Quality Measures Resource Guide - Meaningful Use: Do You Really Know What You’re Doing?

As you’re probably already aware, it is not enough to just possess an electronic health record (EHR) system. The Centers for Medicare & Medicaid Services (CMS) wants healthcare providers to prove they’re making a difference with their patients and producing favorable outcomes. As of press time for this column, most individual providers should have been collecting data and sharing that information with CMS over the past 2-3 years. Those eligible providers who had not started the process of demonstrating compliance of stage I Meaningful Use guidelines prior to 2015 are set to face a 1% deduction in Medicare payments each year until 2018 if compliance is not met this year, which will be a cumulative 4% payment adjustment.

But what actually defines Meaningful Use? According to CMS, the actual formula for the definition is:

13 Core Measures + 5 Menu Measures + 9 Clinical Quality Measures (CQMs).

Some examples of the 13 core measures are computerized order entry, vital signs, demographics, active medication and allergy list, and e-prescribing.  The menu measures include drug formulary checks, summary of care record, and clinical lab interface. CQMs are those directly related to patient care outcomes. There are more than 64 CQMs in the database for 2014. Eligible professionals are required to report on nine of them.

Adult-Recommended Core Measures
1) Controlling high blood pressure

2) Use of high-risk medications in the elderly

3) Preventive care and screening; tobacco use: screening and cessation intervention

4) Use of imaging studies for low back pain

5) Preventive care and screening: screening for clinical depression and follow-up plan

6) Documentation of current medications in the medical record

7) Preventive care and screening: body mass index screening and follow up

8) Closing the referral loop: receipt of specialist report

9) Functional status assessment for complex chronic conditions.

While this may seem confusing, one’s EHR should be able to do the work.  The best part (hint: easy) is that as a qualified healthcare provider and eligible professional, there is no benchmark to report: You just have to report on the data collection to CMS. This also means that a “0” can be reported as the numerator and denominator for any CQM not seen. CMS officials just want to see that data reported by each provider are hitting the number of measures applicable for stage I. 

As we move from stage I to stage II, the criteria will change. Stage II “Meaningful Users” must, for example, have a patient portal and have the ability to upload data to a qualified clinical data registry.  In the first year of participation, providers must demonstrate Meaningful Use for a 90-day EHR reporting period; in subsequent years, providers will demonstrate Meaningful Use for a full-year EHR reporting period. For example, providers who first registered and attested for stage I Meaningful Use in 2011 are required under CMS to report stage II Meaningful Use year-one reporting, which is a 90-day EHR reporting period for 2014.

Stage II retains this core and menu structure for Meaningful Use objectives. Although some stage I objectives were either combined or eliminated, most stage I objectives are now “core objectives” under stage II criteria. For many of these stage II objectives, the threshold that providers must meet for the objective has been raised. The following link demonstrates the difference between stages I and II: www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/stage_2.html.

The process is fairly simplistic. Individual providers can choose to report to CMS using an EHR or accept the penalties that will come forth beginning this year and become a permanent part of one’s payment recovery strategy in future years. Even with the sustainable growth rate repeal, the development of alternative pay models combined with the Meaningful Use requirement to continue to report each and every year just adds more layers of bureaucracy to a system that makes our lives more difficult. In essence, all providers must know what their EHR system is doing and ensure reporting is being done each year. Oh, and by the way, are you ready for ICD-10-CM implementation? n 

Eric J. Lullove is a staff physician at West Boca Center for Wound Healing, Boca Raton, FL; serves on the healthcare policy committee of the Association for the Advancement of Wound Care; and is the AAWC liaison to the Alliance for Wound Care Stakeholders. He also serves as a consultant for Hollister Wound Care, Medline Industries Inc., and ABL Medical.