On Aug. 23, the federal Centers for Medicare & Medicaid Services (CMS) issued the final rule for Stage 2 meaningful use under the American Recovery and Reinvestment Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act.
According to the text of the just-released rule, federal officials note that, “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 Stage 2 final rule maintains the same core-menu structure for meaningful use, but requires that "EPs must meet the measure or qualify for an exclusion to 17 core objectives and three of six menu objectives." Similarly, the rule states that eligible hospitals (psychiatric hospitals and residential treatment centers remain excluded from this category at present) "must meet the measure or qualify for an exclusion to 16 core objectives and three of six menu objectives.
The rule goes on to state that "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.”
Federal officials also noted that “This final rule outlines a process by which EPs and eligible hospitals will submit CQM [care quality management] 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 added.
Another important point: “Medicare payment adjustments are required by statue to take effect in 2015,” federal officials note. “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).
CMS officials took pains to note their careful consideration of the large volume of comments from provider leaders across the industry.
More details are available in the PDF of the rule.