This is a follow-up to my last post on the proposed definition of meaningful use. It is what we will be working toward unless it is revised after the 60 day comment period.
Terms: EPs are eligible professionals and CAHs are critical access hospitals. We will just refer to eligible hospitals as hospitals.
Incentive Programs: The Medicare EHR incentive program will provide incentive payments to EPs, hospitals and CAHs that are meaningful users of certified EHR technology. And, the Medicaid EHR program will provide incentive payments to EPs and hospitals for their efforts to adopt, implement, or upgrade certified EHR technology for meaningful use in the first year of their participation in the program and for demonstrating meaningful use during each of five subsequent years.
Criteria: Proposed in three stages, each with specific objectives that EPs and hospitals must meet to demonstrate meaningful use.
Stage 1 -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. (Begins in 2001 with submission of clinical quality measures to CMS by 2012; 25 objectives/measures (including clinical quality)for EPs and 23 objectives/measures for eligible hospitals; reported by EPs and hospitals to CMS(Medicare) or to the State(Medicaid), through attestation.)
Stage 2- expands upon 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. Criteria may be more broadly applied to both the inpatient and outpatient hospital settings by CMS.
Stage 3 - 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.
EHRs are key vehicle and there is currently a big push to use the HIT stimulus funding over the next two years to get ready for the electronic reporting to CMS by 2012. My advice to both EPs and hospitals is to identify the Regional Extension Center in your area in March 2010 and start planning for EHR adoption. Until then, look at your workflow and start making improvements to your care and administrative processes.
What does this mean to those delivering the healthcare? Advisors recommend:
- Use computerized physician order entry (CPOE) for all medication, laboratory, procedure, imaging, immunization and referral orders
- Have electronic checks for drug interactions
- Keep up-to-date problem lists (electronically) for patients
- Incorporate test results into the EHR as machine-readable "structured" data
- Report to CMS on ambulatory quality measures
- Include at least one specialty-specific rule for clinical decision support
- Check insurance eligibility and submit claims electronically
- prove use of the EHR to improve coordination of care
- provide patients with the data they need to make informed decisions about their own health
Physicians who comply with HIPAA privacy and security regulations can receive the Medicare bonuses (up to $44,000) or Medicaid payments (up to $63,750).
Hospitals that are meaningful users of EHRs in 2011 can earn a baseline annual incentive of $2 million, plus an extra $200 per discharge for the 1,150th through 23,000th discharge per year. Adjustments will be made based on the amount of charity care and Medicare population.
