CMS releases meaningful use proposed rule

The Centers for Medicare and Medicaid Services has laid out the details for how it will raise the bar for healthcare providers to qualify for incentives with the release Feb. 23 of its proposed rule for Stage 2 of meaningful use of electronic health records.

Among its provisions, CMS will delay the start of Stage 2 until 2014 instead of 2013.

As expected, the next stage of meaningful use builds on the criteria of the first stage, including increasing the threshold for performance of existing measures and pushing providers to actually exchange information in various transactions to drive continuous quality improvement.

In Stage 2, CMS said it would keep the same core-menu structure for required measures. Physicians will meet 17 core objectives and three of five menu options. Hospitals will meet 16 core measures and two of four menu options.

Health information exchange will be ramped up to a more “robust transitions of care” core objective, and the measure to provide patients with an electronic copy of their data is replaced by “electronic/online access” as a requirement.

The proposed rule had been widely expected sooner, and agency senior leaders faced disappointed crowds the day before at HIMSS12 without a rule in hand but gave them a “sneak peek” summary of the objectives.

The public will be able to comment on the 455-page proposed rule for 60 days after which CMS will finalize the regulation during the summer.

CMS decided to delay the onset of Stage 2 by one year to 2014 because the original 2013 timeframe does not give vendors enough time to design, develop and test new functionality and providers to deploy it and track measures over the one-year reporting period. As a result, Stage 1 is extended until 2014.

CMS is also trying to make the reporting of quality measures in 2014 easier for providers. For physicians, the clinical quality measures will align with existing quality programs, such as those used for the Physician quality Reporting System and CMS’ Shared Savings Program. For hospitals, the clinical quality measure will line up with the Hospital Inpatient Quality Reporting and the Joint Commission’s hospital quality measures.

Physicians will report 12 clinical quality measures, while hospitals 24. The agency also outlines how providers may electronically submit the quality measures, and. CMS wants public feedback on methods for it, including aggregate-level and group reporting options and through existing quality reporting systems.

Some of the core measures to meet during the reporting period include:
• More than 60 percent of medication, lab and radiology orders created by a provider using computerized physician order entry (CPOE)
• Implement five clinical decision support interventions for five or more clinical quality measures at relevant point in care; use functionality for drug-drug and drug-allergy interaction checks
• More than 55 percent of clinical lab test results whose results are positive/negative or numerical format are incorporated into EHR as structured data
• More than 50 percent of patients seen during reporting period are provided within four business days of visit online access to their information subject to provider’s discretion to withhold certain data
• Provider performs medication reconciliation for more than 65 percent of transitions of care in which patient moves into care of physician or admitted to hospital or ER
• Provider that transitions or refers patient to another care setting or provider supplies summary of care record for more than 65 percent of transitions of care and referrals
• Conduct or review security risk analysis, address encryption or security of data at rest and execute security updates as necessary and correct identified security deficiencies.