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Medicare & Medicaid EHR Incentives NPRM. Implementing the American Reinvestment & Recovery Act of 2009. Overview. American Reinvestment & Recovery Act – February 2009 EHR Incentive NPRM on Display – December 30, 2009; published January 13, 2010 NPRM Comment Period Closes – March 15, 2010.

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medicare medicaid ehr incentives nprm

Medicare & Medicaid EHR Incentives NPRM

Implementing the American

Reinvestment & Recovery Act of 2009

  • American Reinvestment & Recovery Act – February 2009
  • EHR Incentive NPRM on Display – December 30, 2009; published January 13, 2010
  • NPRM Comment Period Closes – March 15, 2010
what is in the cms ehr incentive program nprm
What is in the CMS EHR Incentive program NPRM?
  • Definition of Meaningful Use
  • Definition of Hospital-Based Eligible Professional
  • Medicare FFS EHR Incentive Program
  • Medicare Advantage EHR Incentive Program
  • Medicaid EHR Incentive Program
  • Collection of Information Analysis (Paperwork Reduction Act)
  • Regulatory Impact Analysis
what is not in the cms nprm
What is not in the CMS NPRM?
  • Information about applying for grants
  • Changes to HIPAA
  • Office of the National Coordinator (ONC) Interim Final Rule – HIT: Initial Set of Standards, Implementation Specifications, and Certification Criteria for EHR Technology
  • EHR certification requirements
  • ONC NPRM - Establishment of Certification Programs for Health Information Technology
  • Procedures to become a certifying body
what the nprm does
What the NPRM Does
  • Harmonizes MU criteria across CMS programs as much as possible
  • Closely links with the ONC certification and standards IFR
  • Builds on the recommendations of the HIT Policy Committee
  • Coordinates with the existing CMS quality initiatives
  • Provides a platform that allows for a staged implementation over time
defining meaningful use
Defining Meaningful Use
  • Definition
    • To be determined by Secretary
    • Must include quality reporting, electronic prescribing, information exchange
  • Process of defining
    • NCVHS Hearings
    • HIT Policy Committee recommendations
    • Listening Sessions with providers/organizations
    • Public Comments on the HIT Policy Committee recommendations
    • NPRM comments received from the Department and OMB
meaningful use stages
Meaningful Use Stages
  • Meaningful Use will be defined in 3 stages through rulemaking
    • Stage 1 – 2011
    • Stage 2 – 2013*
    • Stage 3 – 2015*

*Stages 2 and 3 will be defined in future CMS rulemaking.

stage 1 health outcome priorities
Stage 1 – Health Outcome Priorities*
  • Improving quality, safety, efficiency, and reducing 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.

proposed stages of meaningful use timeline
Proposed Stages of Meaningful Use Timeline

*Avoids payment adjustments only for EPs in Medicare EHR Incentive Program

**Stage 3 criteria of meaningful use or a subsequent update to criteria if one is established

meaningful use summary
Meaningful Use Summary
  • EPs
    • 25 Objectives and Measures
    • 8 Measures require ‘Yes’ or ‘No’ as structured data
    • 17 Measures require numerator and denominator
  • Eligible Hospitals and CAHs
    • 23 Objectives and Measures
    • 10 Measures require ‘Yes’ or ‘No’ as structured data
    • 13 Measures require numerator and denominator
  • Reporting Period – 90 days for first year; one year subsequently
clinical quality measures overview
Clinical Quality Measures Overview
  • 2011 – Providers required submit summary quality measure data to CMS by attestation
  • 2012 – Providers required to electronically submit summary quality measure data to CMS
  • EPs are required to submit clinical data on the 2 measure groups: core measures and a subset of clinical measures most appropriate to the EP’s specialty
  • Eligible hospitals are required to report summary quality measures for applicable cases
core quality measures for eps
Core Quality Measures for EPs
  • Preventive care and screening: Inquiry regarding tobacco use
  • Blood pressure management
  • Drugs to be avoided by the elderly:
    • Patients who receive at least one drug to be avoided
    • Patients who receive at least two different drugs to be avoided
specialty quality measures for eps
EPS will need to select one of the following specialties:

Cardiology Obstetrics and Gynecology

Pulmonology Neurology

Endocrinology Psychiatry

Oncology Ophthalmology

Proceduralist/Surgery Podiatry

Primary Care Radiology

Pediatrics Gastroenterology


Specialty Quality Measures for EPs
clinical quality measures for eligible hospitals
Clinical Quality Measures for Eligible Hospitals
  • Hospitals are required to report summary data on 43 clinical quality measures to CMS
  • Hospitals only eligible for Medicaid will report directly to the States
  • For hospitals in which the measures don’t apply, they will have the option of selecting an alternative set of Medicaid clinical quality measures
notable differences between the medicare medicaid ehr programs
Notable Differences Between the Medicare & Medicaid EHR Programs


  • Feds will implement (will be an option nationally)
  • Fee schedule reductions begin in 2015 for providers that are not Meaningful Users
  • Must be a meaningful user in Year 1
  • Maximum incentive is $44,000 for EPs
  • MU definition will be common for Medicare
  • Medicare Advantage EPs have special eligibility accommodations
  • Last year an EP may initiate program is 2014; Last payment in program is 2016. Payment adjustments begin in 2015
  • Only physicians, subsection (d) hospitals and CAHs


  • Voluntary for States to implement (may not be an option in every State)
  • No Medicaid fee schedule reductions
  • Adopt/Implement/Upgrade option for 1st participation year
  • Maximum incentive is $63,750 for EPs
  • States can adopt a more rigorous definition (based on common definition)
  • Medicaid managed care providers must meet regular eligibility requirements
  • Last year an EP may initiate program is 2016; Last payment in program is 2021
  • 5 types of EPs, 3 types of hospitals
nprm changes from hitpc recommendations
NPRM changes from HITPC Recommendations


  • Record advance directives
  • Document a progress note for each encounter
  • Provide access to patient-specific education resources


  • Provide summary care record for each transition of care and referral


  • Adding DOB to record demographics and cause and date of death for hospitals
  • Adding growth charts to record vital signs
  • Limiting smoking status to age 13+
  • Increasing CDS rules from 1 to 5
  • Removed “where possible” from insurance eligibility checks
  • Changed the provision of clinical summaries from “each encounter” to “each office visit”
  • Changed compliance with HIPAA to Protect electronic health information maintained by certified EHR technology
nprm changes from the hitpc recommendations
NPRM changes from the HITPC Recommendations


  • Ensured every objective is matched to a measure
  • Added a % threshold to measures recommended as “% of …”
  • Calculated some % based on “unique patients seen” as not every action would be taken for every office visit
  • Narrowed lab results to those “whose results are in a positive/negative or numeric format”
  • For exchange of information changed “implemented ability” to “Performed at least one test”
  • Clinical quality measures were greatly expanded to accommodate the diversity of specialists meeting the definition of an eligible professional
incentive payment timeline
Incentive Payment Timeline
  • Medicare can pay incentives to EPs no sooner than January 2011
  • Medicare can pay eligible hospitals and CAHs no sooner than October 2010
  • Medicaid EPs can potentially receive payments as early as 2010 for Adopting/implementing or upgrading
next steps
Next Steps
  • HIT Policy and Standards Committees Input-March 1, 2010
  • Public comment period ends March 15, 2010
  • CMS review of comments
  • Draft final regulation
  • CMS/HHS/OMB clearance
  • Final rule publication-Spring 2010