On July 13, the Centers for Medicare and Medicaid Services (CMS) released its final rule for the Medicare and Medicaid electronic health record (EHR) incentive program. The rule, which outlines the final criteria for meaningful use, allows more flexibility and softens some requirements. Physicians and other eligible providers (EPs), however, still must meet a medley of criteria to qualify for bonuses of $44,000 from Medicare or $63,750 from Medicaid. Understanding these rules and putting them into action in your practice is essential to successfully participating in the government’s bonus payment program for using an EHR.
The most significant changes made to the final rule were:
- Reducing from 25 to 15 the “core” criteria that EPs are required to meet;
- Allowing EPs to choose five additional criteria from a menu of 10;
- Easing the minimum requirements of most measures; and
- Introducing narrow but realistic exemptions for some criteria.
A notable change from the proposed rule was the decision to abandon an “all-or-nothing” approach that many physicians felt would make earning the bonuses difficult, if not impossible. In the program’s initial years, CMS sets 15 “core” – required – measurements and objectives for meaningful use.
The 15 core criteria, listed in abbreviated form, are:
1. Use computerized physician order entry (CPOE)
2. Implement drug-drug and drug-allergy interaction checks
3. Generate and transmit permissible prescriptions electronically
4. Record demographics
5. Maintain an up-to-date problem list of current and active diagnoses
6. Maintain active medication list
7. Maintain active medication allergy list
8. Record and chart changes in vital signs
9. Record smoking status for patients 13 years old or older
10. Implement one clinical decision support rule
11. Report ambulatory clinical quality measures
12. Provide patients with an electronic copy of their health information, upon request
13. Provide clinical summaries for patients for each office visit
14. Capability to exchange key clinical information electronically
15. Protect electronic health information through the implementation of appropriate technical capabilities
EPs must meet five additional criteria chosen from a menu of 10. These include incorporating test results into EHR as structured data, general lists of patients with specific conditions and submitting information to immunization registries electronically.
In addition to pointing out the difficulty of meeting all of the initial proposal’s 25 criteria, many comments to CMS centered on where to set the bar for the criteria. In response, CMS lowered thresholds for several measures in the final rule. An example is electronic prescribing – a critical area of meaningful use because it’s a stated goal of the enabling legislation. Initially, the government proposed “at least 75 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.” In the final rule, the measurement is reduced to “more than 40 percent.”
Although the focus of CMS’ recent update was on meaningful use, several key issues were addressed regarding program eligibility . While EPs in the Medicaid incentive program can skip a year and still remain eligible for the entire bonus payment; not so for those in the Medicare incentive program: skipping a year means losing that year of eligibility and receiving a commensurately lower bonus.
The final rule confirms that, as stated in the HITECH Act, EPs qualifying for the Medicare bonus program include physicians, dentists, nurse practitioners, nurse midwives, and physician assistants practicing in federally qualified health centers or rural health clinics led by a physician assistant. Hospital-based physicians – those who furnish more than 90 percent of services (not charges) in a hospital – cannot participate. CMS plans to determine who is and isn’t a hospital-based provider by analyzing claims history for eligible professionals from the previous year. On the flip side, the rule makes it clear that hospital-based physicians will not be subject to the reimbursement penalties that commence in 2015 for any EPs who do not participate or cannot do so successfully.
CMS concludes that 36 percent to 70 percent of EPs will be making meaningful use of certified EHRs by 2019. The agency surmises that the cost of these EHR incentive program payments to Medicare and Medicaid providers will range from $9.7 billion to $27.4 billion over the next 10 years.
Physicians and other seeking to qualify should keep in mind that while CMS reduced the number of reportable meaningful use measures and softened thresholds for some of them, too, the relaxation applies only to the first two years of the program. This first level, known as Stage One, covers the program’s first two years – 2011 and 2012. More meaningful use requirements and measures, including all 10 now on the “choose-five” menu, will likely be required by 2013 in what is known Stage Two. And by 2015, the requirements are likely to ratchet up again.
Sage Is Here to Help
Sage welcomes the final rule and the work CMS has done to minimize uncertainty and provide a clear pathway to meaningful use. CMS clearly gave serious consideration to feedback from providers, and vendors such as Sage, offered during the public comment period. As a result, this final rule makes it easier for physicians to achieve Stage 1 meaningful use, and thereby encourages widespread EHR adoption—which is, after all, the first hurdle to reaching the broader goals identified by CMS.
Sage Intergy Meaningful Use Edition, our product solution for meaningful use, meets the Stage 1 criteria outlined in the final rule. Sage guarantees this product will also meet Stage 2 and Stage 3 requirements once implemented by CMS and the Office of the National Coordinator for Health Information Technology ONC. Sage looks forward to receiving meaningful use certification for our solution as soon as a certifying organization is established.
Beyond guaranteeing certification of our technology, Sage is ready and committed to assist our customers in achieving meaningful use. Our MU Assist program consists of online training, resources, educational webinars, and live training to ensure that eligible providers and practice staff have access to services, education and information needed to support their journey to meaningful use.
The Health Information Technology for Economic and Clinical Health (HITECH) Act represents an opportunity for physicians to acquire the tools and knowledge needed to help them improve efficiency and outcomes (both clinical and financial) within the practice, while contributing to improved population health and quality care for all Americans. Sage supports these goals, along with the ambitions of ambulatory physician practices in the US.
Find out more about how Sage can assist your practice with its goals by:
Watch an online product demo 
Register for the Meaningful Use Final Rule Webinar
Request more information about Sage Products
