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Meaningful Use Summary 1

Stage 1 Core and Menu Sets 3

Core Set Required To Meet Meaningful Use Criteria 3

Menu Set To Meet Meaningful Use Criteria 5

Eligibility 7

Eligible professionals under the Medicaid EHR Incentive Program 7

Important Dates 8

Penalties 8

Other Links 9

 

 

Meaningful Use Summary                             Home

 

For stage 1, which begins in 2011, CMS proposes 25 objectives for physicians to meet to be deemed meaningful EMR usage. Stages 2 and 3 will expand the list in 2013 and 2015, and the added requirements will be proposed through future rulemaking. Physicians failing to adopt an EMR and meet the objectives by 2015 will face Medicare penalties. Doctors who wait until 2013 or 2014 to have EHRs in place will be eligible for smaller bonuses. The 2013 adopters can capture a maximum of $39,000 over four years, while the 2014 adopters can claim up to $24,000 over three years. Medicaid will have its own five-year bonus schedule that will offer as much as $64,000 to eligible physicians who don't claim Medicare bonus money.

 

 

Physicians with approved EHRs in place before 2011 or 2012 will be eligible for the maximum Medicare incentive payments allowed by the stimulus. They will receive bonuses equal to 75% of their allowed Medicare Part B charges -- up to a sliding cap -- in each of the five years after adoption. The maximum of $18,000 in the first year phases down to $2,000 in the fifth year for a total five-year bonus of up to $44,000 for early adopters.

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Physicians with approved EHRs in place before 2011 or 2012 will be eligible for the maximum Medicare incentive payments allowed by the stimulus. They will receive bonuses equal to 75% of their allowed Medicare Part B charges -- up to a sliding cap -- in each of the five years after adoption. The maximum of $18,000 in the first year phases down to $2,000 in the fifth year for a total five-year bonus of up to $44,000 for early adopters.

 

As much as $27 billion may be expended in incentive payments, according to CMS. Eligible physicians who meet all required objectives could receive as much as $44,000 over five years from Medicare, or $63,750 over six years from Medicaid. Hospitals may receive millions of dollars for meaningful use under both Medicare and Medicaid.

 

* Children's Health Insurance Program (CHIP) patients do not count toward the Medicaid patient volume criteria.

The Medicare and Medicaid EHR Incentive Programs are new and separate programs from other active CMS incentive programs, such as the Physicians Quality Reporting Initiative (PQRI) and the MIPPA E-Prescribing Incentive Program.

 

Physicians with approved EHRs in place before 2011 or 2012 will be eligible for the maximum Medicare incentive payments allowed by the stimulus. They will receive bonuses equal to 75% of their allowed Medicare Part B charges -- up to a sliding cap -- in each of the five years after adoption. The maximum of $18,000 in the first year phases down to $2,000 in the fifth year for a total five-year bonus of up to $44,000 for early adopters.

 

As much as $27 billion may be expended in incentive payments, according to CMS. Eligible physicians who meet all required objectives could receive as much as $44,000 over five years from Medicare, or $63,750 over six years from Medicaid. Hospitals may receive millions of dollars for meaningful use under both Medicare and Medicaid.

 

* Children's Health Insurance Program (CHIP) patients do not count toward the Medicaid patient volume criteria.

The Medicare and Medicaid EHR Incentive Programs are new and separate programs from other active CMS incentive programs, such as the Physicians Quality Reporting Initiative (PQRI) and the MIPPA E-Prescribing Incentive Program.

 

Doctors who wait until 2013 or 2014 to have EHRs in place will be eligible for smaller bonuses. The 2013 adopters can capture a maximum of $39,000 over four years, while the 2014 adopters can claim up to $24,000 over three years. Medicaid will have its own five-year bonus schedule that will offer as much as $64,000 to eligible physicians who don't claim Medicare bonus money.

 

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Stage 1 Core and Menu Sets                 Home

 

Each stage 1 objective has a corresponding measure attached to it. For example, an objective for physicians to generate and transmit prescriptions electronically requires doctors to submit at least 75% of all prescriptions electronically using certified EMR technology.

 

Other 2011 objectives include using computerized physician order entry, maintaining patient medication allergy lists and recording patient demographics.

 

For the first round of Medicare and Medicaid EMR bonuses in 2011-12, physicians must meet 15 core objectives and at least five of 10 "menu set" items. Each objective has a measure to determine if an EMR was used to perform the function for an appropriate number of opportunities:

 

Physicians now can defer up to five EMR objectives in the first two years and still qualify for Medicare or Medicaid financial incentives.

 

 

Core set (must meet all)                         

§       Record patient demographics

§       Record vital signs/chart changes

§       Maintain current and active diagnoses

§       Maintain active medication list

§       Maintain active allergy list

§       Record adult smoking status

§       Provide patient clinical summaries

§       Provide electronic health information copy on demand

§       Generate and transmit prescriptions electronically

§       Use computerized physician order entry for drug orders

§       Implement drug-drug/drug-allergy interaction checks

§       Be capable of electronic clinical information exchange

§       Implement one clinical decision support rule

§       Protect patient data privacy and security

§       Report clinical quality measures to CMS or states

 

 

 

Core Set Required To Meet Meaningful Use Criteria

                                                                                                                                             Home

 

 

Objectives

Measures

Exclusions

 

 

1

Use computerized physician order entry (CPOE) for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines.

More than 30% of unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE.

Any EP who writes fewer than 100 prescriptions during the EHR reporting period.

 

 

2

Implement drug-drug and drug-allergy interaction checks.

The EP has enabled this functionality for the entire EHR reporting period.

None

 

 

3

Generate and transmit permissible prescriptions electronically (eRx).

More than 40% of all permissible prescriptions

written by the EP are transmitted electronically using certified EHR technology.

Any EP who writes fewer than 100 prescriptions during the EHR reporting period.

 

 

4

Record demographics: preferred language, gender, race, ethnicity, date of birth.

More than 50% of all unique patients seen by the EP have demographics recorded as structured data.

None.

 

 

5

Maintain an up-to-date problem list of

current and active diagnoses

More than 80% of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data.

None.

 

 

6

Maintain active medication list.

 

More than 80% of all unique patients seen

by the EP have at least one entry (or an

indication that the patient is not currently

prescribed any medication) recorded as

structured data.

None.

 

 

7

Maintain active medication allergy list.

 

More than 80% of all unique patients seen

by the EP have at least one entry (or an

indication that the patient has no known

medication allergies) recorded as

structured data.

None.

 

 

8

Record and chart changes in vital signs: height, weight, blood pressure, calculate and display BMI, plot and display growth charts for children 2-20 years including BMI.

For more than 50% of all unique patients age 2 over seen by the EP, height, weight and blood pressure are recorded as structured data.

Any EP who either sees no patients 2 years

or older, or who believes that all three vital

signs of height, weight, and blood pressure

of their patients have no relevance to their scope of practice.

 

 

9

Record smoking status for patients 13 years or older .

More than 50% of all unique patients 13 years old or older seen by the EP have smoking status recorded.

Any EP who sees no patients 13 years or older.

 

 

10

Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule.

Implement one clinical decision support rule.

None.

 

 

11

Report ambulatory clinical quality measures to CMS or the States.

For 2011, provide aggregate numerator, denominator, and exclusions through attestation is discussed in section II(A)(3) of the Final Rule.

None.

 

 

12

Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies) upon request.

More than 50% of all patients of the EP who request an electronic copy of their health information are provided it within 3 business days.

Any EP that has no requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period.

 

 

13

Provide clinical summaries for patients for each office visit.

 

Clinical summaries provided to patients for more than 50% of all office visits within 3 business days.

Any EP who has no office visits during the EHR reporting period.

 

 

14

Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically.

Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information.

None

 

 

15

Protect electronic health information created or maintained by the certified HER technology through the implementation of appropriate technical capabilities.

 

Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) of the Final Rule and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.

None.

 

 

 

 

Menu set (can defer up to five for 2011-12)    

§       Implement drug formulary checks

§       Incorporate clinical lab test results

§       Generate patient lists by condition

§       Identify patient-specific education resources

§       Perform medication reconciliation between care settings

§       Provide summary of care for transferred patients

§       Submit electronic immunization data to registries

§       Submit electronic epidemiology data to public health agencies

§       Send care reminders to patients

§       Provide timely patient electronic access to health information

 

 

 

Menu Set To Meet Meaningful Use Criteria

                                                                                                                                                                                            Home

 

 

Objectives

Measures

Exclusions

 

 

1

Implement drug-formulary checks.

 

The EP has enabled this functionality and has access to at least one internal or external drug formulary for the entire EHR reporting period.

None.

 

 

2

Incorporate clinical lab-test results into certified EHR technology as structured data.

 

 

More than 40% of all clinical lab-test results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.

Any EP who orders no lab tests whose results are either in positive/negative or numeric format during the EHR reporting period.

 

 

3

Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach.

Generate at least one report listing patients of the EP with a specific condition.

None.

 

 

4

Send reminders to patients per patient preference for preventive/follow-up care.

 

More than 20% of all unique patients 65 years old or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period.

Any EP who has no patients 65 years old or older or 5 years old or younger with records maintained using certified EHR technology.

 

 

5

Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within four business days of the information being available to the EP.

 

More than 10% of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP's discretion to withhold certain information.

Any EP that neither orders nor creates any of the information listed at 45 CFR 170.304(g) in the July 13, 2010 Final Rule during the EHR reporting period.

 

 

6

Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate.

More than 10% of all unique patients seen by the EP are provided patient-specific education resources.

None.

 

 

7

The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation.

The EP performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP.

Any EP who was not the recipient of any transitions of care during the EHR reporting period.

 

 

8

The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary of care record for each transition of care or referral.

The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals.

 

Any EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period.

 

 

9

Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice.

 

Performed at least one test of certified HER technology capacity to submit electronic data to immunization registries and follow-up submission if the test is successful (unless none of the immunization registries to which the EP submits such information have the capacity to receive the information electronically).

Any EP who administers no immunizations during the EHR reporting period or where no immunization registry has the capacity to receive the information electronically.

 

 

10

Capability to submit electronic sydromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice.

 

Performed at least one test of certified EHR technology capacity to submit electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP submits information have the capacity to receive the information electronically).

 

Any EP who does not collect any reportable syndromic information on their patients during the EHR reporting period or does not submit such information to any public health agency that has the capacity to receive the information electronically.

 

 

 

 

Eligibility                                                 Home     

Eligibility Requirements for Professionals

  • Incentive payments for eligible professionals are based on individual practitioners.
  • If you are part of a practice, each eligible professional may qualify for an incentive payment if each eligible professional successfully demonstrates meaningful use of certified EHR technology.
  • Each eligible professional is only eligible for one incentive payment per year, regardless of how many practices or locations at which he or she provide services.
  • Hospital-based eligible professionals are not eligible for incentive payments. An eligible professional is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (Place Of Service code 21) or emergency room (Place Of Service code 23) setting.

 

Eligible professionals under the Medicaid EHR Incentive Program

  • Physicians (primarily doctors of medicine and doctors of osteopathy)
  • Nurse practitioner
  • Certified nurse-midwife
  • Dentist
  • Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant.

 

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To qualify for an incentive payment under the Medicaid EHR Incentive Program, an eligible professional must meet one of the following criteria:

  • Have a minimum 30% Medicaid patient volume*
  • Have a minimum 20% Medicaid patient volume, and is a pediatrician*
  • Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals

 

 

Important Dates                                             Home

  • October 1, 2010 – Reporting year begins for eligible hospitals and CAHs.
  • January 1, 2011 – Reporting year begins for eligible professionals.
  • January 3, 2011 – Registration for the Medicare EHR Incentive Program begins.
  • January 3, 2011 – For Medicaid providers, states may launch their programs if they so choose.
  • April 2011 – Attestation for the Medicare EHR Incentive Program begins.
  • May 2011 – EHR Incentive Payments expected to begin.
  • July 3, 2011 – Last day for eligible hospitals to begin their 90-day reporting period to demonstrate meaningful use for the Medicare EHR Incentive Program.
  • September 30, 2011 – Last day of the federal fiscal year. Reporting year ends for eligible hospitals and CAHs.
  • October 1, 2011 – Last day for eligible professionals to begin their 90-day reporting period for calendar year 2011 for the Medicare EHR Incentive Program.
  • November 30, 2011 – Last day for eligible hospitals and critical access hospitals to register and attest to receive an Incentive Payment for Federal fiscal year (FY) 2011.
  • December 31, 2011 – Reporting year ends for eligible professionals.
  • February 29, 2012 – Last day for eligible professionals to register and attest to receive an Incentive Payment for calendar year (CY) 2011.

 

 

Penalties                                                         Home

 

Simply setting up any paperless system is not enough to earn bonuses and avoid penalties. The stimulus package stipulates that physicians must adopt a qualifying EHR and use it in a "meaningful way." Meaningful users are defined as physicians who demonstrate to the Health and Human Services Dept. that they are using electronic prescribing; that their technology is connected in a manner that provides for electronic exchange of health data to improve quality of care; and that they submit information to HHS on clinical quality measures.

Once the chance for bonuses ends, Medicare starts penalizing physicians who have not responded to the incentives. Doctors who have not adopted an EHR before 2015 and who fail to obtain a hardship exemption will see a 1% cut to their Medicare pay, a reduction that phases up to 3% for 2017 and remains each year after that.

In an effort to prevent additional "double-dipping," physicians who report using an EHR system that is also capable of e-prescribing no longer will be eligible for the e-prescribing bonuses that went into effect this year under the Medicare Improvements for Patients and Providers Act. On the other hand, Medicare penalties for those not e-prescribing by 2012 will sunset after 2014, so that no physician will be subject to double penalties for failing to e-prescribe and failing to use an EHR.

Once the chance for bonuses ends, Medicare starts penalizing physicians who have not responded to the incentives. Doctors who have not adopted an EHR before 2015 and who fail to obtain a hardship exemption will see a 1% cut to their Medicare pay, a reduction that phases up to 3% for 2017 and remains each year after that.

 

 

Other Links                                                     Home

 

CMS Eligibility Flow Chart - http://www.cms.gov/EHRIncentivePrograms/downloads/eligibility_flow_chart.pdf

Medicaid Questions on the CMS EHR Incentive Program Final Rule - http://www.cms.gov/MLNProducts/downloads/Medicaid_Qs-EHRIP_Final_Rule.pdf

CMS Timeline - http://www.cms.gov/EHRIncentivePrograms/Downloads/EHRIncentProgtimeline508.pdf

 

Weblink References:

"The 'Meaningful Use' Regulation for Electronic Health Records," New England Journal of Medicine, July 13 (healthcarereform.nejm.org/?p=3732)

"Finding My Way to Electronic Health Records," by Surgeon General Regina Benjamin, MD, New England Journal of Medicine, July 13