Meaningful use phase 2 coming in 2014

October 1st, 2013 - Scott Kraft

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Earning a Medicare electronic health record (EHR) bonus payment requires you to do more than simply buy and install an EHR system. CMS expects you to use the system, and has set up a series of tasks you must accomplish, known as establishing meaningful use.

Currently, to achieve a bonus payment, you’re required to meet what’s known as phase 1 of meaningful use. Phase 1 consists of 24 measures – 14 core measures you must meet, and 10 additional measures, of which you’re required to meet five. Once you meet these measures, you’re able to earn a meaningful use bonus.

Providers who first met meaningful use for at least 90 days in 2011 or 2012 are eligible for bonus payments of up to $44,000 per provider. Those who begin in 2013 may still receive up to $39,000, paid out over four years ($15,000/$12,000/$8,000/$4,000).

The key is, your work isn’t done after you meet meaningful use under stage 1 requirements. Beginning in 2014, CMS plans to move to stage 2 of meaningful use. One useful thing to remember is that any provider new to proving meaningful use is allowed two reporting years (one of which may be a partial year) in stage 1 before being advanced to stage 2.

Let’s look at Stage 1’s meaningful use requirements with the stage 2 changes in parentheses.

Here are the 14 “core measures” all eligible providers are required to meet under Stage 1:

1. Use computerized point of entry for at least 30 percent of all unique patients with at least one medication in their medication list seen by an eligible provider. (Stage 2 requires 60 percent of medication orders, 30 percent of laboratory and 50 percent of radiology orders to be recorded with CPOE.)
2. Implement drug-drug and drug-allergy interaction checks. (Eliminated for Stage 2.)
3. Transmit at least 40 percent of eligible prescriptions electronically using the EHR. (Increased to 50 percent for stage 2.)
4. Record demographics (preferred language, gender, ethnicity, race and date of birth) for at least 50 percent of all unique patients. (Increased to 80 percent for stage 2).
5. Maintain an up-to-date problem list of current and active diagnoses (including no problems, when applicable) for at least 80 percent of all unique patients. (Eliminated for Stage 2.)
6. Maintain an active medication list (including an indication of no active medications, when applicable) for at least 80 percent of all unique patients. (Eliminated for Stage 2.)
7. Maintain an active medication allergy list (including an indication of no known allergies, when applicable), for at least 80 percent of all unique patients seen. (Eliminated for Stage 2.)
8. Record changes in vital signs (height, weight, blood pressure, BMI and growth charts for children aged 2-20), for at least 50 percent of all unique patients. (Increased to 80 percent for stage 2.)
9. Record smoking status for at least 50 percent of unique patients age 13 and over. (Increased to 80 percent for stage 2.)
10. Report CMS selected ambulatory clinical quality measures successfully. (Eliminated for Stage 2.)
11. Implement one clinical decision support rule relevant to specialty or high clinical priority and be able to track compliance. (Eliminated for Stage 2, but measures must still be submitted.)
12. Provide an electronic copy of health information to at least 50 percent of patients who request one within three business days. (Stage 2 allows four business days to give timely access to health information, but adds a requirement for more than 5 percent of all unique patients seen to be able to view, download or transmit to a third party health information electronically.)
13. Provide clinical summaries to patients for more than 50 percent of all office visits within three business days. (Reduced to one day for stage 2.)
14. Protect electronic health information created or maintained by the certified EHR by conducting a security risk analysis and implementing security updates necessary and correcting deficiencies (Includes requirement to address encryption and security of data in stage 2).

Here are the 10 additional menu objectives, of which five must be met to earn a bonus:

1. Implement drug formulary checks for the entire EHR reporting period. (Eliminated for Stage 2.)
2. Incorporate clinical lab test results into the EHR for more than 40 percent of all lab tests ordered. (Increases to 55 percent for stage 2).
3. Generate a minimum of one list of patients with a specific condition to use for quality improvement, reduction of disparities, research or outreach. (Unchanged in stage 2).
4. Send reminders for more than 20 percent of all unique patients for preventive or follow up care, in the manner preferred by the patient. (Requires reminders for follow up or preventive care to 10 percent of all patients with two or more office visits in the previous two years in stage 2).
5. Provider more than 10 percent of unique patients with timely (within four business days of being updated in the EHR) electronic access to their health information. (Eliminated for Stage 2.)
6. Provide patient-specific education resources to more than 10 percent of unique patients seen. (Resources must be identified by certified EHR in stage 2).
7. Medication reconciliation is performed for more than 50 percent of patients transitioned in from another setting or provider. (Unchanged in stage 2).
8. Provider a summary of care referral more than 50 percent of the time when a patient is transitioned to another provider or care setting. (Stage 2 adds requirements to electronically transmit summary of care to recipient via EHR or facilitated data exchange for 10 percent of transitions and referrals and conduct at least one successful exchange to a provider with a different developer’s EHR technology or conduct one or more tests with CMS designated EHR).
9. Test to see if immunization data can be submitted electronically to an immunization registry, with at least one follow up if the test is successful. (Successful ongoing data exchange required for stage 2).
10. Capacity to submit surveillance data to public health agencies demonstrated by performing one test and a follow-up if the test is successful. (Successful ongoing data exchange required for stage 2).

Here are the new measures for stage 2:

• Use secure electronic messaging to the EHR to communicate with more than 5 percent of unique patients seen.
• Enter at least one electronic note edited and signed by the provider for more than 30 percent of unique patients.
• Imaging results including the image itself and any explanation or accompanying information are available for more than 10 percent of all scans and tests ordered by the provider for patients seen during the EHR reporting period.
• Record patient family health history as structured data for more than 20 percent of all unique patients.

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