The meaningful use of certified EHR technology is one piece of the broader health information technology initiative to improve the quality, safety and efficiency of patient care and to create a private and secure 21st century electronic health information system.  The 2009 HITECH Act authorized CMS incentive payments to eligible providers and hospitals when they adopt EHRs and demonstrate use in ways that can improve healthcare.

Having the goal of expanding the meaningful use of certified EHR technology, and ultimately improve health care quality, efficiency and patient safety CMS published a final rule entitled “Medicare and Medicaid Programs; Electronic Health Record Incentive Program” (75 FR 44313 through 44588) on July 28, 2010.

The July 2010 ruling stated that the Medicare and Medicaid EHR Incentive Programs would consist of 3 different stages of meaningful use requirements, with each stage requiring increasing use of EHRs and electronic information exchange. 

Sections:

Main Requirements and Outcome Priorities

According to the 2009 Recovery Act, to be a meaningful user of an EHR, a provider must satisfy three main requirements:

  • Use a certified EHR in a meaningful manner (eg, for e-prescribing)
  • Demonstrate that the certified EHR provides for the electronic exchange of health information to improve quality of healthcare, such as promoting patients’ coordination of care; and
  • Use a certified EHR to submit clinical quality measure reporting

CMS’s definition of meaningful use in its July 28, 2010, final regulation is based on five broad health outcome priorities:

  • To improve quality, safety and efficiency of care while reducing disparities
  • To engage patients and families in their care
  • To improve care coordination
  • To promote population and public health; and
  • To ensure privacy and security protections for personal health information.

Stage 1 Meaningful Use

The rule specified Stage 1 criteria eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to qualify for an incentive payment, calculation of the incentive payment amounts, and other program participation requirements.

For eligible professionals to qualify for a Stage 1 incentive payment, 20 objectives must be met:

  • 15 required core objectives
  • 5 menu set objectives (chosen from a list of 10)

EPs must also attest to data on 2 clinical quality measure (CQM) groups comprising a total of 6 measures:

  • A core set of 3 measures (adult blood pressure levels, tobacco status, and adult weight screening and follow-up) or alternate core measures (weight assessment for children, flu immunization for adults aged 50 and older, and childhood immunization), and
  • 3 additional measures selected from among a list of 38 others

Please refer to Meaningful Use Stage 1 Summary  for a detailed look at the Stage 1 measures.

As of October 2012, over $8 billion has been paid to providers through the EHR Incentive Programs, with over $38 million paid to providers practicing throughout the state of Rhode Island. (Source: Combined Medicare and Medicaid Payments by State, www.cms.gov, October 2012)

Within their November 2011 Data Brief, The National Center for Health Statistic reported the following:

  • Among physicians planning to apply for meaningful use incentives, the percentage with systems that would allow them to meet eight Stage 1 Core Set meaningful use objectives exceeded the national average (43%) in eight states (Iowa, Maine, Massachusetts, Minnesota, Oregon, Utah, Washington, and Wisconsin).
  • Among physicians planning to apply for meaningful use incentives, the percentage of physicians with systems that would allow them to meet eight Stage 1 Core Set meaningful use measures was lower than the national average only in Texas (26%).
  • Rhode Island reported an average of 39.0% of office-based physicians planning to apply for meaningful use incentives (National average being 43.1%).

Stage 2 Meaningful Use

On August 23, 2012 CMS released a final rule that specifies the Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to continue to participate in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. All providers must achieve meaningful use under the Stage 1 criteria before moving to Stage 2.

Similar to Stage 1, Stage 2 criteria are based on a series of specific objectives, each of which is tied to a proposed measure that all EPs and hospitals must meet in order to demonstrate that they are meaningful users of certified EHR technology.

For eligible professionals to qualify for a Stage 2 incentive payment, 20 objectives must be met:

  • 17 core objectives
  • 3 menu set objectives (chosen from a list of 6)

CMS has released a Stage 2 Toolkit to help eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) prepare for Stage 2 of the Electronic Health Record (EHR) Incentive Programs.

For further information, you can also refer to the CMS Stage 2 Overview Tipsheet for a complete list of the Stage 2 core and menu objectives for both EPs and eligible hospitals and CAHs, and the Stage 1 vs. Stage 2 Comparison Table for Eligible Professionals for a closer look at the measures.

Clinical Quality Measures for 2014 and Beyond

All providers are required to report on CQMs in order to demonstrate meaningful use.  Beginning in 2014, all providers regardless of their stage of meaningful use will report on CQMs in the same way.  EPs must report on 9 out of 64 total CQMs.

In addition, all providers must select CQMs from at least 3 of the 6 key health care policy domains recommended by the Department of Health and Human Services’ National Quality Strategy:

  • Patient and Family Engagement
  • Patient Safety
  • Care Coordination
  • Population and Public Health
  • Efficient Use of Healthcare Resources
  • Clinical Processes/Effectiveness

Please refer to the CMS 2014 Clinical Quality Measures Tipsheet for more detailed information on 2014 CQMs and electronic reporting options.

Enroll in RI REC’s EHR Adoption Program Today

The RI REC team is here to guide your practice through meaningful use.  Enroll in our EHR Adoption Program and be paired with a REC Relationship Manager who will help you get started!