In a nut shell, Title XIII of the American Recovery and Reinvestment Act (ARRA), which was signed February 2009, created the Health Information Technology for Economic and Clinical Health Act (HITECH). The purpose was to incentivize the implementation of EHR’s (electronic health records) and their ‘meaningful use’. HITECH allocated $19.2 Billion toward the development of health IT.
To participate in the EHR Incentive Programs from Medicare and Medicaid, eligible hospitals (EH) and eligible professionals (EP) must demonstrate that they have not just installed certified EHR Technology (CEHRT), but that they have been using it in a ‘meaningful ‘way.
The ‘meaningful’ way or Meaningful Use (as the program is commonly known) is divided into ‘stages’ to allow for a gradual, stepped approach to implementing an EHR system.
In the first year, the ‘reporting period’ is 90 days. In subsequent years, the reporting period is the full year, except in 2014 when the reporting period is 90 days regardless of the stage. After meeting the Stage 1 requirements, providers will then have to meet Stage 2 requirements for two full years.
EHs and EPs report their measures each year to CMS in order to remain eligible for continued incentive payments. EPs report according to the calendar year, while EHs report according to the federal fiscal year.
To start the Meaningful Use process, all EHs, EPs and CAHs (critical access hospitals) must register with CMS (Centers for Medicare & Medicaid Services) to determine eligibility and indicate intent to participate. Once registered, an EH, EP and/or CAH must submit data from Certified EHR Technology CQMs to participate.
There are 2 options for CQM reporting:
- Electronic Reporting Pilots
Six (6) topics are required for attestation:
- CMS EHR Certification Number
- Patient Records
- Numerator Information (EX: number of patients in the denominator who have at least 1 entry or an indication that no problems are known for the patient recorded as structured data in their population list)
- Denominator Information (EX: number of unique patients seen during the EHR reporting period)
- Select 5 measures from the meaningful use core and meaningful use menu measures
- Core Clinical Quality Measures (CQM)
- Alternate CQMs (if applicable)
- Additional CQMs
In order to qualify for an EHR incentive payment, EPs must report on all 15 required core measures and 5 additional measures selected from a list of 10. EHs and CAHs must meet the measure (or qualify for an exclusion) to 14 core objectives and 5 out of 10 additional objectives. Additionally, EPs, EHs and CAHs must report on 6 clinical quality measures (CQM), 3 required core measures and 3 additional measures (selected from a set of 38).
Stage 1 Requirements, measures and CQMs can be found here: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/MU_Stage1_ReqOverview.pdf
In order to qualify for an EHR incentive payment, EPs must meet the measure or qualify for an exclusion to 17 core objectives and 3 out of 6 menu objectives. Those measures can be found here: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_MeaningfulUseSpecSheet_TableContents_EPs.pdf
EHs and CAHs must meet the measure or qualify for an exclusion to 16 core objectives and 3 out of 6 menu objectives. Those measures can be found here: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_MeaningfulUseSpecSheet_TableContents_EligibleHospitals_CAHs.pdf
Conversely, EPs, EHs and CAHs that fail to demonstrate meaningful use of certified EHR technology (CEHRT) and other program participation requirements by 2015 will be assessed ‘payment adjustments’ under Medicare for covered professional services and hospitals services.
As of November 2012, CMS reports that 307,129 eligible hospitals and eligible providers had registered for the Medicare and Medicaid EHR Incentive program and has paid out nearly $4 billion in Medicare and $3.5 billion in Medicaid incentive payments.
Centers for Medicare & Medicaid Services - www.cms.gov
Office of the National Coordinator of Health IT (ONC) – www.healthit.hhs.gov
HIMSS – www.himss.org