CMS updates measures for ED patients
The Centers for Medicare & Medicaid Services (CMS) has updated a frequently asked question (FAQ) regarding meaningful use eligibility and inpatients admitted through the emergency department (ED). According to the update, there are now two methods for calculating ED admissions for the denominators for measures associated with Stage 1.
The updated answer was given in response to this question: “A number of measures for meaningful use objectives for eligible hospitals and critical access hospitals (CAHs) include patients admitted to the ED. Which ED patients should be included in the denominators of these measures for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs?”
The denominator was to include “visits to the ED of sufficient duration and complexity that all of the meaningful use objectives for which the ED is included would be relevant.” Eligible hospitals and CAHs should count in the denominator inpatients admitted through the ED, as well as patients who initially present to the ED and who are treated in the ED’s observation unit or who otherwise receive observation services, CMS stated in its original response.
Since that response was issued, CMS has received questions regarding which observation services should be included, and observations that the plain language of the regulation would allow for a reading that counts all ED visits, and not just those identified in the Sept. 17 FAQ.
“Therefore, we are revising our FAQ to allow eligible hospitals and CAHs, as an alternative, for Stage 1 of meaningful use, to use a method that is consistent with the plain language of the regulation,” the Dec. 1 update states. “There are two methods for calculating ED admissions for the denominators for measures associated with Stage 1 of meaningful use objectives. Eligible hospitals and CAHs must … choose either the ‘Observation Services method’ or the ‘All ED Visits method’ to be used with all measures.”
Providers cannot calculate denominator of some measures using one method and use the other for the denominator of other measures. Before attesting, eligible hospitals and CAHs must indicate which method they used in the calculation of denominators, the updated FAQ states.
Under the observation services method, the denominator should include the following visits to the ED:
"Under the All ED Visits method, an alternate method for computing admissions to the ED is to include all ED visits (POS 23 only) in the denominator for all measures requiring inclusion of ED admissions,” the updated FAQ stated. All actions taken in the inpatient or ED of the hospital would count for purposes of determining meaningful use.
The updated FAQ is published here.
The updated answer was given in response to this question: “A number of measures for meaningful use objectives for eligible hospitals and critical access hospitals (CAHs) include patients admitted to the ED. Which ED patients should be included in the denominators of these measures for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs?”
The denominator was to include “visits to the ED of sufficient duration and complexity that all of the meaningful use objectives for which the ED is included would be relevant.” Eligible hospitals and CAHs should count in the denominator inpatients admitted through the ED, as well as patients who initially present to the ED and who are treated in the ED’s observation unit or who otherwise receive observation services, CMS stated in its original response.
Since that response was issued, CMS has received questions regarding which observation services should be included, and observations that the plain language of the regulation would allow for a reading that counts all ED visits, and not just those identified in the Sept. 17 FAQ.
“Therefore, we are revising our FAQ to allow eligible hospitals and CAHs, as an alternative, for Stage 1 of meaningful use, to use a method that is consistent with the plain language of the regulation,” the Dec. 1 update states. “There are two methods for calculating ED admissions for the denominators for measures associated with Stage 1 of meaningful use objectives. Eligible hospitals and CAHs must … choose either the ‘Observation Services method’ or the ‘All ED Visits method’ to be used with all measures.”
Providers cannot calculate denominator of some measures using one method and use the other for the denominator of other measures. Before attesting, eligible hospitals and CAHs must indicate which method they used in the calculation of denominators, the updated FAQ states.
Under the observation services method, the denominator should include the following visits to the ED:
- The patient is admitted to the inpatient setting through the ED. In this situation, the orders entered in the ED using certified EHR technology would count for purposes of determining the computerized provider order entry (CPOE) meaningful use measure. Similarly, other actions taken within the ED would count for purposes of determining meaningful use.
- The patient initially presented to the ED and is treated in the ED’s observation unit or otherwise receives observation services. Details on observation services can be found in the Medicare Benefit Policy Manual, Chapter 6, Section 20.6. Patients who receive observation services under both POS 22 and POS 23 should be included in the denominator.
"Under the All ED Visits method, an alternate method for computing admissions to the ED is to include all ED visits (POS 23 only) in the denominator for all measures requiring inclusion of ED admissions,” the updated FAQ stated. All actions taken in the inpatient or ED of the hospital would count for purposes of determining meaningful use.
The updated FAQ is published here.