Lost in Translation Meaningful Use: Where Are We Today, and What Comes Next?

We’ve been hearing about electronic health record (EHR) stimulus payments and meaningful use since they were introduced as far back as the 2009 economic-stimulus package. Since that time, we have experienced proposals and final rules, met stage 1, read about stage , and tracked numerous changes and revisions along the way. And that is the problem.

There have been so many changes, and our literature has been so saturated with the topic, that many of us have lost track of where we are, where we should be, and where we are headed.

This article will help to clear up some of that confusion and provide some current clarity on this matter. First, we will focus on the overall regulations, and why they are important. From there, this article will review some of the current changes to the stage 1 requirements and provide an overview of stage 2, set to be implemented in 2014. Finally, we will review some of the tools that are available to you, as eligible professionals (EPs) trying to navigate this changing landscape.

The HITECH provision of the American Recovery and Reinvestment Act of 2009 helped provide the outline of meaningful use. The provision that is identified by most EPs today is the Medicare and Medicaid incentive proposal. For those EPs who are able to demonstrate meaningful use based upon a series of established criteria, there is the possibility to obtain as much as $44,000 over five years under the Medicare incentive program and $63,750 over six years under the Medicaid incentive program — with the ability to choose only one under which to participate.

For those who have not yet started the process of demonstrating meaningful use, take note that Feb. 28, 2013 was the last day to register for 2012 reimbursement, as well as the full $44,000 allotment.

Equally important, however, but less talked about is the fact that this act also established a mandatory ‘payment adjustment’ — i.e. reduction in reimbursement — provision for those EPs who do not meet the meaningful-use requirements effective Jan. 1, 2015. These payment adjustments will range from 99{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 95{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of standard reimbursements through 2020. In order to avoid these adjustments, meaningful use must be demonstrated on an annual basis. Additionally, for those participating in the Medicaid incentive program, meaningful use for Medicare will need to be demonstrated separately.

March 1, 2013 is another date that should be noted by all EPs who were hoping to obtain the full $44,000 incentive payment under Medicare. On that date, President Obama signed a sequestration law calling for a 2{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} reduction in all Medicare incentive payments if the reporting period ends on or after April 1, 2013. This order will have no effect on Medicaid payments.

Stage 1 requirements were issued back in 2010, and EPs have been able to begin demonstrate stage 1 meaningful use since 2011. This does not mean, however, that the rules have not changed. Over time, these have evolved, with the most recent ‘final’ ruling coming on Aug. 23, 2012. The changes are designed to better align meaningful use with the 2014 certified EHR requirements, along with other changes coming by way of stage 2.

Essentially, it will be slightly more difficult to obtain stage 1 in 2014, as compared to how it was in 2011.

While not a complete listing, some of these changes include no longer allowing an exclusion of five menu objectives; providing exclusions for certain vitals (height, weight, and blood pressure), assuming certain criteria are met; and realigning patient access to health-information objectives.

Final rules for stage 2 meaningful use were enacted on Sept. 4, 2012 and are set to take place beginning in 2014. For those EPs that have not yet demonstrated stage 1, it is important to note that two years of meaningful use under stage 1 must be met before demonstrating meaningful use under stage 2. Those that began in 2011 will have three years under stage 1 before making this transition.

So, what has changed from stage 1 to stage 2? The first main change is that either 17 core objectives and three menu objectives (out of 6) or 20 core objectives are required to be met. This is a shift toward more required core objectives. Additionally, a series of clinical quality measures must also be met. For those unsure as to where to begin to meet these new quality measures, CMS has created a recommended listing to follow, which can be found at cms.gov/ehrincentiveprograms. Within these new core objectives and quality measures, the ultimate goal is a shift toward a better exchange of health information.

All EPs demonstrating meaningful use will have only to demonstrate compliance for three months in 2014, even though one year is typically required. This is to allow for any time needed to convert to certified EHR technology.

For those EPs that are currently undergoing this process, or even for those getting ready to start, it is easy to become lost along the way. In order to help navigate through these murky waters, CMS has created a very detailed and informational website, which includes an entire section devoted to stage 2. Here, users will be able to access a stage 2 toolkit, providing an array of tips, FAQs, and resources. For any EP hoping to demonstrate meaningful use, this website is a must-read.

In conclusion, please remember that, even though ‘final’ rules have been provided, meaningful use is continually evolving. For those who plan on applying for incentive payments, and for those that do not want to face adjusted reimbursements, it is important to stay on top of current guidelines and best practices.

The preceding facts and dates were obtained from the Centers for Medicare and Medicaid Services at www. cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/index.html. v

James T. Krupienski, CPA, is senior manager of the Health Care Services Division of Meyers Brothers Kalicka, P.C.; (413) 536-8510.