Meaningful Use Stage 2 Deciphered

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1 Meaningful Use Stage 2 Deciphered Providers Face More Stringent Requirements and Greater Challenges In 2014, the federal government will raise the bar for healthcare providers when Meaningful Use Stage 2 requirements go into effect. During Stage 1, eligible professionals have to meet several objectives to demonstrate Meaningful Use of a certified Electronic Health Record (EHR) system in order to qualify for incentive payments from the Centers for Medicare and Medicaid Services (CMS). Going forward, the program requirements will become more stringent. Just when many providers were getting a handle on Stage 1, new rules loom on the horizon. In Stage 2, the three key requirements will be: 1. Longer reporting periods with more data collection 2. Patient engagement in their own healthcare 3. The creation of health information exchange systems. The higher level of accountability in Stage 2 supports the government s Meaningful Use goals to encourage the use of EHRs and ultimately improve healthcare across the nation. According to the U.S. Department of Health and Human Services, the benefits of Meaningful Use include: Complete and accurate patient information that allows healthcare professionals to provide the best possible care. Better access to the information providers need to diagnose health problems earlier and improve health outcomes. Better coordination of care with information that can be more easily shared among doctors offices, hospitals, and across health systems. Patients empowerment to take a more active role in their health. Patients ability to access electronic copies of their medical records securely over the Internet. 1 From Data Collection to Information Exchange Currently, we are about halfway through the three stages of Meaningful Use, which spans a fiveyear period. Stage 1 involves capturing data in a standardized format, using the information to coordinate care and engaging patients in their care. Stage 2 criteria focuses on more rigorous health 1

2 information exchange (HIE), electronic prescribing and lab results, electronic transmission of patient care summaries and more patient-controlled data. In Stage 2, providers will have to collect data from more of their patients. For example, the amount of structured data on height, weight and blood pressure must be collected from 80% of patients instead of the 50% required in Stage 1. Also beginning next year, providers must share more Clinical Quality Measures (CQMs) and report them electronically. In Stage 3, the emphasis will be on improving quality, safety and efficiency for better health outcomes. By the final stage, the focus also will be on decision support for national high-priority conditions, patient access to selfmanagement tools and comprehensive patient data accessed through HIE. 2 Some Stage 1 objectives were either eliminated or combined, but most are now core objectives under the Stage 2 criteria. To demonstrate Meaningful Use under Stage 2 criteria, eligible professionals (EPs) must meet 17 core objectives and 3 menu objectives that they select from a total list of 6, or a total of 20 core objectives. Eligible hospitals and CAHs must meet 16 core objectives and 3 menu objectives that they select from a total list of 6, or a total of 19 core objectives. Facing Possible Penalties With new objectives come new challenges. Beginning in 2015, providers eligible for the Medicare incentive program can face a payment adjustment, or penalty, if they do not demonstrate Meaningful Use of certified EHR technology or qualify for a hardship exception. 3 The following eligible professionals (EPs) face the possibility of penalties under this criteria: Doctors of medicine Doctors of podiatric medicine Doctors of optometry Doctors of osteopathy Doctors of dental medicine or surgery Chiropractors Most hospitals are eligible for both Medicare and Medicaid incentives, so they can be subject to penalties. However, cancer hospitals, children s hospitals and acute care hospitals in U.S. territories won t be penalized because they are only eligible for Medicaid incentives. Another important factor in meeting Meaningful Use Requirements is whether a physician is hospital-based. Physicians will not be penalized in 2015 if they were hospital-based in 2013 and Going forward, the previous two years status will affect whether they could face a penalty. For example, they must be hospital-based in 2014 and 2015 in order to avoid possible penalties in Therefore, it s especially important for physicians to be mindful of their status every year. To avoid penalties, providers across the nation are checking to see whether their EHR has the necessary features such as a patient portal for secure, two-way provider/patient communication, dashboards for analytics and tools to fulfill Meaningful Use reporting requirements. EHRs with features like Meaningful Use dashboards can help providers quickly spot deficiencies and review clinical data with graphical charts to identify patients not meeting clinical measures quickly and easily. Some can even generate tasks, reminders, alerts and letters to improve Meaningful Use status. 2

3 These are the types of tools used by Southside Family Physicians in Indianapolis, which attested to and qualified for Meaningful Use incentives less than four months after choosing an integrated EHR and practice management solution. Southside received its compensation much faster than many organizations that need at least a year before they can even attest. Dr. Kenneth Young attributes this success to their solution s built-in functionality that enables the practice to easily conduct self-audits. We can quickly figure out what information might be missing and where we need to catch up in order to stay on track, Dr. Young says. Timeframes for Attestation In Stage 2, there will be longer reporting periods with higher thresholds than those in Stage 1. The timeline for attesting to Meaningful Use differs, depending on when a physician started the process. For example, eligible professionals who began working toward Meaningful Use in 2011 can attest in Stage 1 for three years. Beginning in 2014, all users will attest for 90 days, whether they re in Stage 1 or have advanced to Stage 2. Following this, Medicare attestation will be quarterly, and states will direct Medicaid reporting. Additionally, beginning in 2014, participants will be required to select a reporting period in one quarter of the year instead of following a rolling 90-day period. 4 Regardless of the stage, documentation of compliance is essential in order to substantiate claims. CMS audits some providers who attest to and receive funds for meeting Meaningful Use goals. Therefore, it is very important to provide thorough documentation of security risk assessments, which must be reviewed and updated during each reporting period. Because the previous year s assessment will not count, a new one must be conducted for each year of attestation. With the new system, patients enjoy seeing how easy it is to access their records. - Megan Butterworth Practice Administrator Accredited Allergy Center of Springfield Secure Two-Way Communication Over the years, has evolved as a preferred means of communication for most people, but it s not a secure method of communication. New Stage 2 objectives require that physicians utilize patient portals to engage patients in their own healthcare and to enable secure patient communications. Individuals must be able to go online to view and download their personal health information. They also should be able to view their clinical summaries, add or modify their demographic or insurance information and communicate securely with their provider. To demonstrate Meaningful Use, more than 5 percent of patients seen by an eligible professional or admitted to an inpatient facility, Emergency Department, or eligible hospital must be able to electronically access their information. This is a major component of Stage 2 Meaningful Use attestation, and will be critical for Stage 3 as well. The most comprehensive types of portals on the market give patients 24/7 online access to appointment requests, prescription information and refill requests, secure messaging tools, online bill pay, educational information, lab results, and more. This is the type of functionality that administrators at Accredited Allergy Center of Springfield sought when they decided to switch EHRs. 3

4 Our practice was looking for a multifunctional, billing-friendly solution that also offered an integrated patient portal, especially as the nature of our practice is so focused on providing personal patient service, Practice Administrator Megan Butterworth explains. With the new system, patients enjoy seeing how easy it is to access their records. Health Information Exchange Another key aspect of Stage 2 is Health Information Exchange (HIE). Eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet this criteria in order to continue to participate in the Medicare and Medicaid EHR incentive programs. HIE is the ability to share health information electronically among organizations, which is the foundation of efforts to improve healthcare safety and quality. EHR vendors are expanding their services to help practices meet this Stage 2 Meaningful Use requirement. For example, some are partnering with clinical health information networks to enable healthcare professionals to e-prescribe and access vital clinical information. This type of HIE allows patient-specific information to be instantly and securely transmitted among healthcare providers to help them make better decisions about patient care, improve clinical outcomes, increase efficiency, and lower healthcare costs. Mobile EHRs Enhance Meaningful Use Meeting the Health Information Exchange requirement is easier thanks to new EHR technology. Mobile EHRs provide physicians with access to their systems when they are completing hospital rounds, covering for other physicians or communicating hospital Emergency Departments. Dr. Priti Patel of Lindenhurst Medical Practice in Lindenhurst, NY said she appreciates the flexibility and mobility of her EHR, highlighted in a recent situation. I had a patient go into the hospital one night and I was able to send all the information the doctors there needed, including the EKG and echocardiogram, from home, Dr. Patel notes. This made my life a lot easier and the emergency physician was pleased with the streamlined transfer of information too. If you re not sure where you fall on the Meaningful Use timeline, the government offers an interactive tool on the Centers for Medicaid and Medicaid Services website, cms.gov, to help you get started. 5 You also can find out more about Meaningful Use incentives, penalties and the requirements of each stage of the program to help make the process run smoothly. References

5 Stage 2 Core and Menu Objectives for Eligible Professionals Report on all 17 Core Objectives: Longer reporting periods with more data collection Generate and transmit permissible prescriptions electronically (erx) Record demographic information Record and chart changes in vital signs Record smoking status for patients 13 years old or older Use clinical decision support to improve performance on high-priority health conditions Provide patients the ability to view online, download and transmit their health information Provide clinical summaries for patients for each office visit Protect electronic health information created or maintained by the Certified EHR Technology Incorporate clinical lab-test results into Certified EHR Technology Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care Use certified EHR technology to identify patient-specific education resources Perform medication reconciliation Provide summary of care record for each transition of care or referral Submit electronic data to immunization registries Use secure electronic messaging to communicate with patients on relevant health information Report on 3 of 6 Menu Objectives: Submit electronic syndromic surveillance data to public health agencies Record electronic notes in patient records Imaging results accessible through CEHRT Record patient family health history Identify and report cancer cases to a State cancer registry Identify and report specific cases to a specialized registry (other than a cancer registry) Source: 5

6 333 Hegenberger Road, Suite 800 Oakland, CA (510) Fax: (510) Download an interactive CMS Toolkit about Stage 2 of the EHR Incentive Programs and 2014 Clinical Quality Measure requirements Download a CMS Tips Sheet on Preparing for Stage 2

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