 in 2012, $12,000 in 2013, $8000 in 2014, $4000 in 2015, and $2000 in 2016. Participants who adopt EHRs in 2013 will receive a total of $39,000: $15,000 in 2013, $12,000 in 2014, $8000 in 2015, and $4000 in 2016. Participants who adopt EHRs in 2014 will receive a total of $24,000: $12,000 in 2014, $8000 in 2015, and $4000 in 2016. Participants who adopt EHRs in 2015 and beyond will not receive any payments. To be eligible for incentives in the Medicare EHR program, providers must report in successive payment years. During the first year, they have to report during a 90-day period, but they must report for the full years in subsequent years. Ms. Chaudhari said that providers cannot receive incentives through the Medicare EHR program if they are enrolled in the federal e-prescribing incentive program. To be deemed a “meaningful user,” participants need to report on 15 core measures, which include 6 quality measures. In addition, they have to report on 5 additional measures from a 10-measure set. The core measures are to perform computer physician order entry on 30% of patients (providers writing <100 prescriptions in the reporting period are excluded); implement drug-to-drug and drug allergy checks; electronically prescribe for 40% of patients (providers writing <100 prescriptions in the reporting period are excluded); maintain a problem list of current and active diagnoses for 80% of patients; maintain an active medication list for 80% of patients; maintain an active medication allergy list for 80% of patients; record preferred language, sex, race, ethnicity, and date of birth for 50% of patients; record vital signs for 50% of patients ≥2 years of age (providers are excluded if they do not collect vital signs); record the smoking status of 50% of patients ≥13 years of age (providers are excluded if they do not see patients >13 years of age); implement a clinical decision-support rule relevant to the provider’s specialty as well as an ability to track the rule’s compliance; provide ≥50% of patients who request their health information with an electronic copy (providers who do not receive requests are excluded); provide clinical summaries for ≥50% for each office visit (providers not offering office visits are excluded); exchange key information electronically; protect electronic health information; and report clinical quality measures. The Medicaid EHR incentive program is open to physicians, nurse practitioners, certified nurse-midwives, dentists, and physician assistants. Eligibility criteria include providers (other than physicians) whose patient population includes ≥30% on Medicaid. Physicians only have to have ≥20% of their patients on Medicaid. CMS also offers an electronic prescribing program in which Medicare providers are eligible to earn 1% of their total Medicare Part B allowed charges if they electronically prescribe 25 times in 2011. Providers who do not partake in the program will be assessed a fine in 2012. They must report ≥10 times by June 30, 2012, or be assessed a penalty of 1% of their total Medicare Part B allowed charges. They will receive a penalty of 1.5% of their total Medicare Part B allowed charges if they do not report ≥25 times by December 31, 2012.