1. Medicare & Medicaid EHR Incentive Programs
Robert Anthony
Deputy Director, Health IT Initiatives Group
Office of E-Health Standards and Services
Centers for Medicare and Medicaid Services

2. Eligibility

3. Who is Eligible to Participate?
Eligibility was defined in statute
Hospital-based EPs are NOT eligible for incentives
DEFINITION: 90% or more of their covered professional services in either an inpatient (POS 21) or emergency room (POS 23) of a hospital
Incentives are based on the individual, not the practice

4. Medicare-only Eligible Professionals
Could be eligible for both Medicare & Medicaid incentives
Medicaid-only Eligible Professionals

5. Meaningful Use

6. Conceptual Approach to Meaningful Use
Data capturing and sharing
Advanced clinical processes
Improved outcomes
Stage 3
This is the structure to get us where we want to be. It is divided into three stages. The first stage involves collecting health information in a structured way and takes the first steps towards using that data. Structured data is crucial to meaningful use of EHRs. What we mean by structured data is that the system recognizes the data for what it is and knows how that data interacts with other data available in the system. For instance, Microsoft Word knows that aspirin is a seven letter word and even how it should be spelled, but it does not know that it is a drug and one that should be given to patients showing signs of a heart attack or not given to one that is also taking an anticoagulant. This is what we mean by structured data. The second stage involves designing and implementing processes that will use the data collected in a way that we believe will generate improved outcomes. The third stage involves finding out if we were right and determining the effects of meaningful use on outcomes.
Stage 2
Stage 1

7. What are the Requirements of Stage 1 Meaningful Use?
2 Years
2 Years
And so on . . .
Stage 3 –
1 Year
Stage 3 –
1 Year
Stage 2 –
1 Year
Stage 2 –
1 Year
Stage 1 –
1 Year
Stage 1 –
90 Days

8. What are the Requirements of Stage 1?
Eligible Professionals
15 core objectives
5 of 10 menu objectives
20 total objectives

9. Stage 1 EP Core Objectives
Computerized physician order entry (CPOE)
E-Prescribing (eRx)
Report ambulatory clinical quality measures to CMS/States
Implement one clinical decision support rule
Provide patients with an electronic copy of their health information, upon request
Provide clinical summaries for patients for each office visit
Drug-drug and drug-allergy interaction checks
Record demographics
Maintain an up-to-date problem list of current and active diagnoses
Maintain active medication list
Maintain active medication allergy list
Record and chart changes in vital signs
Record smoking status for patients 13 years or older
Capability to exchange key clinical information among providers of care and patient-authorized entities electronically
Protect electronic health information

10. Stage 1 EP Menu Objectives
5 of 10 Menu Objectives
Drug-formulary checks
Incorporate clinical lab test results as structured data
Generate lists of patients by specific conditions
Send reminders to patients per patient preference for preventive/follow up care
Provide patients with timely electronic access to their health information
Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate
Medication reconciliation
Summary of care record for each transition of care/referrals
Capability to submit electronic data to immunization registries/systems*
Capability to provide electronic syndromic surveillance data to public health agencies*
* At least 1 public health menu objective + 4 others

11. Stages of Meaningful Use
Data capturing and sharing
Advanced clinical processes
Improved outcomes
Stage 3
This is the structure to get us where we want to be. It is divided into three stages. The first stage involves collecting health information in a structured way and takes the first steps towards using that data. Structured data is crucial to meaningful use of EHRs. What we mean by structured data is that the system recognizes the data for what it is and knows how that data interacts with other data available in the system. For instance, Microsoft Word knows that aspirin is a seven letter word and even how it should be spelled, but it does not know that it is a drug and one that should be given to patients showing signs of a heart attack or not given to one that is also taking an anticoagulant. This is what we mean by structured data. The second stage involves designing and implementing processes that will use the data collected in a way that we believe will generate improved outcomes. The third stage involves finding out if we were right and determining the effects of meaningful use on outcomes.
Stage 2
Stage 1

12. Eligible Professionals Eligible Hospitals & CAHs
What are the Requirements of Stage 2 Meaningful Use?
Stage 1
Stage 2
Eligible Professionals
15 core objectives
5 of 10 menu objectives
20 total objectives
17 core objectives
3 of 6 menu objectives
Eligible Hospitals & CAHs
14 core objectives
5 of 10 menu objectives
19 total objectives
16 core objectives
3 of 6 menu objectives

13. Stage 1 Menu  Stage 2 Core EP Lab Results Patient Lists
Patient Education
Summary of Care Records
Medication Reconciliation
Immunizations
Patient Reminders
Online Patient Information

14. New for Stage 2 EP Secure Messaging Family Health History
Imaging Results
Registry Reporting
Progress Notes

15. Closer Look at Stage 2: Patient Engagement
Patient engagement – engagement is an important focus of Stage 2.
EXCLUSIONS – CMS is introducing exclusions based on broadband availability in the provider’s county.
Requirements for Patient Action:
More than 5% of patients must send secure messages to their EP
More than 5% of patients must access their health information online
More than 5% of patients must access their health information online (of the more than 50% of patients who received access).
Requirements for Patient Action:
More than 5% of patients must send secure messages to their EP
More than 5% of patients must access their health information online

16. Closer Look at Stage 2: Electronic Exchange
Stage 2 focuses on actual use cases of electronic information exchange:
Stage 2 requires that a provider send a summary of care record for more than 50% of transitions of care and referrals.
The rule also requires that a provider electronically transmit a summary of care for more than 10% of transitions of care and referrals.
At least one summary of care document sent electronically to recipient with different EHR vendor or to CMS test EHR.
Credit given when the receiving providers successfully “pulls” info down from HIE. This is in addition to the “push” methods of electronic HIE that were proposed.
Stage 2 requires that a provider send a summary of care record for more than 50% of transitions of care and referrals.
The rule also requires that a provider electronically transmit a summary of care for more than 10% of transitions of care and referrals.

17. Clinical Quality Measures

18. Eligible Hospitals and CAHs Eligible Hospitals and CAHs
CQM Reporting in 2013 and 2014
Reporting in 2013
Reporting in 2014 and Beyond
EPs
Report 6 out of 44 CQMs
3 core or alt. core
3 menu
EPs
Report 9 out of 64 CQMs
Selected CQMs must cover at least 3 of the 6 NQS domains
Recommended core CQMs:
9 for adult populations
9 for pediatric populations
Eligible Hospitals and CAHs
Report 15 out of 15 CQMs
Eligible Hospitals and CAHs
Report 16 out of 29 CQMs
Selected CQMs must cover at least 3 of the 6 NQS domains

19. CQM Selection and HHS Priorities
All providers must select CQMs from at least 3 of the 6 HHS National Quality Strategy domains:
Patient and Family Engagement
Patient Safety
Care Coordination
Population and Public Health
Efficient Use of Healthcare Resources
Clinical Processes/Effectiveness
Such as measures in which performance rates are currently low or for which there is wide variability in performance, or that address known drivers of high morbidity and/or cost for Medicare and Medicaid.
For example, Medicare- and Medicaid-eligible physicians, and Medicaid-eligible nurse-practitioners, certified nurse-midwives, dentists, physician assistants)
Based on the March 2011 report to Congress, "National Strategy for Quality Improvement in Health Care" (National Quality Strategy) ( and the Health Information Technology Policy Committee's (HITPC's) recommendations (

20. Stage 1 and Stage 2 Resources
EHRIncentivePrograms/ For questions, please contact: Robert Anthony Office of E-Health Standards and Services Centers for Medicare & Medicaid Services