Changes Coming to Meaningful Use

The government program providing incentives to health providers for meaningful use of electronic health records continues to be troubled as the final rule for stage 3  has been delayed until 2018. Coupled with recent comments by the Centers for Medicare and Medicaid Services (CMS), it appears that the entire program will undergo substantive changes in the year ahead. However, CMS notes, it is important to continue under the old program until the changes start being unveiled in the spring of 2016.

When meaningful use started in 2009, the intent was to induce medical providers to use the new technology purchased with the help of the federal government. By providing incentive payments to the physicians that showed they were using the new technology in a meaningful way, the government believed it would improve quality, safety, and efficiency of care through electronic health records. However, CMS has found that the program did not operate as envisioned, resulting in the forthcoming changes to the program, expected to start in the spring of 2016.

While the new program has guiding themes that were issued by CMS, it is unclear what the new program will ultimately look like. However, many of the themes are to focus on the outcome of patient care, with less focus on the use of the new technology, in hopes that complaints by all stakeholders about the meaningful use program will be alleviated. For health providers, the pending changes will take time implement and until such time, the meaningful use program is still the operative requirements. To read more about the changes, please visit the official blog of CMS at:

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Final Rules Issued by CMS on Stage 3 Electronic Health Record Incentive Program

On October 6th, 2015, the Centers for Medicare and Medicaid Services (CMS) issued two final rules regarding the incentive program for eligible professionals adopting electronic health records. One rule pertained to the requirements necessary to receive a stage 3 incentive payment and the second rule pertained to the electronic health record use requirements for stage 3 participants.

Of the many specifics in the final rules, eligible professionals should note a change to the meaningful use incentive payment reporting period. Previously, eligible professionals had to report meeting the requirements for a full year, but the new rule only requires reporting that the eligible professional met the specifications for 90 days, significantly shortening the reporting period. Another important change, CMS shifted hospitals to a calendar year from a fiscal year, meaning that the attestation period has been moved as well. For hospitals looking to attest to meeting the meaningful use requirements in 2015, the hospital will have to wait until the online attestation portal opens on January 4, 2016. For non-hospital eligible professionals, this will not change the attestation timing because CMS already required the use of a calendar year for these individuals.

The attestation requirements are important for Medicare providers because these 2016 incentive payments turn into Medicare penalties, a negative payment adjustment, in 2017. The final rules for stage 3 electronic health record incentive payments will be published on October 16, with comments open until December 15, 2015. The final rules can be found at the following links:

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CMS Issues Final Rule on Physician Fees for 2013

On November 1, the Center for Medicare & Medicaid Services released a final rule for 2013 on the payments that Medicare will issue for physicians’ fees. Several items in the rule are notable. First, the rule includes a required 26.5 percent reduction to Medicare payments. At this point, it is unclear whether Congress will accept the reduction in light of increased calls for fiscal restraint or whether it will continue to deny the reduction. Assuming that Congress does reject the reduction, payment to primary care practitioners may increase by anywhere from three to seven percent.

The rule also finalizes several changes made to the Meaningful Use and PQRS incentive programs, and will make a series of additional incentives available over the next several years. In addition, it includes new policies allowing for reimbursement for care coordination services provided for up to 30 days following certain kinds of treatment in a hospital or skilled nursing facility. Finally, certified registered nurse anesthetists will now be included in the group of professionals that may be reimbursed by Medicare, to the extent of any service they may provide under state law. These changes are the primary causes of the projected increase in payment to practitioners; however, this increase is contingent on Congress’s action with regard to the final rule.

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Stage 2 Proposed Rules Published

CMS has published a proposed rule providing standards and guidance for Stage 2 of the Medicare and Medicaid EHR Incentive Program (the “Program”).  The CMS proposed rule explains the requirements that eligible professionals and hospitals must meet to qualify for meaningful use incentive payments under the Program.

The Office of the National Coordinator for Health Information Technology (“ONC”) has also issued Stage 2 certification standards.  The ONC standards establish the technical requirements that electronic health records (“EHR”) must meet to become certified as supporting Stage 2 meaningful use criteria.

Basically, the CMS proposed rule governs the requirements that providers must meet in order to qualify for meaningful use and successfully obtain EHR incentive payments.  The ONC certification standards govern the requirements that EHR must meet so that such EHR can be used by providers to qualify for meaningful use.

Stage 2 of the Program is set to begin no earlier than 2014 (for participants who met the Stage 1 requirements in 2011 or 2012).  Comments on both proposed rules are due by 5:00 p.m. on May 7, 2012.

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4 Meaningful Use Tips for Physicians

The concept of meaningful use is key to earning federal electronic health records (“EHR”) incentives.  The following are four tips to keep in mind when working towards meeting meaningful use criteria:

  1. Track Progress.  Many meaningful use measures establish a threshold that must be reached.  Use “to do” lists and progress charts to track progress as needed.  Make sure that all applicable criteria are addressed with respect to each objective.  Test and re-test any changes made.  Note such changes and results of testing in your progress charts.
  2. Adapt Workflow.  Workflow changes may be necessary and desirable in order to obtain, report and share certain patient information.  Try out different workflow scenarios and determine what works best for your organization. Clinical-care summaries and transition-of-care summaries should be routine.
  3. Welcome Changes.  Develop an environment that is fully supportive of efforts to meet meaningful use criteria.  Encourage behavior that works to reach your organization’s meaningful use objectives and to obtain incentive payments.  Reward behaviors that improve patient care and advance meaningful use goals.
  4. Know Your Vendors.  Ask specific questions about what your organization needs to meet meaningful use requirements.  Do not assume that the software a vendor is trying to sell is certified by the Office of the National Coordinator – Authorized Testing and Certification Body.  Obtain independent verification

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