On Aug. 23, 2012, the federal Centers for Medicare & Medicaid Services (CMS) issued the final rule for Stage 2 meaningful use (www.ofr.gov/OFRUpload/OFRData/2012-21050_PI.pdf) under the American Recovery and Reinvestment Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act.
Federal officials note in the rule, “In the Stage 1 final rule we outlined Stage 1 meaningful use criteria, we finalized a separate set of core objectives and menu objectives for EPs [eligible professionals], eligible hospitals, and CAHs [critical-access hospitals]. EPs and hospitals must meet the measure or qualify for an exclusion to all 15 core objectives and five out of the 10 menu objectives in order to qualify for an EHR incentive payment.”
The text continues: “In this final rule, we maintain the same core-menu structure for the program for Stage 2. We are finalizing that EPs must meet the measure or qualify for an exclusion to 17 core objectives and three of six menu objectives. We are finalizing that eligible hospitals and CAHs must meet the measure or qualify for an exclusion to 16 core objectives and three of six menu objectives.”
The feds also note in the rule, “Nearly all of the Stage 1 core and menu objectives are retained for Stage 2. The ‘exchange of key clinical information’ core objective from Stage 1 was re-evaluated in favor of a more robust ‘transitions of care’ core objective in Stage 2, and the ‘Provide patients with an electronic copy of their health information’ objective was removed because it was replaced by a ‘view online, download, and transmit’ core objective. There are also multiple Stage 1 objectives that were combined into more unified Stage 2 objectives, with a subsequent rise in the measure threshold that providers must achieve for each objective that has been retained from Stage 1.”
The final rule “outlines a process by which EPs, eligible hospitals, and CAHs will submit CQM data electronically, reducing the associated burden of reporting on quality measures for Providers. EPs will submit nine CQMs from at least three of the National Quality Strategy domains out of a potential list of 64 CQMs across six domains. We are recommending a core set of nine CQMs focusing on adult populations with a particular focus on controlling blood pressure. We are also recommending a core set of nine CQMs for pediatric populations,” the officials note in the rule.
Federal officials note that while “Medicare payment adjustments are required by statute to take effect in 2015, we are finalizing a process by which payment adjustments will be determined by a prior reporting period. Therefore, we specify that EPs and eligible hospitals that are meaningful EHR users in 2013 will avoid payment adjustment in 2015. Also, if such providers first meet meaningful use in 2014, they will avoid the 2015 payment adjustment, if they are able to demonstrate meaningful use at least three months prior to the end of the calendar (for EPs) or fiscal year (for eligible hospitals) and meet the registration and attestation requirement by July 1, 2014 (for eligible hospitals) or October 1, 2014 (for EPs)."
Transitions of care
Among the features of the final rule include strengthened proposed provisions for health information exchange during transitions of care and providing patients with access to their health information, which have been retained from the proposed rule; but what had been a requirement that providers send a summary of care record for more than 65% of transitions of care and referrals has been pared back to 50% in the final rule. Meanwhile, eligible providers will be required to use secure messaging for patient-provider communication, and hospitals will be required to track medications from order to administration using tools in concert with an electronic medication administration record (eMAR).