The Department of Health and Human Services has released the final rules for the Stage 2 electronic health records meaningful use incentive program. They include a rule setting meaningful use requirements for providers, and a rule establishing the electronic health records certification program for Stage 2. The rules are available here (MU requirements) and here (EHR certification), with publication in the Federal Register on Sept. 4.

Here is a quick look at some of the key provisions and changes awaiting hospitals and eligible professionals in the EHR meaningful use program for Stage 2:

* The rule strengthens provisions for health information exchange during transitions of care and providing patients with electronic or online access to their health information, but are softened from what was proposed in February. The proposal that providers send a summary of care record for more than 65 percent transitions of care and referrals is finalized at 50 percent. The proposal that providers electronically transmit a summary of care for more than 10 percent of transitions of care and referrals--and that the summary be sent to a provider with no organization or vendor affiliation--is finalized at 5 percent with elimination of organization and vendor limitations. However, at least one exchange with a provider using an EHR from a different vendor or with a CMS-designated test EHR must be done.

* Two new core objectives are finalized: EPs must use secure messaging to communicate with patients, and hospitals must automatically track medications from order to administration “using assistive technologies in conjunction with an electronic medication administration record.”

* Proposed provisions that 10 percent of patients access their information on line and conduct secure messaging with their provider is reduced to 5 percent in the final rule, with exclusions based on the availability of broadband.

* Proposed provisions to enable providers first attesting to Stage 1 in 2011 to wait to attest for Stage 2 in 2014 remain. That means no one is required to attest to Stage 2 before 2014.

* There are 17 core measures for eligible professionals and 3 of 6 menu measures must be met, and 16 core measures for hospitals along with meeting 3 of 6 menu measures.

* EPs must report on 9 of 64 clinical quality measures with hospitals reporting on 16 of 29. However, all providers must select CQMs from at least 3 of 6 “domains,” or categories: Patient and Family Engagement, Patient Safety, Care Coordination, Population and Public Health, Efficient Use of Healthcare Resources, and Clinical Processes/Effectiveness.

* Outpatient lab reporting for hospitals is a menu objective in the final rule.

* There are some exclusions from reporting measures available to providers in areas with insufficient broadband availability, which is aimed at lowering a barrier to participating in meaningful use.

* Beginning in 2014, all Medicare providers beyond their first year of meaningful use must electronically report CQM data to CMS. Medicaid providers eligible only for the Medicaid EHR incentive program will report their CQMs to their state.

* A batch reporting process will permit group practices to submit attestations for individual EPs in a single file. Also, EPs can report CQMs individually or as a group either through the Physician Quality Reporting System or a new CMS portal.

* Hospitals will electronically report CQMs through the EHR Reporting Pilot that aligns with the Hospital Inpatient Quality Reporting program, or through a new CMS portal.

* CMS modified the definition of “hospital-based EP” as follows: “EPs who can demonstrate that they fund the acquisitions, implementation and maintenance of Certified Electronic Health Records Technology, including supporting hardware and interfaces needed for meaningful use without reimbursement from an eligible hospital or critical access hospital--and use such CEHRT at a hospital, in lieu of using the hospital’s CEHRT--can be determined non-hospital based and receive an incentive payment. Determination will be made through an application process."

* Regarding Medicare payment adjustments for failure to become a meaningful user, Medicare EPs and hospitals that demonstrate meaningful use in 2013 will avoid a payment adjustment in 2015. A Medicare provider first attesting in 2014 will avoid the adjustment if attestation is before July 1, 2014, for hospitals and Oct. 1, 2014, for EPs.

* Four hardship category exemptions for EPs are finalized: insufficient or insurmountable barriers to obtaining infrastructure such as broadband; new EPs who have not had time to become meaningful users; unforeseen circumstances such as a natural disaster; and certain scopes of practice such as lack of face-to-face or telemedicine interaction with patients, lack of follow-up need with patients, or lack of control over availability of certified EHRs if practicing in multiple locations. CMS believes these exemptions will primarily affect anesthesiology, radiology and pathology.

* Because of patient volume requirements being a barrier to participating in Medicaid meaningful use, the definition of what constitutes a Medicaid patient encounter was expanded to more easily meet the requirements.

* Twelve children’s hospitals previously ineligible for Medicaid meaningful use because they don’t bill Medicare and therefore don’t have a CMS certification number now are eligible.

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