The Medicare and Medicaid EHR Incentive Programs are designed to increase physician adoption of health information technology. But they are also pieces of the health reform puzzle, supporting the overarching goals of improving preventive care, increasing documented quality reporting, increasing patient engagement, making data interoperable and accessible, generating cost savings and improving outcomes. The success of other health reform initiatives, such as Accountable Care Organizations (ACOs), bundled payments, Patient-Centered Medical Homes and value-based purchasing, will largely depend on the success a provider has both in adoption of health IT and in performance under the EHR incentive programs as relates to improving health care quality, safety and efficiency.
The EHR Incentive Programs spur physicians to achieve 'Meaningful Use' of EHR technology by applying EHR functionality to meet goals designed to improve quality and efficiency. The programs are designed to accelerate and reward health IT adoption. In Stage 1, physicians are challenged to take the first steps on this roadmap by adopting certified EHR (CEHRT) and demonstrating use of basic functionality to capture patient data.
The proposed criteria for Meaningful Use Stage 2 raise the bar higher and go further to support these overarching goals with tactical CEHRT use for moving data interoperability and reporting data to CMS, the states and/or registries. In the proposal, several Stage 1 menu measures evolve to become core measures, thresholds and scopes are increased, new measures are added and some measures are consolidated into a single comprehensive task. Because of the focus on moving data interoperably, Stage 2 Meaningful Use has been termed the "Infrastructure Wave." For instance, data exchange is ramped up from a mere test to a requirement that summary of care records must be transmitted to unaffiliated organizations using different certified EHR vendors for least 10% of all referrals or transitions of care. The Stage 2 proposal also establishes single transport standards for communicating information in certain transactions, such as care summaries, which supports progress towards a common means of moving health information that is secure and HIPAA-compliant.
The federal government is also seeking movement towards care becoming patient-centered. The Stage 2 proposal advances this aim through patient engagement measure including a requirement that 50 percent of a provider's patients are provided access to online health information for viewing, downloading and/or transferring – typically performed through a Patient Portal. In an unusual and somewhat worrisome add-on, the measure seeks provider promotion of patient usage of this technology by adding a second threshold requiring 10 percent of the provider's patients to actually access this information.
Preventive care is also highlighted in Stage 2 supported by the proposed requirement that providers must send reminders for preventive and follow-up care to at least 10 percent of all patients seen in the last two years. The importance of quality reporting for both comparative effectiveness research and to position for reformation of the Medicare payment system is amplified with the removal of Clinical Quality Measures (CQMs) as a formal requirement in Stage 2. Under the proposed rule, CMS seeks to make the reporting of CQMs inherent with health IT adoption by modifying the very definition of a "Meaningful EHR User" and incorporating CQM reporting therein. To facilitate robust quality reporting, CMS also takes first steps towards aligning its quality reporting programs by offering an option under Stage 2 Meaningful Use for providers to fulfill the CQM reporting obligation by successfully reporting under the CMS EHR Direct PQRS program.
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