New Meaningful-Use Rules Stress Online Contact With Patients

February 23, 2012

February 23, 2012 — Physicians will need to communicate with patients online to satisfy new and tougher federal rules for "meaningful use" of electronic health records (EHRs), earn 5-figure bonuses, and avoid a penalty down the line.

Under proposed regulations released today by the Centers for Medicare and Medicaid Services (CMS), physicians must receive "secure messages," an encrypted form of email, from more than 10% of patients seen. In addition, they must give patients timely electronic access to their healthcare information.

The new requirements will not take effect until 2014.

Last year, CMS began awarding bonuses under Medicare and Medicaid to physicians who meet an initial set of meaningful use requirements designed to improve the quality of care. There are currently 25 stage 1 objectives, 15 of which are mandatory and 10 elective. The mandatory objectives include electronically prescribing more than 40% of prescriptions and recording demographic information, such as date of birth, sex, and race, as structured data for more than 50% of patients seen. Physicians must satisfy any 5 of the 10 elective requirements.

In stage 2, the number of mandatory objectives increases to 17, with physicians able to choose 3 of 5 elective objectives. Almost all of the stage 1 mandatory and elective objectives graduated to stage 2, with a few of them combined for simplicity's sake.

The stage 2 requirements raise the bar for digital doctoring that the federal government will reward. For starters, stage 2 thresholds for carryovers from stage 1 are more demanding. Meaningful users, for example, must e-prescribe more than 65% of their prescriptions (increased from 40%), and the threshold for recording demographic data goes up to more than 80% of patients.

In addition, all but 1 of the 10 elective objectives in stage 1 will become mandatory. Such is the case for the stage 1 objective of giving 10% of patients seen during the EHR reporting period timely electronic access to their health information, which can be achieved through an EHR patient portal or personal health record. "Timely" means within 4 business days after the information becomes available to the physician. This objective becomes obligatory under stage 2, and more complicated: More than 50% of patients must enjoy this electronic access to their chart information, and more than 10% must actually view, download, or transmit the data.

One new elective objective in stage 2 takes meaningful use in the direction of diagnostic imaging. Physicians can choose to demonstrate that more than 40% of all tests and scans resulting in an image are accessible through their EHR.

Penalties Looming in 2015

Big bucks are at stake in measuring up to federal meaningful use requirements. As authorized by the American Recovery and Reinvestment Act of 2009, physicians can qualify for up to $44,000 under Medicare over the course of 5 years, provided they began to meet stage 1 requirements in either 2011 or 2012. They also can elect to participate in the incentive program under Medicaid, which pays up to $64,000 over the course of 6 years.

So far, physicians, other eligible clinicians, and hospitals have received $3.1 billion in meaningful use incentive payments, according to the US Department of Health and Human Services (HHS).

On the downside, physicians who fail to demonstrate meaningful use of EHRs will suffer a 1% reduction in Medicare pay in 2015. The penalty increases to 2% in 2016 and 3% in 2017 and beyond.

In the proposed regulations released today, CMS stated that Medicare providers could avoid the penalty in 2015 if they demonstrate meaningful use in 2013. In addition, the penalty in 2015 would not apply to providers who achieve meaningful use for the first time in 2014, provided that they report this to CMS by October 3, 2014.

Last year, HHS announced that it would push back the start date for stage 2 compliance from January 1, 2013, to January 1, 2014.

The comment period for the proposed stage 2 meaningful use rules, posted online, lasts 60 days. The draft regulations list several ways to submit comments. After weighing public input, CMS will issue a final version of the regulations.

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