In the News

Clarification With Major Impact: A Safety Net for Meaningful Use Attestation Success

by Naomi Levinthal and Anantachai (Tony) Panjamapirom

Eligible professionals (EPs) and eligible hospitals (EHs) participating in the CMS Electronic Health Record Incentive Programs must demonstrate meaningful use based on a number of metrics or measures. At its basic level, many of these measures are ratios: denominators are a number of patients seen over a given period of time (i.e., the reporting period), and numerators are information collected about those patients included in denominators. The quotient is the provider’s performance, of which a specified threshold must be met in order to receive incentive payments.

Our Discovery

It had always been our understanding (and we believe the entire industry’s understanding) that numerators are constrained by the reporting period selected within the denominator. Meaning, both denominator and numerator information are collected over the same period of time. However, the Office of the National Coordinator for Health IT’s Health IT Certification Program test data suggested the opposite: providers had time outside of the selected reporting period to increase the numerator for some percentage-based measures. We provided an analysis of those data to CMS because such a discovery could have a significant effect on providers’ success in meaningful use. CMS subsequently confirmed our findings through a recently published Frequently Asked Question

The FAQ indicates providers have until the end of the attestation period (i.e., two months after the end of the calendar year/federal fiscal year) to collect data to increase numerators. For instance, EPs planning to attest in CY 2015 will collect data from Jan. 1, 2015, to Dec. 31, 2015, yet they may increase applicable numerators within the two months following the end of the CY, up to the attestation deadline. Along the same token, EHs in FFY 2015 have until Nov. 30, 2015, to collect data for the numerators.

For example, the Stage 2 View, Download, and Transmit (VDT) objective’s second measure requires 5% of unique patients to view, download or transmit their electronic health information. A patient seen or discharged could log in to a patient portal during or after the reporting period, and either action would count (i.e., increase the numerator).

To illustrate, during a given reporting period, 786 patients were seen or discharged and only 20 of them logged into the patient portal, falling short of the 5% threshold. However, of the remaining 766 patients, an additional 40 accessed the portal subsequent to the end of the reporting period, but before the attestation date. This brings the numerator to 60, or 7.6%, which exceeds the 5% threshold.

What It All Means

Such numerator logic can act as a prioritizing agent for providers’ work plans and increase their chance of meaningful use success. This clarification affects all meaningful use participants regardless of stage and year. Even in the year-long reporting period, providers have this “extra time” in the additional two months following the end of the payment year. However, the CMS clarification applies only to specified numerators, whereas the denominator is constant and always based on the selected EHR reporting period.

The “extra time” is surely welcome news to providers, but we caution two major considerations. First, there is possible downstream impact for certain measures. The first measure of VDT requires patient electronic health information be available online by a specified deadline (i.e., 36 hours after discharge for EH, and four business days for EP). Some of the required health information includes demographics, vital signs, smoking status and lab test results. Providers may jeopardize compliance for this measure if these data elements are not available by the deadline. On the flip side, those data element-associated objectives have higher thresholds than VDT alone, so providers may benefit from the “extra time” should performance lag.

Second, using the “extra time” outside the reporting period may not align well with clinical workflows. For example, during a second FFY quarter reporting period, an EH admits a patient on Feb. 14, 2014. Should the opportunity to create an electronic note not occur during the admission, the EH may do so at some point before Nov. 30, 2014 (the deadline for attestation).

As a result, providers should not delay when planning their implementation timelines and choosing their reporting periods. To the contrary, providers would benefit from the earliest possible reporting periods should their EHR upgrades and process readiness permit. Providers should view the “extra time” as a safety net to ensure they meet the long-term aspirations of meaningful use. The best-case scenario is always one where providers meet all the objective’s measures within the reporting period. However, if any of the percentage-based measures fail to meet the threshold, providers can take advantage of the “extra” time to improve their performance.

Impacted Stage 1 and Stage 2 Core and Menu Measures

Below are those objectives that allow “extra time” for numerator measurement.

Stage 1 Core Set Measures

1. Problem List

2. Medication List

3. Medication Allergy List

4. Demographics

5. Vital Signs

6. Smoking Status

Stage 1 Menu Set Measures

1. Drug Formulary Checks

2. Advance Directive

3. Clinical Lab-Test Results

4. Patient-Specific Education Resources

5. Medication Reconciliation

6. Summary of Care Record

Stage 2 Core Set Measures

1. Demographics

2. Vital Signs

3. Smoking Status

4. View, Download, and Transmit (Measure 2)

5. Clinical Lab-Test Results

6. Patient-Specific Education Resources

7. Medication Reconciliation

8. Summary of Care Record (Measures 1 and 2)

Stage 2 Menu Set Measures

1. Advance Directive

2. Electronic Notes

3. Imaging Results

4. Family Health History

5. Lab Result to Ambulatory Providers

Report: Healthiest Counties Have More Primary Care Physicians

globeMarch 21, 2013

From California Healthline

The healthiest counties in California and other states also have the highest number of primary care physicians, according to an analysis by the Robert Wood Johnson Foundation and the University of Wisconsin’s Population Health Institute, Modern Healthcare reports.

Details of Analysis

To develop the 2013 County Health Rankings, researchers analyzed federal data examining:

  1. Clinical care, such as access to primary care physicians and insurance rates;
  2. Health behaviors, such as smoking and alcohol consumption;
  3. Social and economic factors, such as unemployment and crime rates; and
  4. Physical environment, such as access to healthy foods and air pollution (Barr, Modern Healthcare, 3/20).

National Trends

The analysis identified several national trends, such as:

  1. Residents living in healthier counties are 1.4 times more likely to have access to a physician and a dentist than residents living in the least healthy counties;
  2. Counties where residents do not live as long and experience poorer physical or mental wellness have the highest rates of smoking, teen births and physical inactivity, as well as more preventable hospitalizations; and
  3. Teen birth rates are more than twice as high in the least healthy counties than in the healthiest counties (Robert Wood Johnson Foundation release, 3/20).

California Rankings

The analysis ranked California counties according to health outcomes and health factors.

According to the report, health outcomes represent how healthy a county is, while health factors represent what influences the health of the county.

In California, the highest-ranking counties according to health outcomes are, respectively:

  1. Marin;
  2. Placer;
  3. Santa Clara;
  4. San Mateo; and
  5. Yolo.

The lowest-ranking counties according to health outcomes are, respectively:

  1. Lake;
  2. Siskiyou;
  3. Tehama;
  4. Kern; and
  5. Del Norte.

The highest-ranking counties according to health factors are, respectively:

  1. Marin;
  2. Placer;
  3. San Mateo;
  4. Santa Clara; and
  5. El Dorado.

The lowest-ranking counties according to health factors are, respectively:

  1. Tulare;
  2. Kern;
  3. Imperial;
  4. Fresno; and
  5. Merced (County Rankings 2013: California Report, 3/20).

Read more – California Healthline.

HHS announces next steps to promote use of electronic health records and health information exchange

February 2013

Today, Health and Human Services (HHS) Secretary Kathleen Sebelius announced the next steps in the Obama administration’s work to help doctors and hospitals use electronic health records.

“The changes we’re announcing today will lead to more coordination of patient care, reduced medical errors, elimination of duplicate screenings and tests and greater patient engagement in their own care,” Secretary Sebelius said.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, doctors, health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt and meaningfully use certified electronic health record (EHR) technology.

More than 120,000 eligible health care professionals and more than 3,300 hospitals have qualified to participate in the program and receive an incentive payment since it began in January 2011. That exceeds a 100,000 goal set earlier this year.

That includes more than half of all eligible hospitals and critical access hospitals and 1 out of every 5 eligible health care professionals.  The program is divided into three stages:

  • Stage 1 sets the basic functionalities electronic health records must include such as capturing data electronically and providing patients with electronic copies of health information.
  • Stage 2 (which will begin as early as 2014) increases health information exchange between providers and promotes patient engagement by giving patients secure online access to their health information.
  • Stage 3 will continue to expand meaningful use objectives to improve health care outcomes.

Today, HHS’ Centers for Medicare & Medicaid Services and HHS’ Office of the National Coordinator for Health IT released final requirements for stage 2 that hospitals and health care providers must meet in order to qualify for incentives during the second stage of the program, and criteria that electronic health records must meet to achieve certification.

The requirements announced today:

  • Make clear that stage two of the program will begin as early as 2014. No providers will be required to follow the Stage 2 requirements outlined today before 2014.
  • Outline the certification criteria for the certification of EHR technology, so eligible professionals and hospitals may be assured that the systems they use will work, help them meaningfully use health information technology, and qualify for incentive payments.
  • Modify the certification program to cut red tape and make the certification process more efficient.
  • Allow current “2011 Edition Certified EHR Technology” to be used until 2014.

The CMS final rule also provides a flexible reporting period for 2014 to give providers sufficient time to adopt or upgrade to the latest EHR technology certified for 2014.

A fact sheet on CMS’s final rule is available at

A detailed fact sheet on ONC’s standards and certification criteria final rule is available at

The final rules announced today may be viewed here. More information on the Stage 2 rule can be found at the CMS EHR Incentive Programs website at

New rule protects patient privacy, secures health information

January 2013

Enhanced standards improve privacy protections and security safeguards for consumer health data

The U.S. Department of Health and Human Services (HHS) moved forward today to strengthen the privacy and security protections for health information established under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

The final omnibus rule greatly enhances a patient’s privacy protections, provides individuals new rights to their health information, and strengthens the government’s ability to enforce the law.

“Much has changed in health care since HIPAA was enacted over fifteen years ago,” said HHS Secretary Kathleen Sebelius. “The new rule will help protect patient privacy and safeguard patients’ health information in an ever expanding digital age.”

The changes in the final rulemaking provide the public with increased protection and control of personal health information. The HIPAA Privacy and Security Rules have focused on health care providers, health plans and other entities that process health insurance claims. The changes announced today expand many of the requirements to business associates of these entities that receive protected health information, such as contractors and subcontractors. Some of the largest breaches reported to HHS have involved business associates. Penalties are increased for noncompliance based on the level of negligence with a maximum penalty of $1.5 million per violation. The changes also strengthen the Health Information Technology for Economic and Clinical Health (HITECH) Breach Notification requirements by clarifying when breaches of unsecured hea lth information must be reported to HHS.

Individual rights are expanded in important ways. Patients can ask for a copy of their electronic medical record in an electronic form. When individuals pay by cash they can instruct their provider not to share information about their treatment with their health plan. The final omnibus rule sets new limits on how information is used and disclosed for marketing and fundraising purposes and prohibits the sale of an individuals’ health information without their permission.

“This final omnibus rule marks the most sweeping changes to the HIPAA Privacy and Security Rules since they were first implemented,” said HHS Office for Civil Rights Director Leon Rodriguez. “These changes not only greatly enhance a patient’s privacy rights and protections, but also strengthen the ability of my office to vigorously enforce the HIPAA privacy and security protections, regardless of whether the information is being held by a health plan, a health care provider, or one of their business associates.”

The final rule also reduces burden by streamlining individuals’ ability to authorize the use of their health information for research purposes. The rule makes it easier for parents and others to give permission to share proof of a child’s immunization with a school and gives covered entities and business associates up to one year after the 180-day compliance date to modify contracts to comply with the rule.

The final omnibus rule is based on statutory changes under the HITECH Act, enacted as part of the American Recovery and Reinvestment Act of 2009, and the Genetic Information Nondiscrimination Act of 2008 (GINA) which clarifies that genetic information is protected under the HIPAA Privacy Rule and prohibits most health plans from using or disclosing genetic information for underwriting purposes.

The Rulemaking announced today may be viewed in the Federal Register at inspection.


November 2012

Judy Chan, President of HealthPro Consulting, San Francisco was one of five outstanding consultants from diverse disciplines inducted into the Million Dollar Consultant® Hall of Fame, as announced at a ceremony at the Oriental Mandarin Hotel in San Francisco on November 13, conducted by Alan Weiss, PhD, the globally-acclaimed “consultant’s consultant.” Criteria for membership in this elite group are:

  • Serving as an exemplar to others in the profession.
  • Manifesting the highest levels of integrity, ethics, and accountability.
  • Achieving significant annual revenue and profit improvement.
  • Contributing intellectual capital to the consulting profession.
  • Engaging in continuing, challenging, personal and professional development.
  • Taking prudent risk and demonstrating resilience.

Judy specializes in the turbulent and critical California health field, creating technology strategies that innovatively improve patient care and organizational efficiencies. She is versatile in helping small, medium, and large businesses as well as non-profits in rapidly and effectively implementing new strategies.