Have you been participating in Medicare’s or Medicaid’s electronic health records incentive program? If not, you are leaving money on the table—or in the government’s bank. Incentive payments still available could total up to $24,000. But that’s not all you’re missing by not achieving meaningful use of certified electronic health records (EHR) technology (CEHRT).
“Starting in 2015, if you participate in Medicare you face the possibility of having your Medicare payments reduced with a negative payment adjustment if you are not making meaningful use of certified EHR technology,” warns Washington, D.C. health care attorney at Alston & Bird, Paula Stannard, a former HHS deputy general counsel and acting general counsel. That negative payment adjustment starts at 1% and can increase if you continue to fail to demonstrate meaningful use. We’ll tell you what you need to do and the deadlines you need to meet to avoid that reduction.
What is meaningful use?
Meaningful use is fairly self explanatory. The program encourages meaningful use of electronic health records to improve patient care. The incentive program sets criteria for meaningful use of CEHRT that must be met to receive the incentive payment. There are three stages to the incentive program over the course of several years, each stage building on the prior stage. Stage 2 began this year (except for professionals just entering the program this year, who would start at Stage 1). Stage 3 is scheduled to begin in 2016.
Stage 1 focused on collecting data in a standardized format and using it to track clinical conditions and share that information to coordinate care.
Stage 2 focuses on meaningful use of data and encourages use of IT for continuous quality improvement and sharing information.
Stage 3 will focus on improving quality, patient access and sharing information through health information exchange.
Who must participate?
Eligible professionals who can participate in the Medicare incentive program, and who risk payment reductions starting in 2015 if they are not meaningful EHR users, include
- doctors of medicine, osteopathy, dental surgery or dental medicine,
- podiatrists,
- optometrists, and
- chiropractors.
Hospitals must also participate but we’ll focus on just physicians for purposes of this article.
In group practices, each individual doctor may qualify but can only get one incentive payment regardless of whether he practices in multiple locations or groups.
Click here to check if you are eligible
Who doesn’t have to participate?
Hospital-based professionals and other providers not included in the Medicare list of eligible professionals aren’t obligated to participate in meaningful use of CEHRT. Hospital based professionals are those who perform 90% or more of their services in a hospital inpatient setting or emergency room (Place of Service codes 21 and 23, respectively).
Even eligible professionals may not have to participate in the incentive program or be meaningful EHR users by the 2014 deadlines if they qualify for a hardship exception. The hardship exception applies to the following situations:
- Professional lacks internet access or has other barriers to getting IT infrastructure (such as lack of broadband access).
- Newly practicing professionals.
- Unforeseen circumstances such as natural disaster (but these are subject to case-by-case review).
- Professional has limited ability to interact with patients, or practices at multiple locations with a lack of control over availability of CEHRT at practice locations where the professional has 50% or more of his/her patient encounters.
- The professional’s EHR vendor is unable to get 2014 certification or certification delays rendered the professional unable to implement meaningful use.
For more information see CMS’s Payment Adjustments & Hardship Exceptions” Guide and its Payment Adjustments & Hardship Exceptions Tipsheet for Eligible Professionals” (March 2014).
What are the deadlines?
The year 2014 is the last chance for eligible professionals not only to register for an incentive payment but also to avoid any negative adjustment to their future Medicare payments for services. Eligible professionals must continue to be meaningful EHR users every year to avoid negative Medicare payment adjustments in subsequent years, says Stannard. A professional who fails to demonstrate meaningful use in one year (and is accordingly subject to a negative adjustment in a subsequent year) could thereafter become a meaningful user and avoid future negative payment adjustments, she adds.
July 1, 2014 is the hardship exception deadline for Medicare eligible professionals. If you aren’t eligible for the hardship exception, this is also the last date to begin your 90 day period for which you must demonstrate and attest to meaningful use if you are a new participant in the incentive program. If you don’t start demonstrating meaningful use by this date, you will not be able to attest to meaningful use for 90 days in 2014 in time to avoid the payment adjustment beginning in 2015.
October 1, 2014 is the last day for newly participating eligible professionals to submit their attestation for their 90-day reporting period for the 2014 reporting year to avoid the payment adjustment.
December 31, 2014 is the end of the 2014 calendar year reporting period for eligible professionals.
In 2015, Medicare payment adjustments will start for all eligible professionals who have not demonstrated meaningful use and who didn’t qualify for the hardship exception.
February 28, 2015 is the latest date for eligible professionals to report 2014 data if they already previously reported for 2013.
Get started now if you aren’t already a meaningful user
“It’s daunting to know where to start,” acknowledges Stannard. But it can be done. The first steps are assessing the practice readiness and the practice needs, she says. “It’s a progression in terms of the requirements and someone starting this year has some more leeway than someone who has been participating for a couple of years,” says Stannard.
First, get provider buy-in: As the office manager, “you need to convince the medical providers that this is something that will actually help them with their practice. The first hurdle is getting that buy-in,” says Stannard. “It’s a lot easier to make the jump from having EHR to making meaningful use if you persuade physicians and nurses that this will be helpful and not harm the practice,” she explains.
Why might the office manager encounter resistance or lack of buy-in from the clinical staff? “It’s a change in the way they have been doing things for a very long time,” explains Stannard. “Human nature is resistant to change,” she says. “They may also fear it is taking away from patient interaction,” adds Stannard.
So, emphasize the benefits of electronic records. “The whole goal of EHRs is to make sure health care providers have the information they need at the point of care to properly treat their patients,” says Stannard, “and a properly implemented EHR should provide that information and enhance patient care.”
The Office of the National Coordinator has resources that can help get you started on implementing your practice’s EHR and meaningful use and includes success stories that can convince providers of the benefits, recommends Stannard.
Get certified EHR technology: In order to participate in the incentive programs and avoid payment adjustments, you need a certified EHR system. CMS says the system must store data in a “structured format” which allows it to be easily used, accessed and transferred. The Office of the National Coordinator for Health Information (ONC) created standards for certification of EHR technology. Certification ensures your system has the necessary functions, security, capability and compatibility with other systems to satisfy the meaningful use requirements.
If you are just getting started and you don’t have a certified EHR, get an IT vendor to help you determine, based on your practice, what the best EHR solution will be for your practice, advises Stannard. “Depending on the size and focus of your practice, the best solution for your practice may be different than for another practice,” she explains. You can also seek help or advice from your trade association, and the Office of the National Coordinator has some regional based programs to offer assistance to providers, says Stannard.
Finally, you need to check ONC’s website to be sure your system has the right certification. If you register for meaningful use or go to submit your attestation, you’ll need a certification ID, which is a unique number you get from the ONC website. Note that it is not the same number that your vendor gets issued.
If your EHR technology is certified, achieve meaningful use: If you already have a certified EHR system, but aren’t yet participating in a meaningful use program, educate yourself about what your practice will need to do to show meaningful use, instructs Stannard. Each stage of meaningful use has its own objectives and measures that must be satisfied. Review CMS’s Meaningful Use website for the objectives and measures applicable to the appropriate stage for your practice.
Report Clinical Quality Measures (CQMs)
Professionals must also report clinical quality measures (CQMs). In 2014, all professionals regardless of the stage of meaningful use must report 2014 CQMs in the Stage 2 rule, which for physicians includes 9 measures. The CQMs help measure and track issues such as outcomes, clinical processes, safety, coordination of care, efficient resource use and other aspects of healthcare services to monitor quality of care. Eligible professionals are required to gather data regarding CQM using their CEHRT and report that data. (See article about CQM reporting and HIPAA).
Also new for 2014 is a requirement that quality measures cover at least 3 of the 6 priority areas that HHS has labeled National Quality Strategy (NQS) domains.
The 6 NQS domains are:
1. Patient and Family Engagement
2. Patient Safety
3. Care Coordination
4. Population/Public Health
5. Efficient Use of Healthcare Resources
6. Clinical Process/Effectiveness
Be prepared for audits
Eligible professionals receiving an incentive payment are subject to audits. So keep all documentation (whether paper or electronic) related to your attestation of meaningful use and clinical quality measures for six years after the attestation. Professionals can be audited both pre- and post-payment. Fraudulent attestations are subject to imprisonment and/or fines. See CMS’s guide “EHR Incentive Programs Supporting Documentation for Audits” (February 2013).
Physicians practicing at multiple locations
If a physician practices in more than one location, he or she must have 50% of their patient encounters occur at a place with certified EHR technology in order to meet the threshold requirement to qualify for the incentive program. The professional then calculates their meaningful use data only with patient encounters at locations with a certified EHR.
A patient encounter is a visit in which medical treatment or evaluation and management service is provided, except in a hospital outpatient department or ER. For more information see CMS’s guide “Guide for Eligible Professionals Practicing in Multiple Locations.”
