Meaningful Use: The Medicare EHR Incentive Program

“Meaningful Use,” the Medicare Electronic Health Records Incentive Program, and other PAC Updates for 2012

The ARS patient advocacy committee (PAC) would first like express our deepest thanks and appreciation to Pete Batra, MD for his outstanding leadership and years of service as our immediate past chair. We would also like to congratulate him on his appointment to the ARS Board of Directors and are looking forward to his continued mentorship as our new ARS board liaison.

As we look ahead to 2012 and beyond, continued awareness of Center for Medicare & Medicaid Services (CMS) rules/updates with respect to implementation and reporting of electronic health records (EHR) has become essential. In 2009, as part of the economic stimulus package delineated by the American Recovery and Reinvestment Act (ARRA), $36 billion was invested by the federal government in health information technology (HIT) with $34 billion allotted for distribution directly to providers who successfully demonstrate “meaningful use” of a certified EHR. With this EHR incentive program, non hospital-based Medicare/Medicaid providers are eligible to receive up to $44,000 and $63,750 respectively over a 5-year period beginning in 2011. Physicians located in designated “health professions shortage areas” may also qualify for an additional 10% in supplemental bonuses. All providers with a pre-existing EHR or who implement an EHR prior to 2014 may participate in this incentive plan.

Three criteria for “meaningful use” of a certified EHR were initially outlined by the ARRA: 1) EHR must be shown to be used in a meaningful way that incorporates ePrescribing, 2) EHR is connected in such a manner as to facilitate exchange of information, and 3) Providers report on predetermined clinical quality measures (CQMs).
In July 2010, the final criteria for “meaningful use” of the EHR Medicare Incentive Program were released. Currently, 20 total CQMs must be reported in order to qualify: 15 core measures (i.e. demographic data, vital signs, problem list, active medication list, allergies, smoking status, eprescriptions, medication order entries, etc.) and 5 menu set measures (in which providers may choose from a list of 10.) Examples of individual core measure reporting criteria are listed in Figure 1. Attestations must then be completed and data electronically uploaded via a CMS designated portal, with aggregate numerators and denominators provided for each required measure throughout the reporting period. In July 2011, CMS proposed that eligible physicians (EPs) also participate in a Physician Quality Reporting System (PQRS)-Medicare EHR Incentive Pilot, in which calculated results are directly transmitted to the CMS by the EP’s EHR via a secure portal or by a PQRS-EHR data submission vendor on the EP’s behalf. For further details and latest updates on the EHR incentive program, members are advised to consult the CMS website

In addition to the EHR incentive program, the CMS has also established an electronic prescribing incentive program (ePrescribing). Providers who successfully meet the reporting criteria (i.e. eRx measure reported 25 times during the reporting period) are eligible for additional incentive payments (+1% in 2012) with potential penalties incurred against unsuccessful e-prescribers. The most recently proposed CMS rules regarding reporting criteria, methods, and periods for ePrescribing were released in July 2011 and are summarized in Figure 2. For further information on the eRx incentive program, ARS members may refer to the CMS website

With respect to ARS PAC related news, ARS members should be aware that the CPT code 31231 (diagnostic nasal endoscopy) has been sent to the Relative Value Update Committee (RUC) for review and is in the process of being re-surveyed. The ARS is currently assisting the AAO-HNS CPT/RUC in determining its value and surveys have been sent to ARS volunteers. In terms of upcoming projects, the ARS PAC has also been collaborating with the AAO-HNS on creation of a CT Practice Patterns Survey. The current form has already been vetted by the ARS PAC/ARS Board of Directors and is being evaluated by the AAO-HNS Imaging Committee. It should soon be ready for launch to the general ARS/AAO-HNS membership in the near future. Finally, given the rising prevalence of endoscopic skull base surgery, the ARS PAC has also commenced work on a Skull Base Surgery Practice Patterns Survey and will keep members updated with regards to its progress. If any ARS members have any PAC related issues, please do not hesitate to contact the ARS PAC and we will do our best to assist you in any way we can.

Revised 03/2012
©American Rhinologic Society

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