Health Care Reform: Meaningful Use

In the stimulus bill of 2009, Congress included funding to help incentivize physicians to convert to and electronic health record (EHR).  Who is eligible?

• Medicare Program: Physicians who demonstrate meaningful use (MU) of certified EHR technology and submit Medicare claims
• Medicaid Program: Physicians who demonstrate MU of certified EHR technology if their caseload includes at least 30 percent Medicaid patients (or at least 20 percent Medicaid patients for pediatricians).
• Physicians may not receive both Medicaid and Medicare incentives, although they are permitted a single switch from one to the other during the five years that the programs run.

What is the size of the incentive?

• Medicare: 75 percent of Medicare allowed charges for the year, up to the year's maximum incentive amount spread out over 5 years
• Medicaid: 85 percent of Medicaid allowed charges up to a different maximum spread out over 6 years.
• Diminishing amounts available to those who start in later years
• For providers in federally designated health professional shortage areas (HPSA), payments will be 10 percent greater.

What are some of the requirements?

• Must have National Provider Identifier (NPI).
• Must be enrolled in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
• Most will also need to have an active user account in the National Plan and Provider Enumeration System (NPPES).
• Reporting of data on three core quality measures in 2011 and 2012: blood-pressure level, tobacco status and adult weight screening and follow-up
• Alternates include influenza immunizations for patients older than 50, weight assessment and counseling for children and adolescents, and childhood immunizations.
• Reporting of three more clinical quality measures chosen from 44 familiar National Quality Forum and/or Physician Quality Reporting Initiative (PQRI) measures.
• Only certified complete EHRs and EHR modules may be used to qualify.

What are some of the reporting requiremens:

• For 2011, CMS will allow attestations for all MU measures, along with provision of aggregate data for numerators, denominators and exclusions.
•  In 2012, CMS will continue accepting attestation for most of the MU objectives but plans to require electronic submission of the clinical quality measures.
•  States will also support attestation initially and then move to electronic submission of clinical quality measures for Medicaid providers' demonstration of MU

What is meaningful use?

• Meaningful use requires physicians to attest to using the EHR – for data collection, e-prescribing, health information exchange, clinical decision support, patient engagement, security assurance and quality reporting.
• CMS specifies a "core set" of 15 objectives and measures that must be met, along with five objective from a "menu set" of additional objectives.

What are the 15 core objectives?

• Computerized physician order entry (CPOE) for medications
•  More than 30% of patients.
•  Implement drug-drug and drug-allergy interaction checks.
•  Use e-prescribing.
•  More than 40% of all permissible prescriptions.
•  Record patient demographics.
•  More than 50% of patients
•  Maintain an up-to-date problem list.
•  More than 80% of patients
•  Maintain an active medication list.
•  More than 80% of patients
•   Maintain an active medication allergy list.
•  More than 80% of patients
•  Record and chart changes in vital signs
•  More than 50% of patients age 2 or older have height, weight and blood pressure
•  Record smoking status for patients 13 years old or older
•  More than 50%t of patients age 13 or older
•  One clinical decision support rule
•  Report ambulatory clinical quality measures to CMS or the states.
•  For 2011, provide aggregate numerator, denominator and exclusions through attestation.
•  For 2012, submit the clinical quality measures electronically.
•  Give patients an electronic copy of their health information upon request.
•  More than 50% of patients who request an electronic copy of their health information get it within 3 business days.
•  Provide clinical summaries for patients for each office visit.
•  More than 50% of all office visits within three business days.
•  Be able to exchange key clinical information with other providers and patient-authorized entities electronically.
•  Test EHR's ability to exchange key clinical information electronically.
•  Protect electronic health information.
•  Conduct or review a security risk analysis, implement security updates as necessary and correct identified security deficiencies.

Additional Menu Choices (need 5)

• Implement drug-formulary checks.
• Incorporate test results.
• More than 40% of all lab test results
• Generate lists of patients by specific conditions.
• Send reminders to patients for preventive/follow-up care.
• More than 20% of all patients 65 or older or 5 or younger.
• Give patients timely electronic access to their health information.
• More than 10% of all patients seen are provided electronic access to their health information within four business days of its updating in the EHR
• Provide patient-specific education resources.
• Use the EHR to give more than 10 percent of all patients seen patient-specific education resources.
• Perform medication reconciliation whenever appropriate.
• More than 50% of patients arriving from another setting.
• Provide summary of care records.
• More than 50% when referring patients to other providers or settings
• Be able to submit electronic data to immunization registries or immunization information systems.
• Be able to submit electronic syndromic surveillance data to public health agencies.