Stimulus Center
Welcome to AIM EMR's Stimulus Center. Our goal in collecting the information provided in these pages is to help you in your understanding of the government stimulus and most importantly what constitutes Meaningful Use. Although we've tried to include the most critical information, we know how complex this issue is. If we've left anything out that will further help in your understanding of these government incentives and in making your EMR acquisition decision, please contact us.
Meaningful Use has become a commonly used term in the medical industry. After months of waiting for the definitions of achieving "meaningful use", on July 13, 2010, the Centers for Medicare and Medicaid (CMS) announced the final ruling for the EHR Incentive Program.
CMS will implement the meaningful use criteria in a three stage process, starting with Stage 1 of Meaningful Use (2011 and 2012). This phase of adoption is focused on healthcare professionals using certified EHR technology [such as IMS] to improve health outcomes in the following areas:
- Electronically capturing health information in a coded format
- Using that information to track key clinical conditions and communicating that information for care coordination purposes
- Implement clinical decision support tools to facilitate disease and medication management
- Reporting clinical quality measure and public health information
Stage One: The Criteria
CMS regulations outline five priorities for health outcomes:
- Improve quality, safety, efficiency, and reducing health disparities
- Engage patients and families
- Improve care coordination
- Improve population and public health
- Ensure adequate privacy and security protection of PHI [personal health information]
CMS presents 15 required "core" Objectives representing actions that meaningful users must take in order to demonstrate meaningful use. In addition to the 15 required "core" objectives an eligible professional must select 5 objectives from a menu of 10.
STAGE 1 CORE CRITERIA FOR ELIGIBLE PROFESSIONALS
| OBJECTIVE: | Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. |
| MEASURE: | Subject to paragraph (c) of this section, more than 30 percent of all unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE. |
| EXCLUSION: | In accordance with paragraph (a)(2) of this section Any EP who writes fewer than 100 prescriptions during the EHR reporting period. |
| OBJECTIVE: | Implement drug-drug and drug-allergy interaction checks. |
| MEASURE: | The EP has enabled this functionality for the entire EHR reporting period. |
| OBJECTIVE: | Maintain an up-to-date problem list of current and active diagnoses. |
| MEASURE: | More than 80 percent of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data. |
| OBJECTIVE: | Generate and transmit permissible prescriptions electronically (eRx). |
| MEASURE: | Subject to paragraph (c) of this section, more than 40 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology. |
| EXCLUSION: | In accordance with paragraph (a)(2) of this section Any EP who writes fewer than 100 prescriptions during the EHR reporting period. |
| OBJECTIVE: | Maintain active medication list. |
| MEASURE: | More than 80 percent of all unique patients seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data. |
| OBJECTIVE: | Maintain active medication allergy list. |
| MEASURE: | More than 80 percent of all unique patients seen by the EP have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data. |
| OBJECTIVE: |
Record all of the following demographics:
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| MEASURE: | More than 50 percent of all unique patients seen by the EP have demographics recorded as structured data. |
| OBJECTIVE: |
Record and chart changes in the following vital signs:
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| MEASURE: | Subject to paragraph (c) of this section, more than 50 percent of all unique patients age 2 and over seen by the EP, height, weight and blood pressure are recorded as structured data. |
| EXCLUSION: | In accordance with paragraph (a)(2) of this section. Any EP who either see no patients 2 years or older, or who believes that all three vital signs of height, weight, and blood pressure of their patients have no relevance to their scope of practice. |
| OBJECTIVE: | Record smoking status for patients 13 years old or older. |
| MEASURE: | Subject to paragraph (c) of this section, more than 50 percent of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data. |
| EXCLUSION: | In accordance with paragraph (a)(2) of this section. Any EP who sees no patients 13 years or older. |
| OBJECTIVE: | Report ambulatory clinical quality measures to CMS or, in the case of Medicaid EPs, the States. |
| MEASURE: | Subject to paragraph (c) of this section, successfully report to CMS (or, in the case of Medicaid EPs, the States) ambulatory clinical quality measures selected by CMS in the manner specified by CMS (or in the case of Medicaid EPs, the States). |
| OBJECTIVE: | Implement one clinical decision support rules relevant to specialty or high clinical priority along with the ability to track compliance with that rule. |
| MEASURE: | Implement one clinical decision support rule. |
| OBJECTIVE: | Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, medication allergies) upon request. |
| MEASURE: | Subject to paragraph (c) of this section, more than 50 percent of all patients who request an electronic copy of their health information are provided it within 3 business days. |
| EXCLUSION: | In accordance with paragraph (a)(2) of this section. Any EP who has no office visits during the EHR reporting period. |
| OBJECTIVE: | Provide clinical summaries for patients for each office visit. |
| MEASURE: | Subject to paragraph (c) of this section, clinical summaries provided to patients for more than 50 percent of all office visits within 3 business days. |
| EXCLUSION: | In accordance with paragraph (a)(2) of this section. Any EP who has no office visits during the EHR reporting period. |
| OBJECTIVE: | Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically. |
| MEASURE: | Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information. |
| OBJECTIVE: | Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. |
| MEASURE: | Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process. |
Menu Set for Objectives
| OBJECTIVE: | Implement drug formulary checks. |
| MEASURE: | The EP/eligible hospital has enabled this functionality and has access to at least one internal or external drug formulary. |
| OBJECTIVE: | Incorporate clinical lab-test results into EHR as structured data. |
| MEASURE: | More than 40% of all clinical lab tests results ordered by the EP or by an authorized provider of the eligible hospital or CAH for patients admitted to its inpatient or emergency department (POS 21 or 23) during the EHR reporting period whose results are in either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data. |
| EXCLUSION: | EPs who orders no tests that would included in the denominator during the EHR reporting period. |
| OBJECTIVE: | Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach. |
| MEASURE: | Generate at least one report listing patients of the EP, eligible hospital or CAH with a specific condition. |
| OBJECTIVE: | EP: Send reminders to patients per patient preference for preventive/follow up care. |
| MEASURE: | EP: More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period. |
| EXCLUSION: | EPs with no patients with records maintained in their certified EHR technology in the designated age categories. |
| OBJECTIVE: | EP: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within four business days of the information being available to the EP. |
| MEASURE: | EP: More than 10% of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP’s discretion to withhold certain information. |
| EXCLUSION: | EPs creates none of the data listed in certification as capable to be provided online by certified EHR technology. |
| OBJECTIVE: | Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. |
| MEASURE: | More than 10% of all unique patients seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period are provided patient-specific education resources. |
| OBJECTIVE: | The EP, eligible hospital or CAH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. |
| MEASURE: | The EP, eligible hospital or CAH performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23). |
| EXCLUSION: | EP who does not receive any transitions of care. |
| OBJECTIVE: | The EP, eligible hospital or CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary of care record for each transition of care or referral. |
| MEASURE: | The EP, eligible hospital or CAH who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals. |
| EXCLUSION: | EP who neither refers nor transitions patients to other settings of care. |
| OBJECTIVE: | Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice. |
| MEASURE: | Performed at least one test of certified EHR technology's capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP, eligible hospital or CAH submits such information have the capacity to receive the information electronically). |
| EXCLUSION: | EP/EH/CAH who administers no immunizations during the EHR reporting period. |
| OBJECTIVE: | Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice. |
| MEASURE: | Performed at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP, eligible hospital or CAH submits such information have the capacity to receive the information electronically). |
| OBJECTIVE: | Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice. |
| MEASURE: | Performed at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP, eligible hospital or CAH submits such information have the capacity to receive the information electronically). |
| EXCLUSION: | EP that does not collect any reportable syndromic information on their patients during the EHR reporting period. |
Q: How do I collect $44,000 from Medicare for Meaningful Use?
A: To apply for the Medicare Program Meaningful Use Funds, you will first need to Register. Registration will be online at http://cms.gov/EHrIncentivePrograms. Medicare funds will be paid based on an "attestation process". For an Eleigible Professional's first payment year - the Eleigible Professional [EP] must demonstrate Meaningful Use for a continuous 90-day period and attest that they have met 20 required Meaningful Use Measures. Those 20 Meaningful Use measure encompose the 15 Core Measure and 5 Selections from the Menu of Options. Additionally, the EP must be using a qualified system, such as IMS.
Q: Will Medicare send me the check?
A: Medicare Meaningful Use payments will be made through either a single payment contractor, your carrier or your Medicare Administrative Contractor (MAC). A new Integrated Data Repository (IDR) will accumulate the EP allowed charges. Payments will be made on a rolling basis dictated by 2 milestones:
- CMS ascertains that an EP successfully demonstrated Meaningful Use for the applicable Reporting Period.
- EP’s allowed charges {approx $24,000] have reached the qualifying threshold for maximum incentive payment for that Payment Year.
For EPs who do not reach maximum thresholds, the payment contractor will disburse an incentive payment the following year.
CMS estimates EP's will receive payment 15 - 46 days from successful Meaningful Use attestation.Payments will start as early at May 2011.
Q: When is the distribution of the money going to happen?
A: CMS proposes that it will be distributed on a "rolling basis" after the attestation is received. There is no defined time period you'll need to wait between submitting your attestation and actually receiving the check.
Q: We are a group practice of several providers billing under the same tax ID. Are we eligible for one meaningful use payment or one payment for each provider?
A: The payments are made per eligible professional, not per practice.
Q: Wouldn't it be a requirement for a physician to have available a "portal" or similar setup in order for the provider to meet the definition of meaningful use?
A: There are 10 non-core options of meaningful use criteria which an EP must choose 5. One of those 10 options includes a patient portal allowing the EP to communicate with patients. There are many practices planning to conduct this communication via a portal, but the patient portal is not in the 15 required core meaningful use criteria.
Q: What is the difference between CCHIT certification and "meaningful use" certification?
A: CCHIT certifies a comprehensive suite of EHR functionality. IMS v12.0.5 is CCHIT certified for 2008 with the announcement of CCHIT 2011 certification just days away. Meaningful Use certification will likely be a small subset of the CCHIT certification. Details of how EHR's will be tested, certified and certifying bodies for "Meaningful Use" have not yet been announced.
Q: My practice does not see Medicare or Medicaid patients. Ar there any incentives for my practice to adopt EHR and demonstrate meaningful use?
A: Not at this time. Under ARRA provision only providers of Medicare/Medicaid services will receive any reimbursement. However, HHS has the opportunity to offer additional incentives after 2011 based on adoption levels. Also, industry experts predict that private insurers will follow suit and begin to offer incentives and/or penalties based on certain meaningful use criteria, including reporting of quality measures.
Q: Will I be required by Medicare to adopt EHR?
A: Neither Medicare, CMS, requires the adoption of EHR, providers who fail to demonstrate meaningful use in the 2014 timeframe face reduction of Medicare payments by 1% a year starting in 2015 and continuing through 2017,
Q: Will I be required by Medicaid to adopt EHR?
A: Currently there is no indication that state Medicaid programs will require or penalize providers/practices which do not adopt EHR.
Q: Will IMS guarantee that our practice will receive stimulus dollars by using the IMS EHR program?
A: We guarantee that the IMS v12.0.5 or v14 will meet the certification criteria for Meaningful Use set by the Office of the National Coordinator for Health Information. However, the software itself can not qualify the EP for this funding. Providers must use the software and all areas as noted in the 15 Required Core Set.
Q: If I qualify for Meaningful Use funds, then I decide to drop out am I penalized?
A: There are no penalties to providers retiring or no longer practicing or those who choose to no longer participate in the Medicare program.
Q: If I do nothing and continue as a participating Medicare provider, will I be penalized?
A: Yes, starting in 2015 you will see a reduction in Medicare payments.
Q: Our practice billing staff includes the PQRI code in billing Medicare, will the incentives stop for PQRI once I begin receiving Meaningful Use funds?
A: Eligible Professionals can participate in both PQRI and Meaningful Use.
Q: I currently ePrescribing incentive, will this incentive continue?
A: You must choose between the ePrescribing Incentive program or the Medicare Meaningful Use program.
Q: We are a multi-specialty group, some providers are Pediatric while others are Internal Medicine. Can we participate in the two different programs?
A: Yes, Eligible Professional within the same practice may participate in either the Medicare or Medicaid Meaningful Use program.
Q: We have multiple locations and not all providers are choosing to use a qualified EHR, does this eliminate all providers from receiving Meaningful Use funding at the various locations?
A: If an Eligible Professional practices in multiple locations and more than 50% of the patients are treated in locations using the certified EHR, then the Eligible Professional does qualify. However, those providers choosing not to use a certified EHR will of course not qualify for any funds.
Links to Meaningful Use Related Websites and Documents
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