Meaningful Use Guidelines

Health Care Reform
The Health Information Technology for Economic and Clinical Health (HITECH) Act continues to usher in sweeping health care reforms since it began in January 2011 with the mandatory implementation of health IT infrastructure across practices and hospitals.

The HITECH Act is a component of the American Recovery and Reinvestment Act (ARRA) of 2009; it stipulates eligible health care providers to demonstrate the Meaningful Use of a certified Electronic Health Record (EHR) product, with a financial incentive from the stimulus packages of $19.2 billion.


Meaningful Use in EHR Guidelines

ARRA specifies three main components of Meaningful Use:

  1. The use of a certified EHR in a meaningful manner, such as e-prescribing.
  2. The use of certified EHR technology for the electronic exchange of health information to improve the quality of health care.
  3. The use of certified EHR technology to submit clinical quality and other measures.

Simply put, Meaningful Use means providers need to show they are using certified EHR technology that meets certain mandatory criteria.

What Are the Criteria for Meaningful Use of EHR?
The criteria for Meaningful Use will have to be met in three stages over the course of the next five years:

Stage 1 (2011–2012)
Meaningful Use includes both a core set and a menu set of objectives that are specific to eligible professionals or eligible hospitals and CAHs.
 

  • For eligible professionals, there are a total of 25 Meaningful Use objectives. To qualify for an incentive payment, 20 of these 25 objectives must be met.
  1. There are 15 required core objectives.
  2. The remaining 5 objectives may be chosen from the list of 10 menu set objectives, and users can defer the other 5 to Stage 2.
  • For eligible hospitals and CAHs, there are a total of 24 Meaningful Use objectives. To qualify for an incentive payment, 19 of these 24 objectives must be met.
  1. There are 14 required core objectives.
  2. The remaining 5 objectives may be chosen from the list of 10 menu set objectives, and users can defer the other 5 to Stage 2.

 

Stage 2 (2014)

On September 4 2012, CMS published 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.  The following content was excerpted from the Centers for Medicare and Medicaid Services website, www.cms.gov.

Core and Menu Objectives

Stage 2 uses a core and menu structure for objectives that providers must achieve in order to demonstrate meaningful use. Core objectives are objectives that all providers must meet. There is also a predetermined number of menu objectives that providers must select from a list and meet in order to demonstrate meaningful use.

To demonstrate meaningful use under Stage 2 criteria—

  • EPs must meet 17 core objectives and 3 menu objectives that they select from a total list of 6, or a total of 20 core objectives.
  • Eligible hospitals and CAHs must meet 16 core objectives and 3 menu objectives that they select from a total list of 6, or a total of 19 core objectives.

Download the Stage 2 Overview Tipsheet from www.cms.gov for a complete list of the Stage 2 core and menu objectives for both EPs and eligible hospitals and CAHs. Providers can also download a table of the Stage 2 core and menu objectives and measures by clicking on the links below:

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.

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 Sevices’ National Quality Strategy:

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

A complete list of 2014 CQMs and their associated National Quality Strategy domains will be posted on the Clinical Quality Measures tab of the CMS website in the future. CMS will also post a recommended core set of CQMs for EPs that focus on high-priority clinical conditions.

Stage 3 (2015, anticipated)
The final stage would focus on achieving improvements in quality, safety, and efficiency, and on decision support for national high-priority conditions, patient access to self-management tools, access to comprehensive patient data, and improvements to population health outcomes.

How Do I Meet Meaningful Use of EHR Requirements?
To qualify for incentive payments, Meaningful Use requirements must be met in the following ways:

Medicare EHR Incentive Program
Eligible professionals must successfully demonstrate Meaningful Use of certified electronic health record technology every year they participate in the program.

Medicaid EHR Incentive Program
Eligible professionals may qualify for incentive payments if they adopt, implement, upgrade, or demonstrate Meaningful Use in their first year of participation. They must successfully demonstrate Meaningful Use in subsequent participation years.

Adoption
Acquire and install certified EHR technology. (For instance, providers can show evidence of installation.)

Implementation
Begin using certified EHR technology. (For example, provide staff training or data entry of patient demographic information into EHR.)

Upgrading
Expand existing technology to meet certification requirements. (For example, upgrade to certified EHR technology or add new functionality to meet the definition of certified EHR technology.)

Notable differences between the Medicare and Medicaid EHR incentive programs include:

 

Medicare

Medicaid

Federal government will begin implementation (will be an option nationally).

Implementation is voluntary for states (may not be an option in every state).

Payment reductions begin in 2015 for providers who do not demonstrate Meaningful Use (MU).

Medicaid payments will not be reduced if Meaningful Use is not demonstrated.

Providers must demonstrate MU in the first year.

A/I/U (Adopt, Implement, or Upgrade) option is available for first participation year.

Maximum incentive is $44,000 for EPs (10% bonus for EPs in HPSAs—Health Professional Shortage Areas).

Maximum incentive is $63,750 for EPs.

Meaningful Use definition is common for Medicare.

States can adopt certain additional requirements for Meaningful Use.

A provider may initiate the program at the latest by 2014; the deadline to register for the same is 2016; the payment adjustments begin in 2015.

A provider may initiate the program latest by 2016; the deadline to register for the same is 2016.

Only physicians, subsection (d) hospitals, and CAHs qualify.

Five types of EPs, acute care hospitals (including CAHs) and children’s hospitals qualify.

 

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