Meaningful Use

The Office of the National Coordinator (ONC) has published the meaningful use criteria, implementation standards and technology in the federal register on February 13, 2010.  It was a long read.  For many physicians, this  meaningful use criteria and the process to become eligible for Medicare incentives are very confusing.  I will try to explain different stages of meaningful use criteria and the number of stages that each practice must adopt in each year.  In the next article, i will discuss electronic health records (EHR) certification criteria, fears and apprehensions in adopting an electronic medical record (EMR) system. 

Eligibility Reporting Period:

In order to qualify for an incentive payment under the Medicare incentive payment program for a payment year, a practice or eligible hospital must meaningfully use certified EHR technology for the full reporting period of the relevant payment year.  The proposed reporting period requirements are as follows:

• Continuous 90 day period within the first year of payment - If a physician adopts an EHR in 2011, the practice needs adopt and report required quality measures based on the data collected for a continuous 90 days period.
• For all subsequent payments (second, third, fourth and fifth), the reporting period is the full year.  If a  physician adopts an EHR in 2011 and receives the first payment then that physician must report required data to ONC based on full year's data to receive subsequent payments in years 2012, 2013, 2014 and 2015. 

ONC is seeking public comment on above reporting periods and the earliest start date to demonstrate the meaningful use criteria.  For example,  allowing an EHR reporting period to begin as early as July 3, 2010 would allow an eligible hospital to successfully demonstrate meaningful use on October 1, 2010, the first day of FY 2011.

Three stages:

In its final bill, the Congress specified the following three types of requirements for meaningful use.  

• Use a certified EHR technology in a meaningful manner (for example, electronic prescribing);
• The certified EHR technology is connected to provide electronic exchange of health information to improve the quality of care.
• The physician submits to the Secretary information on clinical quality measures and such other measures selected by the Secretary.

To accurately validate the meaningful use of each EHR adoption, the health information technology (IT) policy and standards committees defined three stages of meaningful use.  Physicians must adopt these three stages no later than 2016 to qualify for the full payment of $44,000 over 5 years (see the table in the section below for adoption requirement of each year to receive full payment in that year).

• The Stage 1 meaningful use criteria focuses on capturing health information in electronically  coded format; using that information to track key clinical conditions and communicating that information for care coordination purposes (whether that information is structured or unstructured, but in structured format whenever feasible); implementing clinical decision support tools to facilitate disease and medication management; and reporting clinical quality measures and public health information.

•  The Stage 2 meaningful use criteria expands upon the Stage 1 criteria to encourage the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible (E.g. electronic transmission of orders entered using computerized provider order entry (CPOE) and the electronic transmission of diagnostic test results). 

• The Stage 3 focuses on promoting improvements in quality, safety and efficiency.  It focuses on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data and improving population health.

The proposed ruling requires practices and eligible hospitals adopt each stage in the following way to receive Medicare incentive payments in each year:

Year of Adoption	Payment Year
	2011	2012	2013	2014	2015
2011	Stage 1	Stage 1	Stage 2	Stage 2	Stage 3
2012		Stage 1	Stage 1	Stage 2	Stage 3
2013			Stage 1	Stage 2	Stage 3
2014				Stage 1	Stage 3
2015					Stage 3

 

If a physician adopts an EHR in 2013 and fulfills stage 1 requirements then the physician receives the first eligible payment of $15,000.  To receive further payments, the physician must adopt stage 2 and stage 3 requirements in the respective two years.

Please see the post below for stage 1 requirements.