MDNews - Central New York

+++++++++++++++++++++++ + + +++++++++++++++++++++++ MEANINGFUL USE +++ +++ The Meaning In Stage 2 of Meaningful Use AS By John Netti PHYSICIANS CON- TI N U E TO adopt elect ronic health record (EHR) systems at lightning speed, another set of federal regulations about how to use them was finalized in August. Spurred largely by government financial incentives and eventual reimbursement penalties, physicians have been putting EHRs in place and trying to meet Stage 1 of meaningful use. Meaningful use is a set of measures each physician needs to meet to receive as much as $44,000 from Medicare or $63,750 from Medicaid. Maintaining meaningful use also staves off Medicare reimbursement penalties of between 1% and 5% beginning in 2015. The most recent meaningful use regulations, referred to as Stage 2, emphasize engag- ing patients and families in care, patient safety and care coordination. While Stage 2 regulations begin in 2014, there have been some modifications to Stage 1 that take effect in January of 2013. Most of the rules covering the incen- tives/penalties established in 2009 in the Health Information Technology for 10 | Central New York MD NEWS s MDNEWS.COM Economic and Clinical Health (HITECH) Act will remain in place. There are, how- ever, a few important hardship exceptions that have been added in Stage 2. The criterion to determine whether a physi- cian is considered an eligible provider (EP) in the program is unchanged. If inpatient encounters account for less than 90% of a physician's total volume, he/she is considered eligible for incentives and penalties. The 90% cutoff forces large numbers of radiology, pathology and anesthesiology specialists into the EP program. The nature of these specialties is such that reaching meaningful use is more difficult than most other special- ties. This was recognized in the Stage 2 ruling, and there are now hardship excep- tions forestalling Medicare penalties for these specialties for at least two years. However, the incentive payments have not been similarly extended. Although Stage 2 will be implemented in 2014, all EPs will have two years at the Stage 1 measures prior to having to meet Stage 2 requirements, regardless of when they start in the program. For example, an EP whose first year of meaningful use is 2013 won't start Stage 2 until 2015. The only exception to this is for EPs who attested in 2011, who will have three years (2011 through 2013) at Stage 1. There are some aspects of the Stage 2 rule that change Stage 1 measures and which begin in 2013. For example, testing the exchange of key clinical information will no longer be required. Also, the requirement to state whether a practice will report on clinical quality measures will no longer be a core (required) measure. Another change for 2013 pertains to computerized physician order entry (CPOE). In addition to the current method of calculating the percentage for the measure, in which the denominator is based on unique patients with a medication in their medication list entered using CPOE, the Centers for Medicare & Medicaid Services (CMS) will also allow an optional alternative method of using the number of medica- tions created within a reporting period. The thrust of Stage 2 meaningful use begins in 2014, when most of the new core measures will be in effect. These include providing a summary of care record for each transition/referral, the use of clinical decision support, the

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