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Meaningful Use

The American Recovery and Reinvestment Act of 2009 (Recovery Act) authorized the Centers for Medicare & Medicaid Services (CMS) to provide reimbursement incentives for eligible professionals and hospitals who are successful in becoming “meaningful users” of certified electronic health record (EHR) technology. The Medicare EHR incentive program provides incentive payments to eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) that are meaningful users of certified EHR technology.

The Medicaid EHR incentive program will provide incentive payments to eligible professionals and hospitals for efforts to adopt, implement, or upgrade certified EHR technology or for meaningful use in the first year of their participation in the program and for demonstrating meaningful use during each of five subsequent years. The focus on meaningful use is a recognition that better health care does not come solely from the adoption of technology itself but through the exchange and use of health information to best inform clinical decisions at the point of care.

Final Rule

Meaningful Use Final Rule [PDF - 13.94 MB]

There are three fundamental criteria for achieving meaningful use:

  1. Use of certified EHR technology in a meaningful manner;
  2. Certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality and coordination of care; and,
  3. In using certified EHR technology, the provider submits clinical quality measures and other measures as determined by the secretary.

Meaningful use requirements are organized to meet the following health care goals:

  • Improve quality, safety, efficiency, and reduce health disparities;
  • Engage patients and families in their health care;
  • Improve care coordination;
  • Improve population and public health; and,
  • Ensure adequate privacy and security protections for personal health information.

Understanding the EHR Incentive Final Rule for Eligible Hospitals [PDF - 3.28 MB]

Criteria for Meaningful Use

The criteria for meaningful use will be staged in three steps over the course of the next five years.

  • Stage 1 (2011 and 2012) sets the baseline for electronic data capture and information sharing.
  • Stage 2 (expected to be implemented in 2013) and Stage 3 (expected to be implemented in 2015) will continue to expand on this baseline and be developed through future rule making.

Meeting Meaningful Use Requirements

To qualify for incentive payments, meaningful use requirements must be met in the following ways:

  • Medicare EHR Incentive Program—Eligible professionals, eligible hospitals, and critical access hospitals (CAHs) must successfully demonstrate meaningful use of certified electronic health record technology every year they participate in the program.
  • Medicaid EHR Incentive Program—Eligible professionals and eligible hospitals may qualify for incentive payments if they adopt, implement, upgrade or demonstrate meaningful use in their first year of participation. They must successfully demonstrate meaningful use for subsequent participation years.
  • Adopted:  Acquired and installed certified EHR technology. (For example, can show evidence of installation.)
  • Implemented: Began using certified EHR technology. (For example, provide staff training or data entry of patient demographic information into EHR.)
  • Upgraded: Expanded existing technology to meet certification requirements. (For example, upgrade to certified EHR technology or add new functionality to meet the definition of certified EHR technology.)

Stage 1 Requirements for Meaningful Use (2011-2012)

Meaningful use includes both a core set and a menu set of objectives that are specific to eligible professionals or eligible hospitals and CAHs.

  • For eligible professionals, there are a total of 25 meaningful use objectives.  To qualify for an incentive payment, 20 of these 25 objectives must be met.
    • There are 15 required core objectives.
    • The remaining 5 objectives may be chosen from the list of 10 menu set objectives. Complete listing [PDF - 398 KB]
  • For eligible hospitals and CAHs, there are a total of 24 meaningful use objectives. To qualify for an incentive payment, 19 of these 24 objectives must be met.
    • There are 14 required core objectives.
    • The remaining 5 objectives may be chosen from the list of 10 menu set objectives. Complete listing [PDF - 398 KB]

What are "Clinical Quality Measures"?

Clinical quality measures (CQMs) have been defined as measures of processes, experience, and/or outcomes of patient care, observations or treatment that relate to one or more of the Institute of Medicine (IOM) domains of health care quality (e.g., effective, safe, efficient, patient-centered, equitable and timely).

To demonstrate meaningful use successfully, eligible professionals, eligible hospitals, and critical access hospitals (CAHs) are required to report CQMs specific to eligible professionals or eligible hospitals and CAHs.

Overview of Clinical Quality Measures Reporting in the Centers for Medicare & Medicaid Services [PDF - 183 KB]

Eligible Professionals

  • Eligible professionals must report from the table of 44 CQMs which includes, 3 Core, 3 Alternate Core, and 38 additional CQMs. Complete Listing >
  • Core CQMs - EPs must report on 3 required core CQMs, and if the denominator of 1 or more of the required core measures is 0, then EPs are required to report results for one or more alternate core measures. EPs also must also select 3 additional CQMs from a set of 38 CQMs (excluding the core/alternate core measures). It is acceptable to have a '0' denominator provided the EP does not have an applicable population for which any other quality measures apply.
  • In sum, EPs must report on 6 total measures: 3 required core measures (substituting alternate core measures where necessary) and 3 additional measures.

Eligible Hospitals and CAHs

  • Eligible hospitals and CAHs must report on all 15 of their clinical quality measures. Complete Listing [PDF - 14 MB]

In order to report quality measures from an EHR, electronic specifications have been developed that include the data elements, logic, and definitions for that measure in a format that can be captured in the EHR and sent or shared electronically with other entities in a structured, standardized format. These electronic specifications are derived from certified EHRs. As part of the criteria for satisfying meaningful use, clinical quality measures results (numerators, denominators, and exclusions) must be reported to the Center for Medicare and Medicaid Services (CMS).

Each electronic specification contains four main components: Electronic Specifications

  1. Measure Overview/Description - This contains the measure title, description, number, measurement period, measure steward, and other relevant information to the measure.
  2. Measure Logic - This contains the population criteria and measure logic for the numerator, denominator, and exclusion categories. The measure logic contains the algorithm used to calculate performance.
  3. Measure Code Lists - This contains all of the codes pertaining to the measure.
  4. QDS Elements - This lists and describes each Quality Data Set (QDS) data element associated with the measure. The QDS is a way to describe clinical concepts in a standardized format so individuals (e.g., providers, researchers, measure developers) monitoring clinical performance and outcomes can clearly and concisely communicate necessary information. The QDS model also describes information in a manner that allows EHR and other clinical electronic system vendors to unambiguously interpret the data and clearly locate the data required.

Reporting Period

The reporting period for the EHR Incentive Program using a certified EHR is any continuous 90 day period during the first payment year. Please note that although the measure specifications assume a full calendar year you should only calculate the denominator and numerator from the 90 day reporting period. In subsequent years, the hospital will be reporting the entire year.

Important Dates

  • October 1, 2010 – Reporting year begins for eligible hospitals and CAHs.
  • January 3, 2011 – Registration for the Medicare EHR Incentive Program begins.
  • January 3, 2011 – For Medicaid providers, states may launch their programs if they so choose. Complete listing of state’s expected launch dates >
  • March 2011 – Expected launch of North Dakota Medicaid EHR Incentive Program
  • April 2011 – Attestation for the Medicare EHR Incentive Program begins.
  • May 2011 – EHR Incentive Payments expected to begin.
  • July 3, 2011 – Last day for eligible hospitals to begin their 90-day reporting period to demonstrate meaningful use for the Medicare EHR Incentive Program for the 2011 fiscal year.
  • September 30, 2011 – Last day of the federal fiscal year. Reporting year ends for eligible hospitals and CAHs.
  • October 2011 – Expected launch of Minnesota Medicaid EHR Incentive Program
  • November 30, 2011 – Last day for eligible hospitals and critical access hospitals to register and attest to receive an Incentive Payment for Federal fiscal year (FY) 2011.

Resources

Stratis Health Health Information Technology Toolkit for Physician Offices - Quality Measurement Reporting and Improvement [DOC - 872 KB]

Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs Official Web Site

CMS Tip Sheets 

CMS Tip Sheet: Medicare EHR Incentive Payments for Eligible Professionals [PDF - 1.95 MB]
This tip sheet describes which types of individual practitioners can participate in the Medicare EHR incentive program. It provides user friendly information about incentive payment amounts and describes how they are calculated for fee for service and Medicare advantage providers. It also describes payment adjustments beginning in 2015 for EPs who are not meaningful users of certified EHR technology. 

CMS Tip Sheet: EHR Incentive Program for Medicare Hospitals [PDF - 824 KB]
Learn which Medicare hospitals are eligible for incentive payments. (See the separate tip sheet for Critical Access Hospitals below.) This sheet provides user friendly information about the factors which impact incentive payment amounts and provides sample payment calculations.

CMS Tip Sheet: EHR Incentive Program for Critical Access Hospitals [PDF - 2.13 MB]
How are Medicare incentive payments calculated for CAHs? When can they be earned? Learn more in this informative discussion of the calculation of incentive payments. Sample calculations are provided. This sheet also provides information on how reimbursement will be reduced for CAHs which have not demonstrated meaningful use of certified EHR technology by 2015.