- What is "Meaningful Use"?
The American Recovery and Reinvestment Act of 2009 specifies three main components of Meaningful Use:
- The use of a certified EHR in a meaningful manner, such as e-prescribing.
- The use of certified EHR technology for electronic exchange of health information to improve quality of health care.
- The use of certified EHR technology to submit clinical quality and other measures.
- Simply put, "meaningful use" means providers need to show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity.
- There are three components to “Meaningful Use”
- Use of certified EHR in a meaningful manner (e.g., e-prescribing)
- Use of certified EHR technology for electronic exchange of health information to improve quality of health care
- Use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by the Secretary
- How do I Meet Meaningful Use Requirements?
To qualify for incentive payments, meaningful use requirements must be met in the following ways:
- Medicare EHR Incentive Program—Eligible professionals must successfully demonstrate meaningful use of certified electronic health record technology every year they participate in the program.
- Medicaid EHR Incentive Program—Eligible professionals may qualify for incentive payments if they adopt, implement, upgrade or demonstrate meaningful use in their first year of participation. They must successfully demonstrate meaningful use for subsequent participation years.
- Adopted: Acquired and installed certified EHR technology. (For example, can show evidence of installation.)
- Implemented: Began using certified EHR technology. (For example, provide staff training or data entry of patient demographic information into EHR.)
- Upgraded: Expanded existing technology to meet certification requirements. (For example, upgrade to certified EHR technology or add new functionality to meet the definition of certified EHR technology.)
- What are Incentive Payments Based On?
Incentive payments are made based on the calendar year.
The reporting period for the first year is any 90 continuous days during the calendar year. The reporting period for all subsequent years is the entire calendar year.
- For calendar years 2011–2016, eligible professionals who demonstrate meaningful use of certified EHR technology can receive up to $44,000 over 5 years under the Medicare EHR Incentive Program. See the payment table at https://www.cms.gov/EHRIncentivePrograms/35_Basics.asp#TopOfPage for more information.
- To receive the maximum EHR incentive payment, Medicare eligible professionals must begin participation by 2012.
- Medicare eligible professionals who also qualify as a Medicaid eligible professional must choose between the Medicare and Medicaid incentive programs when they register.
This applies to physicians who have an office practice and can meet eligibility requirements.
Medicaid eligible professionals who also treat Medicare patients will have a payment adjustment to Medicare reimbursements starting in 2015 if they do not successfully demonstrate meaningful use.
- Medicaid Eligible Professionals
The Medicaid EHR Incentive Program is also offered and administered voluntarily by states and territories. States can start offering their program to eligible professionals as early as 2011. The program continues through 2021. Eligible professionals can participate for 6 years throughout the duration of the program. The last year to begin participation in the Medicaid EHR Incentive Program is 2016.
To qualify for Medicaid incentive payments, Medicaid eligible professionals must adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in the first year of participation, and successfully demonstrate meaningful use in subsequent participation years.
- For calendar years 2011–2021, participants can receive up to $63,750 over 6 years under the Medicaid EHR incentive program. EHR incentive payments are made by the state based on the calendar year. See payment table at https://www.cms.gov/EHRIncentivePrograms/35_Basics.asp#TopOfPage.
- Medicaid eligible professionals who also qualify as Medicare eligible professionals (those with an office practice) must choose between the Medicare and Medicaid EHR Incentive Programs when they register. If you are not sure which program to register for find more information in the Overview page at https://www.cms.gov/EHRIncentivePrograms/
- Medicaid eligible professionals and providers who are not eligible to participate in the Medicare and Medicaid EHR Incentive Programs (those working in nursing homes) will not be subject to payment adjustments. However, Medicaid eligible professionals who also treat Medicare patients will have a payment adjustment to Medicare reimbursements starting in 2015 if they do not successfully demonstrate meaningful use.
- What are the Eligible Professional Meaningful Use Core and Menu Set Measures?
There are 15 eligible core measures and 10 eligible professional menu set measures.
A table of the meaningful use core and menu set measures is located at https://www.cms.gov/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf
Eligible Professionals must complete:
15 core objectives
10 Menu Set Objectives
- Computerized provider order entry (CPOE)
- E-Prescribing (eRx)
- Report ambulatory clinical quality measures to CMS/States
- Implement one clinical decision support rule
- Provide patients with an electronic copy of their health information, upon request
- Provide clinical summaries for patients for each office visit
- Drug-drug and drug-allergy interaction checks
- Record demographics
- Maintain an up-to-date problem list of current and active diagnoses
- Maintain active medication list
- Maintain active medication allergy list
- Record and chart changes in vital signs
- Record smoking status for patients 13 years or older
- Capability to exchange key clinical information among providers of care and patient-authorized entities electronically
- Protect electronic health information
Menu objectives –may defer 5 of 10 objectives from menu set
- Drug-formulary checks
- Incorporate clinical lab test results as structured data
- Generate lists of patients by specific conditions
- Send reminders to patients per patient preference for preventive/follow up care
- Provide patients with timely electronic access to their health information
- Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate
- Medication reconciliation
- Summary of care record for each transition of care/referrals
- Capability to submit electronic data to immunization registries/systems*
- Capability to provide electronic syndromic surveillance data to public health agencies*
* At least 1 public health objective must be selected.
6 total Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from additional set) must be completed by the Eligible Professional:
- Diabetes: Hemoglobin A1c Poor Control
- Diabetes: Low Density Lipoprotein (LDL) Management and Control
- Diabetes: Blood Pressure Management
- Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or AngiotensinReceptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
- Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
- Pneumonia Vaccination Status for Older Adults
- Breast Cancer Screening
- Colorectal Cancer Screening
- Coronary Artery Disease (CAD): Oral AntiplateletTherapy Prescribed for Patients with CAD
- Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
- Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment
- Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation
- Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
- Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
- Asthma Pharmacologic Therapy
- Asthma Assessment
- Appropriate Testing for Children with Pharyngitis
- Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer
- Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients
- Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
- Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies
- Diabetes: Eye Exam
- Diabetes: Urine Screening
- Diabetes: Foot Exam
- Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol
- Heart Failure (HF): WarfarinTherapy Patients with AtrialFibrillation
- Ischemic Vascular Disease (IVD): Blood Pressure Management
- Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
- Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement
- Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)
- Prenatal Care: Anti-D Immune Globulin
- Controlling High Blood Pressure
- Cervical Cancer Screening
- Chlamydia Screening for Women
- Use of Appropriate Medications for Asthma
- Low Back Pain: Use of Imaging Studies
- Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control
- Diabetes: Hemoglobin A1c Control (<8.0%)
- Are all Meaningful Use Objectives Applicable?
Some Meaningful Use objectives not applicable to every provider’s clinical practice, thus they would not have any eligible patients or actions for the measure denominator. Exclusions do not count against the 5 deferred measures
In these cases, the eligible professional would be excluded from having to meet that measure (E.g.: Chiropractors do not e-prescribe)
- Do States have Flexibility to Revise Meaningful Use?
Yes, States can seek CMS prior approval to require 4 MU objectives be core for their Medicaid providers.
- How does Meaningful Use Apply for Eligible Providers Working in Multiple Settings
An Eligible Professional who works at multiple locations, but does not have certified EHR technology available at all of them would:
- Have to have 50% of their total patient encounters at locations where certified EHR technology is available (like within their office practice)
- Would base all meaningful use measures only on encounters that occurred at locations where certified EHR technology is available (as in their office practice)
- Can I receive Technical Assistance at No Charge?
Yes, with Regional Extension Center Programs. ONC has provided funding for 70 regional extension centers that will help providers with EHR vendor selection and support and workflow redesign. Go to http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__rec_program/1495 to find one in your area.
- Where can I locate information on E-prescribing incentive?
The Centers for Medicare & Medicaid Services has published Electronic Health Record Incentive Program FAQs and has a website dedicated to Frequently Asked Questions called All EHR Incentive Program FAQs. In addition, AMDA has published a summary on the requirements in its AMDA Summary of Physician Fee Schedule (see pages 27-32, Members Only).
- How do I submit a hardship exemption request?
Quality Reporting Communication Support Page Now Available for Medicare Electronic Prescribing (eRx) Payment Adjustment Hardship Exemption Requests
In 2009, the Centers for Medicare & Medicaid Services (CMS) implemented the Electronic Prescribing (eRx) Incentive Program, which is a program that uses incentive payments and payment adjustments to encourage the use of qualified electronic prescribing systems.
From calendar year (CY) 2012 through 2014, a payment adjustment that increases each calendar year will be applied to an eligible professional’s Medicare Part B Physician Fee Schedule (PFS) covered professional services for not becoming a successful electronic prescriber. The payment adjustment of 1.0% in 2012, 1.5% in 2013, and 2.0% in 2014 will result in an eligible professional or group practice participating in the eRx Group Practice Reporting Option (eRx GPRO) receiving 99.0%, 98.5%, and 98.0% respectively of their Medicare Part B PFS amount for covered professional services.
Avoiding the 2013 eRx Payment Adjustment
Individual eligible professionals and CMS-selected group practices participating in eRx GPRO who were not successful electronic prescribers in 2011 can avoid the 2013 eRx payment adjustment by meeting the specified reporting requirements between January 1 and June 30, 2012.
6-month Reporting Requirements to Avoid the 2013 Payment Adjustment:
- Individual Eligible Professionals – 10 eRx events via claims>
- Small eRx GPRO – 625 eRx events via claims
- Large eRx GPRO – 2,500 eRx events via claims
For more information on individual and eRx GPRO reporting requirements, please see the MLN Article SE1206 - 2012 Electronic Prescribing (eRx) Incentive Program: Future Payment Adjustments
CMS may exempt individual eligible professionals and group practices participating in eRx GPRO from the 2013 eRx payment adjustment if it is determined that compliance with the requirements for becoming a successful electronic prescriber would result in a significant hardship.
The significant hardship categories are as follows:
- The eligible professional is unable to electronically prescribe due to local, state, or federal law, or regulation
- The eligible professional has or will prescribe fewer than 100 prescriptions during a 6-month reporting period (January 1 – June 30, 2012)
- The eligible professional practices in a rural area without sufficient high-speed Internet access (G8642)
- The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing (G8643)
Submitting a Significant Hardship Code or Request
To request a significant hardship, individual eligible professionals and group practices participating in eRx GPRO must submit their significant hardship exemption requests through the Quality Reporting Communication Support Page (Communication Support Page) on or between March 1 and June 30, 2012. Please remember that CMS will review these requests on a case-by-case basis. All decisions on significant hardship exemption requests will be final.
Significant hardships associated with a G-code may be submitted via the Communication Support Page OR on at least one claim during the 2013 eRx payment adjustment reporting period (January 1 – June 30, 2012). If submitting a significant hardship G-code via claims, it is not necessary to request the same hardship through the Communication Support Page.
For more information on how to navigate the Communication Support Page, please reference the following documents:
For additional information and resources, please visit http://www.CMS.gov/ERxIncentive.
If you have questions regarding the eRx Incentive Program, eRx payment adjustments, or need assistance submitting a hardship exemption request, please contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or via email@example.com. They are available Monday through Friday from 7:00 a.m.-7:00 p.m. CST
If you do not find your questions here, please contact us at firstname.lastname@example.org
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