meaningful use

Meeting the criteria of meaningful use of electronic health records earns healthcare providers reimbursement payments from an EHR incentive program.

Meaningful use (MU), in a health information technology (HIT) context, defines minimum U.S. government standards for using electronic health records (EHR) and for exchanging patient clinical data between healthcare providers, between healthcare providers and insurers, and between healthcare providers and patients.

Its rules, known as meaningful use measures or meaningful use criteria, determine whether or not a healthcare provider may receive federal funds from the Medicare EHR Incentive Program, the Medicaid EHR Incentive Program or both, in cases of "dually eligible" practitioners (EP) and eligible hospitals (EH).

Meaningful use stage 1, stage 2, stage 3

Meaningful use is divided into three stages. Stage 1, which began in 2010, focused on promoting adoption of EHRs. Stage 2, finalized in late 2012, increases thresholds of criteria compliance and introduces more clinical decision support, care-coordination requirements and rudimentary patient engagement rules. Stage 3, which the Centers for Medicare & Medicaid Services (CMS) rulemakers are writing from late 2014 through early-to-mid 2016, will focus on robust health information exchange as well as other more fully formed meaningful use guidelines introduced in earlier stages.  

According to the provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, organizations that are eligible for the Medicare EHR Incentive Program and achieve meaningful use by 2014 will be eligible for incentive payments; those who have failed to achieve that standard by 2015 will be penalized, unless Congress overrides that portion of the 2009 HITECH Act that codified CMS's rulemaking timeline into law.

While meaningful use is voluntary, it is often referred to as a carrot-and-stick program whose penalties provide a strong economic compulsion to participate.  Penalties against Medicare and Medicaid reimbursements for skipping meaningful use will increase in each successive year, expressed as a "payment adjustment" or reduction of a provider's reimbursement for care provided to Medicare or Medicaid patients. If fewer than 75% of EPs have become meaningful users of EHRs by 2018, the adjustment will change by 1% point each year to a maximum of 5%.

But because the meaningful use program is technically voluntary, meaningful use criteria are considered to be guidelines, as opposed to meaningful use regulations.

ONC Meaningful Use Certified EHR Technology (CEHRT)

Healthcare providers can only prove compliance with meaningful use while using government-certified EHR technology, commonly referred to as CEHRT. Meaningful use criteria for healthcare providers are written by CMS, with input from the Office of the National Coordinator for Health IT (ONC). EHR vendors, however, get their systems certified under rules written by the ONC, which currently are updated yearly. Some years CEHRT rules are voluntary, in other years they're mandatory.

CMS has indicated that all CEHRT rules, in the future, may be tied to one or more of its provider reimbursement programs beyond meaningful use, such as the Physician Quality Reporting System (PQRS), a voluntary program that rewards providers who can prove they meet specific care-quality measures.

The net effect of requiring meaningful use CEHRT for other programs will be de facto forcing vendors to certify their EHRs in years when CEHRT rules are voluntary, if they want to hold on to customers in the programs for whichCMS requires CEHRT such as, potentially, PQRS.

Meaningful use attestation, meaningful use penalties, meaningful use audits

To have received the maximum reimbursement, physicians and hospitals must have attested (essentially, swearing to a CMS website that one has met all of the criteria for a particular stage) stage 1 of meaningful use of EHR for at least a 90-day period within the 2011 or 2012 federal fiscal year and for the entire year thereafter.

While there is little validation required to attest to meaningful use, providers who have attested are subject to random audits, sometimes before CMS cuts their next incentive check, sometimes after the fact. Keeping detailed documentation proving meaningful use is essential to passing the audits and keeping EHR incentive program funds. Many providers who have failed audits as of late 2014 have done so because of inadequate or nonexistent HIPAA risk assessments, which are required under meaningful use.

Those eligible for the Medicaid program must demonstrate meaningful use by 2016 in order to receive incentive payments. Many healthcare providers attested to stage 1 in its early years in order to receive the maximum incentives from Medicare, Medicaid or both; in 2015 and 2016, many of these providers are expected to drop out as stage 2 attestation becomes due, because of the difficulty in attesting. Those who have attested cite the "view, download and transmit" criteria as well as care-coordination criteria to be the most difficult with which to comply.

Recent changes to meaningful use stage 2 and stage 3 timelines

To help potential program dropouts stay in the program, CMS adjusted timelines for meaningful use. In a 2014 final rule, CMS extend Stage 2 through 2016 and delayed the start of Stage 3 until 2017. These proposed changes, CMS said, "would address concerns raised by stakeholders and will encourage the continued adoption of Certified EHR Technology."

Further changes may be legislated by Congress if bills up for consideration become law. For example, beginning in 2015, all eligible hospitals and professionals on the Medicare EHR Incentive Program side must use CEHRT based on 2014 standards. And, to attest to stage 2 and avoid future penalties, they must attest for the full calendar 2015. The Flex-IT bill before Congress, advocated by many healthcare providers, proposes reducing that to 90 days, pegged to any calendar quarter.

This was first published in May 2010

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