Overview f the Final Requirements fr Meaningful Use - 2015 thrugh 2017 On Oct. 6, 2015, the Centers fr Medicare & Medicaid Services (CMS) issued a final rule utlining the requirements fr eligible prfessinal (EP) participatin in the Medicare and Medicaid EHR Incentive (meaningful use) Prgrams fr 2015-2017. The rule als included final requirements fr Stage 3 f the prgram, as well as 2015 Certified EHR Technlgy (CEHRT) requirements. Key Meaningful Use Prvisins Imprtant changes in the final rule include: Previus ne-year reprting requirement shrtened t 90 cnsecutive-days in 2015; Reductin in the verall number f bjectives frm 18 t 10; Significant reductin in the reprting requirements fr patient electrnic access requirements (view, dwnlad r transmit frm 5% t at least ne patient and secure messaging frm 5% t simply having the capability in 2015); Mandated reprting f mdified public health measures; Remval f measures that have becme redundant, duplicative r have reached widespread adptin. Critical Dates Jan. 4, 2016 - First day EPs can attest t meeting 2015 reprting requirements Feb. 29, 2016 - Last day EPs can attest t meeting 2015 reprting requirements (subject t extensin) July 1, 2016 - Last day fr EPs t submit a 2015 hardship exceptin t avid the 2017 penalty (subject t extensin) NEW Hardship Exceptin due t delayed release f final rule Fllwing publicatin f the final rule n Oct. 16, 2015, CMS issued an FAQ utlining a NEW hardship exceptin fr EPs that culd nt satisfy 2015 reprting requirements due t the final rule being released after the start f the last 90-day reprting perid. Apprved exceptin applicatins wuld prevent EPs frm receiving a 2017 penalty, but negate any ptential incentive payments. The FAQ reads as fllws: QUESTION: If an EP, eligible hspital r Critical Access Hspital (CAH) is unable t effectively plan fr a reprting perid in 2015 due t the timing f the publicatin f the 2015 thrugh 2017 Mdificatins final rule, can they apply fr a hardship exceptin? ANSWER: Yes, if a prvider is unable t meet the requirements f meaningful use fr an EHR reprting perid in 2015 fr reasns related t the timing f the publicatin f the final rule, a prvider may apply fr a hardship exceptin under the "extreme and uncntrllable" circumstances categry. Each hardship exceptin applicatin will be reviewed n a case-by- Page 1 f 11
case basis, as required by law. In the past, CMS has cnsidered these applicatins seriusly and, in fact, has apprved ver 85% f hardship exemptins. Hardship applicatins will be made available in early 2016. NEW Update: On Oct. 22, 2015, CMS issued an FAQ that utlines an additinal exclusin related t EPs wh were eligible fr a 2015 incentive payment but culd nt meet the Public Health Reprting requirement as stipulated in the Oct. 6, 2015 final rule. This change in plicy will permit an EP t claim an alternate exclusin fr a measure if they did nt intend t attest t the equivalent prir menu bjective. The full FAQ reads as fllws: QUESTION: Fr 2015, hw shuld a prvider reprt n the public health reprting bjective if they had nt planned t attest t certain public health measures? Is there an alternate exclusin available t accmmdate the changes t hw the measures are cunted? ANSWER: We d nt intend t inadvertently penalize prviders fr their inability t meet measures that were nt required under the previus stages f meaningful use. Nr did we intend t require prviders t engage in new activities during 2015, which may nt be feasible after the publicatin f the final rule in rder t successfully demnstrate meaningful use in 2015. In the final rule at 80 FR 62788, we discuss ur final plicy t allw fr alternate exclusins and specificatins fr certain bjectives and measures where there is nt a Stage 1 measure equivalent t the Mdified Stage 2 (2015 thrugh 2017) measure r where a menu measure is nw a requirement. This includes the public health reprting bjective as fllws. First, EPs scheduled t be in Stage 1 may attest t nly 1 public health measure instead f 2 and eligible hspitals r CAHs may attest t nly 2 public health measures instead f 3. Secnd, we will allw prviders t claim an alternate exclusin fr a measure if they did nt intend t attest t the equivalent prir menu bjective cnsistent with ur plicy fr ther bjectives and measures as described at 80 FR 62788. We will allw Alternate Exclusins fr the Public Health Reprting Objective in 2015 as fllws: EPs scheduled t be in Stage 1: Must attest t at least 1 measure frm the Public Health Reprting Objective Measures 1-3 May claim an Alternate Exclusin fr Measure 1, Measure 2 r Measure 3. An Alternate Exclusin may nly be claimed fr up t tw measures, then the prvider must either attest t r meet the exclusin requirements fr the remaining measure described in 495.22 (e)(10)(i)(c). EPs scheduled t be in Stage 2: Must attest t at least 2 measures frm the Public Health Reprting Objective Measures 1-3 May claim an Alternate Exclusin fr Measure 2 r Measure 3 (Syndrmic Surveillance Measure r Specialized Registry Reprting Measure) NEW Update: On Nv.17, 2015, CMS issued an FAQ that clarifies the Public Health Reprting requirement. The full FAQ reads as fllws: QUESTION: Fr 2015, hw shuld a prvider reprt n the public health reprting bjective if they had planned t be in Stage 1 meaningful use which required sending a test message and cntinued submissin if successful, but did nt require registratin f intent? Page 2 f 11
ANSWER: We did nt intend t require prviders t engage in new activities during 2015, which may nt be feasible after the publicatin f the final rule in rder t successfully demnstrate meaningful use in 2015. Since prviders in Stage 1 in 2015 were nt previusly required t submit a registratin f intent t submit data t meet Objective 10 measures, prviders may meet the measures by having sent a test message r by being in prductin. Prviders wh have sent a test message can be cnsidered t have met Optin 2 f Active Engagement - Test and Validatin; prviders wh are in prductin can be cnsidered t have met Optin 3 f Active Engagement - Prductin. NEW Update: On Nv.17, 2015, CMS issued an FAQ that addresses EHRs and the Prescriptin Drug Mnitring Prgram (PDMP). The full FAQ reads as fllws: QUESTION: Des integratin f the PDMP (Prescriptin Drug Mnitring Prgram) int an EHR cunt as a specialized registry? ANSWER: If the PDMP within a jurisdictin has declared itself a specialized registry ready t accept data, then the integratin with a PDMP can cunt twards a specialized registry. The EHR must be CEHRT, but there are n standards fr the exchange f data. Summary f the Regulatry Prvisins: Meaningful Use 2015-2017 Previus Stage 1 and Stage 2 Requirements Cmpared t Final Requirements Previus Stage 1 Requirements 13 cre bjectives EPs must meet 5 f 9 menu bjectives, including 1 public health bjective Previus Stage 2 Requirements 17 cre bjectives EPs must meet 3 f 6 menu bjectives, including 2 public health bjectives Final Stage 1 Requirements 9 cre bjectives 1 public health bjective with 3 measure ptins; must meet 1 in 2015, 2 in 2016-2017) Final Stage 2 Requirements 9 cre bjectives 1 public health bjective with 3 measure ptins, must meet 2) EHR Reprting Perids 2015 Fr 2015 nly, CMS will allw all EPs (regardless f prir participatin in the prgram) t attest t an EHR reprting perid f any cntinuus 90-day perid within the calendar year. Page 3 f 11
2016 EPs demnstrating meaningful use fr the first time may use an EHR reprting perid f any cntinuus 90-day perid between Jan. 1, 2016 and Dec. 31, 2016. All returning participants wuld reprt fr a full calendar year frm Jan. 1, 2016 thrugh Dec. 31, 2016. 2017 All EPs, including new and existing participants, wuld reprt fr ne full calendar year, with a limited exceptin fr Medicaid EPs demnstrating meaningful use fr the first time. Eliminated Objectives and Measures CMS has identified a number f bjectives and measures nw cnsidered t be redundant, duplicative, r tpped ut and wuld n lnger be required fr the successful demnstratin f meaningful use. These changes wuld remve the menu and cre structure f Stages 1 and 2 and reduce the verall number f bjectives t which an EP must attest frm 18 t 10 ttal measures. The fllwing bjectives will n lnger be required: Recrd Demgraphics Recrd Vital Signs Recrd Smking Status Clinical Summaries Structured Lab Results Patient List Patient Reminders Electrnic Ntes Imaging Results Family Health Histry Summary f Care Measure 1 Any Methd Measure 3 Test Mdified Patient Engagement Measures CMS has finalized changes t electrnic patient engagement bjectives and measures fr Stage 2 f meaningful use as fllws: The threshld fr the Stage 2 Objective fr Patient Electrnic Access secnd (view, dwnlad, r transmit) measure decreases frm 5% t "equal t r greater than ne patient" in 2015 and 2016. In 2017, the threshld increases t mre than 5% f patients. Fr 2015 nly, the threshld fr the Stage 2 secure electrnic messaging requirement decreases frm 5% t a yes-n measure stating that functinality is fully enabled. In 2016, the threshld increases t a minimum f ne patient and in 2017, it increases again t at least 5% f patients. NEW Update: On Nv. 9, 2015 CMS released an FAQ that utlines a new calculatin fr meaningful use bjectives requiring patient actin. QUESTION: In calculating the meaningful use bjectives requiring patient actin, if a patient sends a message r accesses his/her health infrmatin made available by their eligible prfessinal (EP), can the ther EPs in the practice get credit fr the patient s actin in meeting the bjectives? Page 4 f 11
ANSWER: Yes. This transitive effect applies t the Secure Electrnic Messaging bjective, the 2nd measure f the Patient Electrnic Access (View, Dwnlad and Transmit) bjective, and the Patient Specific Educatin bjective. If a patient sends a secure message abut a clinical r health related subject t the grup practice f their EP, that patient can be cunted in the numeratr f the Secure Electrnic Messaging measure fr any f the EPs at the grup practice wh use the same certified electrnic health recrds technlgy (CEHRT) that saw and patient during their EHR reprting perid. Similarly, if a patient views, dwnlads r transmits t a third party the health infrmatin that was made available nline by their EP, that patient can be cunted in the numeratr f the 2nd Patient Electrnic Access measure fr any f the EPs in that grup practice wh use the same CEHRT and saw that patient during their EHR reprting perid. If patient-specific educatin resurces are prvided electrnically, it may be cunted in the numeratr fr any prvider within the grup sharing the CEHRT wh has cntributed infrmatin t the patient's recrd if that prvider has the patient in their denminatr fr the EHR reprting perid. Public Health Reprting Measures The final rule deviates frm current public health reprting requirements. Stage 2 EPs are nw required t satisfy at least TWO f the fllwing THREE measures: *Nte: EPs currently in Stage 1 must satisfy ne in 2015 and tw starting in 2016. Measure 1 - Immunizatin registry reprting: The EP is in active engagement with a public health agency t submit immunizatin data. Exclusin fr Measure 1: Any EP meeting ne r mre f the fllwing criteria may be excluded frm the immunizatin registry reprting measure if the EP, eligible hspital, r CAH: (1) Des nt administer any immunizatins t any f the ppulatins fr which data is cllected by their jurisdictin s immunizatin registry r immunizatin infrmatin system during the EHR reprting perid; (2) perates in a jurisdictin fr which n immunizatin registry r immunizatin infrmatin system is capable f accepting the specific standards required t meet the CEHRT definitin at the start f the EHR reprting perid; r (3) perates in a jurisdictin where n immunizatin registry r immunizatin infrmatin system has declared readiness t receive immunizatin data as f 6 mnths prir t the start f the EHR reprting perid. Measure 2 - Syndrmic surveillance reprting: The EP is in active engagement with a public health agency t submit syndrmic surveillance data. Exclusin fr EPs fr Measure 2: Any EP meeting ne r mre f the fllwing criteria may be excluded frm the syndrmic surveillance reprting measure if the EP: (1) Is nt in a categry f prviders frm which ambulatry syndrmic surveillance data is cllected by their jurisdictin s syndrmic surveillance Page 5 f 11
system; (2) perates in a jurisdictin fr which n public health agency is capable f receiving electrnic syndrmic surveillance data frm EPs in the specific standards required t meet the CEHRT definitin at the start f the EHR reprting perid; r (3) perates in a jurisdictin where n public health agency has declared readiness t receive syndrmic surveillance data frm EPs as f 6 mnths prir t the start f the EHR reprting perid. Measure 3 - Specialized registry reprting: The EP is in active engagement t submit data t a specialized registry. Exclusin fr Measure 3: Any EP meeting ne r mre f the fllwing criteria may be excluded frm the case reprting measure if the EP, eligible hspital, r CAH: (1) Des nt treat r diagnse any reprtable diseases fr which data is cllected by their jurisdictin s reprtable disease system during the EHR reprting perid; (2) perates in a jurisdictin fr which n public health agency is capable f receiving electrnic case reprting data in the specific standards required t meet the CEHRT definitin at the start f the EHR reprting perid; r (3) perates in a jurisdictin where n public health agency has declared readiness t receive electrnic case reprting data as f 6 mnths prir t the start f the EHR reprting perid. Active Engagement Defined CMS is maintaining, fr 2015 thrugh 2017, a unified specialized registry reprting measure which adpts the prpsed change in Stage 2 frm "nging submissin" t "active engagement." EPs will have three ptins t establish active engagement with a public health agency r registry: Cmpleted registratin t submit data: The EP is registered t submit data with the public health authrity (PHA) r, where applicable, the clinical data registry (CDR) t which the infrmatin is being submitted; registratin was cmpleted within 60 days after the start f the EHR reprting perid; and the EP is awaiting an invitatin frm the PHA r CDR t begin testing and validatin. Testing and validatin: The EP is in the prcess f testing and validatin f the electrnic submissin f data. EPs must respnd t requests frm the PHA r, where applicable, the CDR within 30 days; failure t respnd twice within an EHR reprting perid wuld result in that prvider nt meeting the measure. Prductin: The EP has cmpleted testing and validatin f the electrnic submissin and is electrnically submitting prductin data t the PHA r CDR. Public Health Exclusins- Additinal Infrmatin An exclusin fr a public health measure des nt cunt tward the ttal f tw measures. Instead, in rder t meet this bjective an EP wuld need t meet tw f the ttal number f measures available t them. If the EP qualifies fr multiple exclusins and the remaining number f measures available t the EP is less than tw, the EP can meet the bjective by meeting the ne remaining measure available t them and claiming the applicable exclusins. If n measures remain available, the EP can meet the bjective by claiming applicable exclusins fr all measures. Page 6 f 11
Nte: An EP wh is scheduled t be in Stage 1 in 2015 must reprt at least ne measure unless they can exclude frm all available measures. Available measures include nes fr which the EP des nt qualify fr an exclusin. Clinical Quality Measurement CMS did nt change the Clinical Quality Measures (CQM) selectin r reprting scheme (nine CQMs acrss at least three dmains) frm current requirements. Fr all EPs in 2015, and fr thse demnstrating meaningful use fr the first time in 2016, EPs may: Attest t any cntinuus 90-day perid f CQM data during the calendar year thrugh the meaningful use registratin and attestatin site; OR Electrnically reprt CQM data using the established methds fr electrnic reprting. Fr 2016 and subsequent years, EPs beynd their first year f meaningful use must attest t ne full calendar year f CQM data r electrnically reprt CQM data using ne f the established methds fr electrnic reprting. Final Objectives, Measures and Alternative Measures fr 2015-2017 Final Objectives fr 2015, 2016 and 2017 Final Measures fr EPs in 2015, 2016 and 2017 Final Stage 1 Alternate Measures and/r Specificatins fr Certain EPs 1. Prtect Electrnic Health Infrmatin 2. Clinical Decisin Supprt Measure: Cnduct r review a security risk analysis in accrdance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (t include encryptin) f ephi data stred in Certified EHR Technlgy in accrdance with requirements in 45 CFR 164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and crrect identified security deficiencies as part f the EP, eligible hspital, r CAHs risk management prcess. Measure 1: Implement five clinical decisin supprt interventins related t fur r mre clinical quality measures at a relevant pint in patient care fr the entire EHR reprting perid. Absent fur clinical quality measures related t an EP s scpe f Nne If fr an EHR reprting perid in 2015, the prvider is scheduled t demnstrate Stage 1: Alternate Objective and Measure 1: Page 7 f 11
practice r patient ppulatin, the clinical decisin supprt interventins must be related t high-pririty health cnditins. Measure 2: The EP has enabled and implemented the functinality fr drugdrug and drug allergy interactin checks fr the entire EHR reprting perid. Objective: Implement ne clinical decisin supprt rule relevant t specialty r high clinical pririty, alng with the ability t track cmpliance with that rule. Measure: Implement ne clinical decisin supprt rule. Exclusin: Fr the secnd measure, any EP wh writes fewer than 100 medicatin rders during the EHR reprting perid. 3. CPOE Measure 1: Mre than 60 percent f medicatin rders created by the EP during the EHR reprting perid are recrded using cmputerized prvider rder entry. Measure 2: Mre than 30 percent f labratry rders created by the EP during the EHR reprting perid are recrded using cmputerized prvider rder entry. Measure 3: Mre than 30 percent f radilgy rders created by the EP during the EHR reprting perid are recrded using cmputerized prvider rder entry Alternate Measure 1: Fr Stage 1 EPs in 2015 nly, mre than 30 percent f all unique patients with at least ne medicatin in their medicatin list seen by the EP during the EHR reprting perid have at least ne medicatin rder entered using CPOE; r mre than 30 percent f medicatin rders created by the EP during the EHR reprting perid during the EHR reprting perid, are recrded using cmputerized prvider rder entry. Alternate Exclusin fr Measure 2: Prviders scheduled t be in Stage 1 in 2015 may claim an exclusin fr measure 2 (labratry rders) f the Stage 2 CPOE bjective fr an EHR reprting perid in 2015; and, prviders scheduled t be in Stage 1 in 2016 may claim an exclusin fr measure 2 (labratry rders) f the Stage 2 CPOE bjective fr an EHR reprting perid in 2016. Alternate Exclusin fr Measure 3: Prviders scheduled t be in Stage 1 in 2015may claim an exclusin fr measure 3 (radilgy rders) f the Stage 2 Page 8 f 11
4. Electrnic Prescribing Measure: Mre than 50 percent f all permissible prescriptins, r all prescriptins, written by the EP are queried fr a drug frmulary and transmitted electrnically using Certified EHR Technlgy. CPOE bjective fr an EHR reprting perid in 2015; and, prviders scheduled t be in Stage 1 in 2016 may claim an exclusin fr measure 3 (radilgy rders) f the Stage 2 CPOE bjective fr an EHR reprting perid in 2016 Alternate EP Measure: Fr Stage 1 prviders in 2015 nly, Mre than 40 percent f all permissible prescriptins written by the EP are transmitted 5. Health Infrmatin Exchange 6. Patient Specific Educatin 7. Medicatin Recnciliatin 8. Patient Electrnic Access (VDT) Measure: The EP that transitins r refers their patient t anther setting f care r prvider f care (1) uses CEHRT t create a summary f care recrd; and (2) electrnically transmits such summary t a receiving prvider fr mre than 10 percent f transitins f care and referrals. Measure: Patient-specific educatin resurces identified by Certified EHR Technlgy are prvided t patients fr mre than 10 percent f all unique patients with ffice visits seen by the EP during the EHR reprting perid. Measure: The EP perfrms medicatin recnciliatin fr mre than 50 percent f transitins f care in which the patient is transitined int the care f the EP. EP Measure 1: Mre than 50 percent f all unique patients seen by the EP during the EHR reprting Alternate Exclusin: Prvider may claim an exclusin fr the measure f the Stage 2 Summary f Care bjective, which requires the electrnic transmissin f a summary f care dcument if fr an EHR reprting perid in 2015 they were scheduled t demnstrate Stage 1, which des nt have an equivalent measure. Alternate Exclusin: Prvider may claim an exclusin fr the measure f the Stage 2 Patient Specific Educatin bjective if fr an EHR reprting perid in 2015 they were scheduled t demnstrate Stage 1 but did nt intend t select the Stage 1 Patient Specific Educatin menu bjective. Alternate Exclusin: Prvider may claim an exclusin fr the measure f the Stage 2 Medicatin Recnciliatin bjective if fr an EHR reprting perid in 2015 they were scheduled t demnstrate Stage 1 but did nt intend t select the Stage 1 Medicatin Recnciliatin menu bjective. Page 9 f 11
9. Secure Messaging perid are prvided timely access t view nline, dwnlad, and transmit t a third party their health infrmatin subject t the EP's discretin t withhld certain infrmatin. EP Measure 2: Fr 2015 and 2016: At least 1 patient seen by the EP during the EHR reprting perid (r patient-authrized representative) views, dwnlads r transmits his r her health infrmatin t a third party during the EHR reprting perid. Fr 2017: Mre than 5 percent f unique patients seen by the EP during the EHR reprting perid (r patient- authrized representative) views, dwnlads r transmits their health infrmatin t a third party during the EHR reprting perid. Fr 2015: Fr an EHR reprting perid in 2015, the capability fr patients t send and receive a secure electrnic message with the EP was fully enabled. Fr 2016: Fr at least 1 patient seen by the EP during the EHR reprting perid, a secure message was sent using the electrnic messaging functin f CEHRT t the patient (r patientauthrized representative), r in respnse t a secure message sent by the patient (r patient-authrized representative) during the EHR reprting perid. Alternate Exclusin Measure 2: Prviders may claim an exclusin fr the secnd measure if fr an EHR reprting perid in 2015 they were scheduled t demnstrate Stage 1, which des nt have an equivalent measure. Alternate Exclusin Measure: An EP may claim exclusin fr the measure if fr an EHR reprting perid in 2015 they were scheduled t demnstrate Stage 1, which des nt have an equivalent measure. Fr 2017: Fr mre than 5 percent f unique patients seen by the EP during the EHR reprting perid, a secure message was sent using the electrnic messaging functin f CEHRT t the patient (r the patient-authrized representative), r in respnse t a secure message sent by the patient (r the patient-authrized representative) during the EHR reprting perid. 10. Public Measure 1 Immunizatin Page 10 f 11
Health Registry Reprting: The EP is in active engagement with a public health agency t submit immunizatin data. Measure 2 Syndrmic Surveillance Reprting: The EP is in active engagement with a public health agency t submit syndrmic surveillance data. Measure 3 Specialized Registry Reprting: The EP is in active engagement t submit data t a specialized registry. Stage 1 EPs in 2015 must meet at least 1 measure in 2015, Stage 2 EPs must meet at least 2 measures in 2015, and all EPs must meet at least 2 measures in 2016 and 2017. Page 11 f 11