Medicare and Medicaid have developed incentive programs to provide financial incentive to eligible professionals (EP), eligible hospitals (EH) and critical access hospitals (CAH) for use of an EHR (Electronic Health Record). The overall objective is improvement of patient care. Providers must demonstrate, through required reporting, that they meaningfully use their EHR. Eligible professionals (EP) can receive $44,000 under Medicare and $63,750 under Medicaid; eligible professionals must choose to participate in either Medicare or Medicaid. An eligible hospital (EH) may annually receive $2 million to $6 million overall for each program. Most hospitals can receive a payment from both programs. Critical access hospitals are paid on a cost formula. There are three stages in the Medicare and Medicaid EHR Incentive Programs. Eligible professionals (EP) participate in the program on the calendar years, while eligible hospitals (EH) participate according to the federal fiscal year which begins in October. Stage one focused on implementation of electronic health records for electronic data capture and sharing. Stage two attempts to balance policy goals, charge management reality and clinical quality imperatives. Focus on rigorous measures around health information exchange and increased patient and family and patient engagement. Stage three will shift to improved outcomes.
Current Status of Meaningful Use Results
The latest HIT Policy Committee Report dated September 3, 2013 showed registration and payment data for hospitals and professionals. Close to $16 billion incentive dollars have been paid since the beginning of the program in 2011. Some statistics as of July 2013: Of the approximately 5,000 eligible hospitals, 81% had received a payment and 90% had registered. For the 527,000 eligible professionals, 59% had received a payment and 77% had registered. In a Health Affairs study, researchers found the hospital attestation rate in 2013 was an improvement over previous years. Their findings show that large hospitals (400 or more beds) have the highest rate of meaningful use achievement (77percent), followed by small rural hospitals (76 percent) and medium-sized (100-399 beds) hospitals (72 percent). A survey compiled by HFMA (Healthcare Financial Management) dated September 2013 shows hospitals spent an average of $7,500 per bed to achieve meaningful use. Nearly two-thirds of the respondents anticipate a positive financial return on meaningful use. Most organizations noted a modest impact to the revenue cycle within the first year of EHR implementation. Within one year 70% of the organizations returned to pre-conversion levels for revenue cycle performance. However, physician productivity performance did not return to normal until the second year. Eligible hospitals and eligible professionals must register and attest for the 2014 payment year to avoid penalties in 2015.
What Are the Requirements for Stage 2 Meaningful Use
Most providers are in Stage 2 of the Meaningful Use Program. This means the provider met Stage 1 requirements of the EHR Incentive Programs for a 90-day period in the first year of participation and a full year in the second year of participation. Organizations must meet Stage 1 before moving to Stage 2. Stage 2 retains the basic core and menu structure from Stage 1. Although some objectives were combined or eliminated, the majority of Stage 1 objectives have become core objectives in State 2. Stage 2 meaningful use requirements begin in 2014 and final rules were published in the Federal Register on September 4, 2013. The Office of the National Coordinator of Health IT issued the final rule for certification, standards and implementation specifications. Providers using a certified EHR, will have to adopt or upgrade to the new certification in order to participate in the EHR Incentive Programs beginning in 2014. Because all providers must upgrade or adopt newly certified EHRs in 2014, all providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a three-month (or 90-day) EHR reporting period in 2014. Stage two has new objectives to improve patient care with better patient engagement, care coordination and clinical decision support. In the final CMS rule for Stage 2, there are 19 measures for hospitals and 20 measures for professionals. For eligible hospitals and CAHs (Critical Access Hospitals), there are 16 core objectives that must be met and 3 out of 6 menu objectives. For eligible providers, there are 17