The Meaningful Use Stage 2 proposed rule has been released earlier this week. You can download a copy of the full 455 page regulation here: MU Stage 2 Proposed Rule. For those keeping score at home, there are three stages of “meaningful use” as that term is defined in section 495.6 of the regulations. Stage 1 set certain Core (required) and Menu (pick from the list to implement) Criteria, and established minimum compliance metrics for a “eligible professional” to qualify for the federal incentives. The original regulations that defined “meaningful use” indicated that there would be future changes to the definition in two more stages. We initially expected Stage 2 to be defined for compliance in 2013. However, the regulations have pushed out compliance for Stage 2 to 2014. This article will take a look at what’s been proposed for Stage 2.
First off, there are more “Core” or required Criteria in Stage 2. Stage 1 had a total of 15 Core Criteria, some of which any certified electronic health record would have to meet (such as collecting certain demographic and vital signs data for patients seen in the office). In addition, there were several Core criteria that, when originally published, no one had yet defined how you might actually comply. For example, there is a Core Criteria in Stage 1 where providers were required to submit certain quality data to either CMS or their State Medicaid program. But, no one had indicated when the regulations were published what data, exactly, or how this data was to be provided. The metric in Stage 1 was merely the ability to submit a test file.
Stage 2 has 17 total Core Criteria. In several cases, CMS has proposed to terminate a prior Stage 1 Core item entirely in Stage 2. And in a number of cases, Criteria that were previously on the “Menu” in Stage 1 are now incorporated as Stage 2 Core Criteria. For example, structured lab data, patient lists by specific condition for use in a quality improvement initiative, patient reminders, patient access to electronic health information, patient education resources, medication reconciliation for transition of care, care summary for patients transitioned to another provider, and data submission to an immunization registry were all Menu Criteria in Stage 1 and are now Core Criteria in Stage 2.
Also, where a Stage 1 Criteria was kept, the minimum compliance percentage has increased, in some cases substantially, in Stage 2. For example, where a 50% compliance rate was sufficient for Stage 1 for collecting patient smoking status, in Stage 2, the compliance rate minimum is 80%. In Stage 1, a single decision support rule needed to be implemented for compliance. In Stage 2, five such rules must be implemented.
As for the Menu Criteria, Stage 1 required that you implement 5 of the 10 on the list as an eligible provider. In total, therefore, a provider had a total of 20 Criteria that had to be met to achieve meaningful use. In Stage 2, there are only 5 menu criteria, and the provider must meet at least three. So the total number of required criteria is no different, but providers have fewer menu criteria to choose to comply with. In addition, the Menu Criteria in Stage 2 include three interfaces with specific state or public health registries, and the remaining two involve access to imaging results in the EHR and storing family health history in a structured data format. You may be able to waive out of some of these if there isn’t a way in your state to submit surveillance or other registry data electronically. However, if you elect to implement one of these interfaces, the compliance requirement under Stage 2 is full year data submission to the registry (not just submitting a test file). If you plan on doing one of these, start early to make sure you can get to the compliance target by 2014.
Overall, Stage 2 appears to “up the game” for providers who wish to continue to receive incentive payments in out years of the program. The Stage 2 rules that were published this week are interim rules. The public has 60 days to submit comments. After that, CMS will ultimately publish a final rule, taking into account comments made during the comment period. While it is possible that CMS may back down on some of these measures, providers should get plan to comply with much of this Rule. Talk with your EHR vendor, consultant, MSO or other service providers to analyze and plan for compliance.