Changes Allow Choices in Final Meaningful Use Rule

Changes Allow Choices in Final Meaningful Use Rule

Federal officials released the final rule on meaningful use on July 13, which will allow physicians and hospitals to qualify for thousands of dollars in stimulus funding incentives for the adoption of electronic health records. The 864-page final rule outlines the specific qualifications providers must meet to achieve the meaningful use of electronic health records. The final rule differs from the proposed rule in January in that it allows providers more flexibility in selecting measures for qualification of meaningful use.

The proposed rule required hospitals to comply with 25 measures and doctors with 23 measures. The final rule requires hospitals to comply with 14 core objectives and 15 for doctors. Both hospitals and doctors will also choose five additional objectives from a menu of 10. Objectives not selected are deferred to Stage 2.

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), federal incentive payments will be available to doctors and hospitals when they adopt EHRs and demonstrate use in ways that can improve quality, safety and effectiveness of care. Through HITECH, the federal government will make available incentive payments up to $44,000 (through Medicare) and $63,750 (through Medicaid) per clinician. The funding provides important support to create a base foundation of EHRs throughout the nation.

The legislation ties payments specifically to the achievement of advances in health care processes and outcomes. The DHHS released a final regulation for the first 2 years (2011 and 2012) of this multiyear incentive program. Subsequent rules will be issued for later phases.

David Bluementhal,MD, national coordinator for health information technology, said he is confident the use of electronic health records will become a core professional competency among physicians, who will eventually lead the way in adoption. Until then, the government will encourage healthcare IT adoption through financial incentives, such as these set up under the meaningful use rule. The government will also supply “shoulder-to-shoulder” support for providers through the regional extension centers.

Key changes in the final CMS rule include:</>

• Greater flexibility with respect to eligible professionals and hospitals in meeting and reporting certain objectives for demonstrating meaningful use. The final rule divides the objectives into a “core” group of required objectives and a “menu set” of procedures from which providers may choose any five to defer in 2011-2012. This gives providers latitude to pick their own path toward full EHR implementation and meaningful use.
• An objective of providing condition-specific patient education resources for both EPs and eligible hospitals and the objective of recording advance directives for eligible hospitals, in line with recommendations from the Health Information Technology Policy Committee.
• A definition of a hospital-based EP is one who performs substantially all of his or her services in an inpatient hospital setting or emergency room only, which conforms to the Continuing Extension Act of 2010.
• Critical Access Hospitals (CAH) are included in the definition of acute care hospital for the purpose of incentive program eligibility under Medicaid.

The “Meaningful Use” Model

By focusing on the effective use of EHRs with certain capabilities, the HITECH Act makes clear that the adoption of records is not a goal in itself: it is the use of EHRs to achieve health and efficiency goals that matters. HITECH’s incentives and assistance programs seek to improve the health of Americans and the performance of their health care system through “meaningful use” of EHRs to achieve five health care goals:

• To improve the quality, safety, and efficiency of care while reducing disparities;
• To engage patients and families in their care;
• To promote public and population health;
• To improve care coordination; and
• To promote the privacy and security of EHRs.

In the context of the EHR incentive programs, “demonstrating meaningful use” is the key to receiving the incentive payments. It means meeting a series of objectives that make use of EHRs’ potential and related to the improvement of quality, efficiency and patient safety in the healthcare system through the use of certified EHR technology.

Meaningful Use Objectives Overview

For 2011, CMS will accept provider attestations for demonstration of all the meaningful use measures, including clinical quality measures. Starting in 2012, CMS will continue attestation for most of the meaningful use objectives but plans to initiate the electronic submission of the clinical quality measures. States will also support attestation initially and then subsequent electronic submission of clinical quality measures for Medicaid providers’ demonstration of meaningful use.

CMS expects to initiate Medicare incentive payments nine months after the publication of the final rule. For Medicaid, States are determining their own deadlines for launching their Medicaid EHR Incentive programs but are required to make timely payments, per the CMS final rule. CMS expects that the majority of States will have launched their programs by the summer of 2011.

In addition to the core set of objectives listed in the table above, eligible professionals, hospitals and critical access hospitals select any five choices from the menu set below.

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