On July 13, 2010, the Centers for Medicare and Medicaid Services (CMS) released the Final Rule for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program (the Meaningful Use Final Rule). Simultaneously, the Office of the National Coordinator for Health Information Technology (ONC) released its Final Rule addressing certification criteria for EHRs (the Certification Criteria Final Rule). These two Final Rules establish what criteria and technical standards constitute the meaningful use of EHR technology and establish eligibility for incentive payments.
The Incentive Program:
The Meaningful Use Final Rule creates incentives across three government programs, Medicare Fee-For-Service (FFS), Medicare Advantage (MA), and Medicaid, for Eligible Professionals (EPs), Eligible Hospitals (EHs) and Critical Access Hospitals (CAHs) to adopt and demonstrate meaningful use of certified EHR technology starting as early as October 2010. The program also retained its downward payment adjustments for providers who fail to adopt and demonstrate meaningful use after 2015 as well as its phased-in, three-stage approach to meaningful use.
The good news is that the Meaningful Use Final Rule is more forgiving than the proposed rule. CMS dropped its “all-or-nothing” approach and lessened the burden on providers seeking to establish meaningful use by requiring a “core” set of only 14 criteria objectives for EHs/CAHs and 15 criteria objectives for EPs, and a “menu” set of 10 criteria objectives from which providers are required to meet five of their choosing. CMS also lowered the measurement requirements associated with several of the individual criteria. Additionally, CMS simplified the rules for quality reporting, reducing the number of quality measures required to be reported by EPs and EHs. A quick reference guide to the Stage 1 meaningful use criteria is available here.
For the first payment year only, providers need only satisfy the Stage 1 criteria for any continuous 90-day period during the payment year. For the Medicare incentive, EPs can receive as much as $44,000 over a five-year period and EH payments are based on the hospital’s Medicare Part A and MA inpatient bed days, total inpatient bed days, and charges for charity care.
The Rule on Certification Criteria:
ONC’s release of the Certification Criteria Final Rule details the standards, implementation specifications, and certification criteria required for the Incentive Program’s first stage (Certification Criteria). The modifications made to the Certification Criteria focused on enhancing the clarity of the Interim Final Rule published in January. The general requirements, however, remain largely unaltered.
The Certification Criteria list the minimum capabilities certified EHR technology will be required to demonstrate to attain certification and are meant to address the digital Babylon typifying the current EHR technology landscape. The ultimate goal of the Certification Criteria is to achieve semantic interoperability through the use of a uniform set of standards in hopes of allowing for the transfer, aggregation, and efficient mining of health information across disparate and, currently, largely unlinked systems.
Throughout the Certification Criteria Final Rule, ONC strikes a balance between various standards by allowing for the use of alternative standards. ONC has expressed a hope that practical experience, when paired with implementation, business, and clinical realities, will highlight the key distinctions and advantages of the various standards and inform the selection of those ultimately chosen in Stages 2 and 3. The unified architecture under the Certification Criteria Final Rule is the basis for health care information to be used for tracking key clinical decisions for care coordination purposes among providers, clinical decision support for individual patients, and the reporting of metrics for clinical quality measures that support and inform broader public health.
The Regulations' Effect:
For many providers, meeting the meaningful use requirements will not be cheap or easy. However, because certification will create a de facto industry standard, meaningful use will likely become a regulatory requirement or practical prerequisite across virtually all future developments in the health care industry. Achieving meaningful use, therefore, presents providers with an opportunity to proactively navigate an uncertain future for the industry, while a shortsighted approach to achieving meaningful use could place a provider at a significant disadvantage in its ability to adapt in the changing marketplace.
A full analysis of the Final Rules is available here. |
