Rheumatology Practice Management
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Linda S. McKee, EFPM
Practice Administrator
Rheumatic Disease Associates
Willow Grove, PA

What is Meaningful Use? If you ask someone at the US Department of Health & Human Services, he or she may tell you that Meaningful Use is an effort to maximize your electronic health record (EHR) technology to involve patients and caregivers in healthcare decisions or to improve care coordination as well as quality, safety, and efficiency. End results of Meaningful Use implementation, such as better clinical outcomes, empowered patients, as well as the strength of research data on US health systems, may be part of the explanation.

Meaningful Use, in more common terms, could be described as a way for healthcare providers to show the Centers for Medicare & Medicaid Services (CMS) that they have meaningfully used their certified EHRs, and that they have met the objectives that CMS established for relevant stages of Meaningful Use within a specified time period to receive Medicare incentive payments.

The most important question, though, is how do you describe it? In these times of reimbursement cuts and rising expenses, what role does it play in your day-to-day practice? Perhaps it is another curveball, or more objectives and requirements to comply with in order to receive payment from the federal government over a 5-year period for the excellent job your staff and physicians do every day.

Regardless of how you explain Meaningful Use, the stages and compliance expectations are clear. A visit to the CMS webpage, plus a few clicks through the Regulations and Guidance1 and EHR Incentive Programs pages will bring up a menu of information and links to learn more about the incentive programs as well as Meaningful Use.2

To become eligible to receive EHR incentive payments, your first step is to get certified EHR technology (CEHRT). Many programs allow you to electronically enter patients’ medical information, but also have other capabilities that have the potential to improve patient care. Once you have an EHR, you then want to make sure you are eligible to participate. Eligible professionals who can participate in the Medicare EHR Incentive Program are as follows3:

  • Doctors of medicine or osteopathy
  • Doctors of dental surgery or dental medicine
  • Doctors of podiatry
  • Doctors of optometry
  • Chiropractors.

Once you register for the program, you then must perform the requirements for Meaningful Use and “attest,” or report to CMS. The amount of your incentive payment depends on when you begin to participate. You will receive 75% of your Medicare allowable charges up to a maximum annual cap. Under mandatory sequestrations as of March 1, 2013, Medicare EHR incentive payments to all eligible professionals have been reduced by 2%.2

If you demonstrated Meaningful Use and received a Medicare EHR incentive payment in 2011 or 2012, you are eligible to receive the maximum incentive payment of approximately $44,000 per eligible provider over 5 consecutive years of participation. If you have not started the program in 2014, you are not eligible to receive any incentive payment under the Medicare EHR Incentive Program. Eligible professionals who do not meet the requirements for Meaningful Use by 2015 will be penalized via potential reductions in their Medicare reimbursements.3 These will start at 1% each year and reach a maximum of 5% annual adjustments by 2020.

Meaningful Use is broken down into stages. Stage 1 begins the first year of participation and continues for 2 years. Eligible professionals must report data on a continuous 90-day period during the calendar year; during the remaining years of participation, eligible professionals must meet requirements for the entire calendar year. These are called reporting periods. Providers must also meet certain other requirements in order to receive payment. There are no partial payments.

Stage 1

Eligible professionals demonstrating Stage 1 in 2014 must meet 13 core measures. Note that there are some exclusions, in limited circumstances, that could exempt providers from having to meet these requirements. Otherwise, you must report on all 13 core measures and meet the thresholds established (Checklist 1).4 As part of Stage 1, you also must report on 5 of 9 available menu measures (Checklist 2). In addition you must report on 9 recommended Clinical Quality Measures (CQMs)5; the data are calculated by your certified EHR (Checklist 3). You enter the data exactly as your certified EHR produced it.







Stage 2

CMS extended Stage 2 of the Meaningful Use program for an additional year through 2016 and postponed the start of Stage 3 until 2017. CMS admitted to problems with CEHRT and its implementation, which contributed to the agency’s decision. The earliest that Stage 2 criteria are effective is 2014.6

For 2014 only, all providers regardless of their stage of Meaningful Use are only required to demonstrate Meaningful Use for a 3-month EHR reporting period. It is fixed to a quarter of the calendar year that aligns with existing CMS quality measurement programs, such as the Physician Quality Reporting System (PQRS). CMS will only allow their 1-time, 3-month reporting period in 2014 so that all providers who must upgrade to 2014 CEHRT will have adequate time to implement their new CEHRT systems.6

Stage 2 Meaningful Use Criteria

Eligible professionals must meet 17 core measures as well as 3 menu measures that they select from a total list of 6 (Checklists 4 and 5). This equals a total of 20 core measures.7 In 2014, all eligible providers, regardless of their stage of participation in Meaningful Use, are required to report on CQMs in the same way; they must report on 9 recommended CQMs (Checklist 3).





In addition, all providers must select CQMs from at least 3 of the 6 key healthcare policy domains recommended by the US Department of Health & Human Services National Quality Strategy. These include the following: (1) patient and family engagement, (2) patient safety, (3) care coordination, (4) population and public health, (5) efficient use of healthcare resources, and (6) clinical processes/effectiveness. All Medicare-eligible providers who are beyond their first year of reporting are required to report their CQM data electronically to CMS. Eligible professionals can electronically report CQMs either individually or as a group.8

Conclusion

However you choose to explain Meaningful Use—and regardless of what it means to you and your practice—the expectations regarding adherence are clear. We as practice administrators learn to wear many hats, and, as we move toward 2015, we will stay ready for whatever the next curveball may be.

References

  1. Centers for Medicare & Medicaid Services. Regulations & guidance. www.cms.gov/Regulations-and-Guidance/Regulations-and-Guidance.html. Accessed November 18, 2014.
  2. Centers for Medicare & Medicaid Services. EHR incentive programs. www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html. Updated October 7, 2014. Accessed November 18, 2014.
  3. Centers for Medicare & Medicaid Services. Medicare Electronic Health Record incentive payments for eligible professionals. www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/MLN_MedicareEHRProgram_TipSheet_EP.pdf. Updated May 2013. Accessed November 18, 2014.
  4. Centers for Medicare & Medicaid Services. Eligible Professional Attestation Worksheet for Stage 1 of the Medicare Electronic Health Record (EHR) Incentive Program. www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EP_Attestation_Stage1Worksheet_2014Edition.pdf. Accessed November 18, 2014.
  5. Centers for Medicare & Medicaid Services. An introduction to EHR incentive programs for eligible professionals: 2014 clinical quality measure (CQM) electronic reporting guide. www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/CQM2014_GuideEP.pdf. Updated Sep­tember 2014. Accessed November 18, 2014.
  6. Centers for Medicare & Medicaid Services. Stage 2. www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html. Updated No­­vember 5, 2014. Accessed November 18, 2014.
  7. Centers for Medicare & Medicaid Services. Stage 2 Eligible Professional (EP) Meaningful Use core and menu measures table of contents. www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_MeaningfulUseSpecSheet_TableContents_EPs.pdf. Published October 2012. Accessed November 18, 2014.
  8. Centers for Medicare & Medicaid Services. 2014 Clinical Quality Measures. www.cms.gov/Regulations-and-Guidance/Legislation/EHR IncentivePrograms/2014_ClinicalQualityMeasures.html. Accessed November 26, 2014.

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