The Centers for Medicare & Medicaid Services (CMS) today announced a final rule to implement provisions of the American Recovery and Reinvestment Act of 2009 (Recovery Act) that provide incentive payments for the meaningful use of certified 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. The Medicaid EHR incentive program will provide incentive payments to eligible professionals and hospitals for efforts to adopt, implement, upgrade or meaningfully use certified EHR technology.
This fact sheet summarizes CMS’ final definition of meaningful use.
Meaningful Use – Policy Goals and Definition
Through the Medicare and Medicaid EHR incentive programs, CMS hopes to expand the meaningful use of certified EHR technology. Certified EHR technology used in a meaningful way is one piece of a broader Health Information Technology infrastructure needed to reform the health care system and improve health care quality, efficiency, and patient safety. The Office of the National Coordinator for Health Information Technology (ONC) is simultaneously issuing a closely related final rule that completes the Secretary’s adoption of an initial set of standards, implementation specifications, and certification criteria for EHRs. ONC also issued a final rule establishing a temporary certification program for health IT on June 24, 2010 and anticipates issuing a final rule establishing a permanent certification program later this year.
CMS’ goal is for the definition of meaningful use to be consistent with applicable provisions of Medicare and Medicaid law while continually advancing the contributions certified EHR technology can make to improving health care quality, efficiency, and patient safety. To accomplish this, CMS’ final rule would phase in more robust criteria for demonstrating meaningful use in three stages.
Development of Stage 1 Criteria for Meaningful Use
The meaningful use criteria is the culmination of an intensive process that involved input from several Federal Advisory Committees (the National Center for Vital Health Statistics, the HIT Policy Committee, and the HIT Standards Committee) and a notice of proposed rulemaking (NPRM) published on January 13, 2010. We received over 2,000 comments on our proposed rule for the Medicare and Medicaid EHR incentive programs. Review of these comments led us to make several changes to the NPRM Stage 1 criteria of meaningful use. Most notably, we will allow the option for deferral of some objectives/measures and the evaluation of the applicability of some objectives/measures to EPs and eligible hospitals. We also made many other specific changes to the objectives/measures individually and encourage all interested stakeholders to review the final rule for these changes.
Stage 1 Criteria for Meaningful Use
The Stage 1 criteria for meaningful use focus on electronically capturing health information in a coded format, using that information to track key clinical conditions, communicating that information for care coordination purposes, and initiating the reporting of clinical quality measures and public health information.
The criteria for meaningful use are based on a series of specific objectives, each of which is tied to a measure that allows EPs and hospitals to demonstrate that they are meaningful users of certified EHR technology.
For Stage 1, which begins in 2011, there will be 25 objectives/measures for EPs and 24 objectives/measures for eligible hospitals. The objectives/measures have been divided into a core set and menu set. EPs and eligible hospitals must meet all objectives/measures in the core set (15 for EPs and 14 for eligible hospitals). They can choose to defer up to five remaining objectives/measures. Each objective/measure was evaluated for its potential applicability to all EPs and eligible hospitals. Where it is impossible for an EP or eligible hospital to meet a specific measure, an exclusion is defined in the final rule. If an exclusion applies to an EP or eligible hospital, then such professional or hospital does not have to meet that objective/measure in order to be determined a meaningful EHR user. For example, if an EP has two exceptions (one for a core objective/measure and one for a menu objective/measure), the EP would need to meet the remaining 14 objectives/measures in the core set and four of the remaining nine objectives/measures in the menu set.
In 2011, EPs, eligible hospitals and CAHs seeking to demonstrate Meaningful Use are required to submit aggregate clinical quality measure numerator, denominator, and exclusion data to CMS or the States by attestation. In 2012, EPs, eligible hospitals and CAHs seeking to demonstrate meaningful use must electronically submit clinical quality measures selected by CMS directly to CMS (or the States) through certified EHR technology. CMS recognizes that for clinical quality reporting to become routine, the administrative burden of reporting must be reduced. By using certified EHR technology to report information on clinical quality measures electronically to a health information network, a State, CMS, or a registry, the burden on providers that are gathering the data and transmitting them will be greatly reduced.
The burden of generating the necessary information for the provider to then use the information to improve health care quality, efficiency, and patient safety will also be reduced. CMS expects that by their second implementation year, States will have the capacity to accept direct submission of Medicaid providers’ clinical quality measures from certified EHR technology.
Beyond the Stage 1 Criteria for Meaningful Use
The policy goals of meaningful use will be most fully realized by building on findings from Stage 1 and by making full use of the greater proliferation of certified EHR technology and supporting HIT/E infrastructure that will take place under Stage 1. CMS intends to propose through future rulemaking two additional stages of the criteria for meaningful use.
Stage 2 would expand upon the Stage 1 criteria in the areas of disease management, clinical decision support, medication management support for patient access to their health information, transitions in care, quality measurement and research, and bi-directional communication with public health agencies. These changes will be reflected by a larger number of core objective requirements for Stage 2. CMS may also consider applying the criteria more broadly to the outpatient hospital settings (and not just the emergency department).. Information exchange is a critical part of care coordination and we expect that the infrastructure will support greater requirements for using health information exchanges for Stage 2.
Stage 3 would focus on achieving improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data, and improving population health outcomes.
Additional information on the Medicare and Medicaid EHR Incentive Programs, including a link to the text of the final rule, can be found at http://www.cms.gov/EHRIncentivePrograms.