Meaningful Use (MU or ARRA)
By now everyone in the healthcare industry has heard about Meaningful Use (MU) or ARRA (American Recovery Reinvestment Act). A lot of hospitals have met the requirements for Stage 1 and are well into planning Stage 2 and how they will meet those requirements. It is hard to believe there are hospitals that still do not have an EMR system and have not started attestation, but since we know they exist, we will start at the beginning.
Currently, the EHR Incentive Program consists of 3 stages of meaningful use (there could be more in the future). There are two choices for attesting for MU – you must choose one way that you will be attesting. One is as an Eligible Hospital or Critical Access Hospital and the other is as an Eligible Professional. An Eligible Provider (EP) according to Medicaid is one of these healthcare providers:
· Physicians (primarily doctors of medicine and doctor of osteopathy)
· Nurse Practitioners
· Certified nurse - midwife
· Dentist
· Physician Assistant who works at a FQHC (Fully Qualified healthcare center) or RHC (Rural Health Clinic) that is led by a physician assistant
Stage 1-Data capture and Sharing
EP (Eligible Professionals) must report on:
14 Core Objectives
5 of 10 Menu Objectives (which one must come from the Public Health list)
(For a total of 19 Objectives)
Clinical Quality Measures (CQMs)-include 3 core (or 3 alternate core) and 3 out of 38 additional CQMs
EH and CAH (Eligible Hospitals and Critical Access Hospitals):
13 Core Objectives
5 of 10 Menu Objectives (which one must come from the Public Health list)
(For a total of 18 Objectives)
Clinical Quality Measures (CQMs)-must report on all 15 of their clinical quality measures.
Highlights:
CQMs do not have thresholds that you have to meet - you have to report data on them.
Stage 2-Focus is on advanced clinical procedures:
Part of advanced clinical procedures includes: Health Information Exchange, additional requirements for e-prescribing and incorporating lab results, electronic transmission of patient care summaries across multiple settings, and increased patient and family engagement. Those providers participating in the EHR Incentive Program who have met stage 1 for two or three years will need to meet meaningful use Stage 2 criteria which use some of the same reporting criteria, but with higher percentages compared to Stage 1 requirements.
Providers will focus on improving patient care through better clinical decision support, care coordination and patient engagement. This stage will save the healthcare system money, save doctors and hospitals time and save lives.
EPs must report on:
17 Core Objectives
3 of 6 menu objectives
(For a total of 20 Objectives)
Clinical Quality Measures
EHs must report on:
16 Core Objectives
3 of 6 menu objectives
(For a total of 19 Objectives)
Clinical Quality Measures
Some of the core objectives have exclusions, but many do not and some objectives that are in stage 1 are now required for all providers in stage 2. We suggest hiring extra help to determine which menu objectives should be selected focusing on what makes sense for your workflow or practice and what exclusions may apply.
Highlights:
Certified EHRs must meet the new certification in order to participate in the EHR Incentive program beginning in 2014 and because of this, there is a special reporting period in 2014 in which all providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a three-month (or 90 day) reporting period in 2014. EP’s beyond their first year of MU must attest to these reporting periods no later than February 28, 2015 at 12am ET. Annual incentive payments by Stage of MU (Medicaid payments) are made over 6 years.
Changes to CQMs for 2014-EPs and EH now state your organization must report on 9 of a possible list of 64 approved CQMs for the EHR Incentive Programs and must cover at least 3 of the 6 available National Quality Strategy (NQS domains). In addition, beginning of 2014 all EPs and EHs beyond their first year of MU will be required to submit CQMs electronically. The 6 domains are:
· Patient and Family engagement
· Patient Safety
· Care Coordination
· Population and Public Health
· Efficient Use of Health Care Resources
· Clinical Processes/Effectiveness
To meet the requirements for Stage 1 and 2 there are several recommendations that should be taken into consideration such as applications and/or functionality:
· Patient portal must be setup and used to meet the object of “provide patients the ability to view online, download and transmit information about a hospital admission” (see the section in the book about Portals for more information)
· Standard nomenclatures for Clinical Quality Measure reports (such as subscription to Intelligent Medical Objects) (see the sections in this book about Clinical Quality Measures and Intelligent Medical Objects for more information)
· Ensure your EHR meets the new requirements (generally your EHR Vendor will alert you on this)
· Utilizing point of care bar coding medication administration system/electronic medication administration record
· Possible interfaces for electronic laboratory results
Stage 3-Improved Outcomes
Expected timing for rulemaking will come in the fall of 2014 when CMS will release a notice of proposed rulemaking for stage 3.
Resources:
HealthIT.gov-Policy, researchers and implementers resource
http://www.healthit.gov/policy-researchers-implementers/meaningful-use-stage-2
CMS-EHR Incentive programs
CMS-Stage 3 progression
http://www.cms.gov/eHealth/ListServ_Stage3Implementation.html
For more detailed information on Meaningful Use Stage 1 and Stage 2, check out our past blog excerpts at: http://excelhcg.wordpress.com/ and look under the category Meaningful Use.