Meaningful Use Rules: The Basics

Over the past couple of months, I’ve been invited to speak about HITECH and Meaningful Use at a number of oncology state society meetings (Texas/Colorado/Oklahoma/New Mexico, Florida, North Carolina, Alabama) and at the ACCC annual gathering, and have received a number of questions about what Meaningful Use is and what it means for oncology clinics. While I’ve been speaking on what it means for patients and their families, it’s clear that healthcare professionals have different levels of understanding about the new legislation and what it means for their practice. Overwhelmingly, most healthcare professionals I speak with have a desire to receive the incentives. The timing in which each practice will qualify for the incentives is more varied, with some practices striving to meet the objectives this year and others that are just starting to learn about what they need to do.

To help answer some of those questions and provide more clarity, I’m going start posting my thoughts here on our blog, and invite the oncology and health IT community to use this as a forum to raise questions and discuss the topic. To follow the conversation you can subscribe to our blog via email (join via right side bar), rss feed, or bookmark the meaningful use tag to see all blog posts on the topic.

Meaningful Use History

In February 2009, President Obama signed into law the American Recovery and Reinvestment Act (ARRA), a multi-billion dollar stimulus package that included incentives for the health care industry to integrate information technology into their daily operations. Specifically, the Health Information Technology for Economic and Clinical Health (HITECH) Act, allocates $19 billion to encourage the adoption of electronic health records (EHR’s) with the goal of improving the quality, efficiency and safety of the nation’s healthcare system.

Stages of Meaningful Use

There are three stages to meaningful use, and each stage will come with additional rules and measures to qualify for incentive payments. Stage 1 began in 2011, Stage 2 will begin in 2013, and Stage 3 will begin in 2015.

Stage 1 is focused on capturing health information electronically in a structured database, using that information to track conditions, communicating that information for care coordination, and starting the reporting process of clinical quality measures and public health information.

Stage 2 will expand on Stage 1 in the areas of disease management, clinical decision support, medication management support, patient access to their health information, transitions in care, quality measurement, and bi-directional communication with public health agencies.

Stage 3 will focus on achieving improvements in quality, safety and efficiency, focusing on decision support, patient access to self-management tools, access to comprehensive patient data, and improving population health outcomes.

Meaningful Use Incentives, Penalties and Timeline

Carrot vs. the stick. Photo by D Sharon Pruitt on Flickr

“Nineteen billion!” you exclaim, “How much of that can I qualify for?” Eligible physicians who implement an electronic health record system can receive up to $63,750 if they primarily treat Medicaid patients and $44,000 if they primarily treat Medicare patients.

To receive the maximum incentive payments, Medicare eligible professionals must begin participation by 2012. Penalties for not complying begin January 2015, and are equal to a one percent reduction of the physician’s annual Medicare payments per year up to five percent.

More information is available on the EHR Incentive Program page on the Centers for Medicaid and Medicare Services (CMS) website.

Meaningful Use Rules

In order to receive the payments, you must show that you’ve put the system to “meaningful use” in your practice. To establish the criteria for determining if a system is being used in a meaningful way, the CMS issued the final rules for Stage One in July of 2010. These rules outline a set of standards and conditions for the implementation of an electronic health record system. For Stage One, there are 25 rules total, 15 that make up the “core set” which every clinic must meet to qualify for the incentives, and 10 that make up the “menu set”, of which clinics can pick any 5 of the 10. A regulation buffet, delicious!

So that brings us to where we are today. In future posts, I’ll talk about the 25 specific meaningful use rules that need to be implemented, the measures you must meet to qualify for the incentive payments, what to look for when evaluating solutions, why patient portals will need to be part of the overall solution, and more.

If you’d like to jump ahead, you can see all the rules on our meaningful use rules page, or you can download a copy of the meaningful use rules for future reference.

Questions? Ideas for future posts? Meaningful use specifics you’d like to know more about? Please leave questions and ideas in comments below and I’ll address them as I can.