EHR Meaningful Use

Background

The American Recovery and Reinvestment Act of 2009 (ARRA) authorizes the Centers for Medicare & Medicaid Services (CMS) to provide financial incentives and penalties to eligible professionals and hospitals based on criteria along the road to becoming "meaningful users" of certified electronic health record (EHR) technology. This includes using an EHR for functions that both improve and demonstrate the quality of care, electronic exchange of health information, and submission of quality measures to CMS.

Some overarching benefits of the meaningful use of EHRs include:

Complete and accurate information. With electronic health records, providers have the information they need to provide the best possible care. Providers will know more about their patients and their health history before they walk into the examination room.

Better access to information. Electronic health records facilitate greater access to the information providers need to diagnose health problems earlier and improve the health outcomes of their patients. Electronic health records also allow information to be shared more easily among doctors' offices, hospitals, and across health systems, leading to better coordination of care.

Patient empowerment. Electronic health records will help empower patients to take a more active role in their health and in the health of their families. Patients can receive electronic copies of their medical records and share their health information securely over the Internet with their families.

Meaningful Use

To receive an EHR incentive payment, providers have to show that they are “meaningfully using” their EHRs by meeting CMS established thresholds for a number of objectives. The Medicare and Medicaid EHR Incentive Programs are staged in three steps with increasing requirements for participation. All providers begin participating by meeting the Stage 1 requirements for a 90-day period in their first year of meaningful use and a full year in their second year of meaningful use. After meeting the Stage 1 requirements, providers will then have to meet Stage 2 requirements for two full years.

Stage 1 requirements

Meaningful use includes both a core set and a menu set of objectives that are specific to eligible professionals or eligible hospitals and CAHs. For eligible professionals, there are a total of 24 meaningful use objectives.  To qualify for an incentive payment, 19 of these 24 objectives must be met:

  • 14 required core objectives
  • 5 objectives chosen from a list of 10 menu set objectives.


More details on the meaningful use core and menu objectives of stage 1 can be found at CMS’ website.

Stage 2 requirements

Meaningful use includes both a core set and a menu set of objectives that are specific to eligible professionals or eligible hospitals and CAHs. For eligible professionals, to demonstrate meaningful use under Stage 2 criteria 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.

More details on the meaningful use core and menu objectives of stage 2 can be found at CMS’ website

Please note, that you would not meet these Stage 2 requirements until you have met the Stage 1 requirements of the EHR Incentive Programs for a 90-day period in your first year of participation and a full year in your second year of participation.

Eligibility

The Medicare Electronic Health Record (EHR) Incentive Program provides for incentive payments to Medicare eligible professionals (EPs) who are meaningful users of certified EHR technology. Under the Medicare EHR Incentive Program, an eligible professional is defined as one of the following five types of professionals:

1.Doctor of medicine or osteopathy

2.Doctor of oral surgery or dental medicine

3.Doctor of podiatric medicine

4.Doctor of optometry

5.Chiropractor

These professionals are eligible for incentive payments for the “meaningful use” of certified EHR technology, if all program requirements are met. Hospital-based EPs are not eligible to participate in the Medicare EHR Incentive Program. An EP is considered to be hospital-based if the EP furnishes 90 percent of his or her services in a hospital inpatient or emergency room setting

To determine your eligibility, use the flow chart on CMS’s website.

Incentives and Adjustments

Medicare EPs who are not meaningful users will be subject to a payment adjustment beginning on January 1, 2015. The payment adjustment is 1% per year and is cumulative for every year that an EP is not a meaningful user. Depending on the total number of Medicare EPs who are meaningful users under the EHR Incentive Programs after2018, the maximum cumulative payment adjustment can reach as high as 5%.

The table below describes the incentive/adjustment payment schedule.

Incentive Payment

Adoption Year

2011

2012

2013

2014

2015

2011

$18,000

 

 

 

 

2012

$12,000

$18,000

 

 

 

2013

$8,000

$12,000

 

 

 

2014

$4,000

$8,000

$12,000

$12,000

 

2015

$2,000

$4,000

$8,000

$8,000

-1%

2016

$0

$2,000

$4,000

$4,000

-2%

2017

$0

$0

$0

$0

-3%

Total

$44,000

$44,000

$39,000

$24,000

Max of -5%

 

Avoiding Meaningful Use Payment Adjustments

Eligible professionals (EPs) participating in the Medicare EHR Incentive Program may be subject to payment adjustments beginning on January 1, 2015. CMS will determine the payment adjustment based on meaningful use data submitted prior to the 2015 calendar year. EPs must demonstrate meaningful use prior to 2015 to avoid payment adjustments.

Determine how your EHR Incentive Program participation start year will affect the 2015 payment adjustments:

If you began in 2011 or 2012…
If you first demonstrated meaningful use in 2011 or 2012, you must demonstrate meaningful use for a full year in 2013 to avoid the payment adjustment in 2015.

If you began in 2013…
If you first demonstrate meaningful use in 2013, you must demonstrate meaningful use for a 90-day reporting period in 2013 to avoid the payment adjustment in 2015.

If you plan to begin in 2014…
If you first demonstrate meaningful use in 2014, you must demonstrate meaningful use for a 90-day reporting period in 2014 to avoid the payment adjustment in 2015. This reporting period must occur in the first 9 months of calendar year 2014, and EPs must attest to meaningful use no later than October 1, 2014, to avoid the payment adjustment.

Avoiding Payment Adjustments in the Future

You must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years.

Detailed information on HER incentive programs can be found at CMS’s Website.