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 ​What’s New in 2014 for Meaningful Use?

By John Tueting, MD 
 
What is Meaningful Use?

Meaningful Use is an incentive payment program established by the Centers for Medicare & Medicaid Services (CMS) in 2011 in an effort to promote the appropriate use of electronic health records (EHR).  The goal of Meaningful Use is to improve health care in the United States by providing complete and accurate health records information, better access to information, and patient empowerment.  In order for a healthcare provider to receive an incentive payment they must show, “Meaningful Use” of their EHR by meeting thresholds for certain objectives as established by CMS.  The Recovery Act specifies the following 3 components of Meaningful Use: 
  1. Use of certified EHR in a meaningful manner,
  2. Use of certified EHR technology for electronic exchange of health information to improve quality of healthcare,
  3. Use of certified EHR technology to submit clinical quality measures (CQM).
 
The incentive program is staged in 3 steps, each with an increasing requirement for participation.  (For a helpful general overview, please refer to the pdf from the Meaningful Use webinar on the ASSH website.)

Stage 1

Providers must begin by meeting Stage 1 requirements for a 90 day period within the first year of Meaningful Use.  They must then continue to meet the Stage 1 requirements for an entire year subsequently (2nd year of Meaningful Use).  The requirements consist of both a core and a menu set of objectives.  These objectives are specific to eligible professionals or hospitals.  For professionals, there are 25 Meaningful Use objectives.  Fifteen of these are required core objectives and professionals must meet an additional 5 objectives chosen from a list of 10 menu set objectives. For eligible hospitals, there are 24 Meaningful Use objectives.  Fourteen required core objectives and an additional 5 objectives chosen from a list of 10 menu set objectives.  (For a complete list of core and menu set objectives, please refer to the pdf provided by CMS.) Stage 1 is mainly concerned with data capture and sharing.  The focus of this process is 5-fold:
  1. electronically capturing health information in a standardized format,
  2. using that information to track key clinical conditions,
  3. communicating that information for care coordination processes,
  4. initiating the reporting of clinical quality measures and public health information,
  5. using information to engage patients and their families in their care.
 
Stage 2
 
All providers must achieve Meaningful Use under the Stage 1 criteria before moving on to Stage 2.  Stage 2 retains the core and menu structure for Meaningful Use objectives of Stage 1.  However, the threshold that providers must meet for the objective is higher in Stage 2 than for Stage 1.  Stage 2 still focuses on many Stage 1 requirements, however, many optional objectives will become mandatory.   Stage 2 has a special focus on electronic health record exchange with patients and other providers.  Specifically, programs or providers should be able to demonstrate Meaningful Use of their Certified EHR Technology for an even larger portion of their patient populations.  Stage 2 is mainly concerned with advanced clinical processes. The focus of this step is 4-fold:
  1. more rigorous health information exchange (HIE),
  2. increased requirements for e-prescribing and incorporating lab results,
  3. electronic transmission of patient care summaries across multiple settings,
  4. more patient-controlled data. 
Finally, providers that are applying for Stage 2 incentives must meet 17 Core Objectives and a minimum of 3 Menu Objectives.  (Get more information on Stage 2 and the specific Objectives.) 
 
Stage 3
 
The focus of Stage 3 is improved outcomes. The criteria for this Stage center around the following 5 goals:
  1. improving quality, safety, and efficiency,
  2. decision support for national high-priority conditions,
  3. patient access to self management tools,
  4. access to comprehensive patient data through patient-centered HIE,
  5. improving population health. 
(For more information on Stage 3 please refer to www.cms.gov.)
 
What’s new in 2014 for Meaningful Use
 
This staged system of Meaningful Use incentive payments has only been in place since 2011, and there are important changes coming in 2014.  First, the reporting of clinical quality measures (CQMs) will change for all providers.  Although CQM reporting has been removed as a core objective for eligible professionals and hospitals, all providers are required to report on CQMs in order to demonstrate Meaningful Use.  Beginning in 2014, all medicare-eligible providers beyond their first year of demonstrating Meaningful Use will be required to electronically report their CQM data to CMS.  Medicaid-eligible providers and hospitals will electronically report their CQM data to their individual states.  Eligible providers will have to report on 9 of 64 approved CQMs and eligible hospitals will have to report on 16 of 29.  The CQMs must cover at least 3 of the National Quality Strategy domains which are posted on the CMS EHR Incentive Programs website (www.cms.gov/EHRIncentivePrograms).  See a full list of approved CQMs.  
 
For 2014 only, all providers are only required to demonstrate Meaningful Use for a three-month EHR reporting period, regardless of their stage of Meaningful Use. This is so that all providers who must upgrade to a 2014 certified EHR technology will have adequate time to implement their new certified EHR systems.  The reporting period for clinical quality measures will be the entire calendar year for eligible providers, or the fiscal year for hospitals, in subsequent years.
 
Resources:
1. www.cms.gov
2. Brinson, Cheyenne MBA, CPA. Crash Course in Meaningful Use: A Practical Guide for Hand Surgeons and Their Staff. November 27, 2012, sponsored by ASSH.