I first heard about meaningful use about a year and a half ago. There were news reports of doctors concerned about the implementation of the program. As a new graduate and practice owner, I was concerned how it would affect my practice. I see hardly any Medicare patients so would it really affect me? When I went to research it myself, I found the information to be scattered and incomplete. I hope this guide will make the process more simplistic.
There are differences between the requirements between the Medicare and Medicaid program. This article will focus on the Medicare program.
WARNING / A message from the author and founder– this is a personal experience with meaningful use. We are in no way giving you instructions for how YOU should expect to qualify. We are simply showing you the exact way that the author went about it. You need to understand that it is on you to do this correctly, the author is simply here as a guide and not acting as definitive solution for your meaningful use needs. The author will be happy to help you with this article and in the comments, but proceed at your own risk. As you will see, there are fines for not doing this correctly and the author nor NewGradOptometry, LLC is responsible for those fines. This article is for informational help only. There is no guarantee the article is error free. NewGradOptometry.com, its sponsors, advertisers, staff and writers make no representation, warranty, or guarantee that this article and its contents are error-free and will bear no responsibility or liability for the results or consequences of the information contained within. – Founder NewGradOptometry.com – Matt Geller O.D.
Meaningful Use is a Medicare and Medicaid program that awards incentives for using certified (EHRs) to improve patient care. According to CMS.gov, "To receive an EHR incentive payment, providers have to show that they are meaningfully using their EHRs by meeting thresholds for a number of objectives." Furthermore, providers must "attest" every year in order not to be financially penalized. Penalties as well as incentives are made to individual providers not practices. Starting January 1, 2015 the penalty will be a 1% reduction in Medicare reimbursement payments.
CMS specifically states using an EHR to do the following:
Why should Meaningful Use Matter to a New Grad?
If you are thinking of buying a practice in the near future, you will have to address this if not being done by the current owner and should be part of negotiations.
What are Core Objectives? – 15 objectives everyone MUST meet
- Computerized provider order entry (CPOE)
- Drug-drug and drug-allergy checks
- Maintain an up-to-date problem list of current and active diagnoses
- E-Prescribing (eRx)
- Maintain active medication list
- Maintain active medication allergy list
- Record demographics
- Record and chart changes in vital signs
- Record smoking status for patients 13 years or older
- Report ambulatory clinical quality measures to CMS/States
- Implement clinical decision support
- Provide patients with an electronic copy of their health information, upon request
- Provide clinical summaries for patients for each office visit
- Capability to exchange key clinical information
- Protect electronic health information
What are Menu Objectives? – You must report on 5 of the 10 menu objectives
- One public health objective (two to pick from)
- Drug formulary checks
- Incorporate clinical lab-test results
- Generate lists of patients by specific conditions
- Send reminders to patients for preventive/follow-up care
- Patient-specific education resources
- Electronic access to health information for patients
- Medication reconciliation
- Summary of care record for transitions of care
What are CQMs?
According to CMS.gov, CQMs are "tools that help measure and track the quality of health care services provided by eligible professionals, eligible hospitals and critical access hospitals (CAHs) within our health care system." Your certified EHR will produce a report for you. You must report on 3 core clinical quality measures and 3 additional you pick from another list.
3 Stages of Meaningful Use
Stage 1: Data Capture & Sharing (2011-2012)
Eligible professionals must meet:
- 13 required core objectives
- 5 menu objectives from a list of 9
- Total of 18 objectives
- Also must report on CQM's
- There are no minimum values that you must achieve for clinical quality measures. You only have to report on them, not achieve a benchmark
Stage 2: Advanced Clinical Processes (2014)
- Same as above
- There is also a new requirement in 2014 that the quality measures selected must cover at least 3 of the 6 available National Quality Strategy (NQS) domains, which represent the Department of Health and Human Services’ NQS priorities for health care quality improvement
Stage 3: Improved Outcomes (2016)
A work in progress. Will be updated as the program is updated.
- You must have a certified EMR. To see if your's is certified click here
- Enroll with an electronic prescription service that is compatible with your EHR
- Visit Medicare & Medicaid EHR Incentive program's website to register
- Pick a start date depending on what stage you are in (any 90 days for stage 1, year 1 vs. a quarter for stage 1, year 2 and stage 2)
- Set your clinical decision support rule, patient lists, and your patient-specific education resources before your 90 days starts
- Begin notifying both current and new patients they need to bring with them an updated medications list with dosages
- Allocate someone in the office to record demographics, assign patient's usernames and passwords for access to their records, and send out patient reminders
- Assign technicians to taking vitals(height,weight, bp) and updating all medications with correct dosages and allergies
- Check your EHR's report each day for the first several days to make sure you are meeting each measure
How Do I Get Paid?
That's what you really want to know right? After you have successfully completed your 90 days. Visit here and attest. I advise printing your reports off to make it easier. Plug and chug.
I hope this helps, and I am willing to answer any questions in the comments.