Demonstration Summary (F- 072808)

DEPARTMENT OF HEALTH & HUMAN SERVICES

Centers for Medicare & Medicaid Services

7500 Security Boulevard
Baltimore, MD 21244-1850

ELECTRONIC HEALTH RECORDS (EHR) DEMONSTRATION
Demonstration Summary
GOAL
The goal of this demonstration is to foster the implementation and adoption of EHRs and
health information technology (HIT) more broadly as effective vehicles not only to improve
the quality of care provided, but also to transform the way medicine is practiced and
delivered. Adoption of HIT has the potential to provide significant savings to the Medicare
program and improve the quality of care rendered to Medicare beneficiaries. This
demonstration is designed to leverage the combined forces of private and public payers to
drive physician practices to widespread adoption and use of EHRs.

DEMONSTRATION SITES
The demonstration will be implemented in 12 locations in two separate phases, one year apart.
Phase I
1. Louisiana
2. Maryland and the District of Columbia
3. Pennsylvania – 11 counties in the Pittsburgh area
4. South Dakota (and some border counties in Iowa, Minnesota, and North Dakota)
Phase II
5. Alabama
6. Delaware
7. Florida - 6 counties in the Jacksonville area
8. Georgia
9. Maine
10. Oklahoma
11. Wisconsin (selected counties)
12. Virginia
Selection of sites was based on a competitive process to identify “community partners” to
assist CMS with education, outreach activities, and recruitment of physician practices.
Community partners will also collaborate with CMS on an ongoing basis in an effort to assist
us in achieving our goal of leveraging the combined forces of private and public payers to
drive physician practices to widespread adoption and use of EHRs. A complete list of
community partners for each site is provided in Attachment 1.

DEMONSTRATION DESIGN
The EHR demonstration is a pay for performance demonstration with two separate but interdependent incentive payments: one for the adoption and use of an electronic health record and
one for the reporting (after year 2) or performance (after each of years 3 through 5) on 26
clinical quality measures related to the care of diabetes mellitus (DM), congestive heart
failure (CHF), coronary artery disease (CAD) and preventive care services.
This is not a grant program and there is no up-front payment for the purchase or
implementation of an electronic health records system.
The demonstration expands upon the foundation created by the Medicare Care Management
Performance (MCMP) Demonstration which began in July 2007 with almost 700 primary care
practices in Arkansas, California, Massachusetts and Utah. However, there are some
significant differences between the two demonstrations. First, the EHR Demonstration will be
implemented in two phases, each of which will last five years. Practices participating in the
EHR Demonstration will also be required to annually complete an Office Systems Survey
(OSS) to measure the use of an electronic health record (EHR). In addition, the EHR
Demonstration involves a randomized control design in which half of the eligible practices
that apply will be assigned to a demonstration treatment group and will be eligible to earn
incentive payments and half will be assigned to a control group that will not be eligible to
receive demonstration incentives.
While practices are not required to have implemented an EHR in order to apply to participate
in the EHR Demonstration, they should intend to do so within the first two years of the
demonstration. Most significant, in the EHR demonstration, by the end of the second year, all
participating physician practices will be required to have implemented and be using a
Certification Commission for Healthcare Information Technology (CCHIT)-certified EHR to
perform certain minimum core functions that can positively impact patient care processes.
These include documentation of patient visits, the recording of orders and results for
laboratory and other diagnostic tests, and the recording of prescriptions. Practices that do not
meet this requirement will be dropped from the demonstration and will not be eligible to
receive any incentive payments.
CMS will recruit approximately 200 eligible practices in each location to participate in the
demonstration. Eligible practices will be randomly assigned to either a “treatment” or
“control” group. Practices that are assigned to the “treatment” group will be eligible to receive
financial incentives for participating in the demonstration and meeting all other demonstration
requirements. Practices that are assigned to the “control” group will not be eligible to receive
financial incentives but they also will not have to meet any of the other demonstration
requirements such as implementation of a CCHIT-certified EHR by the second year, the
annual OSS, or reporting of clinical quality measures. Practices assigned to the control group

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will be asked to complete the OSS at the end of the second and fifth years of the
demonstration and they will receive compensation for their time to complete the survey.

PRACTICE ELIGIBILITY
This demonstration is intended for small to medium sized primary care practices. Small to
medium-sized is defined as 20 or fewer physicians. In addition, this may include advancedpractice nurses and/or physician assistants who bill Medicare independently for services. For
purposes of determining whether a practice meets the “up to 20” limit, all providers,
regardless of specialty are counted. However, only primary care providers may actually
participate in the demonstration. Although it is desirable for all of the primary care providers
in a practice to participate in the demonstration, this is not a requirement. Primary care
providers that are part of a multi-specialty group may participate as a practice even if the
specialists are not eligible to be included in the practice for demonstration purposes.
Similarly, a group of primary care providers may participate as a practice even if one or more
of their primary care colleagues in the practice are not interested in participating. If we
receive more applications in an area than we can accommodate, preference will be given to
the smallest practices and those that are in the early stages of adopting EHRs.
Primary care includes general practice, family practice, internal medicine and geriatrics. In
addition, medical sub-specialists (e.g. cardiologists, endocrinologists, etc.) whose practice is
predominantly primary care may be eligible participate. However, the latter should be aware
that if they are selected to participate, they will be expected to submit the same clinical quality
measures on DM, CHF, CAD and preventive care services for all of their assigned patients as
will all other primary care providers participating in the demonstration.
CMS recognizes that practices may define themselves in a variety of ways and in different
ways for different purposes. For the purposes of applying to the demonstration, a practice may
be a single location or include multiple locations, particularly if the providers work at several
sites. For the demonstration, a practice is usually a single, independent organization that
provides services to patients. In general this would be at a single location, but not necessarily
so. A practice may be comprised of several physicians that each bill under their own Tax
Identification Number (TIN) but share space, nursing support, etc. Or, a practice may be a
part of a larger organization that bills under one Tax ID number for multiple smaller practices.
Although a practice is generally a single site, this is not necessarily so if the physicians work
at multiple sites and patients may see the same doctor at different sites depending, for
example, on the day of week. The key in defining a practice is that CMS must be able to
uniquely “assign” 1 patients to a single practice and group of providers and that services billed

1

CMS has created a “beneficiary assignment” algorithm that, based on historic claims data during any given
reporting period, assigns a patient to the practice where s/he received the most primary care visits. This is a
retrospective process and does not, in any way, affect where a beneficiary may receive care in the future. The

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by those providers can be uniquely and accurately assigned to the practice. Therefore, as part
of the demonstration application, we require that the practice be able to uniquely define the
providers participating in the practice by TIN, individual Medicare Provider Identification
Number (PIN), and individual National Provider Identifier (NPI).
In addition to the above, practices must also meet the following requirements in order to
participate in the demonstration:
•

The practice must be the main provider of primary care to at least 50 Medicare
beneficiaries with Medicare Part A and B coverage under the traditional Medicare fee-forservice program (i.e. not enrolled in a Medicare Advantage or other Medicare health
plan). Beneficiaries enrolled in hospice care are also not counted. CMS will use claims
data to determine where beneficiaries received the plurality of their primary care services
and assign them to that practice.

•

The practice must bill for Medicare office visits and other services through a Medicare
carrier or Medicare Administrative Contractor (not a fiscal intermediary) using a HCFA
1500 form or electronic equivalent.

•

Practices may or may not have an electronic health record (EHR) in order to apply to
participate in the demonstration. However, if the practice has not yet implemented an
EHR, it should be committed to doing so within the next two years. Practices that are
selected to participate in the demonstration and have not implemented a Certification
Commission for Healthcare Information Technology (CCHIT)-certified EHR by the end
of the second year or are not using it for the specified core functionalities will be
terminated from the demonstration and will not be eligible to receive any incentive
payments.

PAYMENT METHODOLOGY SUMMARY
Practices participating in the EHR demonstration will be eligible for two separate financial
incentives. The first is an incentive based on their use of a CCHIT-certified EHR. The second
is an incentive for reporting clinical quality measures and, in years three through five, meeting
performance standards for treating patients with DM, CHF, and CAD. In addition, they will
be measured on how well they provide preventive services (immunizations, blood pressure
screening and cancer screening) to high risk chronically ill Medicare beneficiaries.
Attachment 2 provides a list of the 26 measures to be used. Most of these measures will be
familiar to physicians as they have been used by health plans and other organizations for
several years. The majority of these measures are endorsed by the Ambulatory Quality
Alliance (AQA) and/or the National Quality Forum (NQF).
assignment process is used to determine the number of Medicare beneficiaries seen by a practice and which
patients are eligible for reporting on the clinical measures, and, therefore, impacts payment.

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All of the data submitted by any of the practices as part of this demonstration will be kept
strictly confidential. No personally identifiable data on any beneficiaries or details regarding
the performance of individual providers or practices will be made public.
The potential payment for both of these incentives is a “per beneficiary” amount and
determined, in part, by the number of beneficiaries for which the practice provides the
plurality of primary care visits. In the section below, the rules for determining which practice
a beneficiary is assigned to are described.

BENEFICIARY ASSIGNMENT
Payment under this demonstration is determined, in part, by the number of beneficiaries for
whom the practice is the main provider of primary care services. In addition, practices are
only expected to report the clinical quality measures on patients for whom they have seen for
primary care and for whom it can reasonably be expected that they would be responsible for
providing certain services or coordinating with other specialists to make sure that such
services are received.
CMS has developed a “beneficiary assignment algorithm” that assigns patients to practices for
each reporting period based on where the patient received the greatest number of primary care
visits, as reflected on Medicare claims data for that period. This is a retrospective process and
does not at all influence or determine where a patient may receive care in the future.
Throughout the demonstration, beneficiaries covered under the traditional Medicare fee-forservice program remain free to see any provider they choose. A beneficiary assigned one year
to one practice may, in fact, be assigned to another practice in the following year if s/he
moves or sees another provider for more primary care services for whatever reason. However,
for purposes of the demonstration, a beneficiary can only be assigned to one practice for any
given demonstration year.
The process of assigning beneficiaries to practices 2 starts with examining all Medicare claims
data for the reporting period. Only claims for primary care services by providers with a
primary care related specialty are considered. Beneficiaries are assigned to the practice that
provided the greatest number of such services during the reporting period. Then, based on the
diagnosis data on all claims (not just primary care claims), beneficiaries are further
categorized as to whether they have DM, CHF, CAD, or one of a range of other chronic
conditions that would make them eligible under the demonstration for reporting on the group
of preventive care measures. A beneficiary may be assigned to none, one, or more than one of
these “condition” categories based on whether s/he has any claims with the relevant
2

Beneficiaries are assigned at the practice level and not to individual providers unless the practice is comprised
of a solo practitioner. The reason for this is to aggregate those visits to the primary care provider with those to
partners in the practice that may cover for him in his/her absence.

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diagnoses. For example, a beneficiary with CHF and DM will be assigned to the DM
category, the CHF category, and the “chronic condition” category for reporting the preventive
care measures.
The number of beneficiaries assigned to each category will determine the potential payment
for each practice, as described in the “Payment Model” section below. In addition, it is from
these groups of assigned patients by category, that patients will be selected for reporting the
clinical quality measures. The specification for each clinical quality measure may, in addition,
have its own requirements (e.g. age or gender; prior hospitalization; diagnostic test, etc.) that
determine which beneficiary is ultimately eligible for reporting any given measure.
Accurate coding of diagnoses and submission of the provider identification numbers (e.g.
PIN, TIN, and NPI) on both the demonstration application form and claims are, therefore,
critical because of the impact of the beneficiary assignment process on reporting and
payment.

PAYMENT MODEL
Within the two broad categories of incentives (EHR-related and clinical quality related), there
are three types of financial incentives:
1. An annual incentive payment for performance on the Office Systems Survey; and
2. A payment after the second year of the demonstration for reporting the clinical quality
measures; and
3. A payment after each of the third through fifth years of the demonstration for performance
on the clinical quality measures.
To assist in reporting the clinical quality measures, CMS will provide as much information as
possible to practices including identification of which patients are eligible for each measure
and relevant data from Medicare claims. This should limit the amount of medical record
abstraction that is required. CMS will also provide an electronic reporting tool called the
Performance Assessment Tool (“PAT”) to be used for reporting. Practices may export some
or all of the data needed for reporting from their electronic health record system into this tool,
thereby further limiting the amount of manual work that might be needed for reporting. There
is no fee for using this tool or submitting the data.

Annual Incentive for Performance on the Office Systems Survey

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At the end of each year of the demonstration, practices will be asked to complete an Office
Systems Survey. 3 The survey will include questions about the EHR system used by the
practice and how it is being used to manage patient care. In order to receive any credit under
this incentive, practices will have to have implemented and be using a CCHIT-certified EHR
and be using it for minimum core functionalities including recording of patient visit notes,
recording of diagnostic test orders and results, and recording of prescriptions. Payment will be
tied to both the score on the survey and the number of beneficiaries with a chronic condition
that are assigned to the practice. Practices will receive up to $45 per beneficiary under this
incentive.
For example, a practice with two physicians that has 200 beneficiaries with chronic conditions
assigned to it that scores 100% on the survey could earn $9000 (200 x $45 x 100%) under this
incentive. If the same practice scored only 60% on the survey, the payment would be $5400
(200 x $45 x 60%). All demonstration practices will be required to complete the survey each
year and the amount of money earned is tied to the score on the survey that year. A practice
that scores 60% in year one will, hopefully, improve its score and earn greater financial
incentives in subsequent years by using its EHR for more advanced functionalities. In total,
practices will be eligible to earn up to $5000 per physician (up to $25,000 per practice) per
year under this incentive. Practices should note that, regardless of score on the OSS, starting
in the second year of the demonstration, payment of this incentive is contingent upon
reporting the clinical quality measures and, in years three through five, achieving minimum
performance standards on them. To the extent that measures are not fully reported or
minimum scores are not achieved for any given category, the payment on the OSS will be
reduced. (See Table I, as discussed in greater detail below).

Year 2 Incentive Payment for Reporting Clinical Quality Measures
After the end of the second year, the demonstration will include a “pay for reporting”
incentive to provide baseline information on the clinical quality measures and to help
physicians and their staff become familiar with the quality measurement data collection
process. For Year 2, practices will be paid $20 per beneficiary with a chronic condition 4 for
reporting the clinical quality measures. The total amount available to practices for this
incentive is $3,000 per physician (up to $15,000 per practice) based on the number of
3

Practices assigned to the control group will be asked to complete the OSS only after the second and fifth years
of the demonstration. They will be paid for their time to complete the survey, but will not be eligible for the
incentive payments.
4
Patients with a claim during the reporting year with any of the following diagnoses will be counted in the “any
chronic disease” category: congestive heart failure, coronary artery disease, stroke, atrial fibrillation,
atherosclerosis, diabetes, Alzheimer’s disease and/or senile dementia, depression, kidney disease, COPD,
emphysema, asthma, rheumatoid arthritis, osteoporosis, and cancer. This count of patients with a chronic
disease will be used to calculate payment of the clinical incentive on the preventive services measures. Patients
counted for the specific disease measures (diabetes, coronary artery disease, congestive heart failure) will be a
subset of this group.

Page 7 of 19

beneficiaries assigned to the practice. For this baseline data collection only, payment will not
be contingent upon a practice’s scores (performance) on the quality measures.
EXAMPLE #1:
In the example below (Table 1), the sample practice has a single physician with the
indicated number of beneficiaries assigned in each category. Because the practice did
not report on some of the clinical quality measures, it does not receive the full
reporting incentive payment for that category and the payment for the OSS score is
also reduced proportional to the number of measures reported (3 measures out of 26,
or 11.5%). In addition, the clinical reporting payment is also reduced because the
initial calculated amount is above the cap for a solo practitioner. In total, this provider
would earn $6204.82 for the year. Although the scores on the clinical quality measures
are calculated for the practice, they are for information only and are not used in the
incentive payment calculation in the second year.
TABLE 1: EXAMPLE OF INCENTIVE PAYMENT CALCULATION
Years 2 (Pay for Reporting)

Practice Size = 1 Physician

DM

CLINICAL QUALITY INCENTIVE PAYMENT
CHF
CAD
Preventive Care
Services

EHR BASED
INCENTIVE
Office Systems
Survey

50

36

25

100

100

$20

$20

$20

$20

$45

8

7

6

5

26

Maximum Possible Points

40

35

30

25

Points earned

38

25

8

8

95%

71%

27%

32%

# Medicare patients assigned
to the practice with relevant
diagnoses
Payment Per Patient for
Performance
# Quality Measures in
Category

Composite Quality Score

score calculated but not used for reporting
Measures Reported
% Clinical Reporting
Incentive Earned

8

7

(score on OSS)

6

2

100%

100%

100%

reported on
all
measures

reported on all
measures

reported on all
measures

did not report
on three of
five measures

50 x $20 x
100%

36 x $20 x
100%

25 x $20 x
100%

100 x $20 x
40%

Page 8 of 19

80%

40%

80%

100 x $45 x 80%

Sub Total Payment

$ 1,000.00

Total Payment for Clinical
Performance *

$

$

720.00

$

$

800.00

$ 3,600.00

3,020.00

Clinical Payment Due After
Maximum Cap Applied

$ 3,000.00

Reduction in OSS Incentive
Due to Failure to Report All
Measures in a Category

11.5%

Total Payment for OSS Use

Total Payment For Year

500.00

$ (415.38)

$3184.62

$

$6204.62

* Note: Maximum clinical reporting payment for year 2 is $3,000 per physician, up to $15,000 per practice per year.
Maximum OSS incentive is $5,000 per physician up to $25,000 per practice per year.

Year 3-5 Incentive Payment Based for Performance on Clinical Quality Measures
Starting at the end of the third year and for the remainder of the demonstration, practices will
be eligible to earn an incentive payment of up to $10,000 per physician per year (up to
$50,000 per practice per year) based on the practice’s scores on the clinical quality measures
during each demonstration year. This is the key payment incentive under the demonstration,
as reflected in the greater payment amounts potentially available to participating treatment
practices. Data will be collected starting approximately four or five months after the end of
each demonstration year, allowing sufficient lag time so that claims data are complete. CMS
will compare each practice’s score on each of the relevant clinical measures to an established
threshold 5 . Practices will be able to earn up to 5 points for each measure, depending upon
their individual score. Within each category (DM, CAD, CHF and preventive services), the
scores on all of the measures will be added up to calculate a composite score representing the
percentage of total possible points earned. Based on this composite percentage, practices will
be able to earn $45 per beneficiary 6 for each patient with each of the specific disease
categories and $25 per beneficiary for each patient with any chronic disease for scores on the
preventive measures. Practices that score 90% or more of the potential points in a category
will be eligible for the full per beneficiary payment in that category. Practices that score less
than 30% of the available points in a category 7 will not be eligible to earn any incentives for
that category. Between these two end points, the payment level earned will be prorated.
5

Practices that meet the top quartile of the most current Medicare HEDIS performance data will score full points
for the measure. Where HEDIS standards are not available for a measure, a 75 percent compliance rate will be
used as the threshold for full points. Lower scores will receive reduced point scores.
6
The targeted conditions are diabetes, congestive heart failure, and coronary artery disease. The preventive care
measures apply to beneficiaries with a range of chronic conditions, as noted above.
7
For the third year of the demonstration, practices must achieve a composite score of at least 30% in order to
earn any incentive payment for the category. During the fourth and fifth years of the demonstration, the
minimum required percentage of points to earn any payment will be raised to 40% and 50%, respectively.

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EXAMPLE #2:
In the example below (Table 2), the sample practice has a single physician with the
indicated number of beneficiaries assigned in each category. Assume that the data is
for year 3, the first year in which performance scores on the quality measures
determines the incentive payment. Because the practice did not achieve a minimum
score of 30% (See footnote 6.) on the Coronary Artery Disease (CAD) measures, it
earns no clinical incentive payment for that category and is penalized in the
calculation of the OSS related incentive proportional to the number of measures in that
category (6 out of 26 or 23%). However, because the practice scored over 90% on the
diabetes measures, it earns 100% of the potential incentive in that category. In total,
this provider would earn $8304.95 for the 3rd year.

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TABLE 2: EXAMPLE OF INCENTIVE PAYMENT CALCULATION
Years 3-5 (Pay for Performance)
Practice Size = 1 Physician

CLINICAL QUALITY INCENTIVE PAYMENT
CHF
CAD
Preventive
Care
Services
50
36
25
100

DM

# Medicare patients assigned to
the practice with relevant
diagnoses
Payment Per Patient for
Performance

EHR BASED
INCENTIVE
Office Systems
Survey
100

$45

$45

$45

$25

$45

8

7

6

5

26

Maximum Possible Points

40

35

30

25

Points earned

38

25

8

18

95%

71%

27%

72%

8

7

6

5

# Quality Measures in Category

Composite Quality Score
Measures Reported
% Clinical Performance
Incentive Earned

Sub Total Payment

100%
th

79%

0%
th

(score on OSS)
80%

80%

(over 90
percentile)

(prorated)

(below min. 30
percentile)

(prorated)

50 x $45 x
100%

36 x $45 x
79%

25 x $45 x 0%

100 x $25 x
80%

100 x $45 x 80%

$ 2,250.00

$ 1,285.71

$

$ 2,000.00

$

3,600.00

$

(830.77)

$

2,769.23

Total Payment for Clinical
Performance *

-

$

5,535.71

Clinical Payment Due After
Maximum Cap Applied

$ 5,535.71
23%

Reduction in OSS Incentive Due
to Below Minimum Quality
Score
Total Payment for OSS Use

Total Payment For Year

80%

$

8,304.95

* Note: Maximum clinical performance incentive for years 3-5 $10,000 per physician per year up to $50,000 per practice per year.
Maximum OSS incentive is $5,000 per physician up to $25,000 per practice per year.

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PAYMENT SUMMARY
Table 3, below, summarizes the total potential payment per year for each of the incentives
available under this demonstration.

TABLE 3: PAYMENT SUMMARY BY YEAR AND CATEGORY

Year 1

EHR Adoption
(Office Systems
Survey)
$5,000

Reporting
Clinical
Quality
Measures
n/a

Clinical
Quality
Measure
Performance
n/a

Maximum $ /
provider / Year
$5,000

Maximum $ /
Practice/ Year
$ 25,000

Year 2

$5,000

$3,000

n/a

$8,000

$ 40,000

Year 3

$5,000

n/a

$10,000

$15,000

$ 75,000

Year 4

$5,000

n/a

$10,000

$15,000

$ 75,000

Year 5

$5,000

n/a

$10,000

$15,000

$ 75,000

$58,000

$290,000

Total Potential Payment

Practices should keep in mind that due to the retrospective nature of the reporting process,
there will be a lag between the end of the demonstration year and when reporting and
payment occur. In particular, with the reporting of clinical quality measures, CMS must wait
at least 3 months to insure that all of the necessary claims data for the reporting period is
complete. It then takes approximately 8 weeks for CMS and its contractors to analyze and
prepare the data and put it in a format that practices can use to report the data. This includes
running the beneficiary assignment algorithm, determining which beneficiaries in each
practice are eligible for each measure, “pre-populating” the Performance Assessment Tool
(PAT) for each practice, and distributing the reporting databases to each participating
treatment practice. Practices are then given approximately 8 weeks to complete the tool and
submit the measures. Once the data is submitted, it is then analyzed for completeness and
obvious reporting errors before practice-specific summary reports are distributed and
payments issued. In addition, a small sample of practices may be selected for audit. In total,
practices can expect a delay of approximately 9 months after the reporting period before
payments are issued. All payments will be issued electronically.

DEMONSTRATION EVALUATION
CMS will be conducting an independent evaluation to determine the impact of financial
incentives on the rate of adoption of EHRs and their impact on quality and costs for the
Medicare program. Mathematica Policy Research has been awarded the contract to conduct
this evaluation which will include analyses of the quality measures and OSS data, Medicare

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claims, beneficiary and provider surveys, and site visits. Practices participating in the
demonstration will be expected to cooperate with the evaluation if they are asked to be part of
a survey or interview. Every effort will be made to work with practices and minimize any
possible disruption. All data collected will be kept confidential and no data at the individual
beneficiary, provider, or practice level will be made public.
TIME LINE
CMS will be recruiting physicians in Phase I sites to participate in this demonstration in the
late summer and fall of 2008. All applications will be due by November 26, 2008. Once all
applications have been received, they will be reviewed for eligibility and then randomly
assigned to the treatment or control group. Practices will be notified of their selection and
assignment to either the treatment or control groups by the end of March, 2009. Practices that
are assigned to the demonstration treatment group will be invited to an all-day informational
“kick off” meeting in their state in May 2009.
Below are some key dates and general time frames to keep in mind for the first few years of
the demonstration for Phase 1 sites.
Fall 2008
•

Practices submit completed applications to participate in demonstration. Applications
should be submitted no later than November 26, 2008 to receive full consideration.

November 2008 – March 2009
•

CMS reviews all applications for eligibility and randomly assigns those eligible to the
treatment or control group.

•

Late March – CMS notifies practices of their assignment to the treatment or control group.

May 2009
•

Demonstration “kick-off” meetings in each location (dates and locations to be announced)
for practices in the demonstration treatment group.

June 1, 2009
•

First operational year of the demonstration starts.

Late Spring / Summer 2010

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•

Practices complete and submit the Office Systems Survey (OSS).

Fall 2010
•

CMS calculates and sends to practices the initial incentive for performance on the OSS.

Late Spring / Summer 2011
•

Practices complete and submit a second Office Systems Survey (OSS).

Fall 2011
•

Practices complete and submit clinical quality measures for the second demonstration
year.

Winter / Spring 2012
•

CMS calculates and sends to practices Year 2 “pay for reporting” and OSS incentives.

FOR MORE INFORMATION
For more information about the demonstration, please check the demonstration web site:
http://www.cms.hhs.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?itemID=CMS1204776
Practices can sign up for email alerts to receive automatic notification whenever new
information is added to the demonstration.
If you have additional questions, you may also email the CMS Demonstration Project Officer
at: [email protected] (note: There is an underscore between ‘EHR’ and ‘Demo’ in
the email address.)

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ATTACHMENT 1
Community Partners for the Electronic Health Records Demonstration Project (rev 7/7/08)
Phase
Location
Defined Communities
Community Partner
1
Louisiana
Statewide
Louisiana Health Care Quality Forum
1
Maryland &
Statewide; district-wide
MedChi & Maryland Health Care
Washington, DC
Commission
1
Pennsylvania –
Allegheny, Armstrong, Beaver, Butler, Fayette,
Pittsburgh Regional Health Initiative
Pittsburgh area
Greene, Indiana, Lawrence, Somerset,
Washington & Westmoreland Counties
1

South Dakota – and
selected counties in
bordering states

South Dakota- Statewide
Minnesota- Big Stone, Clay Cottonwood,
Jackson, Lincoln, Lyon, Murray, Nobles,
Pipestone, Redwood, Rock, and Yellow Medicine
counties
Iowa- Buena Vista, Clay, Dickinson, Emmet,
Lyon, O’Brien, Osceola and Sioux counties
North Dakota- Dickey county

South Dakota Dept. of Health / SD EHealth Collaborative

2
2
2

Alabama
Delaware
Florida – Jacksonville
area
Georgia
Maine
Oklahoma
Virginia
Wisconsin – selected
counties

Statewide
Statewide
Baker, Clay, Duval, Nassau, Putnam and St.
Johns counties
Statewide
Statewide
Statewide
Statewide
Statewide EXCLUDING Ashland, Barron,
Chippewa, Clark, Eau Claire, Lincoln, Marathon,
Oneida, Portage, Price, Rusk, Sawyer, Shawano,
Taylor, Vilas, Washburn and Wood counties

Alabama Medicaid Agency
Delaware Health Information Network
Duval County Health Dept.

2
2
2
2
2

Page 15 of 19

Georgia Dept. of Community Health
Maine Chartered Value Exchange Alliance
Oklahoma State Dept. of Health
MedVirginia, LLC
Wisconsin Medical Society

ATTACHMENT 2
CLINICAL QUALITY MEASURES IN THE EHR DEMONSTRATION
Diabetes
Heart Failure
Coronary Artery Disease
Preventive Care
(measured on population
with specified chronic
diseases)
DM-1 HbA1c
HF-1 Left Ventricular CAD-1 Antiplatelet
PC-1Blood Pressure
Management
Function Assessment Therapy
Measurement
DM-2 HbA1c
HF-2 Left Ventricular CAD-2 Drug Therapy for
PC-5 Breast Cancer
Control
Ejection Fraction
Lowering LDL Cholesterol Screening
Testing
DM-3 Blood
HF-3 Weight
CAD-3 Beta Blocker
PC-6 Colorectal Cancer
Pressure
Measurement
Therapy – Prior MI
Screening
Management
DM-4 Lipid
HF-5 Patient
CAD-5 Lipid Profile
PC-7 Influenza
Measurement
Education
Vaccination
DM-5 LDL
HF-6 Beta Blocker
CAD-6 LDL Cholesterol
PC-8 Pneumonia
Cholesterol
Therapy
Level
Vaccination
Level
DM-6 Urine
HF-7 ACE
CAD-7 ACE
Protein Testing Inhibitor/ARB
Inhibitor/ARB Therapy
Therapy
DM-7 Eye
HF-8 Warfarin
Exam
Therapy for Patients
with AF
DM-8 Foot
Exam

Page 16 of 19

Diabetes Mellitus
DM-1

HbA1c Management – The percentage of diabetic patients with one or more A1c
tests

DM-2

HbA1c Control - The percentage of diabetic patients with a most recent A1c level
>9.0% (poor control)

DM-3

Blood Pressure Management - The percentage of diabetic patients with a most
recent BP < 140/90 mmHg

DM-4

Lipid Measurement – The percentage of diabetic patients with at least on lowdensity lipoprotein (LDL) cholesterol test

DM-5

LDL Cholesterol Level - The percentage of diabetic patients with a most recent LDL
cholesterol <130 mg/dl

DM-6

Urine Protein Testing - The percentage of diabetic patients with at least one test for
microalbumin during the measurement year; or who had evidence of medical
attention for existing nephropathy (diagnosis of nephropathy or documentation of
microalbuminuria or albuminuria)

DM-7

Eye exam - The percentage of diabetic patients who received a dilated eye exam or
evaluation of retinal photographs by an optometrist or ophthalmologist during the
measurement year, or during the prior year (this measure is adapted for claims data
measurement).

DM-8

Foot exam - The percentage of diabetic patients receiving at least one complete foot
exam (visual inspection, sensory exam with monofilament, and pulse exam).

Congestive Heart Failure
HF-1.

Left Ventricular Function Assessment- The percentage of CHF patients who
have quantitative or qualitative results of LVF assessment recorded.

HF-2.

Left Ventricular Ejection Fraction Testing - The percentage of CHF patients
hospitalized with a principle diagnosis of heart failure during the current year
who had left ventricular ejection fraction testing during the current year.

HF-3.

Weight measurement – The percentage of CHF patients with weight
measurement recorded.

Page 17 of 19

HF-5.

1. Patient Education- The percentage of CHF patients who were provided with
patient education on disease management and health behavior changes
during one or more visit(s) within a six month period

HF-6.

Beta-Blocker Therapy – The percentage of CHF patients who also have LVSD
who were prescribed beta-blocker therapy.

HF-7

ACE Inhibitor Therapy - The percentage of CHF patients who also have LVSD
who were prescribed ACE inhibitor therapy.

HF-8

Warfarin Therapy for Patients with Atrial Fibrillation – The percentage of CHF
patients who also have paroxysmal or chronic atrial fibrillation who were
prescribed warfarin therapy.

Coronary Artery Disease
CAD-1

Antiplatelet Therapy – The percentage of CAD patients who were prescribed
antiplatelet therapy.

CAD-2

Drug Therapy for Lowering LDL Cholesterol - The percentage of CAD patients
who were prescribed a lipid-lowering therapy (based on current ATP III
guidelines).

CAD-3

Beta-Blocker Therapy – The percentage of CAD patients with prior MI who were
prescribed beta-blocker therapy.

CAD-5

Lipid Profile – The percentage of CAD patients receiving at least one lipid profile
during the reporting year.

CAD-6

LDL Cholesterol Level- The percentage of CAD patients with most recent LDL
cholesterol <130 mg/dl.

CAD-7

ACE Inhibitor Therapy - The percentage of CAD patients who also have diabetes
and/or LVSD who were prescribed ACE inhibitor therapy.

Preventive Care
PC -1.

Blood Pressure Screening – The percentage of patients’ visits with blood pressure
measurement recorded.

PC -5

Breast Cancer Screening – The percentage of female beneficiaries aged 50-69
years who had a mammogram during the measurement year or the year prior to the
measurement year.

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PC -6.

Colorectal Cancer Screening- The percentage of beneficiaries 50 years or older
who were screened for colorectal cancer during the one year measurement period.

PC-7

Influenza Vaccination – The percentage of patients with a chronic condition 50
years or older who received an influenza vaccination from September through
February of the year prior to the measurement year.

PC-8

Pneumonia Vaccination – The percentage of patients with a chronic condition 65
years or older who ever received a pneumococcal vaccination.

Page 19 of 19