CMS Meaningful Use Rule Responsive to ACEP Concerns

By Angela Franklin
ACEP's Director of Quality and Health IT

July 15, 2010

This week, CMS and the Office of the National Coordinator for Health IT (ONC), released two complementary final rules establishing Medicare and Medicaid incentive programs for the meaningful use of electronic health records (EHRs) and establishing initial data standards, implementation specifications and certification criteria for those EHRs.

The rules are expected to be published in the Federal Register on July 28th and will become effective 60 days later.

Highlights and revisions relevant to ACEP and emergency medicine include:

  • Hospital EDs included in CPOE requirement. ACEP asked that computerized provider order entry (CPOE) used for any type of orders that take place in the ED be included in the hospitals meaningful use requirements, as the proposed program did not provide for this.
  • ED throughput measures finalized. ACEP stressed the importance of ED throughput measures in the rule. Two measures around median time for ED arrival to ED departure, and admit decision time to ED departure time for admitted patient have been finalized for hospital and CAH reporting for payment years 2011 and 2012. These are among just 15 measures finalized in the CMS rule.
  • Syndromic surveillance measure remains in Stage 1. ACEP urged that this measure remain in the initial phase of the program as EDs will be a key collection point. The drafters agreed, noting the measure for this objective allows exceptions and allows for the possibility that such electronic exchange of syndromic data may not be possible.
  • “Hospital-based physicians” clarified (emergency physicians remain ineligible for direct incentives—control over hospital systems is at issue). Conforms with the Continuing Extension Act of 2010, which clarified a “hospital-based provider” as performing substantially all of his or her services in an inpatient hospital setting or emergency room only.
  • CAHs are included. Under Medicaid, the final rule includes critical access hospitals (CAHs) in the definition of acute care hospital for the purpose of incentive program eligibility.
  • Billions in incentives to be paid. The final rule’s economic analysis estimates that incentive payments under Medicare and Medicaid EHR programs for 2011 through 2019 will range from $9.7 billion to $27.4 billion.

Dr. David Blumenthal, National Coordinator for Health IT, will be speaking at ACEP’s Scientific Assembly on Sept. 28, and engaging members in a listening session on these topics. 

General revisions to the CMS EHR incentive program (or “meaningful use” rule) include a move from the proposed all or nothing approach, to a more flexible set of core criteria, along with other objectives that clinicians and hospitals may choose from and meet in order to earn financial incentives beginning in 2011.

The revised program is more sensitive to the current adoption levels and implements a phased approach for providers to meet requirements, beginning with “meaningful use based on currently available technological capabilities and providers’ practice experience.” CMS plans to ramp up the required criteria through future rulemaking.

Dr. Blumenthal noted that the new approach builds in flexibility and “allows different providers can take different pathways to achieve meaningful use”.

The ONC Standards and Certification Criteria rule establishes an initial set of required capabilities and related standards and implementation specifications that Certified EHR Technology will need to include to, at a minimum, support the achievement of meaningful use Stage 1 by eligible health care providers under the Medicare and Medicaid EHR Incentive Program regulations. The final rule also coordinates the standards required of EHR systems with the meaningful use requirements for eligible professionals and hospitals.

CMS’ and ONC’s final rules complement two other rules that were recently issued, also intended to spur the meaningful use of health IT, per HITECH. ONC published a final rule June 24 to establish a temporary certification program for health information technology, the Office for Civil Rights announced a proposed rule on July 8 that would strengthen and expand privacy, security, and enforcement protections under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Timetable for Implementation of the Final Rules  

  • July 1, 2010 – ONC began accepting applications from entities that seek approval as an ONC-Authorized Testing and Certification Body (ONC-ATCB).
  • Fall, 2010 – ONC projects that certified EHR software will be available for purchase by hospitals and eligible professionals
  • January 2011 – Registration by both EPs and eligible hospitals with CMS for the EHR incentive program will begin in January 2011. Registration for both the Medicare and Medicaid incentive programs will occur at one virtual location, managed by CMS.
  • April 2011 – For the Medicare program, attestations may be made for both EPs and eligible hospitals.
  • May 2011 – Medicare EHR incentive payments will begin in mid May 2011.
  • States will be initiating their incentive programs on a rolling basis, subject to CMS approval of the State Medicaid HIT plan, which details how each State will implement and oversee its incentive program.


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