Meaningful Use Stage 2, set to begin in 2014, builds on the use and capabilities of EHRs introduced in Meaningful Use Stage 1. Regulations call on care providers to put more advanced processes into place, increase the interoperability of health information and adopt standardized data formats. Stage 2 also places a greater emphasis on exchanging clinical data between providers and enabling patient engagement.
Below are several questions and answers related to specific aspects of Meaningful Use Stage 2.
Q: Does medication reconciliation include medication dosages?
A: CMS defines medication reconciliation as the process of identifying the most accurate list of all medications that the patient is taking, including name, dosage, frequency, and route, by comparing the medical record to a list of medications obtained from a patient, hospital, or other provider.
Q: Who can enter medication, lab and radiology orders for computerized physician order entry (CPOE)?
A: Though the acronym implies that a physician must enter the order, the truth is that any licensed healthcare professional who is operating under state, local and professional guidelines can place an order into the medical record. The CPOE objective expands on the definition by stating that the order must be entered by someone who could exercise clinical judgment in the case that the entry generates any alerts about possible interactions or other clinical decision support aides. This means that CPOE must occur when the order first becomes part of the patient’s medical record and before any action can be taken on the order. Each provider will have to evaluate on a case-by-case basis whether a given situation is entered according to state, local, and professional guidelines, allows for clinical judgment before the medication is given, and is the first time the order becomes part of the patient’s medical record.
Q: We have providers in different stages. How will that be handled with the group reporting option in Meaningful Use Stage 2?
A: Medicare EPs within a single group practice may report core and menu objective meaningful use data through a “batch” file process in lieu of individual Medicare EP attestation through the CMS Attestation website. The batch process includes defining the stage of meaningful use the individual EP is in, numerator, denominator, exclusion, and yes/no information for each core and menu objective. CMS outlines all of this and indicates on page 123 of the Final Rule that the batch reporting process will be established no later than January 1, 2014. CMS defines a Medicare EHR Incentive Group as two or more EPs, each identified with a unique National Provider Identifier (NPI) associated with a group practice identified under one tax identification number (TIN) through the Provider Enrollment, Chain, and Ownership System (PECOS).
Q: Can you explain the reporting function for patient reminders?
A: First, let’s define the details of this measure:
Denominator: the number of unique patients who have had two or more office visits with the EP in the 24 months prior to the beginning of the EHR reporting period.
Numerator: the number of patients in the denominator who were sent a reminder per patient preference when available during the EHR reporting period.
Threshold: The resulting percentage must be more than 10 percent in order for an EP to meet this measure.
One way to succeed with this measure is to run a report at the beginning of your EHR reporting period, singling out patients who have been in for a visit twice in the past two years. For every 100 patients on that report, send out at least 10 reminders. Reminders sent before the reporting period will not count toward meaningful use.
Q: Do you have any recommendations for physicians to meet the 5% patient engagement threshold, especially those in low income areas where patients have limited access to the internet?
A: Getting patients engaged in their health takes creativity and long-term thinking. To start, it may be worth investing in a kiosk that connects to your patient portal for your reception area. Especially in low income areas where patients may not have access to the internet at home or at work, patients could still have a chance to look at their health record either before or after their visit. A good portal will give patients a chance to update any of their demographic, medication, or family history information, as well as see if they are due for any vaccinations or schedule future appointments. Their engagement through the portal could result in bettering their health, but it could also help providers meet their targets for meaningful use. As for promoting a patient portal, studies show that patients are more likely to enroll in a portal at check-out rather than at check-in. Posting signs about the portal where patients will seem them is a great way to communicate.
Q: What qualifies as transfer of care for the medication reconciliation objective?
A: For medication reconciliations, CMS defines transitions of care as the movement of a patient from one clinical setting (inpatient, outpatient, physician office, home health, rehab, long-term care facility, etc.) to another or from one EP to another. At a minimum, transitions of care include first encounters with a new patient and encounters with existing patients where a summary of care record (of any type) is provided to the receiving provider. The summary of care record can be provided either by the patient or by the referring/transiting provider or institution.
Q: If a provider moves to a new practice during the reporting period, how can we get complete, accurate numbers for attestation?
A: Since the reporting period is increasing to a full calendar year (except in 2014), any provider who transfers to another practice mid-year will need to bring his or her Meaningful Use Dashboard report along. Most all certified EHR systems have a Meaningful Use Dashboard or reporting function to track an individual provider’s progress in meeting the criteria to participate in the EHR Incentive Program. This report will include their individual Meaningful Use metrics for both Stage 1 and Stage 2 and will help you to compile accurate numbers when it’s time to attest.
Q: Where can I find state immunization & surveillance registries? If my state’s registry is not able to receive information electronically, can I be excluded from the public health measure?
A: A list of the statewide immunization registries can be found on the CDC website. The syndromic surveillance information needs to be submitted to your state public health agency. If your state’s public health agency does not have the capacity to receive the information electronically, the provider can be excluded. However, keep in mind that you must report on at least one public health measure. You cannot claim an exclusion to both.
For any additional questions, please contact us at 1-888-KY-REC-EHR.
Source: HITECH Answers
October 3, 2013 Meaningful Use Deadline
To all providers planning to participate in the Medicare and Medicaid EHR Incentive Program: The deadline for becoming a Meaningful User in 2013 is fast approaching.
In order to receive the maximum incentive of up to $39,000 for the Medicare EHR incentive program, providers must begin their 90-day reporting period no later than October 3, 2013.
Providers waiting until 2014 to begin Meaningful Use will only be eligible to receive up to $24,000 in Medicare incentive payments and will face a less flexible reporting structure.
Additional Meaningful Use Timeline Information
EPs that have not successfully attested for Meaningful Use Stage 1 before October 1, 2014 will be facing a penalty adjustment to their Medicare Part B reimbursements.
EPs will be able to begin attesting to Meaningful Use Stage 2 on January 1, 2014. The Stage 2 attestation period for 2014 will be 90 days, but in 2015 and beyond will be for a full calendar year due to changes in MU certification requirements for EHR systems in 2014. The briefer reporting period will give EPs additional time to acquire or upgrade to Stage 2-certified technology.
Medicaid EPs can choose any 90-day period in 2014 in which to attest, but Medicare EP attestation periods will start on January 1, April 1, July 1, or October 1.
Like Stage 1, qualifying for Stage 2 requires meeting a series of core (required) and menu (optional) objectives.
A complete list of Stage 2 objectives is available here.
A self-directed timeline showing the length of time required to demonstrate Meaningful Use at each stage and the maximum incentive payment for each year of participation is available here.
From 2008 to 2013, adoption of electronic health records (EHRs) increased 58% among physicians and nearly 80% among hospitals. Today more than 38% of physicians have adopted an EHR and over 145,000 providers are moving through the stages of Meaningful Use.
Kentucky continues to be a leader in Health IT initiatives. To date, Kentucky REC has supported more than 2,800 healthcare providers and assisted clients in receiving more than $61 Million in EHR incentive payments.
To honor these achievements and celebrate National Health IT Week, we will be providing education and expert guidance on “hot topics” in Health IT each day of this week on our blog and social media platforms. Daily topics will include Meaningful Use, HIPAA Privacy & Security, Patient Centered Medical Home, and ICD-10.
Follow along and participate in the action!
Additional National Health IT Week information can be found here.
We would like to thank you for partnering with us to improve health care in our community by leveraging the power of Health IT. We applaud your continued leadership in transforming patient care.
If you are not currently working with the Kentucky REC it’s not too late to take advantage of our expert Health IT support tailored to your unique circumstances. Kentucky REC offers support in: Meaningful Use, EHR Implementation and Optimization, HIPAA Privacy and Security, Patient-Centered Medical Home and ICD-10.
For more information, contact us at 1-888-KY-REC-EHR.
On August 15, 2013, the Office of the Inspector General of the Department of Health and Human Services (OIG) released a report entitled “Most Critical Access Hospitals Would Not Meet the Location Requirements if Required to Re-enroll in Medicare” (Report). If the recommendations in the Report are fully executed, it could have a significant negative impact on critical access hospitals (CAHs). There are approximately 1,300 CAHs currently in operation.
To be designated as a CAH, a hospital must meet multiple conditions of participation, which include being located in a rural area and at least 35 miles (or 15 miles in the case of secondary roads or mountainous terrain) from any other hospital. Collectively, these are known as the “location requirement.” However, if prior to December 31, 2005, a facility was designated as a “necessary provider” pursuant to a State plan and was approved by Medicare as meeting the CAH conditions of participation, the facility is permanently exempt from the distance portion of the location requirement. Medicare officials lack statutory authority to decertify CAHs which have been given the necessary provider status by individual State waivers.
As a result of their findings, OIG made, and CMS concurred with, three recommendations in its Report:
- CMS should “seek legislative authority to remove necessary provider CAHs’ permanent exemption from the distance requirement, thus allowing CMS to reassess these CAHs;”
- CMS should “ensure that it periodically reassesses CAHs for compliance with all location-related requirements;” and,
- CMS should “ensure that it applies its uniform definition of ‘mountain terrain’ to all CAHs.”
OIG also recommended that CMS “seek legislative authority to revise the CAH conditions of participation to include alternative location-related requirements.” CMS did not concur with this suggestion. The Report found that if CAHs less than 15 miles from the nearest hospital were removed from the program, savings would be more than $268 million a year.
It is questionable what real savings would be realized by eliminating CAHs, as many patients without a local provider would have to seek care at a more urban hospital or delay care until it reached emergency status. Proponents of CAHs also maintain that these hospitals provide important jobs in rural areas, benefit other local healthcare providers, and bring critical services to high poverty areas where chronic illnesses are prevalent. Additionally, the CAH program was never designed as a cost saving program but instead was created to preserve access to healthcare for vulnerable populations living in medically underserved areas.
Currently, there are 29 CAHs in Kentucky. Cost report data shows that 60% of Kentucky’s CAHs had a negative profit margin in 2011. Struggling economies, persistent unemployment rates and lack of private insurance are still significant challenges CAHs face in Kentucky. If executed, these recommendations would create a significant loss in access to quality acute care hospital services in rural Kentucky. Under this report, the majority of Kentucky CAHs would lose their CAH designation and many report they would not be able to continue services to their communities. Kentucky’s 29 CAHs provide care for the residents of 40 Kentucky counties with no hospital. If Kentucky lost one CAH, it reduces access not only for that county but for surrounding counties with no hospital.
CAHs will no doubt continue to lobby against implementation of the Report’s recommendations. We will continue to track this issue and inform you of any changes to the CAH program.
The Health System Measurement Project tracks government data on critical U.S. health system indicators. The website presents national trend data as well as detailed views broken out by population characteristics such as age, sex, income level, and insurance coverage status.
- Access to Care
- Cost & Affordability
- Healthcare Workforce
- Health IT
- Population Health
- Vulnerable Populations