Understanding the Numbers - Meaningful Use Final Rule

The recent release of the Final Rule on Medicaid and Medicare Incentive Programs for Electronic Health Records includes the Stage 1 meaningful use criteria that eligible professionals (EP), such as Physicians, Nurse Practitioners or Physician Assistants, and eligible hospitals (EH) must achieve to qualify for incentive funding. What hasn't been exactly clear in many discussions is the actual number of meaningful use criteria that are now required in order to reach Stage 1 meaningful use.

The list of criteria was reduced from the “all or nothing” approach recommended in the proposed rule to a new model. EPs or EHs now must achieve the core criteria (15 for EPs and 14 for EHs) plus achieve an additional 8 criteria from a menu of 12 options listed below. So for EPs, a total of 23 measures must be achieved to reach Stage 1, and for EHs a total of 22 measures will be required to reach Stage 1.

Eligible professionals and hospitals can select any five of the optional menu items TO DEFER, however, they must always achieve at least one of the population and public health criteria and related measures.

The menu set of criteria (from which 5 may be deferred) include:

• Implement drug-formulary checks for prescribing/medication ordering
• Record advanced directives (applies to hospitals only)
• Incorporate clinical laboratory test results into certified EHR technology as structured data
• Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach
• Send reminders to patients per patient preference for preventive or follow-up care (applies to eligible professionals only)
• Provide patients with timely electronic access to their health information (eligible professionals only)
• Use certified EHR technology to identify patient-specific education resources and provide those to the patient if appropriate
• Perform medication reconciliation when a patient is received from another setting or provider
• Provide a summary care record when transferring or referring a patient
• Capability to submit electronic data to immunization registries in accordance with applicable law and practice
• Capability to submit reportable laboratory test result data to public health agencies (hospitals only)
• Capability to submit electronic syndromic surveillance data to public health agencies in accordance with applicable law and practice

The final rule recognizes that in some cases these criteria cannot be accomplished because of a lack of infrastructure or readiness. For example, if there is no state immunization registry in place or it is not capable of receiving electronic data. In these cases the EP or EH can indicate the criteria is not applicable. Otherwise, all EPs and EHs will need to review the menu set to determine what is applicable and feasible and determine whether any criteria can or should be deferred.

The Colorado Rural Health Center and ClinicNet operating as a Regional Extension Center (“REC”) Contractor will be providing a meaningful use analysis to all eligible professionals or hospitals who enroll with us as their primary REC Contractor.

Join our next Consortium Webinar August 19th, 12-1:15 pm where we will begin discussing meaningful use and the final rule in greater detail.

REC Services Now Available - Sign up Today!

The Colorado Rural Health Center (CRHC), in partnership with ClinicNET, is now available to provide clinics with Colorado Regional Extension Center (CO-REC) services to help you assess, implement and adopt certified Electronic Health Records (EHR). These REC services are intended to help you achieve meaningful use, which for many will allow you to draw upon Medicaid or Medicare federal incentive payments!

The federal funding for CO-REC partners means that we can provide clinics with no-cost consultation services through CRHC’s Technology for Healthcare Excellence Consortium. These services include assisting you with:

1. Effectively selecting, implementing and meaningfully using an EHR
2. Standard contract language for EHRs and negotiated pricing including standard interfaces
3. Progress towards meaningful use of an existing EHR
4. Optimizing your practice workflow to ensure improvements in the quality of care
5. EHR contract language regarding Health Information Exchange (HIE) interfaces before you select your EHR so that you can position your practice to take full advantage of interoperability
6. Protecting the integrity, privacy and security of your patient’s Personal Health Information
7. Meeting the qualifications for Incentive Payments for Medicaid or Medicare
8. Developing an overall IT roadmap and infrastructure assessments

The no-cost CO-REC services are only available through federal subsidy for two years, so act now to begin taking advantage of this valuable resource that can save you time, money and the headaches usually associated with adopting technology!

To begin working with us as your REC partner, please fill out the provider letter of agreement and send us a signed copy by July 30, 2010, to attn: Nadine Gressett at 3033 S Parker Road, Suite 606, Aurora, CO 80014.

A Fact sheet is also available to provide you with more information about CO-REC as well as incentive funding and details regarding the CO-REC structure in our state. Feel free to email me with any questions you may have at cf@coruralhealth.org! We look forward to working with you.

ONC Webinar on Final Rules: July 22

ONC is hosting a Webinar Thursday: Certification and Medicare and Medicaid EHR Incentive Programs: Final Rules How will they impact you? The Centers for Medicare & Medicaid Services (CMS) together with The Office of the National Coordinator for Health Information Technology (ONC) invite you to join us for an Audio Training on the Final Rules for ONC Certification and Medicare and Medicaid EHR Incentive Programs.

Learn about:

1. The Benefit of HIT
2. Summary of the final rules
3. ONC temporary certification process
4. ONC initial set of standards and implementation specifications
5. Medicare and Medicaid EHR Incentives Programs including the initial definition of meaningful Use
6. Where to find additional resources

Hear first hand from ONC and CMS Experts!

Date: Thursday, July 22, 2010
Time: 2:00-3:30 pm EST
Call in information Dial: 1-877-251-0301
Conference ID pass code: 87841621

Materials will be made available prior to the training at the following web address: http://www.cms.gov/EHRIncentivePrograms/05_Spotlight_and_Upcoming_Events.asp
Be sure to visit CMS’ web section on the Medicare & Medicaid EHR Incentive Programs at: http://www.cms.gov/EHRIncentivePrograms/

Incentive Funding Clarifications for CAHs and Providers

The American Recovery and Reinvestment Act of 2009 (Recovery Act) authorizes the Centers for Medicare & Medicaid Services (CMS) to provide reimbursement incentives for eligible professionals and hospitals who are successful in becoming “meaningful users” of certified electronic health record (EHR) technology. The Medicare EHR incentive program will provide incentive payments to eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) that are meaningful users of certified EHR technology.

Incentive payments will be made to EPs and hospitals for efforts to adopt, implement, or upgrade certified EHR technology for meaningful use in the first year of their participation in the program and for demonstrating meaningful use during each of five subsequent years. Requirements for meaningful use incentive payments will be implemented over a multi-year period, phasing in additional requirements that will raise the bar for performance on IT and quality objectives in later years. These incentive payments begin in 2011 and gradually decrease. Starting in 2015, providers are expected to have adopted and be actively utilizing a certified EHR in compliance with the "meaningful use" definition or they will be subject to financial penalties under Medicare.

Below are key points on how the final rule will impact critical access hospitals (CAHs). This criterion applies to Stage 1 of meaningful use. It is anticipated that there will be at least three stages of meaningful use. Stage 1 criteria for meaningful use can be found on page 52: http://www.ofr.gov/OFRUpload/OFRData/2010-17207_PI.pdf

• There are a reduced number of required meaningful use objectives: The proposed rule for meaningful use had an all or nothing standard with providers needing to meet 23 required hospital objectives and 25 required meaningful use objectives for eligible professionals (EPs) to attain HIT Medicare and Medicaid incentive payments. The final rule has only 14 required objectives for hospitals and 15 required objects for EPs. An additional five objectives need to be chosen from a set of ten menu requirements. Generally, the most challenging objectives are on the menu list rather than the required list. Stage 1 meaningful use objectives and associated measures can be found starting on page 221: http://www.ofr.gov/OFRUpload/OFRData/2010-17207_PI.pdf
• While Computerized Physician Order Entry (CPOE) remains a required objective, it has been modified to include pharmacist or RN medication order entry: The proposed rule only counted orders entered directly by ordering physicians toward a required 10% CPOE utilization metric to meet the definition of meaningful use. The final rule has raised the utilization requirement to 30%, but orders no longer need to be entered directly by the ordering physician. Any “licensed health care professional” such as pharmacists, registered nurses, nurse practitioners and physician’s assistant may enter CPOE orders on behalf of the physicians. This means that these licensed health care professionals (who in most hospitals currently enter handwritten physician orders) can be utilized to meet the CPOE requirement, which postpones CPOE physician adoption challenges into later meaningful use stages.
• CAHs are now eligible for the Medicaid incentive: The proposed rule excluded CAHs from participating in the Medicaid program. CAHs that meet the 10% Medicaid utilization threshold are entitled to the full “acute care hospital” amount of the Medicaid formula, just like prospective payment system (PPS) hospitals. CAHs can receive both Medicare and Medicaid incentives but EPs will still need to choose between Medicare and Medicaid incentives.
• The required quality metrics that have been reduced to 15 are endorsed by the National Quality Forum (NQF) and tested for electronic use. Please note that this is different from the NPRM and that the quality metrics reporting is different than the required meaningful use objectives in the first bullet point.
• The CAH eligible expense incentive, while not clearly defined, remains broad: by defining a CAH eligible expense as “depreciable costs necessary for the administration of certified EHRs,” CMS may have effectively signaled that it intends to provide incentive funding for a large portion of costs necessary for CAHs to implement comprehensive EHR environments, including network infrastructure, security systems, PACS, and other EHR-related depreciable costs.
• Additional Resources
  1. CMS/ONC fact sheet on the rules, http://www.cms.gov/EHRIncentivePrograms/
  2. Technical fact sheet on ONC’s standards and certification criteria final rule, http://healthit.hhs.gov/standardsandcertification
  3. Meaningful use final rule, http://www.ofr.gov/OFRUpload/OFRData/2010-17207_PI.pdf
  4. Standards, implementation specifications, and certification criteria for EHR technology final rule, http://www.ofr.gov/OFRUpload/OFRData/2010-17210_PI.pdf

Meaningful Use Final Rule - Significant Changes Summarized

The moment we’ve all been waiting for – the final definition of Meaningful Use of Electronic Health Records is here! On July 13, 2010, the Centers for Medicare & Medicaid Services (CMS) released the final rule on Medicare and Medicaid Programs: Electronic Health Record Incentive Programs. This is the response to the proposed rule released the end of December and the hundreds of public comments.

The final rule outlines the Medicare and Medicaid incentive guidelines for Eligible Providers (EPs) and Eligible Hospitals (EH) for Stage 1 of Meaningful Use (MU). The final rule defines the minimum requirements that providers must meet through their use of certified Electronic Health Record (EHR) technology in order to qualify for the incentive payments as well as the specifics of funding attestation and payment. The final rule is 864 pages long, but never fear, THE Consortium will be digesting the information for you and providing valuable tools and education to ensure you understand the criteria. Below you will find a synopsis of the key elements that are different in the final rule.

Meaningful Use
Meaningful use has undergone some significant changes from the proposed rule. Essentially the final rule relaxes the criteria and requirements for meaningful use to a list that hopefully will be easier to achieve.

The proposed rule required doctors to comply with 25 measures, and hospitals 23 measures. The final rule requires doctors to comply with a set of 15 core objectives during the first year – or stage 1– of adoption. Hospitals are required to comply with 14 core objectives. In addition to the core objectives, both hospitals and doctors will have to choose five more objectives from a "menu" of 10. The remaining objectives can be deferred to stage 2 of adoption.
For the Medicare program, attestations may be made starting in April 2011 for both EPs and eligible hospitals. Medicare EHR incentive payments will begin in mid May 2011.

Critical Access Hospitals – Medicaid Incentive Eligible
CMS modified the eligibility requirements for Critical Access Hospitals (CAH) by expanding the definition of acute care hospitals to include the CMS Certification Number (CCN) of 1300-1399, which now enables CAHs to qualify for the Medicaid incentives under MU as long as 10% of their inpatient census constitutes Medicaid recipients.

Computerized Physician Order Entry (CPOE) flexibility for hospitals
CMS had previously proposed to require 10 percent of all orders are entered through CPOE. Though this 10 percent CPOE threshold was raised to 30 percent, the final rule did allow significant flexibility in this requirement. Now, CPOE orders entered by "licensed professionals," such as RNs and pharmacists, will count toward a hospital's CPOE threshold.

Hospital-based Eligible Providers (EP)
The final rule includes a definition of a hospital-based EP as one who performs substantially all of his or her services in an inpatient hospital setting or emergency room only. This conforms to the Continuing Extension Act of 2010 and will allow non-inpatient and emergency hospital-based providers to qualify for incentives.

Physician Assistant-led RHC Definition
CMS has expanded the definition of Physician Assistant-led Rural Health Clinics: 1) When a PA is the primary provider in a clinic (for example, when there is a part-time physician and full-time PA, CMS would consider the PA as the primary provider); 2) When a PA is a clinical or medical director at a clinical site of practice; or 3) When a PA is an owner of an RHC.

Requirements for meaningful use incentive payments will be implemented over a multi-year period, phasing in additional requirements that will raise the bar for performance on IT and quality objectives in later years. The rule also includes the formula for the calculation of the incentive payment amounts; a schedule for payment adjustments under Medicare for covered professional services and inpatient hospital services provided by EPs, eligible hospitals and CAHs that fail to demonstrate meaningful use of certified EHR technology by 2015; and other program participation requirements.

A CMS/ONC fact sheet on the rules is available on the Consortium Website.

CMS Final Rules on Medicare and Medicaid Incentive Funding

We are all eagerly awaiting the final rule from CMS to the Medicare and Medicaid Electronic Health Record Incentive Funding proposed rules that were published in January 2010. This final rule will define the meaningful use criteria that providers must achieve to qualify for incentive funding. A final release date has not been announced, however, it is expected to be released soon and we will keep you updated.

New HIPAA Rules Expected

On July 1, 2010 the Office of Management and Budget completed its review of the ”Modifications to the HIPAA Privacy, Security, and Enforcement Rules Under the Health Information Technology for Economic and Clinical Health Act”. This is the long awaited regulation that goes with the changes to the HIPAA Privacy, Security and Enforcement rules that were put into law by the American Recovery and Reinvestment Act of 2009 and specifically the HITECH Act subsection. Many of these laws have already been put into place (several in February) such as HIPAA enforcement of Business Associates, and changes in patient restriction of disclosures of Personal Health Information (PHI).

These rules will provide more detail into how the laws are applied and should be followed. With the availability of these rules, THE Consortium will be planning a series of HIPAA update Webinars in the early fall. We expect the rules to be published in the Federal Register within the next two weeks, and will keep you posted. If you have any questions, feel free to contact David Ginsberg at dg@coruralhealth.org.