HIT Standards Committee: Meaningful use enters operations phase
The final rule for Stage 1 meaningful use has been published in the Federal Register, marking “the end of just one part of the first cycle that is the first stage of meaningful use,” said Karen Trudel, deputy director of the Office of E-Health Standards & Services at the Centers for Medicare & Medicaid Services (CMS), speaking at the July 27 meeting of the Health IT Standards Committee. “We’re moving away from completely a policy development process to one that is a mixture of policy and operations,” she said.
In that process, what didn’t change in the final rule was “who gets incentive payment and how much do they get,” said Trudel. The meaningful use matrix goals remain the same, although the criteria themselves did change. Eligible professionals are still required to demonstrate meaningful use individually, not as a group. The meaningful use reporting period continues to be 90 days for first year.
Some of the bigger changes include a group start: All the programs will begin in 2011, “simply because it was much easier and we’re going to be using one system to register everyone,” she said.
In addition, because there was a lot of discussion about computation of patient volume for Medicaid, the definition of a patient encounter has been expanded to include any encounter for which Medicaid has any payment liability and states can define patient volume based on their own criteria, according to Trudel.
Although the health outcome priorities are the same, the changes that were made in the final rule allow more flexibility in the core set and menu set. Thresholds have been made more manageable—most are in the low to middle range, said Trudel, adding: “The ones that are higher are high because we believe several of the criteria are current standards of practice, so doing them electronically is not going to be a huge leap.”
Denominators have been scaled down and recalibrated in the measures to either use data that is clearly available in the EHR or include total patient population volumes. Administrative claims and eligibility measures were taken out because practice management systems that do these functions are not well enough integrated with EHRs yet, Trudel said.
Thresholds are as low as 30 high as 80 percent, and were set on a case-by-case basis. For example, e-prescribing was set at 40 percent rather than 75 because not all pharmacies participate, and patients may prefer to have a piece of paper, she said.
The electronic registration system will come up in January 2011: Medicare and Medicaid providers will all register through same system and CMS will keep track in the national level repository (NLR) of everyone’s participation status, which program they’re in, when they were paid, how they attested, and how much we’ve paid out through which program. The attestation program will be effective April 2011, and first payments could go out in May, she said.
CMS is now preparing staff and system development, and engineering the changes in the final rule into the systems, according to Trudel. The NLR registration, attestation and payment modules must be built and tested, and a help desk will be implemented to answer system questions and basic questions about the HITECH Act.
“We’re working toward eventually making all of this a reality and we have six months to do it,” Trudel said.
In that process, what didn’t change in the final rule was “who gets incentive payment and how much do they get,” said Trudel. The meaningful use matrix goals remain the same, although the criteria themselves did change. Eligible professionals are still required to demonstrate meaningful use individually, not as a group. The meaningful use reporting period continues to be 90 days for first year.
Some of the bigger changes include a group start: All the programs will begin in 2011, “simply because it was much easier and we’re going to be using one system to register everyone,” she said.
In addition, because there was a lot of discussion about computation of patient volume for Medicaid, the definition of a patient encounter has been expanded to include any encounter for which Medicaid has any payment liability and states can define patient volume based on their own criteria, according to Trudel.
Although the health outcome priorities are the same, the changes that were made in the final rule allow more flexibility in the core set and menu set. Thresholds have been made more manageable—most are in the low to middle range, said Trudel, adding: “The ones that are higher are high because we believe several of the criteria are current standards of practice, so doing them electronically is not going to be a huge leap.”
Denominators have been scaled down and recalibrated in the measures to either use data that is clearly available in the EHR or include total patient population volumes. Administrative claims and eligibility measures were taken out because practice management systems that do these functions are not well enough integrated with EHRs yet, Trudel said.
Thresholds are as low as 30 high as 80 percent, and were set on a case-by-case basis. For example, e-prescribing was set at 40 percent rather than 75 because not all pharmacies participate, and patients may prefer to have a piece of paper, she said.
The electronic registration system will come up in January 2011: Medicare and Medicaid providers will all register through same system and CMS will keep track in the national level repository (NLR) of everyone’s participation status, which program they’re in, when they were paid, how they attested, and how much we’ve paid out through which program. The attestation program will be effective April 2011, and first payments could go out in May, she said.
CMS is now preparing staff and system development, and engineering the changes in the final rule into the systems, according to Trudel. The NLR registration, attestation and payment modules must be built and tested, and a help desk will be implemented to answer system questions and basic questions about the HITECH Act.
“We’re working toward eventually making all of this a reality and we have six months to do it,” Trudel said.