The Centers for Medicare & Medicaid Services (CMS) has posted a revised Frequently Asked Question document to its website providing hospitals with a choice of which emergency department (ED) patients to consider when demonstrating that they have met the “meaningful use” requirements of the Medicare and Medicaid electronic health record incentive programs.

To receive incentive payments and avoid future payment penalties, hospitals must meet a number of metrics, many of which include both inpatient and ED patients in the denominator, such as the share of patients with medications ordered electronically. CMS’ decision to provide a choice in which ED patients to consider recognizes that some hospitals prioritized EHR adoption in their EDs, while others focused first on deployments in their inpatient departments.

The first option outlined in the revised FAQ – the “Observation Services method” – is consistent with previous guidance and includes patients admitted directly to inpatient departments, patients presenting to the ED and subsequently admitted, and patients treated in the ED and provided observation services. The new option – the “All ED Visits method” – includes those patients plus patients treated and discharged directly from the ED. The revision responds to feedback from hospitals that the earlier guidance was unclear about which observation services can be counted and that a “plain language reading” of the final rule would allow all ED services to be counted.

According to the FAQ, eligible hospitals and critical access hospitals must select one of these two methods for calculating their meaningful use metrics and use the same method for all metrics that apply to both inpatient and ED patients. The two methods are described in the FAQ on CMS’ website. “CMS’ clarification offers hospitals some flexibility in determining how to account for ED patients,” said Chantal Worzala, AHA director of Policy. “This will benefit hospitals as they seek to qualify as meaningful users.”