Meaningful Use Recommendations Controversial

The Health Information Technology (HIT) Policy Committee reviewed at an Aug. 14 meeting in Washington, D.C. its latest recommendations for how physicians and hospital providers will be able to earn incentives for adoption and meaningful use of certified electronic health record (EHR) technology.

To qualify for a piece of the $19 billion pie set forth in the American Reinvestment and Recovery Act of 2009 (ARRA), “meaningful EHR users” will have to successfully fulfill a long list of objectives and measures over the coming years.

Review of Meaningful Use Definition & Future Plans

The meaningful use matrix and 2011 draft measures approved by National Coordinator for Health IT David Blumenthal, M.D., July 16, infer that eligible providers will have to use computerized order entry (CPOE) for all orders; implement drug-drug, drug allergy, drug-formulary checks; maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or Systematized Nomenclature of Medicine (SNOMED), among other things.

2011 draft quality measures include: percentage of diabetics with A1c under control; percentage of hypertensive patients with blood pressure under control; percentage of smokers offered smoking cessation programs; and percentage of patients with recorded body mass index (BMI)—just to name a few.

Certification/Adoption Workgroup Recommendations

Certification was the hot topic of the meeting. The proposed definition of Health and Human Services (HHS) certification “means that a system is able to achieve the minimum government requirements for security, privacy, and interoperability, and that the system is able to produce the meaningful use results that the government expects. It is not intended to be viewed as a ‘seal of approval’ or an indication of the benefits of one system over another.”

Health IT Policy Committee member Marc Probst, Intermountain Healthcare, said, “Nothing on this definition has changed. This is still what we believe certification is and it is focused very much on meaningful use, and that this is not intended to be the seal of approval process.”

Of the five certification recommendations discussed at the meeting, however, improving objectivity and transparency of the certification process by allowing multiple certification organizations other than the Certification Commission for Health Information Technology (CCHIT) had some attendees voicing their concerns at the end of the meeting.

For meeting specifics, view the Aug. 14 meeting materials, available on the Health IT Web site. A (very) rough draft transcript of the meeting is also available on Brian Ahier’s Blog site.

EHR Adoption/Incentives Timeline

As you can see in the chart below, physicians and providers who adopt an EHR in a meaningful way (as yet to be determined) by 2011 or 2012 will earn $18,000 their first year and qualify for the full $44,000 incentive by 2015 or 2016. Incentive payments for late adopters start to phase out thereafter and are no longer offered after 2014, when EHR adoption is expected to be complete.

EHR Adoption

2011

2012

2013

2014

2015

2016

Total Incentive

2011

18,000

12,000

8,000

4,000

2,000


44,000

2012


18,000

12,000

8,000

4,000

2,000

44,000

2013



15,000

12,000

8,000

4,000

39,000

2014




12,000

8,000

4,000

24,000

The Centers for Medicare & Medicaid Services (CMS) will use the HIT Policy Committee recommendations to develop regulations that will govern the initial year of the incentives program, including a meaningful use definition for 2011. The proposed rule, with a 60-day period for public comment, is targeted for publication by yearend.

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