Margaret Dick Tocknell and Scott Mace
The final rule for Meaningful Use Stage 2 was released late Thursday afternoon by the Department of Health and Human Services. In a step sure to please many stakeholders, HHS will delay the onset of MU Stage 2 criteria until 2014 to allow time for vendors to develop the necessary certified electronic health record technology.
The 672-page rule specifies the criteria that eligible professionals, hospitals, and critical access hospitals must meet to qualify for Medicare and/or Medicaid electronic health record incentive payments. It also specifies the Medicare payment adjustments that will be made for failing to demonstrate meaningful use of certified EHR technology.
The final rule reflects some give and take based on 6,100 “items of timely correspondence” received in response to the proposed rule released in March. In addition to delaying the onset of MU Stage 2 criteria, HHS finalized a special three-month EHR reporting period, rather than a full year, for providers attesting to either Stage 1 or Stage 2 in 2014 to allow time for providers to implement newly certified EHRs.
Despite complaints from the American Hospital Association and others, HHS stood its ground and will require stakeholders to provide patients with the ability to view, download, and transmit their health information on the Internet, as well as provide clinical summaries of care for each office visit.
Among the highlights of the final rule:
Core and menu objectives
- Nearly all of the Stage 1 core and menu objectives are retained for Stage 2. Eligible professionals must meet the measure or qualify for an exclusion to 17 core objectives and three of six menu objectives. Eligible hospitals and CAHs must meet the measure or qualify for an exclusion to 16 core objectives and three of six menu objectives.
- The “exchange of key clinical information” core objective from Stage 1 is replaced with a “transitions of care” core objective in Stage 2.
- “Provide patients with an electronic copy of their health information” objective is replaced by a “view online, download, and transmit” core objective.
Clinical quality measures (CQM)
- CQM data can be electronically submitted after the first year of demonstrating meaningful use. For the first year CQM data must be submitted via attestation.
- Eligible professionals will submit nine CQMs from at least three of the National Quality Strategy domains. The rule recommends a core set of nine CQMs that focus on adult populations and controlling blood pressure. A core set of nine CQMs are also recommended for pediatric populations.
- Eligible hospitals and CAHs will submit 16 CQMs from at least three of the National Quality Strategy domains.
- Medicare payment adjustments are required by statute to take effect in 2015.
- Eligible professionals and hospitals that are meaningful EHR users in 2013 will avoid the 2015 payment adjustment.
- Eligible professionals that are meaningful EHR users in 2014 will also avoid the adjustment if they demonstrate meaningful use at least three months before the end of the calendar year meet the registration and attestation requirement by Oct. 1, 2014.
- Eligible hospitals that are meaningful EHR users in 2014 will also avoid the adjustment if they demonstrate meaningful use by the end of the fiscal year and meet the registration and attestation requirement by July 1, 2014.
Modifications to Medicaid EHR Incentive Program
- Expands the definition of what constitutes a Medicaid patient encounter to include individuals enrolled in a Medicaid program, including Title XXI-funded Medicaid expansion encounters (but not separate Children’s Health Insurance Programs encounters).
- Specifies the look back period for patient volume to be the 12 months preceding attestation and not the previous calendar year.
- Revises the definition of a children’s hospital to include any separately certified hospital (freestanding or hospital within a hospital) that predominately treats individuals under age 21 that has been provided an alternative Medicare number in order to enroll in the Medicaid EHR Incentive Program.
Online Information Access & Reminders
- Allows eligible hospitals and CAHs to withhold or remove information from online access if they believe substantial harm may arise from its disclosure online.
- Lowers from 40 percent to 10 percent the percentage of images ordered by providers’ inpatient or emergency departments which must be accessible through a certified EHR.
- Requires providers to send patients reminders for preventive or follow-up care.