CMS and the Office of the National Coordinator for Health Information Technology (ONC) have both published correlated rules pertaining to certified electronic health record (EHR) technology. These rules were developed to implement provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act that involve the adoption of health information technology and electronic exchange of health information.
The CMS proposed rule defines and provides standards for the term "meaningful use" of certified EHR technology, which eligible hospitals and providers must demonstrate in order to qualify for the incentive payment under the Medicare and Medicaid EHR incentive programs. These incentive payments are tied to the initial set of standards, which are adopted in the ONC interim final rule, along with implementation specifications, and certification criteria to assure that certified EHR technology is capable of supporting the achievement of meaningful use by eligible professionals and hospitals.
Meaningful Use Requirements
Eligible providers (EPs) and hospitals shall be considered meaningful EHR users if they:
- Demonstrate use of certified EHR technology in a meaningful manner;
- Demonstrate certified EHR technology is connected in a manner that provides for the electronic exchange of health information; and
- Appropriately submit information on clinical quality measures and other measures using certified EHR technology.
CMS will provide meaningful use criteria in three phases. The first, referred to as "Stage 1," is introduced in its proposed rule. A phased approach, according to CMS, encompasses reasonable criteria for meaningful use based on currently available technology capabilities and provider practice experience, and builds up to a more robust definition of meaningful use, based on anticipated technology and capabilities development. To qualify as a meaningful EHR user, CMS proposes that an EP or eligible hospital must demonstrate that they meet all of the objectives and their associated measures.
"Stage 1" Meaningful Use Criteria
Stage 1 has four goals:
- Electronically capturing health information in a coded format
- Using that information to track key clinical conditions and communicating that information for care coordination purposes (in a structured format whenever feasible)
- Implementing clinical decision support tools to facilitate disease and medication management, consistent with other provisions of Medicare and Medicaid law
- Reporting clinical quality measures and public health information
Under the proposal, eligible hospitals that are meaningful users of certified EHR technology may begin to receive incentive payments in October 2010, while payments for EPs may begin in January 2011. The incentive payment for each payment year would be calculated as the product of an initial amount, the Medicare share, and a transition factor applicable to that payment year. The EHR reporting period may be any continuous 90-day period within the first payment year, and the entire payment year for all subsequent payment years (two through six). Failure to adopt EHRs will result in reductions in future hospital rate increases and physician payment amounts.
The graphs below illustrate the Medicare incentive payments that will be provided to meaningful users based on the year of eligibility, and reductions in the market basket update percentage received by those who do not adopt the EHR.
Both rules were published in the January 13, 2009, Federal Register. The ONC interim final rule is effective February 12, 2010. Comments on both rules are due on March 15, 2010.
Download a PDF of tables containing information on the certification criteria objectives and related measures, as well as the certification criteria to support the achievement of "Stage 1" meaningful use.
Publication Date: Wednesday, February 10, 2010