Core Measure Objectives Incorporated Stage2 differences to Stage 1..

These modifications where measures have been combined or eliminated are great news. This will help with minimizing physician and staff time having to track some of these measures. A few of them are completed by your EHR/EMR software and it should be doing this for you automatically.  If your software or workflow is not set up to handle these changes, then you may want to seek the help of your vendor or a professional consulting company.

In this portion we are going to cover six (6) of the Core measure objectives and two (2) of the menu measures since some of the changes are straight forward with the incorporation of the core measures and the menu measures and how they have been eliminated or incorporated into another measure and are being tracked.

Core Measure Objective 2 Stage 1 is written as:

“Implement drug-drug and drug-allergy interaction checks.”

The measure for Stage 1 is:
“The EP has enabled this functionality for the entire EHR reporting period.”

Exclusion for Stage 1:
“No Exclusion”

For Stage 2 this is no longer a separate objective. This measure is incorporated into the Stage 2 Clinical Decision Support measure.

Core measure objective 3 of 15.

Core Objective 3 Stage 1 is written as:

“Maintain an up-to-date problem list of current and active diagnoses.”

The measure for Stage 1 is:

“More than 80 percent of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data.”

Exclusion for Stage 1:

“No exclusion”

For Stage 2 this is no longer a separate objective. This measure is incorporated into the Stage 2 of Summary of Care Document at Transitions of Care and Referrals.

Core measure objective 5 of 15.

“Maintain active medication list.”

The measure for Stage 1 is:

“More than 80 percent of all unique patients seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data.”

Exclusion for Stage 1:

“No exclusion”

For Stage 2 this is no longer a separate objective. This measure is incorporated into the Stage 2 of Summary of Care Document at Transitions of Care and Referrals.

Core measure objective 6 of 15.

“Maintain active medication allergy list.”

The measure for Stage 1 is:

“More than 80 percent of all unique patients seen by the EP have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data.”

Exclusion for Stage 1:

“No exclusion”

For Stage 2 this is no longer a separate objective. This measure is incorporated into the Stage 2 of Summary of Care Document at Transitions of Care and Referrals.

Core measure objective 10 of 15.

“Report ambulatory clinical quality measures to CMS.”

The measure for Stage 1 is:

“Successfully report to CMS ambulatory clinical quality measures selected by CMS in the manner specified by CMS.”

Exclusion for Stage 1:

“No exclusion”

No longer a separate core measure objective for Stage 2, but providers must still submit CQMs to CMS or the States in order to achieve meaningful use.

However like the other core measures this will still have to be reported on in Stage 2. Starting in 2014; all CQMs will be submitted electronically to CMS.

Measure 14 of 15

The objective for Stage 1 was “Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, and diagnostic test results), among providers of care and patient authorized entities electronically.”

The measure was “Performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information.”  With No exclusion.

This objective and the measure was eliminated from Stage 1 in 2013 and is no longer an objective for Stage 2.

That is a total of 6 core measures that have been eliminated or incorporated into a Stage 2 core measures. We have a total of 2 Menu Set Measures that have been incorporated or eliminated from Stage 2 completely.

Measure 1 of 10 Stage 1

Objective: “Implement drug formulary checks”

Measure: “The EP has enabled this functionality and has access to at least one internal or external formulary for the entire EHR reporting period.”

Exclusion: “Any EP who writes fewer than 100 prescriptions during the EHR reporting period.”

Stage 2: This is no longer a separate objective for Stage 2. This measure is incorporated into the e-Prescribing measure for Stage 2. Which, we will discuss in the next issue of this series.

The last change we will cover today is:

Menu set measure 5 of 10.

The objective: “Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP.”

Measure:  “At least 10 percent of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP’s discretion to withhold certain information.”

Exclusion: “Any EP that neither orders nor creates lab tests or information that would be contained in the problem list, medication list, medication allergy list (or other information as listed at 45 CFR 170.304(g)) during the EHR reporting period.”

This objective and measure has been eliminated from Stage 1 in 2014 and is no longer an objective or measure for Stage 2.

One of the best practices for maintain active list for any measure that is 80% or greater is to start working with your staff and implementing a workflow change that will incorporate maintaining an active list on 100% of the patients.  You are more than likely already doing this when you are talking with your patient. It’s just making sure that the correct button is being clicked in your EHR/EMR.

This will help in a couple of ways. 1) The staff and patients get familiar with the procedure of bringing in an up to date medication list and having it updated in the EMR. 2) This familiarity will over time become a natural part of the office procedure and not disrupt the natural process of checking in.

Of course with any new change comes resistance and the how will we make it work.  The question is how can you not afford to make it work to collect that incentive payment now and avoid the penalties in the future.