If you work in healthcare, you’ve probably heard this phrase thrown around a bit before. You know meaningful use is something that your organization must comply with to receive $$, but what is it really?
Simply put, providers and hospitals must show that they are using their Electronic Health Records (EHRs) in a “meaningful” way that is determined by Centers for Medicare & Medicaid Services (CMS) in order to receive an incentive payment used to encourage implementation of EHRs.
A little wordy, but we’ll break it down for you into some easier to understand concepts…
Show “Meaningful” Use, Get $$
The Medicare and Medicaid EHR Incentive Programs provide incentives to providers that show that they are “meaningfully using” their Electronic Health Records.
How does one show “Meaningful Use”?
- Use of certified EHR in a meaningful manner
- Use of certified EHR technology for electronic exchange of health information to improve quality of health care
- Use of certified EHR technology to submit clinical quality measures and other such measures
Who Gets Incentive Payments
- eligible professionals
- eligible hospitals
- critical access hospitals (CAHs)
How Much Do They Get?
Those eligible professionals enrolled in the program by 2012 can receive up to $43,720 over 5 continuous years (Medicare program) or up to $63,750 over 6 years (Medicaid program). EPs can only choose one program if they quality for both.
Those eligible professionals who did not enroll by 2012 have until 2014 to enroll in the incentive program, but are not eligible for the full amount previously mentioned.
According to CMS, “Incentive payments to eligible hospitals and CAHs are based on a number of factors, beginning with a $2 million base payment“. This can vary and is calculated by the following formula: Allowable Costs * Medicare Share = EHR Incentive Payment
Stage One of Meaningful Use
Eligible Providers (EPs) and Eligible Hospitals (EHs) must meet stage one requirements “for a 90-day period in their first year of meaningful use and a full year in their second year of meaningful use.”
Remember: Stage 1 = 90 Days + 1 Year
Hang with me here, because this is going to be a loooooong one.
We’ll talk about the requirements including core objectives, menu objectives, and clinical quality measures that providers and hospitals must meet in order to show meaningful use.
- Meet 15 core objectives
- Meet 5 of 10 menu objectives
- Meet 6 Clinical Quality Measures (CQMs) plus 3 addtnl CQMs
- Meet 14 core objectives
- Meet 5 of 10 menu objectives
- Meet 15 Clinical Quality Measures (CQMs)
For both providers and hospitals: 80% of patients must have records in the certified EHR technology
Ok. That’s simple enough….but what is a core objective, or menu set, or Clinical Quality Measure for that matter?
Here are the core objectives that providers and hospital’s EHRs must meet.
Each objective also has a “measure” associated with it. For example, to meet the CPOE measure, CMS requires that “More than 30% of unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE”.
We’re not going to get into these details…but you can look at the additional resources listed at the end of the article if you’re curious.
1. Computerized provider order entry (CPOE)
2. E-Prescribing (eRx)
3. Report ambulatory clinical quality measures to CMS/States
4. Implement one clinical decision support rule
5. Provide patients with an electronic copy of their health information, upon request
6. Provide clinical summaries for patients for each office visit
7. Drug-drug and drug-allergy interaction checks
8. Record demographics
9. Maintain an up-to-date problem list of current and active diagnoses
10. Maintain active medication list
11. Maintain active medication allergy list
12. Record and chart changes in vital signs
13. Record smoking status for patients 13 years or older
14. Capability to exchange key clinical information among providers of care and
patient-authorized entities electronically
15. Protect electronic health information
Hospitals must meet the 12 items bolded above, plus
- Report hospital clinical quality measures to CMS or states
- Provide patients with an electronic copy of their discharge instructions at time of discharge, upon request
Providers and hospitals must meet 5 of the following 10 menu objectives. There are different objectives for eligible providers and eligible hospitals.
1. Drug-formulary checks
2. Incorporate clinical lab test results as structured data
3. Generate lists of patients by specific conditions
4. Send reminders to patients per patient preference for preventive/follow up care
5. Provide patients with timely electronic access to their health information
6. Use certified EHR technology to identify patient-specific education resources
and provide to patient, if appropriate
7. Medication reconciliation
8. Summary of care record for each transition of care/referrals
9. Capability to submit electronic data to immunization registries/systems*
10. Capability to provide electronic syndromic surveillance data to public health
* At least 1 public health objective must be selected.
Like providers, hospitals must also meet five of the ten menu objectives. Menu objectives for hospitals include the 8 objectives above emphasized in bold, plus the following two menu items.
- Record advanced directives for patients 65 years or older
- Capability to provide electronic syndromic surveillance data to public health agencies
Clinical Quality Measures
Eligible Professionals, eligible hospitals and CAHs seeking to demonstrate Meaningful Use are required to electronically submit aggregate CQM numerator, denominator, and exclusion data to CMS or the States.
Core CQMs for Professionals
Eligible professionals must meet the following core Clinical Quality Measures (CQMs)
- NQF0013 – Hypertension: blood pressure management
- NQF0028 – Preventative care and screen measure pair: Tobacco Use assessment/tobacco cessation intervention
- NQF 0421 / PQRI 128 – Adult weight screening and follow-up
- NQF0024 – Weight assessment and counseling for children and adolescents
- NQF0041/PQRI110 – Preventative care and screening: influenza immunization for patients 50 years old or older
- NQF0038 – Childhood immunization status
In addition, they must meet 3 of 38 additional CQMs. This list is long and may be a bit overwhelming, so I included it at the end of the post, rather than in the body of the discussion.
Hospital CQMs (must meet all 15)
1. Emergency Department Throughput – admitted patients Median time from ED
arrival to ED departure for admitted patients
2. Emergency Department Throughput – admitted patients –Admission decision
time to ED departure time for admitted patients
3. Ischemic stroke – Discharge on anti-thrombotics
4. Ischemic stroke –Anticoagulation for A-fib/flutter
5. Ischemic stroke – Thrombolytic therapy for patients arriving within 2 hours of
6. Ischemic or hemorrhagic stroke –Antithrombotic therapy by day 2
7. Ischemic stroke – Discharge on statins
8. Ischemic or hemorrhagic stroke – Stroke education
9. Ischemic or hemorrhagic stroke – Rehabilitation assessment
10. VTE prophylaxis within 24 hours of arrival
11. Intensive Care Unit VTE prophylaxis
12. Anticoagulation overlap therapy
13. Platelet monitoring on unfractionated heparin
14. VTE discharge instructions
15. Incidence of potentially preventable VTE
Ok. Here’s stage one in a nutshell. Meet the CQM, Menu, and Core objectives for 90 days + 1 Year to show meaningful use.
Now on to stage two.
Deep breaths. Ok. Let’s go.
Stage Two of Meaningful Use
After their first full year of meeting meaningful use stage one requirements, providers can move on to stage two of meaningful use. They then must meet these requirements for two full years (calendar year for providers, fiscal year for hospitals & CAHs).
Remember: Stage Two = 2 Full Years
Eligible Provider Core Objectives
Here we go again. Fortunately, a lot of these seem to build off of the core objectives of meaningful use stage one.
- Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines.
- Generate and transmit permissible prescriptions electronically (eRx).
- Record the following demographics: preferred language, sex, race, ethnicity, date of birth.
- Record and chart changes in the following vital signs: height/length and weight (no age limit); blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI.
- Record smoking status for patients 13 years old or older.
- Use clinical decision support to improve performance on high-priority health conditions.
- Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP.
- Provide clinical summaries for patients for each office visit.
- Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities.
- Incorporate clinical lab-test results into Certified EHR Technology as structured data.
- Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.
- Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference.
- Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient.
- The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation.
- The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide a summary care record for each transition of care or referral.
- Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice.
- Use secure electronic messaging to communicate with patients on relevant health information
Core objectives for hospitals include the 8 objectives above emphasized in bold, plus the following 8. Many of the below are similar to language used in the eligible provider core objectives, its just that they use hospital/CAH in place of EP.
- Similar to EP Stage 2 Core Objectives #2. Record all of the following demographics: preferred language, sex, race, ethnicity, date of birth, date and preliminary cause of death in the event of mortality in the eligible hospital or CAH.
- Similar to EP Stage 2 Core Objectives #6. Provide patients the ability to view online, download, and transmit information about a hospital admission.
- Similar to EP Stage 2 Core Objectives #14. The eligible hospital or CAH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation.
- Similar to EP Stage 2 Core Objectives #15. The eligible hospital or CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care provides a summary care record for each transition of care or referral.
- Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities
- Capability to submit electronic reportable laboratory results to public health agencies, where except where prohibited, and in accordance with applicable law and practice.
- Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice.
- Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR).
Eligible Provider Menu Objectives
- Capability to submit electronic syndromic surveillance data to public health agencies except where prohibited, and in accordance with applicable law and practice.
- Record electronic notes in patient records.
- Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT.
- Record patient family health history as structured data.
- Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice.
- Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice.
Eligible Hospital Menu Objectives
Eligible hospital menu objectives include the menu objectives from the eligible provider list above that are bolded, plus the following menu objectives.
- Record whether a patient 65 years old or older has an advance directive
- Generate and transmit permissible discharge prescriptions electronically (eRx).
- Provide structured electronic lab results to ambulatory providers
Other Important Stuff
Stage 3? Say What?!
Yes, stage three is in the works. It’s expected to come out in 2016, so there’s some time. In the mean time, keep tuned in to the latest in clinical informatics news @ http://www.healthcare-informatics.com/
Why Implement Meaningful Use?
After this wall of text, you’re probably wondering why your organization would ever want to go through the hassle of showing meaningful use. It is however, a good decision for your practice or organization. Not only do you receive incentive payment, but many patients get that “wow” factor when their data is magically transferred with them wherever they go…and customer satisfaction is good for business, right?
Meaningful Use aims to do the following for EHRs:
- Improve quality, safety, efficiency, and reduce health disparities
- Engage patients and families in their health care
- Improve care coordination
- Improve population and public health
- Maintain privacy and security
However, it should be noted that not all aspects of EHRs are good. For example, EHRs can results in
- High upfront acquisition costs
- Ongoing maintenance costs
- Disruptions to workflows
- Temporary losses in productivity
- Potential perceived privacy concerns
Important to understand terms and Acronyms:
CQM – Clinical Quality Measures
Denominator – Can be one of two definitions:
all patients seen or admitted during the EHR reporting period -OR- actions or subsets of patients seen or admitted during the EHR reporting period
EP: Eligible Professional
EH: Eligible Hospital
CQMs for providers (choose 3) mentioned in stage one
Diabetes: Hemoglobin A1c Poor Control
Diabetes: Low Density Lipoprotein (LDL) Management and Control
Diabetes: Blood Pressure Management
Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or AngiotensinReceptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
Pneumonia Vaccination Status for Older Adults
Breast Cancer Screening
Colorectal Cancer Screening
Coronary Artery Disease (CAD): Oral AntiplateletTherapy Prescribed for Patients with CAD
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment
Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation
Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
Asthma Pharmacologic Therapy
Appropriate Testing for Children with Pharyngitis
Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer
Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients
Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies
Diabetes: Eye Exam
Diabetes: Urine Screening
Diabetes: Foot Exam
Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol
Heart Failure (HF): WarfarinTherapy Patients with AtrialFibrillation
Ischemic Vascular Disease (IVD): Blood Pressure Management
Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement
Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)
Prenatal Care: Anti-D Immune Globulin
Controlling High Blood Pressure
Cervical Cancer Screening
Chlamydia Screening for Women
Use of Appropriate Medications for Asthma
Low Back Pain: Use of Imaging Studies
Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control
Diabetes: Hemoglobin A1c Control (<8.0%)