HHS Announces Meaningful Use Proposals Toward Final Regulation

The much-anticipated proposals of meaningful use criteria by the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) covering EHR technology capabilities and how providers must utilize it to qualify for ARRA incentives were jointly released late Wednesday afternoon.

It’s clear from their reading that the two dominate themes and goals of the proposed rules are standardization and interoperability, all toward the eventuality of a National Health Information Network.

Meaningful use is “based on currently available technological capabilities and providers’ practice experience,” according to the documents, which also state that “the standards adopted in the rule are consistent with current industry standards.”

That means that basic incentive funding for Medicare and Medicaid pathways - along with the majority of the specific clinical meaningful use functionality EHRs must provide - has not changed from preliminary requirements published earlier in 2009.

What’s new is that the proposals outline a manageable 3-step phasing in of criteria goals beginning in 2011. The first phase focuses on the tracking and exchange of clinical summaries and prescriptions, lab tests and medication information using standard exchange language

Phase 2 expands the standard functionality to include disease management, quality reporting and information exchange with public health agencies, and Phase 3 moves those functions to high priority national healthcare issues.

Also new in the proposals is the announcement that EHRs will be certified specific to meaningful use functionality in 2010, the same year that CMS and ONC expect these proposals to become a final regulation.

The broad goals in front of eligible professional (EP) providers are to improve quality, safety and efficiency, reduce outcome disparities, engage patients, improve coordination of care and ensure privacy.

For EHRs, the proposals focus on securely exchanging information using standard data language for clinical summaries, medical descriptions and test results, for example.

The proposals state that the criteria largely drew on recommendations already compiled from the National Committee on Vital and Health Statistics, which Greenway testified before last April, the Health IT Policy Committee and the Health IT Standards Committee.

Similarly, the provider incentive payment schedule and amounts remain largely the same as earlier recommended. For example within the Medicare incentive pathway, EPs can qualify for the first-year maximum $18,000 incentive whether their first year of meaningful use is 2011 or 2012. A new provision that should further motivate EPs to adopt EHRs is that to qualify for meaningful use incentives, reporting only has to take place for 90 continuous days that first year. Then in following years the reporting period would be the entire year.

These proposals offer a 60-day period for public comment, and Greenway is currently formulating its response. Below are links to the proposals as outlined in Wednesday’s announcement, and to a recent article by ONC Director Blumenthal that appeared in the New England Journal of Medicine.

Medicare Incentive Fact Sheet

Medicaid Incentive Fact Sheet

EHR Meaningful Use Fact Sheet

Launching HITECH by David Blumenthal, M.D., M.P.P.