Electronic Health Records (EHR) and Meaningful Use

Please click on the links (below) to take you to related items:

I) Background and Resources
II) Summaries of Regulations
III) Comment Letters 

I) Background and Resources for the EHR Incentive Programs

The Electronic Health Records (EHR) Incentive Program is an initiative from CMS designed to facilitate the use of EHRs in clinical settings. Eligible professionals, hospitals, and critical access hospitals that demonstrate meaningful use of EHRs are eligible for incentive programs. For eligible professionals, incentive programs can accumulate up to $44,000 total by 2015 if they begin to successfully participate in 2012. Starting in 2015, eligible professionals, hospitals and critical access hospitals that do not successfully demonstrate meaningful use of EHRs will be subject to penalties starting with a 1% payment reduction in 2015 (based on 2013 reporting) and increasing annually to 5% by 2020.

The EHR Incentive Program is structured in three stages, with a possible fourth stage starting as early as 2018. Below is a snap shot of implementation dates for the EHR Incentive Program through 2016:

In order to achieve the full $44,000 in incentive payments, EPs must begin participating in the EHR Incentive Program by October 3rd, 2012. Starting in 2013, incentive payments will be reduced annually and EPs will be subject to payment penalties in 2015. 

Certified Health IT Product List

The ONC Certified HIT Product List (CHPL) is a comprehensive list of Complete EHRs and EHR Modules that have been tested and certified by an ONC-Authorized Testing and Certification Body (ATCB) under the Temporary Certification Program. CMS will only grant and accept reporting numbers from the EHR technologies on the ONC-Certified Health IT Product List. These reporting numbers are required for attestation under the EHR (“meaningful use”) incentives programs.
 
Factsheets on the Medicare and Medicaid EHR Incentive Programs

Learn more about the Medicare and Medicaid EHR incentive programs from these compilations (includes registration details, incentive payments, meaningful use criteria etc.)

1. Medicare EHR Incentive Program  
2. Medicaid EHR Incentive Program

Stage 1 Meaningful Use Criteria: Reporting Criteria

Eligible Professionals must report on 20 - 25 meaningful use objectives to qualify for an incentive payments. There are fifteen core objectives that are required. The additional five objectives may be chosen from the list of 10 menu set objectives (you will note not all are applicable to your practice). The table (link above) from the American Medical Association (AMA) includes the meaningful use objectives, how to report them, and exemption criteria for reporting them.

A list of all the meaningful use objectives can be found here

In order to successfully attest, participating physicians must meet meaningful use criteria using EHR technology. The American Academy of Otolaryngology- Head and Neck Surgery Medical Informatics Committee authored an article that provides recommendations from the Academy for implementing "meaningful use" of EHRs to improve safety, quality, and efficiency of patient care and receiving incentive payments as defined by CMS regulations. This article can be found in the February 2011 issue of Otolaryngology- Head and Neck Surgery and is available online to members here (Academy login required).

Clinical Quality Measures (CQMs)

Eligible professionals must report at total of 6 measures from a list of 44 choices. EPs must report 3 measures from the Core and Alternate Core choices and 3 additional measures, chosen from the 38 other clinical quality measures. This table from the American Medical Association contains the CQMs and guidelines on how to report them. 

*It is important to note, although EPs are required to report core measures, there is no minimum value for any numerator, denominator, or exclusion fields for measures. This means a physician may report zero to CMS. If a physician reports zero for the additional measures, they must attest all other measures calculated by the EHR system also have a value of zero. 

Getting Started

CMS has developed a number of resources for you to see if you are eligible to begin participating in the EHR Incentive Program as well as instructions on how to register and tips on how you can successfully attest to Meaningful Use, earn incentive payments, and avoid Medicare Payment Penalties. See the CMS Getting Started page here. 

II) Summaries of Regulations

Stage 2 Meaningful Use Criteria Summary (10/4/2012)
The Centers for Medicare and Medicaid Services (CMS) released the final rule on Meaningful Use Stage 2 Criteria. Within the final rule, Eligible Professionals (EPs) must report 17 core objectives and 3  of 6 menu objectives, or qualify for an exclusion, to successfully attest to Meaningful Use. A list of the core and menu objectives can be found here.

EPs must also report on 9 clinical quality measures, out of a list of 64, in addition to the core and menu objectives. EPs will also have the choice of reporting via PQRS. 

Eligible Professionals will not be required to meet Stage 2 criteria until 2014, which represents a one year delay from the schedule defined in the Stage 1 final rule and allows EPS two years to participate in Stage 1 regardless of what year they begin participating.

Proposed Rule on Meaningful Use Stage 2 Criteria (3/8/2012)
On March 7, 2012, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule on Meaningful Use Stage 2 Criteria. Within the proposed rule, CMS proposed 17 core objectives and 5 menu objectives- Eligible Professionals (EPs) must meet or qualify for an exclusion, for all 17 core objectives and 3 of 5 menu objectives to successfully attest to Meaningful Use. A list of the proposed core and menu objectives can be found here.

In the proposed rule, there are 125 potential clinical quality measures for EPs to report, with only a subset expected to be finalized in the Final Rule, which is expected to be released in the summer 2012. EPs must also report on 12 clinical quality measures in addtion to the core and menu objectives. CMS is working to align the clinical quality measures for Stage 2 with other programs like Accountable Care Organizations and PQRS and focusing on uniform menu sets, standardized measurement development and processes, and minimizing multiple requirements and mechanisms for the different programs.

Eligible Professionals will not be required to meet Stage 2 criteria until 2014, which represents a one year delay from the schedule defined in the Stage 1 final rule and allows EPS two years to participate in Stage 1 regardless of what year they begin participating.

Final Rule for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Program
On July 28, 2010, the Centers for Medicare and Medicaid Services (CMS) released the final rule for the Medicare and Medicaid EHR programs.

Proposed Rule for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Program

Enacted on February 17, 2009, the American Recovery and Reinvestment Act (ARRA) under the Health Information for Economic and Clinical Health Act (HITECH) provision established payments for eligible professionals (EP) and eligible hospitals that meaningfully use EHRs. In order to leverage the definition of “meaningful use” and the guidelines required for EPs and eligible hospitals to prove that they are meaningful uses of EHR, on December 30, 2009 CMS released a proposed rule for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Program and the Office of the National Coordinator of Health Information Technology (ONC) released the interim final rule on the specification and certification criteria for EHR.

III) Comment Letters 

Academy Submits Comments to HIT Policy Committee on Proposed Stage 3 Meaningful Use Criteria (1/23/2013)
On January 14th, the Academy sent a letter to the Health Information Technology (HIT) Policy Committee regarding their proposed criteria for Stage 3 of the EHR Meaningful Use Incentive Program, scheduled to take effect in 2016. In the letter, the Academy expressed concerns with the criteria and asked that the policy recommend delaying the beginning of Stage 3. See the letter.

Academy Submits Comments to CMS on Stage 2 Meaningful Use Final Rule (10/22/12)
The Academy sent a letter to CMS expressing concerns with the final rule of Stage 2 of the Electronic Health Record (EHR) Meaningful Use Incentive Program. In comments, the Academy noted the high thresholds make attaining meaningful use difficult for specialty physicians and hinders the adoption of EHRs and Health Information Technology (HIT).  See the letter.

Academy Signs onto ACS and AMA Meaningful Use Comment Letters (5/17/12)
The Academy signed onto joint letters from the American College of Surgeons (ACS) and the American Medical Association (AMA) regarding the proposed rule for Stage 2 of the Electronic Health Record (EHR) Meaningful Use Incentive Program. The signed organizations expressed their desire to work with CMS on the adoption of EHRs and Meaningful Use, but outlined concerns related to the stringent requirements which could exclude specialists, such as otolaryngologists. In areas where comments contradict Academy priorities, the Academy positions take precedent. See the ACS Letter and the AMA Letter.

Academy's Comment Letter on Proposed Rule for Stage 2 of the EHR Meaningful Use Incentive Program (5/7/12)
On May 7th, 2012, the Academy submitted a comment letter to CMS on the proposed rule for Stage 2 of the EHR Meaningful Use Incentive Program. In the letter, the Academy expressed concerns that stringent program requirements with high satisfaction thresholds will hinder health information technology (HIT) adoption.

Academy’s Comment Letter on the Proposed Rule for the EHR Incentive Program
On March 10, 2010 the Academy submitted a comment letter to CMS on the proposed rule for meaningful use.  

Academy's Comment Letter on the Proposed rule for the Certification Programs for Health Information Technology (HIT)On March 30,2010, we sent a letter to the ONC recommending that they require the ONC-Authorized Testing and Certification Body (ONC-ATCB) to certify and test EHRs' capabilities to be integrated into EHRs from other vendors, post a frequently updated list of "de-certified" EHRs on the ONC website, limit the number of ONC-ATCBs to five and much more. 

 
Sign on Comment Letter on the Definition of Meaningful Use of EHR  
The Academy in addition to other specialty societies sent a letter with recommendations for defining and demonstrating the meaningful use of Electronic Health Records (EHR).

Page Last Updated on January 23rd, 2013