The Path to Paperless

“Meaningful Use”: The Final Rules

Part 1: How CMS wants you to use EMR.

By Peter J. Polack, MD, FACS

For a physician to receive financial incentives for implementing EMR, he or she must qualify as a “meaningful user.” That means one who can:

► Demonstrate use of certified EMR technology in a “meaningful manner” (see below).
► Demonstrate that certified EMR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of health care, such as promoting care coordination.
► Submit, in a form and manner specified by CMS, information on clinical quality measures and other measures.

CMS Relents on “Meaningful Use”

In July, the Centers for Medicare and Medicaid Services (CMS) announced its final rules for Stage 1 of the meaningful use of EMR, in essence defining the term “meaningful manner.”

CMS had previously released proposed rules that led to heated objections. Most providers felt that the 80% across-the-board threshold for all 25 meaningful-use objectives and measures would be impossible for most physicians (Eligible Providers, or EPs) to meet. In the final ruling, many of the objectives and measures have much lower thresholds.

Core Set: Objectives/Measures

The Core Set for EPs includes:

► CPOE (computerized physician order entry).
► Implementing drug-drug and drug-allergy interaction checks.
► ePrescribing.

The core set of objectives also encompasses such areas as demographics, problems list, medication list, medication allergy list, vital signs, smoking status, clinical decision support, electronic copy of record for patient, clinical summaries, exchange key clinical information and privacy/security test.

Menu Set: Objectives/Measures

The Menu Set allows the EP to choose five among the following: implement drug-formulary checks, advance directives, lab results into EMR, patient list, patient reminders, timely access to information for patients, patient specific education, medication reconciliation, summary of care, immunization registries, submit lab results to public health agencies and syndromic surveillance.

While some of these will have different thresholds, the latter three need to have just one test done to meet the qualifications.

What Are the Rewards?

Meaningful use financial incentives are set on a graduated payment scheme, with the highest payment in the first year and successively lower payments in subsequent years: $18,000 the first year, $12,000 the next and so on. Practices starting in either 2011 or 2012 can potentially receive $44,000 per provider over five years.

After 2015, practices that still have not implemented meaningful use of EMR can expect to see cuts in their reimbursement as a penalty for noncompliance.

EPs must meet the thresholds for a given year to qualify for the financial incentives, with payment to be expected the following year.

In the first calendar year (2011 or 2012), stage 1 criteria must be met. In the second year, stage 2 criteria, and in the third year, stage 3 criteria. If an EP cannot meet all of the objectives and measures in that calendar year, then there is no bonus it is all or nothing. OM

Next: Part 2: An Action Plan to Qualify for Meaningful Use

Peter J. Polack, MD, FACS, is co-managing partner for Ocala Eye, a multisubspecialty ophthalmology practice located in Ocala, Fla. He is also founder of Emedikon, an online practice management resource for physicians and administrators.