The moment we’ve all been waiting for – the final definition of Meaningful Use of Electronic Health Records is here! On July 13, 2010, the Centers for Medicare & Medicaid Services (CMS) released the final rule on Medicare and Medicaid Programs: Electronic Health Record Incentive Programs. This is the response to the proposed rule released the end of December and the hundreds of public comments.

The final rule outlines the Medicare and Medicaid incentive guidelines for Eligible Providers (EPs) and Eligible Hospitals (EH) for Stage 1 of Meaningful Use (MU). The final rule defines the minimum requirements that providers must meet through their use of certified Electronic Health Record (EHR) technology in order to qualify for the incentive payments as well as the specifics of funding attestation and payment. The final rule is 864 pages long, but never fear, THE Consortium will be digesting the information for you and providing valuable tools and education to ensure you understand the criteria. Below you will find a synopsis of the key elements that are different in the final rule.

Meaningful Use
Meaningful use has undergone some significant changes from the proposed rule. Essentially the final rule relaxes the criteria and requirements for meaningful use to a list that hopefully will be easier to achieve.

The proposed rule required doctors to comply with 25 measures, and hospitals 23 measures. 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. The remaining objectives can be deferred to stage 2 of adoption.
For the Medicare program, attestations may be made starting in April 2011 for both EPs and eligible hospitals. Medicare EHR incentive payments will begin in mid May 2011.

Critical Access Hospitals – Medicaid Incentive Eligible
CMS modified the eligibility requirements for Critical Access Hospitals (CAH) by expanding the definition of acute care hospitals to include the CMS Certification Number (CCN) of 1300-1399, which now enables CAHs to qualify for the Medicaid incentives under MU as long as 10% of their inpatient census constitutes Medicaid recipients.

Computerized Physician Order Entry (CPOE) flexibility for hospitals
CMS had previously proposed to require 10 percent of all orders are entered through CPOE. Though this 10 percent CPOE threshold was raised to 30 percent, the final rule did allow significant flexibility in this requirement. Now, CPOE orders entered by “licensed professionals,” such as RNs and pharmacists, will count toward a hospital’s CPOE threshold.

Hospital-based Eligible Providers (EP)
The final rule includes 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. This conforms to the Continuing Extension Act of 2010 and will allow non-inpatient and emergency hospital-based providers to qualify for incentives.

Physician Assistant-led RHC Definition
CMS has expanded the definition of Physician Assistant-led Rural Health Clinics: 1) When a PA is the primary provider in a clinic (for example, when there is a part-time physician and full-time PA, CMS would consider the PA as the primary provider); 2) When a PA is a clinical or medical director at a clinical site of practice; or 3) When a PA is an owner of an RHC.

Requirements for meaningful use incentive payments will be implemented over a multi-year period, phasing in additional requirements that will raise the bar for performance on IT and quality objectives in later years. The rule also includes the formula for the calculation of the incentive payment amounts; a schedule for payment adjustments under Medicare for covered professional services and inpatient hospital services provided by EPs, eligible hospitals and CAHs that fail to demonstrate meaningful use of certified EHR technology by 2015; and other program participation requirements.

A CMS/ONC fact sheet on the rules is available on the Consortium Website.