Physician Practice

EHR incentive programs proposed rules seek to create 'smarter' systems

Physician Practice Insider, May 19, 2015

The latest rules proposed this spring for the electronic health records (EHR) incentive programs and related IT certification criteria are aimed at creating a “better, smarter, healthier system,” according to CMS.

CMS and the Office of the National Coordinator for Health Information Technology (ONC) say the changes will increase flexibility, simplify the process for participating physicians and hospitals, promote better practices, improve the way information is shared between systems, and ensure the future sustainability of the programs, thereby improving outcomes for patients.

Various aspects of the incentive program will be streamlined for healthcare providers, certain requirements that are no longer relevant will be eliminated, and more advanced uses of certified EHR technology (CEHRT) will be promoted, according to rules proposed for Stage 3 of the EHR incentive program and the 2015 Edition Health IT Certification Criteria.

The Stage 3 rules would take effect in 2017, giving participating providers the option of entering Stage 3 that year, but CMS wants all providers in the program to operate on the same definition of meaningful use, regardless of whether they’re still at Stage 1 or 2, by 2018. The public comment period in the Federal Register for both rules closes on May 29. Comments can be submitted electronically at

A similar vein of more immediate changes on reporting guidelines are also under consideration for 2015, which CMS Deputy Administrator for Innovation & Quality and Chief Medical Officer Patrick Conway, MD, MSc, explained on The CMS Blog.

“The flow of information is fundamental to achieving a health system that delivers better care, smarter spending, and healthier people. The steps we are taking today will help to create more transparency on cost and quality information, bring electronic health information to inform care and decision making, and support population health,” said U.S. Health and Human Services Secretary Sylvia Burwell in a March 20 statement announcing the proposed rules.

The changes are also in line with working toward a nationwide interoperability roadmap laid out by the ONC earlier this year.

“ONC’s proposed rule will be an integral component in the shared nationwide effort to achieve an interoperable health system,” said Karen DeSalvo, MD, MPH, MSc, national coordinator for health IT. “The certification criteria we have proposed in the 2015 Edition will help achieve that vision through provisions that consider the range of health IT users and uses across the care continuum, including those focused on interoperable standards, data portability, improved transparency, privacy and security capabilities, and increased oversight through ONC’s Health IT Certification Program.”

Some existing program standards, for example, that call for redundant paper-based versions of what are now electronic functions would be removed under the new rules along with other duplicative forms of more advanced measures that can be achieved with CEHRT. In particular, those latter measures focus on health information exchange, consumer engagement and public health reporting.

In recent weeks, CMS has conducted free webinars and other information sessions to bring healthcare professionals up to speed on the proposals. (Access the most recent May 11 webinar “Stage 3/2015 Edition Health IT Certification Criteria Proposed Rules Overview” presentation here.)

A significant change in Stage 3 will be reducing the number of objectives to eight, retaining and modifying some existing objectives from Stage 2, and expanding the scope on others.

The new proposed objectives are as follows:

  • Protect electronic health information
  • Electronic prescribing (eRx)
  • Clinical decision support
  • Computerized provider order entry (CPOE)
  • Patient electronic access to health information
  • Coordination of care through patient engagement
  • Health information exchange
  • Public health reporting

In regard to protecting electronic health information, the new measure calls for eligible professionals to conduct or review a security risk analysis that addresses encryption and security of data stored in CEHRT as well as implement security updates as necessary and correct any identified problem areas.

The scope of patient electronic access, for example, would be expanded so physicians would have to satisfy two measures. One is ensuring more than 80% of all unique patients seen during the EHR reporting period are given access to new information within 24 hours of its availability to the physician, and the other is using clinically relevant data from CEHRT to identify patient-specific educational resources and provide electronic access to those materials for at least 35% of patients.

Making the switch to EHR systems has been a long and costly process for healthcare providers over the past decade. As a way to promote greater use of electronic records, the EHR incentive program for Medicare and Medicaid was created in 2009 under the Health Information Technology for Economic and Clinical Health (HITECH) Act, but it wasn’t until 2011, following the passage and subsequent legal challenges to the Affordable Care Act, that payments actually began to go out to eligible professionals and hospitals.

The voluntary program runs through 2021 and pays incentives for up to six years of participation. Individual physician incentives could total $43,720 for Medicare and $63,750 for Medicaid. CMS says that since 2011, more than 433,000 eligible professionals and hospitals have received incentive payments – that’s about 60% of eligible physicians in Medicare or Medicaid programs and about 95% of eligible hospitals.

The program has progressed in three stages, first establishing basic requirements for electronically capturing and sharing clinical data, such as providing patients with electronic copies of their own health records, then setting numerous objectives in Stage 2 for providers to meet in order to receive incentive payments.

Providers that met those 25 different objectives, such as incorporating lab results into their EHR as discrete data and electronically prescribing medications, were considered meaningful users and awarded incentives. Providers that didn’t meet those goals could have their Medicare payments reduced.
Stage 3, which was unveiled by CMS in March, is expected to be the final stage and would incorporate portions of the prior stages into its meaningful use requirements for providers to qualify for Medicare incentives and avoid those downward payment adjustments under Medicare.

CMS says consolidating requirements into a single stage for all providers was in response to stakeholder input about the complexity of the program, success of certain measures and a need for a long-term sustainability.

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