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CMS and ONC Proposed Rules

During the last week of December 2009, the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) announced publication of two important documents outlining proposed rules governing Electronic Health Record (EHR) incentives under the American Reinvestment and Recover Act of 2009 (ARRA).

These proposed rules mark a substantive step toward the final definition of “meaningful use” of Electronic Health Records (EHR) systems by healthcare providers and toward an initial set of standards that must be met by certified EHR technology. While not yet finalized (a 60-day public comment period follows the announcement), the proposed rules give providers and technology vendors alike sufficient guidance to begin finalizing their EHR strategies.

CMS Notice of Proposed Rulemaking (NPRM)

This document defines the proposed criteria for meaningful use that Eligible Professionals (EPs) must achieve in order to be eligible for incentive payments under the HITECH provisions of the ARRA. In the NPRM, CMS identifies three proposed stages of meaningful use criteria:

Stage 1, focuses on the electronic capture and tracking of codified health information, use of data for care coordination purposes, and on reporting of clinical quality measures and health information to CMS. EP’s must complete 25 measures in order to be deemed a “meaningful” EHR user and to qualify for 2011 incentive payments
Stages 2 and 3, to be finalized at a later date, expand on the requirements to include disease and medication management, quality measurement and sharing of data with public health agencies

Q: So, what is meant by “meaningful use” and is there a definition?

A: Meaningful use is a central concept under ARRA/HITECH. Purchasing EHR does not, on its own, qualify you to receive stimulus dollars. A provider must actually make “meaningful use” of this technology, as defined by CMS. The proposed rule announced on December 30 is the closest the federal government has come to defining the term. It consists three stages, the first beginning in 2011 and consisting of 25 measures. At the conclusion of a 60 day public comment period, the final definition will be released.

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ONC Interim Final Rule (IFR)

This document from the ONC outlines initial standards, implementation specifications, and certification criteria applicable to EHR technology. ONC plans to release an additional NPRM specific to the certification of EHR systems.

The IFR describes an initial set of standards that ensures accurate and secure health information exchange across different EHR systems such as:

Standard formats for clinical summaries and prescriptions
Standard terms to describe clinical problems, procedures, lab tests, medications and allergies
Standards for the reliable and secure transportation of the above information

The standards will rely on those already established and promoted by leading standards bodies such as HL7, Integrating the Healthcare Enterprise (IHE) and National Institute of Standards and Technology (NIST).

What does this mean to you?
While the details concerning payment to practices are contained in the proposed CMS rule and subject to change after the 60-day public comment period, here are some important highlights.

There are two CMS incentive programs – Medicare and Medicaid
Eligible Providers (EPs) may only participate in one CMS incentive program, although EPs will have one opportunity to switch programs
Amount and timing of incentive payments will vary depending on when the provider elects to participate and which program they participate in (Medicare or Medicaid). The programs are structured to provide the greatest financial benefit to providers and practices participating from the beginning and for the full duration of the program.
In general, the maximum amount of total incentive payments that an EP can receive is up to $44,000 under the Medicare program and up to $63,750 under the Medicaid program.
To earn incentives for a given payment year, an eligible provider must demonstrate meaningful use during a designated “reporting period”.
For 2011 (the first payment year), Medicare providers need to demonstrate meaningful use for a minimum of 90 consecutive days. Under the proposed rule, the reporting period for the 2011 payment year could begin as early as July 2010 or as late as September 2011.
In subsequent years, demonstration of meaningful use will be required for the full payment year.

What now?
If your practice is not currently utilizing an EHR or you don’t believe your current EHR will meet certification requirements, you should begin actively searching now. It typically takes several months to implement a new system after completing the selection and purchase.