'Meaningful Use' Compliance Slow

The medical system is undeniably morphing into a more electronic one, but many clinicians are still not ready for it, according to current and former government officials.

Although more than 30,000 clinicians qualified for bonus payments for using electronic health records in 2011, many others are unaware of how to prove they're meaningful users of the technology, wrote Donald Berwick, MD, former administrator of the Centers for Medicare and Medicaid Services, and current National Coordinator for Health IT, Farzad Mostashari, MD, along with several others, in a special article in the May 14th issue of Archives of Internal Medicine.

In the article, the authors provide a "Guide for Physicians to the EHR Incentive Programs" that explains how to register for, report, and attest to meaningful use of health IT.

"Meaningful Use" refers to provisions in the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which authorized incentive payments through Medicare and Medicaid to clinicians and hospitals that use electronic health records (EHRs) in a meaningful way that significantly improves clinical care.

Broadly, in order to be eligible for bonus payments, clinicians must show their EHR is capable of e-prescribing; exchanging health information with other doctors, patients, and the Centers for Medicare and Medicaid Services (CMS); and submitting clinical quality and other measures for analysis.

There will be three different stages of meaningful use requirements under which providers will have to progressively increase their use of EHRs. Stage 1 criteria, which focused on the basic requirements to create a health IT foundation, are already finalized.

In order to be eligible for bonuses under Stage 1, clinicians must meet at least 15 objectives from a list that includes generating and transmitting e-prescriptions; recording patient demographics; recording smoking status; providing clinical summaries of each visit; and having the ability to submit immunization data.

Stage 2 criteria, which is in the rule-making process, delves deeper and focuses on e-prescribing, incorporating lab results into EHRs, and allowing data to be accessed by patients, among other things.

Stage 3 criteria will be released in 2014 and will concentrate on measuring outcomes and making self-management tools available to patients.

Most U.S. physicians are eligible for incentive programs, but there are some exceptions. Physicians and other clinicians can determine if they're eligible by checking on the CMS web site, the article's authors said.

After determining whether a clinician qualifies, the next step is certification, where physicians must prove they are using certified EHR technology. There are over 900 certified health IT products, and clinicians can view the list here.

As of Dec. 31, 2011, more than 172,000 clinicians were registered for the EHR Incentive Programs, according to the authors of the Archives article.

The next step is attestation, which differs depending on whether it's Medicare's EHR incentive program, or Medicaid's EHR incentive program that the clinician is attesting to.

In order to receive incentive payments from the Medicare program, a clinician must attest to meeting all of the required objectives using certified EHR technology during 90 days in the first payment year and a full year beginning the second payment year. Attestation user guides and an attestation calculator are available here. Clinicians are eligible to receive up to $44,000 over five years under the Medicare incentive program, but will be subject to a 1% penalty if they are not using EHR in a meaningful way in 2015.

Registration for Medicaid's EHR incentive program occurs with CMS, but each state will establish its own system for determining whether doctors and others are using EHR for Medicaid patients, and to determine bonus payments, which could total a maximum of $63,750 over six years. Unlike the Medicare EHR incentive program, clinicians participating in the Medicaid program won't be penalized for failing to adopt EHRs.

The authors said they understand the move away from a paper medical system and to an electronic one isn't easy.

"Even the strongest enthusiasts for EHRs recognize that their adoption involves significant changes for physicians, with attendant dislocations in workflows, investments, and habits of practice," the authors wrote. "Although the ultimate benefits for both practice management and health care almost certainly make this transition worthwhile, the discomfort for physicians during the transition ought not to be underestimated."

They said the first years of meaningful use will likely be the most difficult, but the transition should become smoother once sectors of healthcare embrace an increasingly electronic medical system, and as medical students learn how to manage patient care electronically.

CMS Releases Stage 2 Meaningful Use Proposals

Officials with the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) announced proposed requirements for Stage 2 Meaningful Use and 2014 certification of electronic health records. The Stage 2 Meaningful Use rules and EHR certification standards largely reflect the recommendations made last year. The proposed regulations emphasize the need for greater interoperability among systems and health information exchange. On the Meaningful Use side, this means that organizations will have to exchange data across organizational boundaries and disparate EHRs. The proposed Stage 2 regulations will keep some Stage 1 criteria unchanged, revise others, and include new requirements. Some highlights include:

• Patients must be given the opportunity to view, download and transmit their medical records online.
• The number of decision support elements that must be used will increase.
• Data must be submitted to public health agencies, where possible.Viewing of images will be on the optional menu of criteria.
• Clinical quality measures for Meaningful Use will be aligned with those in other programs that involve quality reporting, including Medicare's Physician Quality Reporting System, the shared savings program for accountable care organizations, medical homes and the Joint Commission's quality program.
• Eligible professionals will be able to report data in batches.
• Physician groups of a certain size can report quality data for their groups.
• Connections to registries will be required, including cancer registries.
• CMS will do prospective reporting of "payment adjustments" for those who don't show Meaningful Use by 2015.

On the EHR certification side, some of the proposals include:

• EHRs must include the direct protocol for secure clinical messaging.
• Vendors will have to begin incorporating standard clinical terminologies into their products. Mostashari cited SNOMED, LOINC, and RXNorm, as examples, but it was unclear whether EHRs must have all of those for 2014 certification. RXNorm for medications must be included, said Steve Posnak, the director of ONC's federal policy division.
• There will be new vendor requirements for usability, partly to give more flexibility to specialists who need "scope of practice" exclusions to meet the Meaningful Use criteria.
• The definition of a certified EHR no longer will be based on meeting 100 percent of a set list of criteria. Instead, the criteria will be revised so that they enable providers to meet the requirements they have chosen to meet for Meaningful Use. That means that specialists who don't use certain aspects of primary care EHRs can qualify for Meaningful Use by using EHRs that are certified to meet the needs of their specialties.
• Beyond satisfying "base EHR" requirements, such as patient demographics, problems, clinical decision support, and computerized physician order entry, EHRs or EHR modules can be certified if they have the capability to help providers achieve the core criteria for their stage of Meaningful Use (with exclusions for specialists) and only those optional menu items that the providers who use those applications have chosen.

Start Using EMR Today and Get $44K  

2011 was the year of “meaningful use”. EMR vendors had to meet certification criteria for the EHR Incentive Programs, and urgent care practitioners had to learn how to be meaningful users of their EMRs in order to qualify for incentive payments. 2012 is the year to jump on board meaningful use and get your share of the stimulus! 

Physicians who begin participating in the program in 2012 are still eligible to receive full incentive payments – up to 75% of their Medicare allowable charges. Remember: the program is about the “meaningful use” of an EMR, so you don’t qualify by just using an EMR; you have to prove you are using the EMR in a meaningful way based on criteria set by the government.  

What does “meaningful use” mean? The idea is that accelerating the use of EMRs will result in healthcare that is focused on evidence-based preventative care through the use of electronic health technology. The government is committed to accelerating the transition from paper to electronic, and health experts expect tangible changes in the U.S. healthcare system to manifest as early as this year as a result of meaningful use.  

Are you a physician who is eligible for the Medicare EHR Incentive Program? Unless you meet all of the exemptions to the meaningful use criteria, you MUST become a meaningful user of an EMR by 2015. Failure to do so will result in payment adjustments to your Medicare reimbursements that start at 1% each year, up to a maximum of a 5% annual adjustment. The Medicare EHR Incentive Program provides incentive payments to eligible professionals, eligible hospitals, and CAHs that demonstrate meaningful use of certified EHR technology. Eligible professionals can receive up to $44,000 over five years under the Medicare EHR Incentive Program. There's an additional incentive for eligible professionals who provide services in a Health Professional Shortage Area (HSPA). To get the maximum incentive payment, Medicare eligible professionals must begin participation by 2012.

Medicare and Medicaid EHR Incentive Program Basics

Get on board fast before time runs out!