In late July, the Centers for Medicare and Medicaid Services (CMS) published the “meaningful use” final rule in the Federal Register. The final rule becomes effective September 27, 2010, and, among other things, specifies the initial criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals must meet to qualify for an incentive payment. CMS received more than 2,000 comments to its proposed rule, and based on those comments, made significant changes to several important provisions. Among the highlights:

  • For Stage One, the proposed rule had called on physicians and other eligible professionals to meet 25 objectives (23 for hospitals) in reporting their meaningful use of electronic health records (EHRs). The final rule, however, divides the objectives into a “core” group of required objectives and a “menu set” of procedures from which providers can choose. There are 15 core requirements for eligible professionals and 14 for hospitals. There are 10 discretionary requirements for both EPs and hospitals from which five must be chosen. This two-track approach is intended to ensure that the basic elements of meaningful use will be met by all providers qualifying for incentive payments, while at the same time allowing flexibility in other areas to reflect varying needs.
  • Many thresholds contained in the proposed rule have been reduced. For example, under the proposed rule, providers would have been required to use computerized physician order entry for 80 percent of orders for Eligible Professionals and 10 percent of orders for hospitals. The language in the final rule focuses on order entry of medications and requires that 30 percent of patients with medication orders have at least one medication order entered electronically in a payout year. This requirement applies to both EPs and hospitals.
  • The required clinical quality measures have been reduced to six for eligible professionals and 15 for hospitals. For EPs, there are three core measures required, three alternative core measures, and a choice of three from a pool of discretionary measures. Reporting by attestation is required beginning in 2011, electronic reporting in 2012. Clinical quality measurements for specialists have been eliminated for Stage One.
  • The final rule includes the objective of providing patient-specific educational resources for both EPs and eligible hospitals and the objective of recording advance directives for eligible hospitals.
  • A hospital-based EP is defined as one who performs substantially all of his or her services in an inpatient hospital setting or emergency room only, which conforms to the Continuing Extension Act of 2010.
  • The rule makes final a proposed rule definition that would make individual payments to eligible hospitals identified by their individual CMS Certification Number. The final rule retains the proposed definition of an “eligible hospital” because CMS deems it to be most consistent with how Medicare has applied the statutory definition of a “subsection (d)” hospital under other hospital payment regulations.
  • Under Medicaid, the final rule includes critical access hospitals in the definition of acute care hospital for the purpose of incentive program eligibility.
  • The final rule’s economic analysis estimates that incentive payments under Medicare and Medicaid EHR programs for 2011 through 2019 will range from $9.7 billion to $27.4 billion.

To view the final rule, please click here.