S1mu part 1 an overview of core requirements and big changes ahead
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S1MU Part 1: An Overview of Core Requirements and Big Changes Ahead. Moderator: Mary Zile, BSN, MHSA Presenters: Nathan Diller, MBA, MHSA Marty Larson, MS Stefanie Strinko, MBA, CPHIMS. Agenda. Overview of Meaningful Use

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S1MU Part 1: An Overview of Core Requirements and Big Changes Ahead

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S1MU Part 1: An Overview of Core Requirements and Big Changes Ahead


Mary Zile, BSN, MHSA


Nathan Diller, MBA, MHSA

Marty Larson, MS

Stefanie Strinko, MBA, CPHIMS


  • Overview of Meaningful Use

  • Contrasting Stage 1 Meaningful Use (S1MU) to Stage 2 Meaningful Use (S2MU)

  • Deep Dive: S2MU Core Measures

  • Question & Answers

Overview of Meaningful Use

HITECH: Policy Framework

Better care for individuals, better health for populations, and lower per-capita costs.

IHI-Triple Aim Initiative

Pillars of Meaningful Use

  • Improve quality, safety, efficiency, and reduce health disparities

    • Provide access to comprehensive patient health data for patient’s health care team

    • Use evidence-based order sets and CPOE

    • Apply clinical decision support at the point of care

    • Generate lists of patients who need care and use them to reach out to patients

  • Engage patients and families

    • Provide patients and families with timely access to data, knowledge, and tools to make informed decisions and to manage their health

  • Improve care coordination

    • Exchange meaningful clinical information among professional health care team

  • Improve population and public health

    • Submit immunization, syndromic surveillance and reportable disease data to public health agencies

  • Ensure privacy and security protection for personal health information

    • Protect confidential information through operating policies, procedures, and technologies

    • Provide transparency of data sharing to patient

Definition of Meaningful Use

  • Use of ONC-HIT Certified Electronic Health Records (EHR)

  • Electronic Exchange of Health Information

  • Quality Reporting

Why S2MU Matters

  • Stage 2 Meaningful Use serves as a foundation for other health care innovation initiatives

  • S2MU is a glide path to:

    • Accountable care organizations

    • Medical home

    • Payment reform initiatives

Stages of Meaningful Use


For Medicare Hospitals:

Meaningful Use – Potential Penalties

  • Penalties apply to Medicare only

  • You must begin your first 90-day reporting period no later than July 3, 2014

  • EPs must attest to Meaningful Use no later than October 1, 2014

  • AIU for year one Medicaid does not count as attestation

The Penalty

  • Adjustments will be applied as a percentage of Medicare Part B Professional Fee Schedule Charges

  • Penalties scheduled to begin in Jan 1, 2015, and continue as follows:

    • 2015: 1%

    • 2016: 2%

    • 2017: 3%

    • 2018-2019: may increase 1% per year at discretion of HHS Secretary

  • You cannot wait until 2015 to be Meaningful User if you are concerned about penalties

Medicare Payment Adjustments

  • EPs who first demonstrated meaningful use in 2011 or 2012 must demonstrate meaningful use for a full year in 2013 to avoid payment adjustments in 2015. They must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years.

Hardship Exceptions for Medicare EPs

  • EPs can apply for hardship exceptions in the following categories:

  • Infrastructure

  • New EPs

  • Unforeseen circumstances

  • By specialist/provider type

Contrasting S1MU to S2MU

An Overview

Meaningful Use – Who is eligible for incentives?

No Changes from Stage 1 Meaningful Use

Stage 2 Meaningful Use Overview

  • Stage 2 Meaningful Use (S2MU) Final Rule was published on August 23, 2012.

  • Beginning in 2014, providers participating in the EHR Incentive Programs who have met Stage 1 for 2 or 3 years will need to meet S2MU criteria.

What is in the Rule

  • Changes to Stage 1 of Meaningful Use

  • Stage 2 of Meaningful Use

  • New clinical quality measures (CQMs)

  • New CQM reporting mechanisms

  • Medicaid program changes

S2MU Change in Total Objectives Required

How to Get to S2MU

  • 17 Core Objectives

3 of 6 Menu Objectives

9 Clinical Quality Measures

Meaningful Use

Key Changes to Stage 1 Meaningful Use

  • Menu Objective Exclusion– While you can continue to claim exclusions if applicable for menu objectives, starting in 2014 these exclusions will no longer count towards the number of menu objectives needed.

Medicaid Eligibility Changes

  • The definition of what constitutes a Medicaid patient encounter has changed.

  • A Medicaid encounter now includes anyone enrolled in a Medicaid program, including:

    • Medicaid expansion encounters (excluding stand alone Title 21)

    • Zero-pay claims

Medicaid Eligibility Changes

  • States have the option to allow providers to calculate Medicaid patient volume across 90-day period in last 12 months preceding a provider’s attestation.

  • This also applies to needy patient volume and patient panel methodology with at least one Medicaid encounter taking place in the 24 months prior to the 90-day period.

2014 Changes

  • EHRs Meeting ONC 2014 Standards – starting in 2014, all EHR Incentive Programs participants will have to adopt certified EHR technology that meets ONC’s Standards & Certification Criteria 2014 Final Rule

2014 Changes

  • Reporting Period Reduced to Three Months – to allow providers time to adopt 2014 certified EHR technology and prepare for Stage 2, all participants will have a three-month reporting period in 2014.

  • All providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a three-month EHR reporting period.

2014 Changes

  • For Medicare providers, this 3-month reporting period is fixed to the quarter of either the fiscal (for eligible hospitals and CAHs) or calendar (for EPs) year in order to align with existing CMS quality measurement programs, such as the Physician Quality Reporting System (PQRS) and Hospital Inpatient Quality Reporting (IQR).

2014 Changes

  • For Medicaid providers only eligible to receive Medicaid EHR incentives, the 3-month reporting period is not fixed, where providers do not have the same alignment needs. CMS is permitting this one-time three-month reporting period in 2014 only so that all providers who must upgrade to 2014 Certified EHR Technology will have adequate time to implement their new Certified EHR systems.

Stage 2: Batch Reporting

  • Stage 2 MU rules allows for batch reporting:

  • Starting in 2014, groups will be allowed to submit attestation information for all of their individual EPs in one file for upload to the Attestation System, rather than having each EP individually enter data.

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.

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.

  • Medicaid providers will electronically report their CQM data to their state.

Clinical Quality Measures

Deep Dive: S2MU Core Measures

Stage 2 MU EP Core Objectives

Stage 2 MU EP Core Objectives

EP Core Requirements

EP Core Requirements

EP Core Requirements

EP Core Requirements

EP Core Requirements

EP Core Requirements

EP Core Requirements

EP Core Requirements

EP Core Requirements

EP Core Requirements

EP Core Requirements

EP Core Requirements

EP Core Requirements

EP Core Requirements

EP Core Requirements

EP Core Requirements

EP Core Requirements

Stage 2 MU EP Menu Objectives

Q&A Session

Additional MU Information

Tri-State Regional Extension Center


CMS EHR Incentive Program Home Page


Office of National Coordinator for Health IT


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