This document discusses changes to Meaningful Use Stage 1 requirements for eligible professionals in 2014. Key changes include reducing the EHR reporting period to 3 months, removing one core objective, modifying measures for CPOE and vital signs, and providing more flexibility for public health objectives and clinical quality measures. Eligible professionals must also upgrade to 2014 certified EHR technology and may be subject to Medicare payment adjustments if Meaningful Use requirements are not met.

1. Meaningful Use Stage 1 Changes
for Eligible Professionals in 2014
Michelle Brunsen, Sr. Health IT Advisor

2. Today’s Objectives
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ARRA Background and Incentive Program Statistics
2014 Timelines for EHR Vendors and Eligible Professionals
Changes to Stage 1 Meaningful Use
Clinical Quality Measures
Payment Adjustments and Hardships
Medicaid Program Specific Changes
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3. BACKGROUND AND STATISTICS
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4. Where Did Meaningful Use Begin?
American Reinvestment and Recovery Act of 2009
“Stimulus Bill”
 HITECH Act: All healthcare providers must adopt electronic
health records by 2015
 CMS EHR Incentive Program established for Meaningful Use
 Office of the National Coordinator Funded 60+ RECs
 ONC Funded the creation of Health Information
Exchanges in every state
 ONC website: www.healthit.hhs.gov
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5. EPs Paid By Medicare or Medicaid
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6. Payments to Eligible Professionals
National Payments as of October 2013
 130,669 payments to Medicaid Eligible Professionals (33.9%)
 255,282 payments to Medicare Eligible Professionals (66.1%)
 Total Medicare and Medicaid payments of $6.428B
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7. Payments to Michigan EPs
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8. Payments to Eligible Professionals
Michigan Payments as of October 2013
 3,365 Medicaid Eligible Professionals have been paid (27.8%)
 8,737 Medicare Eligible Professionals have been paid (72.2%)
 Total Medicare and Medicaid payments to Michigan of $572M
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9. 2014 TIMELINES FOR EHR VENDORS
AND ELIGIBLE PROFESSIONALS
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10. Point to Remember
 Stage 1 is a stepping stone to Stage 2
which is a stepping stone to Stage 3
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11. What is Your Meaningful Use Path?
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12. Starting in 2014
Changes

EHRs Meeting ONC 2014 Standards – Starting in 2014, all
EHR Incentive Program participants will have to adopt
certified EHR technology that meets ONC’s Standards &
Certification Criteria 2014 Final Rule
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13. What does this mean for EPs?
 Pay your annual maintenance/support with your EHR vendor
 Speak with a representative from your EHR vendor to get in
the queue to receive the 2014 upgrade
 Install the 2014 EHR version as soon as possible
 Start educating your patients about the patient portal,
collecting email addresses
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14. 2014 Reporting Period
Reporting Period Reduced to Three Months
 To allow providers time to adopt 2014 certified EHR
technology and prepare for Stage 2
 Regardless of Meaningful Use stage or year
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15. What does this mean for EPs?
 All participants will have one calendar quarter reporting
period in 2014
 Medicare and Medicaid = 1 quarter
 Jan – Mar, Apr – June, July – Sep, Oct – Dec
 Stage 1 Year 1 attesting for first time – MUST attest NO LATER
THAN 10/1/14 to avoid a disincentive and use reporting
period of Q1, Q2 or Q3
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16. CHANGES TO STAGE 1 MEANINGFUL USE
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17. Meaningful Use: Stage 1 in 2014
Eligible Professionals
2013
2014
14 Core Objectives
13 Core Objectives
5 of 10 Menu Objectives
5 of 9 Menu Objectives
19 Total Objectives
18 Total Objectives
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18. Stage 1 Meaningful Use Core Objectives - 2014
Core Set: Must Do All 13
 E-prescribing
 Drug-drug & drug allergy
checks
 Medication list
 Allergy list
 CPOE
 Problem list
 Clinical decision support rule
 Record demographics
 Smoking status
 Vital signs
 Clinical summaries to patient
 View, download & transmit
 Protect health information
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19. Changes to Stage 1: CPOE
Current Stage 1 Measure
Denominator
Unique patient with
at least one
medication in the
medication list
New Stage 1 Option
Denominator
Number of orders
during the EHR
Reporting Period
The optional CPOE denominator is available in 2013 and beyond for Stage 1.
Includes Certified Medical Assistants beginning in 2013.
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20. Changes to Stage 1: Vital Signs in 2014
2013 Stage 1 Measure
Age Limits
Age 2 for BP
and
Height/Weight
Exclusion
All 3 elements
not relevant to
the scope of
practice
2014 Stage 1 Measure
Age Limits
Age 3 for BP,
NO age limit
for
Height/Weight
Exclusion
BP to be
separated from
height/weight
The vital signs changes are required starting in 2014
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21. Changes to Stage 1: Testing of HIE
Current Stage 1 Measure
One test of electronic
transmission of key clinical
information
Stage 1 Measure Removed
Requirement removed for
2013
The removal of this objective is effective in 2013
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22. Changes to Stage 1: View, Download and
Transmit (VDT) Health Information
2013 Stage 1 Objective
Objective
2014 Stage 1 Objective
Provide patients
with e-copy of
health information
upon request
Provide electronic
copy of health
information
Objective
Provide patients
with the ability to
view online,
download and
transmit their
health information
The measure of the new objective is 50 percent of patients have online access to their
information
The change in objective takes effect in 2014 to coincide with the 2014
certification and standards criteria
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23. Changes to Stage 1: eRx and Public Health
 eRX
– Addition of an exclusion: Any EP who does not have a pharmacy
within their organization and there are no pharmacies that accept
electronic prescriptions within 10 miles of the EP’s practice location at
the start of his/her EHR reporting period.
– 2013 onward
 Public Health Objectives
– Addition of “except where prohibited” to the objective text for the
public health objectives
– 2013 onward
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24. Stage 1 Meaningful Use Menu Objectives - 2014
Menu Set: Must do 5 of 9
 Implement drug-formulary
checks
 Generate patient list
 Incorporate clinical labs
 Medication reconciliation
 Send reminder
 Patient-specific education
 Summary of care record
 Submit electronic data to
immunization registry*
 Submit electronic syndromic
surveillance data*
*At least one public health objective
must be selected.
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25. CLINICAL QUALITY MEASURES
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26. How Do CQMs Relate to the CMS
Incentive Programs?
 Although reporting CQMs is no longer a core objective of the
EHR Incentive Programs, all providers are required to report
on CQMs in order to demonstrate meaningful use
 In 2014 and beyond, reporting programs (i.e., PQRS, eRx
reporting) will be streamlined in order to reduce provider
burden
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27. CQMs in 2014 and Beyond
CQMs change in 2014
*Regardless of the stage of meaningful use, all providers will complete this number of
CQMs in 2014
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28. CQM Alignment with HHS Priorities
All Providers Must Select CQMs from at least 3 of
the 6 HHS National Quality Strategy domains
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Patient and Family Engagement
Patient Safety
Care Coordination
Population and Public Health
Efficient Use of Healthcare Resources
Clinical Processes/Effectiveness
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29. CQMs in 2014 and Beyond
www.cms.gov/EHRIncentivePrograms
 A complete list of 2014 CQMs and
their associated National Quality
Strategy domains is posted on the
CMS EHR Incentive Programs
website
 CMS has posted a recommended
core set of CQMs for EPs that focus
on high priority health conditions
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30. CLINICAL QUALITY MEASURES
REPORTING MECHANISMS
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31. Reporting CQMs in 2014 and Beyond
 Beginning in 2014, all Medicare-eligible providers in
their second year and beyond of demonstrating
meaningful use must electronically report their CQM
data to CMS
 Michigan Medicaid providers will possibly electronically
report their CQM data to their state in 2015.
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32. EP CQM Reporting in 2014
EPs Reporting for the Medicare EHR Incentive Program
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33. PAYMENT ADJUSTMENTS AND
HARDSHIP EXEMPTIONS
(MEDICARE ONLY)
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34. Payment Adjustments
 The HITECH Act stipulates that for a Medicare EP, subsection
(d) hospitals and CAHs, a payment adjustment applies if they
are not a Meaningful User
 An EP, subsection (d) hospitals and CAHs, becomes a
Meaningful EHR User when they successfully attest to
Meaningful Use under either the Medicare or Medicaid EHR
Incentive Program
– Adopt, Implement or upgrade for the Medicaid EHR Incentive Program
DOES NOT EQUAL Meaningful Use
– A provider receiving the Medicaid Incentive for AIU is still subject to
the Medicare payment adjustment
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35. EP Payment Adjustments
% adjustment below assumes less than 75% of EPs are meaningful users by CY 2018+
2015
2016
2017
2018
2019 2020+
EP is not subject to the
payment adjustment for eRx
in 2014
99%
98%
97%
96%
95%
95%
EP is subject to the payment
adjustment for eRx in 2014
98%
98%
97%
96%
95%
95%
% adjustment below assumes more than 75% of EPs are meaningful users by CY 2018+
2015
2016
2017
2018
2019
2020+
EP is not subject to the
payment adjustment for eRx in
2014
99%
98%
97%
97%
97%
97%
EP is subject to the payment
adjustment for eRx in 2014
98%
98%
97%
97%
97%
97%
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36. EP EHR Reporting Period
 Payment adjustments are based on prior years' reporting periods
 The length of the reporting period depends upon the first year of
participation
 To avoid payment adjustments:
– EPs MUST continue to demonstrate meaningful use every year to avoid
payment adjustments in subsequent years
For an EP who has demonstrated meaningful use in 2011 or 2012
Payment Adjustment Year
2015
2016
2017
2018
2019
2020
Based on full year EHR
reporting period
2013
2014* 2015
2016
2017
2018
*Special three month reporting period
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37. EP EHR Reporting Period
For an EP who demonstrates meaningful use
in 2013 for the first time
Payment Adjustment Year
2015
Based on 90 day EHR
reporting period
2013
Based on full year EHR
reporting period
2016
2017
2018
2019
2020
2014* 2015
2016
2017
2018
*Special three month reporting period
To avoid payment adjustments:
EPs MUST continue to demonstrate meaningful use every year to avoid
payment adjustments in subsequent years
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38. EP EHR Reporting Period
EP who demonstrates meaningful use in 2014
for the first time:
Payment Adjustment Year
2015
Based on 90 day EHR
reporting period
2014* 2014
Based on full year EHR
reporting period
2016
2017
2018
2019
2020
2015
2016
2017
2018
* In order to avoid the 2015 payment adjustment, the EP must attest no later than 10/1/14, which
means they must begin their 90-day reporting period no later than 7/1/14
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39. Payment Adjustments for Providers
Eligible for Both Programs
 If you are eligible to participate in both the Medicaid and
Medicare EHR Incentive Programs, you MUST demonstrate
Meaningful Use according to the timelines in the previous
slides to avoid the payment adjustments
 You may demonstrate meaningful use under either program
– NOTE: Congress mandated that an EP must be a meaningful user in order to avoid a
payment adjustment; therefore receiving a Medicaid EHR Incentive Payment for
adopting, implementing or upgrading your certified EHR Technology would not exempt
you from the payment adjustments
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40. EP Hardship Exceptions
EPs can apply for hardship exceptions in the following categories:
1. Infrastructure
EPs must demonstrate they are in an area without sufficient
internet access or face insurmountable barriers to obtaining
infrastructure.
2. New EPs
Newly practicing EPs who would not have time to become a
meaningful user can apply for a 2-year limited exception to
payment adjustments.
3. Unforeseen
circumstances
Natural disaster or other unforeseeable barrier.
4. EPs must
demonstrate the
criteria
1. Lack of face-to-face or telemedicine interaction with
patients.
2. Lack of need for follow up with patients.
5. EPs who practice Lack of control of availability of CEHRT for more than 50% of
in multiple locations patient encounters.
must demonstrate
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41. Applying for Hardship Exceptions
 Applying: EPs/EHs must apply for hardship exceptions to avoid
payment adjustments
 Granting Exceptions: CMS will grant hardship exceptions only
if they determine that providers have demonstrated that those
circumstances pose a significant barrier to them achieving
meaningful use
 Deadlines: Applications need to be submitted no later than
July 1 for EPs of the year before the payment adjustment
year, but CMS recommends earlier submission
 For More Information: Details on how to apply will be available
in the future at www.cms.gov/EHRIncentivePrograms
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42. MEDICAID PROGRAM SPECIFIC CHANGES
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43. Medicaid Eligibility Expansion
Patient Encounters
 Definition of patient encounter has changed
 The rule includes encounters for anyone enrolled in the
Medicaid program, including Medicaid expansion encounters
(except stand-alone Title 21) and those with zero-pay claims
 The rule adds flexibility in the look-back period for overall
patient volume
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44. Provider Eligibility:
Patient Volume Calculation
Medicaid Encounters
 Previously under Stage 1 rule:
– Service rendered on any one day where Medicaid paid for all or part of
the service or Medicaid paid the co-pays, cost-sharing or premiums
 Changes in Stage 2 rule (applicable to all stages):
– Service rendered on any one day to a Medicaid-enrolled individual,
regardless of payment liability
– Includes zero-pay claims and encounters with patients in Title-21
funded Medicaid expansions (but not separate CHIPs)
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45. Provider Eligibility:
Patient Volume Calculation
90 Day Period for Medicaid Patient Volume
Calculation
 Under Stage 1 rule, Medicaid patient volume for providers
calculated across 90-day period in last calendar year
 Under Stage 2 rule (applicable to all stages), States also have the
option to allow providers to calculate Medicaid patient volume
across 90-day period in last 12 months preceding provider’s
attestation
 Also applies to needy individual patient volume
 Applies to patient panel methodology:
– With at least one Medicaid encounter taking place in the last 24 months
prior to the 90-day period (expanded from 12 months prior)
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46. RESOURCES
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47. Stage 2 Resources
CMS Stage 2 Website
 http://www.cms.gov/Regulations-and
Guidance/Legislation/EHRIncentivePrograms/Stage_2.html
 Links to the Federal Register
 Tip Sheets:
– Stage 1 Changes
– 2014 Clinical Quality Measures
– Payment Adjustments & Hardship Exceptions
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48. Contact Us
Michelle Brunsen
Sr. Health IT Advisor
mbrunsen@telligen.org
(515) 453-8180
www.telligenhitrec.org
@TelligenHITREC
In Partnership with: The Office of the National Coordinator for Health Information Technology (ONC) U.S. Department of
Health and Human Services grant 90RC0004/01.
IA-HITREC-05/13-794
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