ACR 2011: The Goal of Meaningful Use Is to Improve the Quality of Care

With Medicare and Medicaid incentives scheduled to start this year, physicians owe it to their patients and their practices to learn about the requirements to qualify as meaningful users of health care technology.

The term “meaningful use” and what it represents is complicated, said Robert Warren, MD, PhD, MPH, founding member of ACR HIT subcommittee, and CMIO of Medical University of South Carolina. It’s about information exchange and research, HIT adoption, and a host of other factors and frameworks. During “The Road to Meaningful Use and Beyond - A Simple Overview of a Complex Topic” at the 2011 ACR/ARHP Annual Meeting, Warren offered a broad overview of the goals of meaningful use and briefly outlined the various components of the legislation and incentive programs.

He said the there are five goals that are fueling meaningful use, including the desire to improve care quality, engage patients and families, and improve care coordination. The American Recovery and Reinvestment Act of 2009 (ARRA) and the Health Information Technology for Economic and Clinical Health Act (HITECH) enacted as part of ARRA, call for physicians to use certified EHR in a meaningful way, use certified EHR technology for electronic exchange of health information to improve quality of care, and use certified EHR to submit quality care data.

Many physicians, wary of the complex rules and requirements of the Medicare and Medicaid meaningful use incentive programs, have questioned whether their practices to pursue eligibility. Warren acknowledged that the incentive funds a practice will derive from following the steps for implementation will not meet its costs for training, buying equipment, and the initial loss of productivity following EHR installation. However, he stated that physicians shouldn’t do this for the money; they should do it for the patients.

There are greater total Medicare incentive reimbursement for early adopters ($44,000 if a practice starts in 2011 or 2012 and participates for all five years), $39,000 if start participating in 2013, etc. Medicaid incentive payments add up to more total dollars ($63,750) and don’t penalize late adopters. Adult providers have to see 30% Medicaid patients to be eligible. Warren reminded the audience that nurse practitioners are considered eligible providers for the Medicaid program, but not for the Medicare incentive program. Hospital-based providers are also excluded.

Although the incentive payments starting in 2011 are intended to promote utilization of certified EHR technologies by physicians and other eligible providers, there are also negative incentives in the form of Medicare payment penalties that will begin in 2015 for nonadopters. The ONC/CMS has also announced they will publish lists of meaningful users (providers and hospitals). Warren also said that multiple private insurers have declared that future contracting will reflect demonstrated meaningful use, and he predicted that board certification, MOC, and state licensing may include meaningful use status in the future.

Just because a practice is using an EHR does not guarantee that it will receive any incentive funding. The first step, if the certification status of the EHR is unknown, is to consult the certified health IT product list on the ONC website. Then, after confirming that the EHR system is a certified product, to qualify as a meaningful use provider, an interested physician must enroll as a Medicare provider, register for the EHR incentive program, get a NPPES user ID and password, and a taxpayer identification number.

Each eligible provider must select to participate in either the Medicare or Medicaid program; dual enrollment is not allowed (although you can switch programs one time). The requirements for participation become stricter over time. For the Medicaid program, in 2011 (or the first year the provider participates in the program), the eligible provider must merely certify that he or she is adopting, implementing, or upgrading certified EHR technology. In 2012 (or the second year of participation), he or she must attest to 90 days of meaningful use. In 2013 (or year 3 of participation), he or she must attest to a full year of meaningful use. For the Medicare program, in year one the provider must attest to 90 days of meaningful use; in year 2 and beyond, he or she must attest to a full year of meaningful use.

In closing, Warren reminded that each physician should have a good understanding of meaningful use, to be patient during implementation, and remember that in the end, it’s all about workflow. “Work with your with your vendor, pursue stage 1 with stage 2 in mind, and be part of the process,” he said.

This activity is not sanctioned by, nor a part of, the American College of Rheumatology.