ORBA’s Health Care Group Newsletter is a quarterly publication focused on effective practice management.

The Ins and Outs of Stage 2 Meaningful Use
Robert Rifkin, CPA, MBA

The federal government’s initiative to encourage the deployment of meaningful use (MU) among health care providers has moved on to Stage 2. The bar has been raised for what is demanded of physician practices. There are more core measures, new menu measures and higher reporting thresholds. In Stage 2, MU focuses on care coordination and patient engagement.

Meeting the Deadline
Eligible providers who did not start the MU program and met the March 20, 2015, attestation deadline will be penalized in 2015 the equivalent of 1% of their Medicare Part B reimbursement. The penalty increases to 2% in 2016, and providers will not be eligible for Electronic Health Record (EHR) incentive payments.

If a practice has not yet initiated its MU program, it should do so immediately because it must start by meeting Stage 1 standards. There are certain steps you will need to do:

1. Register with the CMS.
2. Select an EHR system that is suited to your practice, certified to 2014 MU standards and compliant with the upcoming ICD-10 transition.
3. Designate a team that includes doctors to lead the effort. If you are already behind schedule, consider hiring a consultant.
4. Choose the Clinical Quality Measures (CQMs) for which your practice intends to demonstrate MU. Pick measures that are most relevant and beneficial to the practice.
5. Deploy a patient portal, which is mandatory under both Stage 1 and Stage 2.

Moving On to Stage 2 and its New Standards
If your practice is currently satisfying Stage 1 and is ready to move on to Stage 2, it can look forward to some new standards. Your practice must achieve 17 core objectives and its choice of three out of six menu objectives, for a total of 20 objectives. Here are a few of the core objectives:

• Use computerized provider order entry for medication, laboratory and radiology orders;
• Generate and transmit permissible prescriptions electronically;
• Record demographic information;
• Provide patients the ability to view, download and transmit their health information online;
• Create clinical summaries for patients for each office visit;
• Keep lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach;
• Collect clinically relevant information to identify patients who should receive reminders for preventive/follow-up care; and
• Implement secure electronic messaging to communicate with patients on relevant health information.

The six menu objectives include submitting electronic syndromic surveillance data to public health agencies and recording electronic notes in patient records. Other objectives include making imaging results accessible through Certified Electronic Health Record Technology, recording patient family health history, identifying and reporting cancer cases to a state cancer registry and identifying and reporting specific cases to a specialized registry.

Still another objective is to commit to nine CQMs out of a total of 64 options. Those nine must lie in at least three of the following domains:

• Patient and family engagement;
• Patient safety and care coordination;
• Population and public health; and
• Efficient use of health care resources.

The last objective aims to improve clinical process and effectiveness.

Testing the System
The performance of MU activities revolves around the practice’s EHR system, which must be tested and certified under the Office of the National Coordinator for Health Information Technology Certification Program. The original certification criteria expired last year and were replaced by a 2014 edition. All EHRs must be upgraded to that edition.

The transition to Stage 2 should be relatively seamless. The EHR vendor must insert Stage 2 thresholds into the EHR workflow to make sure the right person is doing the right work. Vendors also need to ensure delivery of critical information to physicians at the point of care. And all of this should be accompanied by support, training and coaching until the practice is comfortable with the new system.

Your Portal: Moving from Stage 1 (Creating a Portal) into Stage 2 (Conveying Meaningful Information)
Stage 1 required that practices make an online portal available to their patients, without necessarily doing anything to ensure that they use it. Under Stage 2, the portal must be engaging and user-friendly and must support patient-centered outcomes. The portal must be integrated into clinical encounters so that it can convey information, communicate with patients, and support self-care and decision-making. Finally, the practice must actively promote and facilitate portal use.

Meeting the Requirements
Whether you are just starting Stage 1 or ready to move on to Stage 2, make sure you work with your health care advisor on meeting these requirements. He or she can walk you through the process.

For questions, contact Bob Rifkin at 312.670.7444. Visit orba.com to learn more about our Health Care Group.

Tips on How to Engage Your Patients
Jason Flahive, CPA

Patient engagement has always been considered a desirable feature of physician practices and health care organizations. Today, it has become vital to business success in the delivery of care. In fact, the elements of a robust patient engagement strategy are among the required objectives of Stage 2 meaningful use program.

The Benefits
Focusing on patient engagement improves efficiency, reduces out-migration and can reduce the costs of care. Patients who are actively involved in their health care can achieve better outcomes and even have lower per capita costs than patients who are less engaged.

A practice that implements a patient engagement strategy will improve the care experience of its patients, who will likely pay more attention and follow directives. Engaged patients maintain a stronger attachment to their medical practices, and experience greater value, trust and quality in their care.

The Concept
Patient engagement occurs at the interface between the practice and its patients. It involves both parties collaborating on record keeping, care plans, health tracking, appointments, preventive care, decision making, patient-focused education and medication management.

Also incorporated in patient engagement is the ability and willingness of patients to manage their own health care, as well as a practice culture that prioritizes and supports patient engagement. A true partnership between patients and providers to manage health outcomes is the ultimate objective.

The Strategy
To create your strategy, define an ideal model of patient engagement for the practice and compare this to where the practice is today. Then, identify any gaps that must be closed. This strategy should be tailored to individual specialties and departments, and to particular staff members and care teams.

Next, build a practice culture that embraces patient engagement. Implement engagement-friendly technologies, with patient portals being the best example. The portal solution should connect to the practice’s Electronic Health Record, billing and practice management systems. It serves as an integrated, multi-featured patient communications platform that offers live operator support; automated phone, text and e-mail reminders for bills and appointments; and medication schedule alerts.

Promote the portal to existing patients and during orientation for new patients. Explain its benefits clearly, and provide incentives for using it.

A Great Team
Naturally, it is critical that you use regular patient input (such as short surveys and focus groups) to help shape engagement efforts. Over time, you will find that you and your patients make a great team. For questions, contact Jason Flahive at [email protected] or call him at 312.670.7444. Visit orba.com to learn more about our Health Care Group.