Dealing with the government for reimbursements can sometimes be confusing
What are the requirements for Stage 1 of Meaningful Use (2012 Guidelines)?
CMS has set forth an extensive set of guidelines that a practice must follow to become eligible to receive the incentive for meeting Meaningful Use Objectives for successful EMR implementation.
Meaningful use includes both a core set and a menu set of objectives that are specific to eligible professionals or eligible hospitals and CAHs. The following is from the Center for Disease Control Government Web Site
For eligible professionals, there are a total of 25 meaningful use objectives. To qualify for an incentive payment, 20 of these 25 objectives must be met.
There are 15 required core objectives. The remaining 5 objectives may be chosen from the list of 10 menu set objectives.
There are 6 total Clinical Quality Measures that need to be met (3 core or alternate core, and 3 out of 38 from alternate set)
Summary of Meaningful Use Objectives are as follows ( based on 2012 National CMS guidelines):
Core set Objectives: Physicians must have a computerized system that incorporates all 15 of the following Core Set Objectives:
1. Use computerized provider order entry for medication orders directly entered by any licensed healthcare provider who can enter orders into the medical record per state, local and provider guidelines
Measure: more than 30 percent of all unique patients with at least one (1) medication in their medication list seen by the EP have at least one (1) medication order entered using CPOE
Exclusions: Any EP who writes fewer than one hundred (100) prescriptions during the EHR reporting period
2. Implement drug-drug and drug-allergy interaction checks
Measure: the EP has enabled this functionality for the entire Electronic Health Record reporting period.
Exclusions: None
3. Maintain an up-to-date problem list of current and active diagnoses
Measure: more than 80% of all unique patients seen by the EP have at least one (1) entry or an indication that no problems are known for the patient recorded as structured data
Exclusions: None
4. Generate and transmit permissible prescriptions electronically (eRx)
Measure: more than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified Electronic Health Record Technology
Exclusions: Any EP who writes fewer than one hundred (100) prescriptions during the EHR reporting period
5. Maintain an active medication list
Measure: more than 80% of all unique patients seen by the EP have at least one (1) entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data
Exclusions: None
6. Maintain active medication allergy list
Measure: More than 80% of all unique patients seen by the EP have at least one (1) entry (or an indication that the patient has no known medication allergies) recorded as structured data
Exclusions: None
7. Record all of the following demographics: Preferred language, Gender, Race, Ethnicity, Date of Birth
Measure: More than 50% of all unique patients seen by the EP have demographics recorded as structured data
Exclusions: None
8. Record and chart changes in vital signs: height, weight, blood pressure; calculate and display the Body Mass Index; plot and display growth charts for children 2-20 years, including BMI
Measure: More than 50% of all unique patients age 2 and over seen by the EP have height, weight and blood pressure are recorded as structured data
Exclusions: Any EP who either sees no patients 2 years or older, or who believes that all three vital signs of height, weight, and blood pressure of their patients have no relevance to their scope of practice
9. Record smoking status for patients 13 years or older
Measure: more than 50% of all unique patients 13 years or older seen by the EP have smoking status recorded as structured data
Exclusions: Any EP who sees no patient 13 years or older
10. Report ambulatory clinical quality measures to CMS or, in the case of Medicaid EPs, the States
Measure: Successfully report to CMS ambulatory clinical quality measures selected by CMS in the manner specified (or in the case of Medicaid, the States)
Exclusions: None
11. Implement one (1) clinical decision support rule
Measure: Implement one (1) clinical decision support rule
Exclusions: None
12. Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, medication allergies) upon request
Measure: more than 50% of all patients who request an electronic copy of their health information are provided it within 3 business days
Exclusions: Any EP than has no requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period
13. Provide clinical summaries for patient for each office visit
Measure: clinical summaries provided to patients for more than 50% of all office visits within 3 business days
Exclusions: Any EP who has no office visits during the EHR reporting period
14. Capability to exchange key clinical information (for example, problem list, medication list, allergies and diagnostic test results) among providers of care and patients authorized entities electronically
Measure: Performed at least one (1) test of certified Electronic Health Record technology’s capacity to electronically exchange key clinical information
Exclusions: None
15. Protect electronic health information created or maintained by the certified Electronic Health Record technology through the implementation of appropriate technical capabilities
Measure: Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process
Exclusions: None
Eligible Professionals must meet all but 5 of Menu Set Objectives, deferring the selected 5 for later stages. Of the objectives being used, you must include one public health objective either #9 or #10. Eight of the ten objectives have exclusions that can be taken to meet the objective.
1. Implement drug-formulary checks
Measure: The EP enabled this functionality and has access to at least one (1) internal or external formulary for the entire Electronic Health Record reporting period
Exclusions: Any EP who writes fewer than 100 prescriptions during the EHR reporting period.
2. Incorporate clinical lab-test results into Electronic Health Record as structured data
Measure: more than 40% of all clinical lab tests results ordered by the EP during the Electronic Health Record reporting period whose results are either in a positive/negative or numerical format are incorporated in certified Electronic Health Record technology as structured data
Exclusions: An EP who orders no lab tests whose results are either in a positive/negative or numerical format during the EHR reporting period
3. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, and outreach
Measure: generate at least one (1) report listing patients of the EP with a specific condition
Exclusions: None
4. Send reminders to patients per patient preference for preventive/follow up care
Measure: More than 20% of all patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the Electronic Health Record reporting period
Exclusions: An EP who has no patients 65 years or older or 5 years old or younger with recorded maintained using certified EHR technology
5. Provide patients with timely electronic access to their health information (including lab results, medication lists, allergies) within 4 business days of the information being available to the EP
Measure: at least 10% of all unique patients seen by the EP are provided timely (available to the patient within 4 business days of the information updated in the certified Electronic Health Record technology) electronic access to their health information, subject to the EP’s discretion to withhold certain information
Exclusions: Any EP that neither orders nor creates any of the information listed at 45 CFR 17-.304(g) during the EHR reporting period
6. Identify patient-specific education resources using certified Electronic Health Record technology and provide those resources to the patient if appropriate
Measure: more than 10% of all unique patients seen by the EP are provided patient-specific resources
Exclusions: None
7. Perform medication reconciliation
Measure: The EP performs medication reconciliation for more than 50% of all transitions of care in which the patient is transitioned into the care of the EP
Exclusions: An EP who was not the recipient of any transitions of care during the EHR reporting period
8. Provide a summary care record for each transition of care or referral
Measure: The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals
Exclusions: An EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period
9. Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice
Measure: Performed at least one (1) test of certified Electronic Health Record technology’s capacity to submit electronic data to immunization registries and follow up submission if test is successful (unless none of the immunization registries to which the EP submits such information has the capacity to receive the information electronically)
Exclusions: An EP who administers no immunizations during the EHR reporting period or where no immunization registry has the capacity to receive the information electronically
10. Capacity to submit electronic syndrome surveillance data to public health agencies and actual transmission according to applicable law and practice
Measure: Performed at least one (1) test of the certified Electronic Health Record technology’s capacity to provide electronic syndrome surveillance data to public health agencies and follow up submission if test is successful (unless none of the public health agencies to which an EP or eligible hospital submits such information have the capacity to receive the information electronically)
Exclusions: An EP does not collect any reportable syndrome information on their patients during the EHR reporting period or does not submit such information to any public health agency that has the capacity to receive the information electronically
Core Set of Clinical Measures(3 core set or alternative core set must be incorporated into the EMR)
Alternate Core Set of Clinical Measures
Additional Set CQM–3 out of the following 38 Clinical Quality Measures must be incorporated into the EMR)
For practices with a 30% medicaid patient population, during the first year of participation in the Medi-Cal EHR Incentive Program, providers only need to demonstrate that they have adopted, implemented, or upgraded certified EHR technology. A list of acceptable certified EHR technology is available on the CMS web site. Providers do not have to prove actual use or installation—only that they have a binding financial or legal commitment that assures them access to the technology that has been signed prior to and including December 31st of the year for which they are requesting payment. Also, providers do not need to provide proof that they actually use their incentive payments to purchase certified EHR technology, only that they have assured access to such technology through some means. For more information see “Adoption, Implementation, or Upgrade of Certified EHR Technology” please see the CMS web site.
To receive payments in program years 2-6 providers must use certified EHR technology for at least 50% of their patient encounters and report on a number of “meaningful use” measures to Medi-Cal. Currently providers are required to report on 20 administrative or clinical measures. For more information about meaningful use visit CMS web site.