Electronic Health Records (EHR) and Meaningful Use

Electronic Health Records (EHR) and Meaningful Use

I) Important Announcements

New Proposed Rules for Meaningful Use (4/21/15)
Recently the CMS issued two new proposed rules for the Electronic Health Records (EHR) Meaningful Use (MU) Incentive Program. Proposed changes include: introducing Stage 3 requirements, aligning Stage 1 and Stage 2 requirements with Stage 3; changing the 2015 reporting period to 90-days; and the removal of measures deemed redundant. The Academy is reviewing the draft rules and will submit any necessary comment. Learn more.

Important Deadline Approaching!  EHR MU Hardship Exception Application Reopened (11/12/2014)
If you missed the July 1 Electronic Health Records (EHR) Meaningful Use (MU) hardship exception application deadline, you still have an opportunity to apply and possibly avoid the 2015 penalty.  CMS is reopening the submission period through November 30, 2014.  To access the requirements, click here.

II) Background and Resources for the EHR Incentive Programs

The Electronic Health Records (EHR) Meaningful Use (MU) Incentive Program is an initiative from CMS designed to facilitate the use of EHRs in clinical settings. Eligible professionals (EPs), hospitals, and critical access hospitals that demonstrate MU of EHRs are eligible for incentive payments. For EPs, incentive payments can accumulate up to $44,000 by 2015 if they began to successfully participate in 2012. Starting in 2015, EPs, hospitals and critical access hospitals that do not successfully demonstrate MU of EHRs will be subject to penalties starting with a 1% payment reduction in 2015 (based on 2013 reporting) and increasing annually to 5% by 2020.

The EHR MU Incentive Program is structured in three stages, with a possible fourth stage starting as early as 2018. Below is a snap shot of implementation dates for the EHR Incentive Program through 2016:

1st Payment Year

2012 2013 2014 2015 2016
2011 Stage 1 Stage 1 Stage 2 Stage 2 Stage 3
2012 Stage 1 Stage 1 Stage 2 Stage 2 Stage 3
2013   Stage 1 Stage 1 Stage 2 Stage 2
2014     Stage 1 Stage 1 Stage 2
2015       Stage 1 Stage 1

In order to obtain the full $44,000 in incentive payments, EPs must have begun participating in the EHR MU Incentive Program by October 3rd, 2012. Starting in 2013, incentive payments will be reduced annually and EPs will be subject to payment penalties, beginning in 2015.  

1.  Getting Started   

CMS has developed a number of resources for you to see if you are eligible to begin participating in the EHR MU Incentive Program, as well as instructions on how to register and tips on how to successfully attest to MU, earn incentive payments, and avoid Medicare Payment Penalties. See the CMS Getting Started page here.

2.  How to Earn Incentive Payments and  Avoid Penalties

First, you must purchase an Office of the National Coordinator (ONC) Health IT Certified EHR System.  The ONC Certified HIT Product List (CHPL) is a comprehensive list of Complete EHRs and EHR Modules that have been tested and certified by an ONC-Authorized Testing and Certification Body (ATCB) under the Temporary Certification Program. CMS will only grant and accept reporting numbers from the EHR technologies on the ONC-Certified Health IT Product List. These reporting numbers are required for attestation under the EHR MU incentives programs.  The Certified Health IT Product List should help members find an appropriate CEHRT to meet the needs of their practice. 

*IMPORTANT CHANGE FOR 2014* New standards and certification criteria take effect in 2014!  Even if an EP already has a certified EHR, he or she will have to adopt or upgrade to the new certification in order to participate in the program.  If the EHR is certified to 2014 standards/certification criteria, then providers should be able to meet both Stage 1 and Stage 2 requirements.
**NOTE**  CMS updated language in its "hardship exception" applications for Fiscal Year 2015 for both eligible hospitals and eligible professionals participating in the Medicare Meaningful Use incentive program. Those who struggled to adopt or upgrade to 2014 CEHRT, may qualify for a hardship. 
**NOTE** In September 2014, CMS released a final rule that allows providers to use the 2011 Edition of Certified Electronic Health Record Technology (CEHRT) for 2014. Providers unable to fully implement 2014 Edition CEHRT for an EHR reporting period in 2014 due to availability delays may now use EHRs that are certified under the 2011 Edition, a combination of 2011 and 2014 Editions, or the 2014 Edition. To determine whether you are eligible, click here.

Next, you must report the required number of MU Objectives (Core Objectives + Menu Objectives) PLUS the required number of Clinical Quality Measures (CQMs) and meet other reporting requirements, such as:

  • For your first year, report data from any continuous 90-day period during the calendar year (any 90 continuous days from January 1st to December 31st)
  • After your first year, report for the entire calendar year (January 1st to December 31st).  Special Note for 2014:  All providers, regardless of their stage of MU, are only required to demonstrate MU for a 90-day EHR reporting period because all must upgrade or adopt newly certified EHRs in 2014.
  • After two or three program years under Stage 1, providers progress to Stage 2.  2014 is the earliest year to begin Stage 2, and its requirements differ from that of Stage 1. 
  • For 2014, all participating providers (regardless of which stage they’re in) are required to demonstrate MU for a three-month reporting period.  Those beyond their first year of MU must select a 3-month period fixed to a quarter of the calendar year.

 MU Chart 2

  • *Note:  If none of the menu objectives are applicable to your scope of practice and you qualify for all of the exclusions for each objective, then you can select any 3 and claim the exclusion for each.
  • ** The CQMs selected must cover at least 3 of the 6 available National Quality Strategy domains.
  • IMPORTANT CHANGE FOR 2014:  EHR technology that is certified to the 2014 standards will contain new CQM criteria, and EPs will report using the new 2014 criteria, regardless of whether an EP is participating in Stage 1 or Stage 2.  Remember, attestation for the EHR MU Incentive Program is not complete until CQM data is submitted!

3.  Need More Information on the Programs?  

View the Following Documents Published by CMS on the Medicare EHR MU Incentive Programs:

Additional Resources:

The American Academy of Otolaryngology- Head and Neck Surgery Medical Informatics Committee authored an article that provides recommendations from the Academy for implementing "meaningful use" of EHRs to improve safety, quality, and efficiency of patient care and receiving incentive payments as defined by CMS regulations. This article can be found in the February 2011 issue of Otolaryngology- Head and Neck Surgery and is available online to members here (Academy login required).

STILL HAVE QUESTIONS?  Call the CMS EHR MU Incentive Program Information Center at: 1 (888) 734 6433.  

Don’t forget to print out a copy of the Academy’s EHR MU Factsheet as a quick and handy reference for MU!  

III) Summaries of Regulations

Stage 2 Meaningful Use Criteria Summary (10/4/2012)
CMS released the final rule on MU Stage 2 Criteria. Within the final rule, EPs must report 17 core objectives and 3  of 6 menu objectives, or qualify for an exclusion, to successfully attest to MU. A list of the core and menu objectives can be found here.

EPs must also report on 9 clinical quality measures, out of a list of 64, in addition to the core and menu objectives. EPs will also have the choice of reporting via PQRS. 

EPs will not be required to meet Stage 2 criteria until 2014, which represents a one year delay from the schedule defined in the Stage 1 final rule and allows EPS two years to participate in Stage 1 regardless of what year they begin participating.

Final Rule for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Program
On July 28, 2010, the CMS released the final rule for the Medicare and Medicaid EHR MU Incentive programs.

IV) Comment Letters 

AAO-HNS Submits Comments on HIT Policy Committee Recommendationsfor Stage 3 of EHR Meaningful Use (4/24/214)
On April 21, the Health Policy team submitted comments to the AMA regarding the Health Information Technology Policy Committee’s (HIT Policy Committee) recommendations on Stage 3 of the Electronic Health Records (EHR) Meaningful Use (MU) Incentive Program. Key points raised included:  increased costs associated with Stage 3; lack of interoperability between EHR systems; the need for flexibility; and much more. The Academy, along with other specialty societies, is working in collaboration with the AMA to better ensure specialty feedback is reflected inthe proposed rulemaking this fall and will continue to keep members apprised of important information.

Academy Comments on CQMs for EHR Stage 3 Meaningful Use  (11/19/13)
On November 19, 2013 the Academy submitted a comment letter to CMS regarding Proposed Clinical Quality Measures for Use in Stage 3 of the EHR MU Incentive Program, specifically, the proposed Stage 3 measure on Overuse of Diagnostic Imaging for Uncomplicated Headache.  The letter reiterated the Academy’s concerns regarding Stage 2 timing requirements and Stage 3 thresholds and penalties.  The Academy once again requested an extension of Stage 2 for providers who need extra time to meet the new requirements.  It also emphasized the continued difficulty specialists will have with meeting Stage 3 requirements, particularly in light of the increased thresholds and penalties of Stage 3.  The Academy would like to thank the Imaging Committee, Patient Safety and Quality Improvement Committee, and the Physician Payment Policy Workgroup for their input and feedback regarding the proposed measure.   Click here to view the letter.   

Senators Urge CMS to Delay MU Stage 2 Requirements (9/24/2013)
Recently, 17 Members of the U.S. Senate joined together to send a letter to Secretary Sebelius and CMS, urging them to implement a one year delay (from 2014 to 2015) for Stage 2 MU requirements. Click here to access the letter.

Academy Submits Comments to HIT Policy Committee on Proposed Stage 3 Meaningful Use Criteria (1/23/2013)
On January 14th, the Academy sent a letter to the Health Information Technology (HIT) Policy Committee regarding their proposed criteria for Stage 3 of the EHR MU Incentive Program, scheduled to take effect in 2016. In the letter, the Academy expressed concerns with the criteria and asked that the policy recommend delaying the beginning of Stage 3. See the letter.

Academy Submits Comments to CMS on Stage 2 Meaningful Use Final Rule (10/22/12)
The Academy sent a letter to CMS expressing concerns with the final rule of Stage 2 of the EHR MU Incentive Program. In comments, the Academy noted the high thresholds make attaining meaningful use difficult for specialty physicians and hinders the adoption of EHRs and Health Information Technology (HIT).  See the letter.

Academy Signs onto ACS and AMA Meaningful Use Comment Letters (5/17/12)
The Academy signed onto joint letters from the American College of Surgeons (ACS) and the American Medical Association (AMA) regarding the proposed rule for Stage 2 of the EHR MU Incentive Program. The signed organizations expressed their desire to work with CMS on the adoption of EHRs and Meaningful Use, but outlined concerns related to the stringent requirements which could exclude specialists, such as otolaryngologists. In areas where comments contradict Academy priorities, the Academy positions take precedent. See the ACS Letter and the AMA Letter.

Academy's Comment Letter on Proposed Rule for Stage 2 of the EHR Meaningful Use Incentive Program (5/7/12)
On May 7th, 2012, the Academy submitted a comment letter to CMS on the proposed rule for Stage 2 of the EHR MU Incentive Program. In the letter, the Academy expressed concerns that stringent program requirements with high satisfaction thresholds will hinder health information technology (HIT) adoption.

Academy’s Comment Letter on the Proposed Rule for the EHR Incentive Program
On March 10, 2010 the Academy submitted a comment letter to CMS on the proposed rule for meaningful use.  

Academy's Comment Letter on the Proposed rule for the Certification Programs for Health Information Technology (HIT)On March 30,2010, we sent a letter to the ONC recommending that they require the ONC-Authorized Testing and Certification Body (ONC-ATCB) to certify and test EHRs' capabilities to be integrated into EHRs from other vendors, post a frequently updated list of "de-certified" EHRs on the ONC website, limit the number of ONC-ATCBs to five and much more. 

Sign on Comment Letter on the Definition of Meaningful Use of EHR  
The Academy in addition to other specialty societies sent a letter with recommendations for defining and demonstrating the meaningful use of EHR.