Health Care

On September 4, 2012, the Centers for Medicare & Medicaid Services (CMS) published the Final Rules for Stage 2 Meaningful Use (the “Final Rules”). The Final Rules are the next step in the Medicare and Medicaid Electronic Health Record Incentive Program (the “Incentive Program”) to encourage the use of electronic health records. While Stage 1 Meaningful Use focused on becoming familiar with electronic health records, Stage 2 Meaningful Use is designed to enhance the interoperability of electronic health record systems with the goal of improving patient care and engaging patients to become involved in the process. You can find additional information about the Incentive Program, including summaries of the available incentive payments, here. CMS reports that since the program began in January of last year, more than 120,000 physicians and more than 3,300 hospitals have participated in the Incentive Program, resulting in payments of $6.6 billion in incentives.

The key provisions of the Final Rule are as follows:

Objectives
In total, Stage 2 will require 20 Objectives for physicians (17 Core and 3 of 6 Menu) and 19 Objectives for hospitals (16 Core and 3 of 6 Menu).

• Most of the Stage 1 Core and Menu Objectives will continue in Stage 2 (see the list of Core and Menu Objectives), except that the “exchange of key clinical information” Core Objective from Stage 1 is replaced by a “transitions of care” Core Objective in Stage 2 and the “provide patients with an electronic copy of their health information” Core Objective is replaced by an “electronic/online access” Core Objective.
• New Objectives include:
  • “Outpatient lab reporting” (Menu for hospitals);
  • “Recording clinical notes” (Menu for physicians and hospitals);
  • “Use secure electronic messaging to communicate with patients on relevant health information” (Core for physicians); and
  • “Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (Core for hospitals).

Group Reporting
CMS will provide a batch reporting process so physician groups may attest information for all of the group’s physicians in one file.

Hospital-based Physicians
CMS has revised its definition of “hospital-based” to include physicians who can demonstrate their contributions to the acquisition, implementation, and maintenance of the electronic health record, including supporting hardware and interfaces.

Electronic Reporting of Clinical Quality Measures (CQMs)

• Physicians must report on 9 out of 64 total CQMs; and
• Hospitals must report on 16 out of 29 total CQMs;
• Physicians and hospitals must select CQMs from at least 3 of the 6 key health care policy domains:
  • Patient and Family Engagement;
  • Patient Safety;
  • Care Coordination;
  • Population and Public Health;
  • Efficient Use of Healthcare Resources; and
  • Clinical Processes/Effectiveness.

Hardship Exceptions
CMS finalized the following hardship exceptions:

• Infrastructure (physicians and hospitals);
• New Providers (physicians and hospitals);
• Unforeseen Circumstance (physicians and hospitals); and
• By Specialist/Provider Type (physicians in anesthesiology, radiology, and pathology).

In order to receive incentive payments, providers will need to attest to Stage 2 Meaningful Use in 2014.