Meaningful use: an update on the recent health it policy committee findings

At the Health IT Policy Committee meeting in July 2014, CMS and the ONC reported on attestations for meaningful use (MU) Stage 2 as well as the progress and performance of eligible professionals (EPs) in the first three years of the EHR Incentive Program. 2014 attestations through July 1 included 2,823 EPs, with 443 new participants, and 972 attesting to MU Stage 2. Eligible Hospitals (EHs) had 128 attestations, with 70 new program participants, and 10 attesting to Stage 2 (two more than from June). This data represents what the health care industry had predicted with the enormous challenge required by the American Recovery and Reinvestment Act of 2009. The attestations through July 2014 equate to approximately 1% of EPs and 3% of EHs who have installed a 2014-certified EHR by January 1, 2014, completed a reporting period, and attested as of July 1.

HIT Policy Committee listening sessions in May found that the Transition of Care (TOC) objective required of Stage 2 was the most challenging for EPs and EHs to meet. The TOC objective requires providers give a summary of care record for more than 50% of transition of care or referrals, of which 10% must be transmitted electronically, and exchange at least one summary of care record with another user from a different EHR system. The committee found that the TOC is not well defined, has issues with referral sources, and recipients were not ready or are overwhelmed. The 10% electronic transmission requirement is virtually impossible to meet since providers have no control over the recipients. Given the enormous challenge of meeting the TOC objective, many providers are unable to attest to Stage 2. This is especially concerning as 2014 is the last year to begin participation in the Medicare program and earn incentive payments. Payment reductions under Medicare begin in 2015.

While Stage 2 MU attestation is proving to be more difficult to achieve at the current regulatory timeline, the ONC reports that EPs’ performance in the first three years of EHR incentives have been encouraging. A majority, 59%, of the 537,600 EPs have attested to MU Stage 1, with an additional 37% in other phases of Stage 1, and only 3% not participating in some aspect of the program. The trend also indicated that EPs return to the program year after year (75% of EPs attested in 2011, 2012, and 2013). Similarly, EPs have increasingly met core objectives each payment year from 78%, 84%, and 86% respectively. As of April 30, 2014:

• More than 477,671 EPs and EHs registered for the Medicare and Medicaid EHR Incentive Program, including:
  • Approximately 316,303 EPs registered for Medicare incentives
  • Over 156,640 EPs registered for Medicaid incentive
  • 4,727 hospitals registered for both Medicare and Medicaid
• Of 4,993 hospitals eligible for Medicare and Medicaid incentives, more than 94% have registered for EHR incentives, and more than 91% have been paid incentives
• For the 537,600 professionals eligible for Medicare or Medicaid incentives, more than 87% have registered for an Incentive Program, and more than 70% have received an incentive payment
• More than $24 billion in incentive payments have been paid to eligible providers
• More than $15.8 billion in Medicare incentive payments to providers
• More than $8.1 billion in incentives for Medicaid providers

By the sheer number of incentive payments made to date, meaningful use of certified EHR technology means big bucks to the health care industry. Beginning January 1, 2015, the payment adjustment will be applied to the Medicare physician fee schedule amount for covered professional services furnished by the eligible professional during the year. The payment adjustment is 1% per year and is cumulative for every year that an eligible professional is not a meaningful user. Eligible professional may apply for hardship exceptions to avoid payment adjustments only under specific circumstances in the following categories:

• Infrastructure: Eligible professionals must demonstrate that they are in an area without sufficient internet access or face insurmountable barriers to obtaining infrastructure (e.g., lack of broadband).
• New Eligible Professionals: Newly practicing eligible professionals who would not have had time to become meaningful users can apply for a 2-year limited exception to payment adjustments. Thus eligible professionals who begin practice in calendar year 2015 would receive an exception to the penalties in 2015 and 2016, but would have to begin demonstrating meaningful use in calendar year 2016 to avoid payment adjustments in 2017.
• Unforeseen Circumstances: Examples may include a natural disaster or other unforeseeable barrier.
• Patient Interaction: Lack of face-to-face or telemedicine interaction with patient / lack of follow-up need with patients.
• Practice at Multiple Locations: Lack of control over availability of CEHRT for more than 50% of patient encounters.
• 2014 EHR Vendor Issues: The eligible professional’s EHR vendor was unable to obtain 2014 certification or the eligible professional was unable to implement meaningful use due to 2014 EHR certification delays.

In May 2014, CMS released an NPRM that would grant flexibility to providers who are experiencing difficulties fully implementing 2014 Edition CEHRT to attest this year. Providers scheduled to demonstrate Stage 2 of meaningful use in 2014 can:

• Demonstrate 2013 definition of Stage 1 of meaningful use with 2011 Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT;
• Demonstrate 2014 definition of Stage 1 of meaningful use with 2014 Edition CEHRT;
• Demonstrate Stage 2 of meaningful use with 2014 Edition CEHRT.

2014 Reporting Periods:
All providers, regardless of their stage, are only required to demonstrate meaningful use for a 3-month EHR reporting period. For Medicare providers, this 3-month reporting period is fixed to the quarter of either the fiscal (for eligible hospitals and CAHs) or calendar (for eligible professionals).

The 3-month reporting period is not fixed for Medicaid eligible professionals and hospitals that are only eligible to receive Medicaid EHR incentives.

For a discussion of the meaningful use stages criteria, you may refer to my May 2014 client alert or visit the CMS website here.

Important 2014 Dates for the EHR Incentive Programs:

• September 30, 2014: End of 2014 fiscal year and end of the 2014 reporting period for eligible hospitals
• November 30, 2014: Attestation deadline for Medicare eligible hospitals for the 2014 program year
• December 31, 2014: End of 2014 calendar year and end of the 2014 reporting period for eligible professionals

By Moses Suarez