CMS Clarifies Hospital Patient Requirements Under Meaningful Use

Last week, CMS revised an online frequently asked questions site regarding provisions in the meaningful use ehr program that affect patient-reporting requirements for hospitals, AHA News reports.

Under the 2009 economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

According to the revised FAQ site, eligible hospitals and critical access hospitals have two choices concerning the type of patients to consider for Stage 1 rules of meaningful use ehr:

• The “Observation Services method” includes patients who are admitted directly to an inpatient setting, patients who arrive in an emergency department and then are taken to an inpatient department, and patients who receive treatment in an ED and are given observation care.
• The “All ED Visits method” includes patients who receive care in and are discharged from an ED.
  

The FAQ section was revised based on feedback from hospitals that earlier guidance was not clear about which observation services can be counted.

The revision recognizes that some hospitals are prioritizing EHR adoption in their EDs, while others are concentrating on deployments in inpatient departments, according to AHA News (AHA News, 12/2).

Source : http://www.myemrstimulus.com/cms-clarifies-hospital-patient-requirements-under-meaningful-use/

AMA Meeting: Physician Input Welcomed On Meaningful Use, CMS Official Says

San Diego — With stage 1 regulations for meaningful use released and discussion begun on stage 2, a federal official speaking at the AMA Interim Meeting called for more feedback to ensure these regulations will be workable for physicians.

“We need to work together and make sure that meaningful use ehr is defined and carried out appropriately,” said Betsy L. Thompson, MD, DrPh, chief medical officer for the Centers for Medicare & Medicaid Services’ Region IX office in San Francisco. She spoke during an educational session at the meeting. Based on a show of hands when she asked the crowd about EMR use, about half of the participants had an EMR in their offices, and the remainder were considering getting one.

Stage 1 rules are intended to increase adoption of health information technology, stage 2 rules are meant to change the process of care, and stage 3 rules are for improving outcomes. “Right now our emphasis is for practices to adopt and start to use these systems,” Dr. Thompson said. “At stage 2, we expect processes of care to change so that we can truly improve outcomes and population health by stage 3.”

Achieving meaningful use at the three stages qualifies physicians for financial incentives for using electronic medical records. They were part of the 2009 economic stimulus package. While finalizing meaningful use standards for stage 1, CMS received more than 2,000 comments, including those from the AMA and other medical associations.

“We had to read and respond to each, and the comments improved the rule substantially,” Dr. Thompson said.

This led to stage 1 rules being issued with more flexibility for physicians and deferral of some early requirements, but the AMA continues to request improvements.

“These are challenging times. … It is worth the effort to be able to collect data and collaborate with each other for the betterment of the patient, but we have reasons to be concerned and worried about what the future holds,” said AMA Trustee Steven J. Stack, MD.

Stage 2 of meaningful use is scheduled to begin in 2012.

Source : http://www.myemrstimulus.com/ama-meeting-physician-input-welcomed-on-meaningful-use-cms-official-says/

Terrific Head Start To Meaningful Use

CHICAGO – Hospitals across the country are on track to meet 2011 meaningful use criteria set by the federal government, according to new data from HIMSS Analytics. Nearly a quarter of the participating hospitals reported they could achieve 10 or more of the 14 required meaningful use core requirements today.

HIMSS Analytics, a subsidiary of the Healthcare Information and Management Systems Society (HIMSS), introduced Monday the first of what executives promised would be quarterly analysis of hospitals’ progress toward achieving meaningful use.

The 687 hospitals that responded to the HIMSS Analytics survey have the ability to meet some of both core and menu requirements for Stage 1 of meaningful use ehr. The final rules designate a “core” group of 14 requirements that must be met, plus an additional “menu” of 10 procedures from which providers must select five.

“It’s good to see that so many hospitals are in position to meet the criteria” said John P. Hoyt, executive vice president, HIMSS. “We’ve got a terrific head start.”

The key findings of the survey showed:

• Nearly one quarter (22 percent) of participating hospitals have the capability to achieve 10 or more of the required core measures in the meaningful use Stage 1 requirements.
• Some 34 percent of respondents have the capability to achieve between five and nine of the core measures for meaningful use.
• Just over 40 percent (40.47 percent) of the market indicated they have the capability to meet five or more of the menu items for meaningful use.

“Our data indicate that hospitals have the capability now to meet some of the requirements for meaningful use, which is significant in the lead up to the Medicare and Medicaid EHR Incentive Programs because they indicate that healthcare organizations continue to move toward implementation of health IT,” said Hoyt.

Michelle Glenn, senior director, product management at HIMSS Analytics, said the results of the survey are statistically significant at a 99 percent confidence level and a 5 percent margin of error.

Each quarter, beginning January 2011, HIMSS Analytics will release updated data and analysis on meaningful use compliance for healthcare organizations.

HIMSS Analytics, known for its annual analysis of health IT implementations at more than 5,000 U.S., non-federal hospitals, added questions on meaningful use to its annual survey of U.S. hospitals before the final rules were announced. Thus, the data reports on 12 of the 14 core and eight of the 10 menu requirements, since not all of the final requirements were initially included in the questions.

Source : http://www.myemrstimulus.com/terrific-head-start-to-meaningful-use/

Making Meaningful Use Meaningful for Patients and Health Care Providers

HHS recently released a package of regulations clarifying the definition of achieving “meaningful use” of electronic health record systems. Eligible providers and hospitals must meet the meaningful use criteria to qualify for government incentives and bonus payments for the adoption of EHR systems. The regulations signify a milestone accomplishment in moving forward our nation’s commitment to the universal adoption of EHRs.

Each day, the American health care system conducts more transactions than the New York Stock Exchange, most of them on paper and at risk of human error. The Institute of Medicine estimates there are between 44,000 and 98,000 deaths attributed to medical errors each year, and while not all errors can be precluded by the adoption of EHRs, there is no question that standardized, interoperable systems will move us in the direction of improved quality and efficiency and reduced errors and waste.

We expect to experience bumps along the way. The core criteria for meaningful use cover several domains, and stakeholders provided a great deal of feedback to HHS after the proposed rule was issued. While changes were made, there remain some issues that may not directly be addressed by HHS but have widespread implications. I offer several for discussion below and request feedback from iHealthBeat readers.

1. EHRs and health care professionals ineligible for government incentives: In its current form, the monetary incentives provided by the federal government (which could total $44,000 under Medicare and $63,750 under Medicaid for eligible providers) are not broadly applied to the entire spectrum of care providers. For example, while physician assistants and nurse practitioners are eligible for the Medicaid EHR incentive program, they are not eligible for the Medicare EHR incentive program. In parts of our nation, particularly in rural and isolated areas, nurse practitioners and physician assistants provide independent and critical care to Medicare patients. While they always work closely with physicians, they may be located hundreds of miles away.
2. Meaningful use ehr, bending the cost curve and quality of care: The widespread adoption of EHRs is expected to significantly improve the quality of clinical care; however, without concerted effort and commitment, the opportunity for bending the cost curve and improving quality of care could go unrealized. Most health systems have already made and will continue to make large investments in interoperable EHR systems, spending tens of millions of dollars on systems that will push them farther along the meaningful use spectrum. This does not, however, inevitably translate to an immediate return on investment; moreover, it may not be enough to change the quality paradigm of an institution. For example, the Veterans Health Administration has an EHR system that goes above and beyond the meaningful use criteria, but recent studies have shown that the VHA’s quality of care is variable across the country. This demonstrates that even the most sophisticated and robust EHR is not alone a panacea.
3. Implications for patient-centered care: There is no question that wiring the country is a step in the right direction, but will patients notice? And if so, will they like what they see? Many patients (including my own) express concern that their doctors spend more time typing on the computer than talking to them. In an age when we are embracing patient-centered care, where can health IT fit in the patient-doctor relationship? What functions of health IT do patients care most about? Potentially the following:
   

• The ability to schedule appointments with clinicians online during or after official office hours;
• A mechanism to receive relevant health advice or recommendations online; and
• An integrated and meaningful capacity for discharge instructions after a hospitalization. (Given the emphasis on discharge instructions and clinic visits in the core set of criteria, the next step is a patient-centered approach to ensuring that a clinic visit in the outpatient setting related to a hospital discharge is also “bundled” together with the original hospital visit, creating a more integrated picture of a particular patient’s care continuum.)
  

Health reform has brought many changes to the health sector, most of which have been long overdue. With 58.5% of practices still using only pen and paper, we need to take advantage of this wave of change, push our comfort limits, and think about how best to augment, complement and modify the existing criteria to rekindle and reinvigorate the very reason we all went into health professions — to deliver the best care for our patients to the best of our ability.

Source : http://www.myemrstimulus.com/hhs-panel-seeks-public-input-on-2013-quality-measures/

Officials Preparing Adjustments to Meaningful Use Final Rule

CMS soon will release modifications for certain provisions in the final rule for Stage 1 of the meaningful use ehr incentive program, Government Health IT reports.

Under the 2009 economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for incentive payments through Medicaid and Medicare.

Tony Trenkle — director of the Office of e-Health Standards and Services at CMS — said the adjustments to the meaningful use criteria currently are undergoing a federal clearance process, which is the final step before publication. Trenkle spoke on Wednesday during a Health IT Policy Committee meeting.

Trenkle added that CMS also will release guidance for health care providers on how to meet quality measures in the incentive program.

Discussion of Stages 2, 3

During the meeting, the Policy Committee also considered what incentive requirements to include in the next stages of the meaningful use program.

Committee members discussed whether Stage 2 meaningful use requirements — which are expected to go into effect in 2013 — should be incrementally built on requirements from Stage 1, or if there should be a set of larger steps framed around measuring and improving patient outcomes.

Paul Tang — chair of the meaningful use work group and chief medical information officer at the Palo Alto Medical Foundation — said the committee would prefer to establish the Stage 3 goals for 2015 first and then backtrack to form Stage 2 requirements.

Committee member Latanya Sweeney — director of the data privacy lab at Carnegie Mellon University — said future meaningful use criteria should incorporate privacy regulations (Mosquera, Government Health IT, 10/20).

National Coordinator for Health IT David Blumenthal said that the rollout of Stage 1 of the meaningful use criteria “was very rushed” (Conn, Modern Healthcare, 10/21). He added that the next stages should focus on infrastructure and interoperability.

Time Frame

Tang said that the meaningful use work group aims to have draft requirements for Stages 2 and 3 by Nov. 19, adding that it will revise the draft after taking comments from the full Policy Committee.

He said final recommendations could be submitted to the Office of the National Coordinator for Health IT by the third quarter of 2011, while CMS could release a notice of proposed rulemaking on the next stages by the fourth quarter of next year (Manos, Healthcare IT News, 10/21).

Source : http://www.myemrstimulus.com/officials-preparing-adjustments-to-meaningful-use-final-rule/

Meaningful use final rule to see minor revisions

BALTIMORE – The Centers for Medicare and Medicaid Services plans to correct a few inconsistencies in the meaningful use final rule it published in July and will post on its web site more detailed guidance for providers on how to meet quality measures required by the health IT incentive program.

The minor revisions, including more detailed descriptions of each of the meaningful use objectives and measures, “should help clarify issues and help the (Health IT Policy Committee) plan for recommendations for future stages,” said Tony Trenkle, director of CMS’s Office of e-Health Standards and Services.

Trenkle, who spoke at a Sept. 22 meeting of the policy committee’s meaningful use workgroup, did not offer further information on the clarifications. They would be released “shortly,” he said.

The panel met to propose preliminary requirements for the second stage of meaningful use in 2013, such as raising the level of performance required for computerized physician orders, electronic prescribing and other measures that were begun in the first stage.

In doing so, Paul Tang, chairman of the meaningful use work group, reminded the panel of its main goal: to move clinical practices operating without EHRs into the digital age.

“We want to pay particular attention to smaller practices and hospitals,” said Tang, who is also chief medical information officer of the Palo Alto Medical Foundation. “We want to raise the tides but not sink the boats.”

To set preliminary requirements for stage 2 in 2013, the panel is taking a ‘backfilling’ approach by splitting the difference between existing stage 1 requirements and where it wants to end up by 2015 for stage 3 of meaningful use of ehr.

For example, to set the stage 2 requirement that physicians should use e-prescribing for 60 percent of their prescriptions in 2013, it picked the midpoint between the current stage 1 requirement of 30 percent and the stage 3 goal that 90 percent of prescriptions should be ordered electronically.

Compared with the first set of meaningful use requirements, stage 2 should also incorporate more standard and coded data from EHRs, which should reduce the reporting burden on providers. “We hope that they are capturing the information as part of patient care and not a separate activity,” Tang said.

Staking out new ground, the group introduced objectives for a glide path to care coordination, starting with a measure that calls for providers to link members of their care teams electronically with at least 20 percent of their patients.

The work group will present its preliminary recommendations on stage 2 meaningful use measure in October. In December, the panel will put out a request for comments on the proposals.

In April, the panel will be able to get indications of the number of providers reporting stage one measures and a sense of the market, Tang said. The policy committee wants to make final recommendations by April to give vendors sufficient time to add functionality to EHRs.

Source : http://www.myemrstimulus.com/meaningful-use-final-rule-to-see-minor-revisions/