What is Meaningful Use?

What is Meaningful Use? It's a program enacted by the US Federal Government in 2009 to incentivize eligible medical professionals with payments to use a certified electronic health record (EHR), according to HealthIT.gov. The Meaningful Use program was designed to improve health care for patients by making it safer and more efficient. It's separated into three stages that we'll go over in a bit.

How does a clinic or clinician qualify for Meaningful Use? In order to become eligible, you need to show that you are meaningfully using it to improve the care your patients receive. Your hospital has to show the Centers for Medicare & Medicaid Services (CMS) that it has adopted, upgraded, and implemented certified EHR technology.

Participation in the Meaningful Use program comes with definite financial incentives. If you're looking for a certified EHR, you can learn more about how to choose an EHR here.

How does Meaningful Use improve quality of care?

The program is dependent on five priorities of health care policy, according to the CDC including:

  1. Reducing health care disparity by improving efficiency, safety, and quality
  2. Engaging with patients and their families in their health care
  3. Improving health care coordination
  4. Improving public health
  5. Protecting patients personal health information (you can read more about how to do this here in our post on HIPAA violations and how to avoid them)

How much are payments and fines?

Your health care facility can get a lot of money for working toward these goals through an EHR. In fact, incentive payments start at $44,000 over a five-year period for Medicare Providers. Medicaid providers can get $63,750 in incentives over a six-year period. Those amounts are nothing to scoff at. However, keep in mind that these amounts depend on when a facility starts meeting the requirements.

Participation in the program started out as voluntary but that has since changed. It started out by simply giving incentives to physicians that participated. Now, providers who don't participate will be penalized with reduced Medicare reimbursements. So, not only does it pay to get in on the Meaningful Use program, but it also hurts you if you don't.

A really good EHR will also help you avoid HIPAA violations. And those can cost up you up to $5k per violation depending on the state you're in. All the more reason to have a really good EHR.

How many Meaningful Use stages are there?

There are three stages to this program and the stages build on each other over time.

Stage 1

Stage 1, launched in 2011, focuses on proper electronic data sharing through an EHR. The criteria for stage 1 consists of 15 core requirements and 10 menu requirements. Providers must meet all of the core requirements but only five of the menu requirements are needed to complete this stage.

If you want to get 100% of the incentive, you have to meet the standards of meaningful use for a minimum of 90 days.

Stage 2

The emphasis here is on properly exchanging patient information and care coordination. In order to meet the requirements for stage 2, you must continue meeting the requirements of stage 1. Stage 2 launched in 2014 and requires health care professionals to reach a larger number of their patient populations through their EHR.

To qualify for payment in stage 2, Eligible Professionals (EPs) need to qualify for 17 core objectives and 3 out of 6 menu objectives. Eligible Hospitals (EHs) and Critical Access Hospitals (CAHs) need to qualify for 16 core objectives and 3 out of 6 menu objectives.

One of the core requirements for EPs is to have the capability to submit electronic data for immunizations. For EHs, one of their core objectives is to be able to submit electronic data for immunizations, Reportable Laboratory Results, and Syndromic Surveillance.

Stage 3

The third and final stage of Meaningful Use is all about improving patient outcomes. But remember, you have to continue stages 1 and 2 in order to receive payment for stage 3.

Stage 3 has eight required objectives for clinicians to meet in order to avoid penalties and receive incentives. The eight objectives are as follows:

  1. Protected Health Information: Also known as PHI, physicians have to conduct a "security risk analysis" to prevent patient PHI data leaks. This is also a HIPAA requirement, which, if violated, can result in huge fines
  2. Electronic Prescribing: You need to send at least 80% of your permissible prescriptions to pharmacies electronically
  3. Clinical Decision Support (CDS): This is a two-part objective. The first requires implementing five CDS interventions and the second requires active checks on drug and drug-allergy interaction
  4. Computerized Provider Order Entry: EPs need to meet the following three standards: medication, lab, and diagnostic imaging orders
  5. Patient Engagement: At least 80% of patients need to be able to view and download their health records through your EHR. You must also provide educational information to at least 35% of your patients
  6. Coordination of Care: This is meant to increase patient engagement through three processes. 1) Have at least 25% of patients use your EHR. 2) A minimum of 35% of your patients must obtain secure digital information from a health care provider. 3) You need to get data from a minimum of 15% of patients through fitness trackers/wearable devices. EPs need to shoot for all three standards but only meet the requirements for two
  7. Health Information Exchange: The focus here is twofold. 1) At least 50% of care record-transition must be done electronically. 2) When seeing a patient for the first time, you must receive health records electronically no less than 40% of the time
  8. Public Health Data Reporting: Here, you need to choose three of five EHR destinations to submit data. The options include a public health registry, clinical data registry, syndromic surveillance, cases, and an immunization registry.

MACRA and Meaningful Use

What is MACRA?

The Medicare Access and CHIP Reauthorization Act, or MACRA, gives EPs and EHs more tools to provide patients with better care. MACRA created the Quality Payment Program (QPP), which is designed to benefit providers that provide great health care. QPP gives you various payment options as well.

The QPP is designed to do the following according to CMS.gov:

  • Repeals Sustainable Growth Rate formula. This was predicted to make cuts of 25-30% each year for the services you and other clinicians make to Medicare beneficiaries
  • Gives bonus payments to participating providers with alternative payment models (APMs)
  • Makes multiple quality programs faster and more efficient under the new Merit-Based Incentive Payments System (MIPS)
  • Requires all Social Security Numbers be removed from Medicare cards by April 2019
  • Changes how clinicians are rewarded for value and volume by Medicare

You can participate based on the following factors:

  • Size of your practice
  • Specialty
  • Patient population
  • Specialty

In short, MACRA created a way for health care providers to be paid for Medicare beneficiaries. It also set rules for data sharing.

What are MACRA's data sharing rules?

The CMS's Qualified Entity (QE) program helps your organization get Medicare claims data and this can be used to determine the performance of the provider. If your organization is or has been approved as a QE then you're required to produce and publically provide reports approved by the CMS.

QEs are also allowed to make non-public analyses and sell it to users that have been authorized, and you're also allowed to give out or sell combined data/information, including Medicare data at no cost to authorized users. The CMS certifies and monitors QEs that receive this data. You can see which QEs the CMS has certified, the region they're in, and the date of certification here.

How Meaningful Use and MACRA work together

When MACRA came out, Meaningful Use turned into part of MIPS, another part of MACRA. If you're a clinician, you won't participate in the Meaningful Use program for Medicare Eligible Professionals. Instead, QPP has incentives for clinicians to use certified EHR technology and includes categories based on performance like Advancing Care Information and Quality Measures Reporting in MIPS.

MACRA's new payment system aims to make it easier for your organization to simplify payment models and value-based health care delivery. Starting in 2019, if you treat Medicare patients, you will most-likely have to choose between using MIPS or APMs as your payment track. I say "most likely" because not clinicians will have to choose between these two tracks.

Under the new rule, you will get reimbursed based on a performance score on the following four factors:

  1. Quality measures (30%)
  2. Resource use (30%)
  3. Meaningful Use (25%)
  4. Clinical practice improvement activities (15%)

MACRA provides a path for you and your clinic, if eligible, to receive reimbursements through APMs or MIPS. But this isn't all new. Health care providers have been reporting on quality measures for a long time now under different programs, including Meaningful Use, Physician Quality Reporting System, Value-Based Payment Modifier program, and e-prescribing.

Are MACRA and Meaningful Use good for health care providers?

There have been a lot of reactions to MACRA and Meaningful Use, as is the case with any government regulation. Some health care professionals and clinics have lost money as a result while others have seen significant gains.

But are these programs good for health care? I believe they are. Obviously, I'm a huge fan of doing things that help hospitals be more efficient and help more people get treatment. I strongly believe that a great way to improve health care and get people the treatment they need is through having a really good EHR.

While I believe EHRs are a great way to improve health care, I also strongly believe that you have to use the EHR that's right for you and you need buy-in from everyone who will be working with it. If you're looking for a substance abuse or mental health EHR, you can also get a free demo of ours here.

How has Meaningful Use affected you?

We want to know what your thoughts are on the effects of Meaningful Use. Has it been positive or negative? If you think it's been good, comment with the word "good" below. If you think it's been bad, comment with the word "bad" below. I'm just curious about how many of you approve or disapprove of it.

Conclusion

In conclusion, Meaningful Use is a program created by the Federal Government with the purpose of incentivizing clinicians and health care providers to improve health care by using a certified EHR. It has three stages, each of which builds upon the previous stage. and has seen some significant changes since its inception in 2009.

Even if hospitals and clinicians weren't incentivized by the government to use an EHR, I'd still strongly recommend using one as I've seen providers increase their revenue by as much as 30% after switching from a paper to a digital EHR.