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The Medicare and Medicaid Electronic Health Record Incentive Programs, funded by the federal government, offer financial incentives to health care providers for the meaningful use of certified EHR technology in a manner that improves patient care.
To receive an EHR incentive payment, health care providers must demonstrate they are using electronic health records in a “meaningful” way. The Centers for Medicare & Medicaid Services established specific criteria for meaningful use that eligible professionals, eligible hospitals and critical access hospitals must satisfy in order to receive incentive payments.
The EHR Incentive Programs, which began under Stage 1 in 2011, are being implemented in three distinct phases, with increasing requirements for participation in each phase.
Under the original timeline of the Stage 1 meaningful use regulations, providers who first demonstrated meaningful use in 2011 would have been required to meet Stage 2 criteria in 2013.
However, CMS delayed the onset of Stage 2 until the fiscal year 2014 for eligible hospitals and critical access hospitals and until the calendar year 2014 for eligible professionals.
As a result, all providers who have demonstrated at least two years of meaningful use under Stage 1 as of 2013 will progress to Stage 2 in 2014.
Stage 2 retains the core and menu structure of the meaningful use objectives that providers had to achieve under Stage 1. However, CMS combined or eliminated some of the Stage 1 objectives and converted most of the Stage 1 objectives to core objectives under Stage 2.
To demonstrate meaningful use under Stage 2 criteria, eligible hospitals and critical access hospitals must meet 16 core objectives and three out of six menu objectives, and eligible professionals must meet 17 core objectives and three out of six menu objectives.
CMS raised the threshold measure that providers must meet for certain objectives under Stage 2.
For example, the required number of computerized provider order entries for medication orders was increased from 30 percent of unique patients having at least one medication order entered with CPOE to 60 percent of all medication orders entered with CPOE.
CMS also introduced a few new objectives, such as the use of secure electronic messaging to communicate with patients on relevant health information.
Stage 2 criteria require providers to give patients the ability to view online, download and transmit their health information within 36 hours after discharge from the eligible hospital or critical access hospital or within four business days after the information is available to the eligible professional.
CMS also puts the onus on providers to encourage patients to use health information technology by adding a core objective that requires more than 5 percent of patients seen by an eligible professional or admitted to an inpatient or emergency department of an eligible hospital or critical access hospital, to electronically view, download or transmit their health information.
Health information exchange between providers is of central importance under Stage 2 criteria because CMS believes a greater and more efficient exchange of health information will improve care coordination for patients.
Under Stage 2, all providers who transition or refer a patient to another care setting or to another provider must provide a summary of care record for more than 50 percent of those transitions of care and referrals and must provide an electronic summary of care record for more than 10 percent of those transitions of care and referrals.
Clinical quality measures have been removed as a core objective under Stage 2. However, all providers must continue to report their CQMs and must submit them electronically beginning in 2014 to demonstrate meaningful use.
Eligible professionals must report on 9 out of 64 total CQMs, and eligible hospitals and critical access hospitals must report on 16 out of 29 total CQMs.
While meaningful use incentives are still being offered, health care providers who fail to meet meaningful use requirements will begin to face annual penalties in the form of Medicare reimbursement reductions in 2015.
When acquiring EHR technology, consult with an attorney who has experience advising health care providers with respect to such transactions to ensure you have the appropriate contractual protections in place regarding meaningful use requirements.