Meaningful Use Stage-1

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  • Logo: EHR Incentive Programs (Tagline: Connecting America for Better Health) Logo: CMS – Centers for Medicare and Medicaid Services
  • NPRM vs. Final Rule Meet all MU reporting objectives vs. Must meet “core set”/can defer 5 from optional “menu set” 25 measures for EPs/23 for eligible hospitals vs. 25 measures for EPs/24 for eligible hospitals Measure thresholds range from 10% to 80% of patients or orders (most at higher range) vs. Measure thresholds range from 10% to 80% of patients or orders (most at lower to middle range) Denominators – To calculate the threshold, some measures required manual chart review vs. Denominators – No measures require manual chart review to calculate threshold (Speaker Note: Manual chart review including the counting of orders. For the final rule, the only counting that would be required would be to know the number of patients seen or admitted during the EHR reporting period. All other denominators can be obtained automatically using certified EHR technology. ) Administrative transactions (claims and eligibility) included vs. Administrative transactions removed Measures for Patient-Specific Education Resources and Advanced Directives discussed but not proposed vs. Measures for Patient-Specific Education Resources and Advanced Directives (for hospitals) included
  • NPRM vs. Final Rule, continued States could propose above/beyond MU floor, but not with additional EHR functionality vs. States’ flexibility with Stage 1 MU is limited to seeking CMS approval to require 4 public health-related objectives to be core instead of menu Core CQM and specialty measure groups for EPs vs. Modified Core CQM and removed specialty measure groups for EPs 90 CQM total for EPs vs. 44 CQM total for EPs – must report total of 6 35 CQM total for eligible hospitals and 8 alternate Medicaid CQM vs. 15 CQM total for eligible hospitals 5 CQM overlap with CHIPRA initial core set vs. 4 CQM overlap with CHIPRA initial core set
  • Core Set CQM for EPs Hypertension: Blood Pressure Measurement (NQF 0013) Preventive Care and Screening Measure Pair: a) Tobacco Use Assessment b) Tobacco Cessation Intervention (NQF 0028) Adult Weight Screening and Follow-up (NQF 0421, PQRI 128)
  • Alternate Core CQM Set for EPs Weight Assessment and Counseling for Children and Adolescents (NQF 0024) Preventive Care and Screening: Influenza Immunization for Patients > 50 Years old (NQF 0041, PQRI 110) Childhood Immunization Status (NQF 0038)
  • Other Medicare Incentive Program -- Eligible for HITECH? Medicare Physician Quality Reporting Initiative (PQRI) -- Yes, if the EP is eligible. Medicare Electronic Health Records Demonstration (EHR Demo) -- Yes, if the EP is eligible. Medicare Care Management Performance Demonstration (MCMP) -- Yes, if the practice is eligible. The MCMP demo will end before EHR incentive payments are available. Electronic Prescribing (eRx) Incentive Program -- If the EP chooses to practice in the Medicare EHR Incentive Program, they cannot participate in the Medicare eRx Incentive Program simultaneously in the same program year. If the EP chooses to participate in the Medicaid EHR Incentive Program, they can participate in the Medicare eRx Incentive Program simultaneously.
  • Meaningful Use Stage-1

    1. 1. Medicare & Medicaid EHRIncentive Program Final Rule Implementing the American Recovery & Reinvestment Act of 2009
    2. 2. The Journey to Meaningful UseFaith is the bird that sings when the dawn is still dark.  Rabindranath Tagore 2
    3. 3. Overview• American Recovery & Reinvestment Act (Recovery Act) – February 17, 2009• Medicare & Medicaid Electronic Health Record (EHR) Incentive Program Notice of Proposed Rulemaking (NPRM) • Display – December 30, 2009 • Publication – January 13, 2010• Final Rule on Display – July 13, 2010• Final Rule Published – July 28, 2010 3
    4. 4. What did not change in the final rule• Adopted statutory provider eligibility and payment requirements• Meaningful Use matrix goals remained the same.• Hospital definition did not change.• EPs will still be required to demonstrate MU individually• Clinical quality measures reporting timeline will stay the same• MU reporting period of 90 days for first year and one year thereafter. 4
    5. 5. What Changed from the NPRMto the Final Rule?• Meaningful Use Criteria• Clinical Quality Measures• Hospital-based EPs• Medicaid acute care hospitals• Medicaid patient volume• Removed reporting period for adopt, implement or upgrade (Medicaid)• All programs will start in 2011• More clarification throughout 5
    6. 6. Changes to Provider Eligibility• Due to recent legislation, hospital-based EPs are only those who see more than 90% of their patients in a hospital in-patient or ER setting• Medicaid included critical access hospitals in its definition of “acute care hospital” (but incentive is like other acute care hospitals, not following the Medicare CAH formula) 6
    7. 7. Medicaid Patient VolumeMedicaid EP participation hinges on patient volume requirements.• Medicaid patient volume was significantly clarified • Expanded definition of “encounter” to include any encounter for which Medicaid had any payment liability e.g. premiums, co-pays, waivers • Allows States to define patient volume as just encounters or encounters plus patient panel (managed care), both or propose a new methodology 7
    8. 8. Meaningful Use: Process of Defining• National Committee on Vital and Health Statistics (NCVHS) hearings• HIT Policy Committee (HITPC) recommendations• Listening Sessions with providers/organizations• Public comments on HITPC recommendations• Comments received from the Department and the Office of Management and Budget (OMB)• Revised based on public comments on the NPRM 8
    9. 9. Meaningful Use Stage 1 –Health Outcome Priorities*• Improve quality, safety, efficiency, and reduce health disparities• Engage patients and families in their health care• Improve care coordination• Improve population and public health• Ensure adequate privacy and security protections for personal health information*Adapted from National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America’s Healthcare. Washington, DC: National Quality Forum; 2008. 9
    10. 10. Meaningful Use: Changes fromthe NPRM to the Final RuleNPRM Final RuleMeet all MU reporting objectives Must meet “core set”/can defer 5 from optional “menu set”25 measures for EPs/23 measures for 25 measures for EPs/24 for eligibleeligible hospitals hospitalsMeasure thresholds range from 10% to Measure thresholds range from 10% to80% of patients or orders (most at higher 80% of patients or orders (most at lowerrange) to middle range)Denominators – To calculate the Denominators – No measures requirethreshold, some measures required manual chart review to calculatemanual chart review thresholdAdministrative transactions (claims and Administrative transactions removedeligibility) includedMeasures for Patient-Specific Education Measures for Patient-Specific EducationResources and Advanced Directives Resources and Advanced Directives (fordiscussed but not proposed hospitals) included 10
    11. 11. Meaningful Use: Changes fromthe NPRM to the Final Rule, cont’dNPRM Final RuleStates could propose requirements States’ flexibility with Stage 1 MU isabove/beyond MU floor, but not with limited to seeking CMS approval toadditional EHR functionality require 4 public health-related objectives to be core instead of menuCore clinical quality measures (CQM) Modified Core CQM and removedand specialty measure groups for EPs specialty measure groups for EPs90 CQM total for EPs 44 CQM total for EPs – must report total of 635 CQM total for eligible hospitals and 15 CQM total for eligible hospitals8 alternate Medicaid CQM5 CQM overlap with CHIPRA initial core 4 CQM overlap with CHIPRA initial coreset set 11
    12. 12. How were MU Core Objectives Selected?• Overarching considerations • Statutory requirements-e.g.- e-prescribing, CQM, health information exchange • Foundational objectives-e.g. privacy and security and those that provide foundational data needed for other measures, like demographics, medication lists, etc. • Patient-centered • Patient access- e.g. clinical summaries • Patient safety-e.g.-drug-drug and drug-allergy features) • Part of providers’ “normal” practice• Looked at how the objectives aligned• Feedback received from HIT Policy Committee and commenters 12
    13. 13. Meaningful Use: Denominators• Two types of percentage based measures are included to address the burden of demonstrating MU 1. Denominator is all patients seen or admitted during the EHR reporting period • The denominator is all patients regardless of whether their records are kept using certified EHR technology 1. Denominator is actions or subsets of patients seen or admitted during the EHR reporting period 13
    14. 14. Meaningful Use: Applicability ofObjectives and Measures• Some MU objectives are not applicable to every provider’s clinical practice, thus they would not have any eligible patients or actions for the measure denominator.• In these cases, the EP, eligible hospital or CAH would be excluded from having to meet that measure • Ex: Dentists who do not perform immunizations; Chiropractors do not e-prescribe • The denominator only includes patients, or actions taken on behalf of those patients, whose records are kept using certified EHR technology 14
    15. 15. How were the Thresholds Selected• 80%-Objective part of standard practice-e.g.- maintain active medication list• Others-defined on a case-by-case basis based on commenter or clearance feedback• Example-e-prescribing set at 40% lowered from 75% to address concerns by commenters regarding non-participation by pharmacies and patient preference. 15
    16. 16. Meaningful Use – Stage 1 Core SetHealth Stage 1 Objective Stage 1 MeasureOutcomesPolicyPriorityImproving Use CPOE for medication orders directly entered by More than 30% of unique patients with at least onequality, any licensed healthcare professional who can enter medication in their medication list seen by the EP orsafety, orders into the medical record per state, local, and admitted to the eligible hospital or CAH have at leastefficiency, professional guidelines one medication entered using CPOEand Implement drug-drug and drug-allergy interaction The EP/eligible hospital/CAH has enabled thisreducing checks functionality for the entire EHR reporting periodhealthdisparities EP Only: Generate and transmit permissible More than 40% of all permissible prescriptions written prescriptions electronically (eRx) by the EP are transmitted electronically using certified EHR technology Record demographics: preferred language, gender, More than 50% of all unique patients seen by the EP or race, ethnicity, date of birth, and date and admitted to the eligible hospital or CAH have preliminary cause of death in the event of mortality demographics as recorded structured data in the eligible hospital or CAH Maintain up-to-date problem list of current and More than 80% of all unique patients seen by the EP or active diagnoses admitted to the eligible hospital or CAH have at least one entry or an indication that no problems are known for the patient recorded as structured data
    17. 17. Meaningful Use – Stage 1 Core Set, cont’dHealth Stage 1 Objective Stage 1 MeasureOutcomesPolicyPriorityImproving Maintain active medication list More than 80% of all unique patents seen by the EP orquality, admitted to the eligible hospital or CAH have at leastsafety, one entry (or an indication that the patient is notefficiency, currently prescribed any medication) recorded asand structured datareducing Maintain active medication allergy list More than 80% of all unique patents seen by the EP orhealth admitted to the eligible hospital or CAH have at leastdisparities one entry (or an indication that the patient has no known medication allergies) recorded as structured data Record and chart vital signs: height, weight, blood For more than 50% of all unique patients age 2 and over pressure, calculate and display BMI, plot and display seen by the EP or admitted to the eligible hospital or growth charts for children 2-20 years, including BMI CAH, height, weight, and blood pressure are recorded as structured data Record smoking status for patients 13 years old or More than 50% of all unique patients 13 years or older older seen by the EP or admitted to the eligible hospital or CAH have smoking status recorded as structured data Implement one clinical decision support rule and the Implement one clinical decision support rule ability to track compliance with the rule Report clinical quality measures to CMS or the States For 2011, provide aggregate numerator, denominator, and exclusions through attestation; For 2012, electronically submit clinical quality measures
    18. 18. Meaningful Use – Stage 1 Core Set, cont’dHealth Stage 1 Objective Stage 1 MeasureOutcomesPolicyPriorityEngage Provide patients with an electronic copy of their More than 50% of all unique patients of the EP, eligiblepatients and health information (including diagnostic test results, hospital or CAH who request an electronic copy of theirfamilies in problem list, medication lists, medication allergies, health information are provided it within 3 businesstheir discharge summary, procedures), upon request dayshealthcare Hospitals Only: Provide patients with an electronic More than 50% of all patients who are discharged from copy of their discharge instructions at time of an eligible hospital or CAH who request an electronic discharge, upon request copy of their discharge instructions are provided it EPs Only: Provide clinical summaries for each office Clinical summaries provided to patients for more than visit 50% of all office visits within 3 business daysImprove care Capability to exchange key clinical information (ex: Performed at least one test of the certified EHRcoordination problem list, medication list, medication allergies, technology’s capacity to electronically exchange key diagnostic test results), among providers of care and clinical information patient authorized entities electronicallyEnsure Protect electronic health information created or Conduct or review a security risk analysis per 45 CFRadequate maintained by certified EHR technology through the 164.308(a)(1) and implement updates as necessary andprivacy and implementation of appropriate technical capabilities correct identified security deficiencies as part of thesecurity EP’s, eligible hospital’s or CAH’s risk managementprotections processfor personalhealthinformation
    19. 19. Meaningful Use – Stage 1 Menu SetHealth Stage 1 Objective Stage 1 MeasureOutcomesPolicyPriorityImproving Implement drug-formulary checks The EP/eligible hospital/CAH has enabled thisquality, functionality and has access to at least one internal orsafety, external drug formulary for the entire EHR reportingefficiency, periodand reducing Hospitals Only: Record advance directives for More than 50% of all unique patients 65 years old orhealth patients 65 years old or older older admitted to the eligible hospital or CAH have andisparities indication of an advance directive status recorded Incorporate clinical lab-test results into certified EHR More than 40% of all clinical lab test results ordered by technology as structured data the EP, or an authorized provider of the eligible hospital or CAH, for patients admitted during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data Generate lists of patients by specific conditions to Generate at least one report listing patients of the EP, use for quality improvement, reduction of disparities, eligible hospital or CAH with a specific condition research or outreach EPs Only: Send reminders to patients per patient More than 20% of all unique patients 65 years or older preference for preventive/follow-up care or 5 years old or younger were sent an appropriate reminder during the EHR reporting period
    20. 20. Meaningful Use – Stage 1 Menu Set, cont’dHealth Stage 1 Objective Stage 1 MeasureOutcomesPolicyPriorityEngage EPs Only: Provide patients with timely electronic More than 10% of all unique patients seen by the EP arepatients and access to their health information (including lab provided timely (available to the patient within 4families in results, problem list, medication lists, medication business days of being updated in the certified EHRtheir health allergies) within 4 business days of the information technology) electronic access to their healthcare being available to the EP information subject to the EP’s discretion to withhold certain information Use certified EHR technology to identify patient- More than 10% of all unique patients seen by the EP or specific education resources and provide those admitted to the eligible hospital or CAH are provided resources to the patient, if appropriate patient-specific education resourcesImprove care The EP, eligible hospital or CAH who receives a The EP, eligible hospital or CAH performs medicationcoordination patient from another setting of care or provider of reconciliation for more than 50% of transitions of care in care or believes an encounter is relevant should which the patient is transitioned into the care of the EP perform medication reconciliation or admitted to the eligible hospital or CAH The EP, eligible hospital or CAH who receives a The EP, eligible hospital or CAH who transitions or refers patient from another setting of care or provider of their patient to another setting of care or provider of care or refers their patient to another provider of care provides a summary of care record for more than care should provide a summary of care record for 50% of transitions of care and referrals each transition of care or referral
    21. 21. Meaningful Use – Stage 1 Menu Set, cont’dHealth Stage 1 Objective Stage 1 MeasureOutcomesPolicyPriorityImprove Capability to submit electronic data to immunization Performed at least one test of the certified EHRpopulation registries or Immunization Information Systems and technology’s capacity to submit electronic data toand public actual submission in accordance with applicable law immunization registries and follow-up submission if thehealth1 and practice test is successful (unless none of the immunization registries to which the EP, eligible hospital or CAH submits such information have the capacity to receive such information electronically) Hospitals Only: Capability to submit electronic data Performed at least one test of certified EHR on reportable (as required by state or local law) lab technology’s capacity to provide submission of results to public health agencies and actual reportable lab results to public health agencies and submission in accordance with applicable law and follow-up submission if the test is successful (unless practice none of the public health agencies to which the EP, eligible hospital or CAH submits such information have the capacity to receive such information electronically) Capability to submit electronic syndromic Performed at least one test of certified EHR surveillance data to public health agencies and actual technology’s capacity to provide electronic syndromic submission in accordance with applicable law and surveillance data to public health agencies and follow- practice up submission if the test is successful (unless none of the public health agencies to which the EP, eligible hospital or CAH submits such information have the capacity to receive such information electronically)1 Unless an EP, eligible hospital or CAH has an exception for all of these objectives and measures they must complete at least one as part of theirdemonstration of the menu set in order to be a meaningful EHR user.
    22. 22. Future Stages• Intend to propose 2 additional Stages through future rulemaking. Future Stages will expand upon Stage 1 criteria.• Stage 1 menu set will be transitioned into core set for Stage 2• Administrative transactions will be added• CPOE measurement will go to 60%• Will reevaluate other measures – possibly higher thresholds• Stage 3 will be further defined in next rulemaking 22
    23. 23. States’ Flexibility to ReviseMeaningful Use• States can seek CMS prior approval to require 4 MU objectives be core for their Medicaid providers: • Generate lists of patients by specific conditions for quality improvement, reduction of disparities, research or outreach (can specify particular conditions) • Reporting to immunization registries, reportable lab results and syndromic surveillance (can specify for their providers how to test the data submission and to which specific destination) 23
    24. 24. MU for Hospitals that Qualify forBoth Medicare & Medicaid Payments• Applies to sub-section (d) and acute care hospitals• Attest/Report on Meaningful Use to CMS for the Medicare EHR Incentive Program• Will be deemed meaningful users for Medicaid (even if the State has CMS approval for the MU flexibility around public health objectives) 24
    25. 25. Clinical Quality Measures (CQM)Overview• 2011 – EPs, eligible hospitals and CAHs seeking to demonstrate Meaningful Use are required to submit aggregate CQM numerator, denominator, and exclusion data to CMS or the States by attestation. 25
    26. 26. Meaningful Use for EPs who Work atMultiple Sites• An EP who works at multiple locations, but does not have certified EHR technology available at all of them would: • Have to have 50% of their total patient encounters at locations where certified EHR technology is available • Would base all meaningful use measures only on encounters that occurred at locations where certified EHR technology is available• 2012 – EPs, eligible hospitals and CAHs seeking to demonstrate Meaningful Use are required to electronically submit aggregate CQM numerator, denominator, and exclusion data to CMS or the States. 26
    27. 27. CQM: Eligible Professionals• Core, Alternate Core, and Additional CQM sets for EPs • EPs must report on 3 required core CQM, and if the denominator of 1or more of the required core measures is 0, then EPs are required to report results for up to 3 alternate core measures • EPs also must select 3 additional CQM from a set of 38 CQM (other than the core/alternate core measures) • In sum, EPs must report on 6 total measures: 3 required core measures (substituting alternate core measures where necessary) and 3 additional measures 27
    28. 28. CQM: Core Set for EPsNQF Measure Number & PQRI Clinical Quality Measure TitleImplementation NumberNQF 0013 Hypertension: Blood Pressure MeasurementNQF 0028 Preventive Care and Screening Measure Pair: a) Tobacco Use Assessment b) Tobacco Cessation InterventionNQF 0421 Adult Weight Screening and Follow-upPQRI 128 28
    29. 29. CQM: Alternate Core Set for EPsNQF Measure Number & PQRI Clinical Quality Measure TitleImplementation NumberNQF 0024 Weight Assessment and Counseling for Children and AdolescentsNQF 0041 Preventive Care and Screening:PQRI 110 Influenza Immunization for Patients 50 Years Old or OlderNQF 0038 Childhood Immunization Status 29
    30. 30. CQM: Additional Set for EPs1. Diabetes: Hemoglobin A1c Poor Control2. Diabetes: Low Density Lipoprotein (LDL) Management and Control3. Diabetes: Blood Pressure Management4. Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)5. Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)6. Pneumonia Vaccination Status for Older Adults7. Breast Cancer Screening8. Colorectal Cancer Screening9. Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD10. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)11. Anti-depressant medication management: (a) Effective Acute Phase Treatment,(b)Effective Continuation Phase Treatment12. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation13. Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy14. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care15. Asthma Pharmacologic Therapy16. Asthma Assessment17. Appropriate Testing for Children with Pharyngitis18. Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer19. Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients 30
    31. 31. CQM: Additional Set for EPs, cont’d20. Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients21. Smoking and Tobacco Use Cessation, Medical assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies22. Diabetes: Eye Exam23. Diabetes: Urine Screening24. Diabetes: Foot Exam25. Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol26. Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation27. Ischemic Vascular Disease (IVD): Blood Pressure Management28. Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic29. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement30. Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)31. Prenatal Care: Anti-D Immune Globulin32. Controlling High Blood Pressure33. Cervical Cancer Screening34. Chlamydia Screening for Women35. Use of Appropriate Medications for Asthma36. Low Back Pain: Use of Imaging Studies37. Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control38. Diabetes: Hemoglobin A1c Control (<8.0%) 31
    32. 32. CQM: Eligible Hospitals and CAHs1. Emergency Department Throughput – admitted patients Median time from ED arrival to ED departure for admitted patients2. Emergency Department Throughput – admitted patients – Admission decision time to ED departure time for admitted patients3. Ischemic stroke – Discharge on anti-thrombotics4. Ischemic stroke – Anticoagulation for A-fib/flutter5. Ischemic stroke – Thrombolytic therapy for patients arriving within 2 hours of symptom onset6. Ischemic or hemorrhagic stroke – Antithrombotic therapy by day 27. Ischemic stroke – Discharge on statins8. Ischemic or hemorrhagic stroke – Stroke education9. Ischemic or hemorrhagic stroke – Rehabilitation assessment10. VTE prophylaxis within 24 hours of arrival11. Intensive Care Unit VTE prophylaxis12. Anticoagulation overlap therapy13. Platelet monitoring on unfractionated heparin14. VTE discharge instructions15. Incidence of potentially preventable VTE 32
    33. 33. Participation in HITECH and otherMedicare Incentive Programs for EPsOther Medicare Incentive Eligible for HITECH EHR Incentive Program?ProgramMedicare Physician Quality Yes, if the EP is eligible.Reporting Initiative (PQRI)Medicare Electronic Health Yes, if the EP is eligible.Record Demonstration (EHRDemo)Medicare Care Management Yes, if the practice is eligible. The MCMP demo will endPerformance Demonstration before EHR incentive payments are available.(MCMP)Electronic Prescribing (eRx) If the EP chooses to practice in the Medicare EHR IncentiveIncentive Program Program, they cannot participate in the Medicare eRx Incentive Program simultaneously in the same program year. If the EP chooses to participate in the Medicaid EHR Incentive Program, they can participate in the Medicare eRx Incentive Program simultaneously. 33
    34. 34. EHR Incentive Program Timeline• Registration for the EHR Incentive Programs will begin in January 2011• For Medicare providers, attestation for the EHR Incentive Programs will begin in April 2011• EHR incentive payments will be made 11 months after the rule is published*• For Medicaid providers, States may launch their programs in January 2011 and thereafter• November 30, 2011 – Last day for eligible hospitals and CAHs to register and attest to receive an incentive payment for FFY 2011 (Medicare providers)• February 29, 2012 – Last day for EPs to register and attest to receive an incentive payment for CY 2011 (Medicare providers)• 2015 – Medicare payment adjustments begin for EPs and eligible hospitals that are not meaningful users of EHR technology**• 2016 – Last year to receive a Medicare EHR incentive payment; Last year to initiate participation in Medicaid EHR Incentive Program**• 2021 – Last year to receive Medicaid EHR incentive payment** **Statutory 34
    35. 35. More Information• http://www.cms.gov/EHRIncentivePrograms 35

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