Federal Officials Release the Final Rule on Meaningful Use

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specified objectives. One of the two regulations announced today defines the “meaningful use” objectives that providers must meet to qualify for the bonus payments, and the other regulation identifies the technical capabilities required for certified EHR technology.
According to David Blumenthal, MD, national coordinator for health information technology, the final rule differs from the proposed rule issued last January: It allows providers more flexibility in choosing which measures to use for qualifications. According to Blumenthal, the proposed rule required doctors to comply with 23 measures, and hospitals 25 measures. The government received more than 2,000 comments on the rule, many of them asking for more flexibility in allowing clinicians to qualify.

Blumenthal said the final rule took those comments into account. The final rule requires doctors to comply with a set of 15 core objectives during the first year - or Stage 1- of adoption. Hospitals are required to comply with 14 core objectives. In addition to the core objectives, both hospitals and doctors will have to choose five more objectives from a "menu" of 10, he said. The remaining objectives will be deferred to Stage 2 of adoption.

Dr. Blumenthal authored an article in the New England Journal of Medicine on the MU rules – to view this article go to http://content.nejm.org/cgi/reprint/NEJMp1006114.pdf 

Key changes in the final CMS rule include:

• Greater flexibility with respect to eligible professionals and hospitals in meeting and reporting certain objectives for demonstrating meaningful use. The final rule divides the objectives into a “core” group of required objectives and a “menu set” of procedures from which providers may choose any five to defer in 2011-2012. This gives providers latitude to pick their own path toward full EHR implementation and meaningful use.
• An objective of providing condition-specific patient education resources for both EPs (eligible providers) and eligible hospitals and the objective of recording advance directives for eligible hospitals, in line with recommendations from the Health Information Technology Policy Committee.
• A definition of a hospital-based EP as one who performs substantially all of his or her services in an inpatient hospital setting or emergency room only, which conforms to the Continuing Extension Act of 2010
• CAHs (critical access hospitals) within the definition of acute care hospital for the purpose of incentive program eligibility under Medicaid.

The AMCNO sent comments on the meaningful use rules and we are in the process of reviewing the final rule to ascertain if our concerns were addressed.

Two companion final rules were also announced. One regulation, issued by the Centers for Medicare & Medicaid Services (CMS), defines the minimum requirements that providers must meet through their use of certified EHR technology in order to qualify for the payments. The other rule, issued by the Office of the National Coordinator for Health Information Technology (ONC), identifies the standards and certification criteria for the certification of EHR technology, so eligible professionals and hospitals may be assured that the systems they adopt are capable of performing the required functions.

As much as $27 billion may be expended in incentive payments over ten years. Eligible professionals may receive as much as $44,000 under Medicare and $63,750 under Medicaid, and hospitals may receive millions of dollars for implementation and meaningful use of certified EHRs under both Medicare and Medicaid.

As part of this process, HHS is establishing a nationwide network of Regional Extension Centers to assist providers in adopting and using in a meaningful way certified EHR technology. In Ohio the Ohio Health Information Partnership (OHIP) will be working with regional partners. The regional partner for the Northern Ohio region is CWRU and the AMCNO and our physician leadership are working with CWRU on this project. OHIP and their regional partners will provide services to physicians that will help practices identify and address practice-specific technical and functional requirements that may serve as barriers to EHR adoption; assist practices in the selection and acquisition of a certified EHR; help practices maximize the benefits associated with the use of an EHR, and serve as a liaison between the practices and EHR vendors regarding the technical assistance they need to “go live.” For additional information on OHIP go to www.ohiponline.org

A CMS/ONC fact sheet on the rules is available at http://www.cms.gov/EHRIncentivePrograms/ 

Technical fact sheets on CMS’s final rule are available at http://www.cms.gov/EHRIncentivePrograms/

A technical fact sheet on ONC’s standards and certification criteria final rule is available at http://healthit.hhs.gov/standardsandcertification.

Links to Rules via Federal Register:

http://www.ofr.gov/OFRUpload/OFRData/2010-17207_PI.pdf
http://www.ofr.gov/OFRUpload/OFRData/2010-17210_PI.pdf 
http://content.nejm.org/cgi/reprint/NEJMp1006114.pdf