The final version of the Meaningful Use regulations, including the final Stage 2 requirements, were published at the end of August. A copy of the full regulations can be found here: 2012-21050 (you can also get these from the Federal Register’s web site; the final regulations were published on September 4, 2012.) The final version of the Stage 2 regulations are similar to the interim regulations that were published earlier this year (and discussed in this post). However, the final regulations made some changes to what’s in store for providers trying to obtain their incentive payments from the interim regulations. This article is intended to briefly cover these changes.
Core Criteria Changes
First, the Stage 2 metrics for specific Core criteria were reduced from the interim regulation targets. For example, for provider use of computerized order entry (§ 495.6(j)(1)), the interim regulations for Stage 2 required that 60% of orders be computerized. The final regulations softened this so that only 60% of medication orders be electronic, leaving the target of 30% for lab and radiology orders where it had been under Stage 1. Also, the Stage 2 target for electronic prescriptions in the interim regulation was to be 65% of all prescriptions (up from 40% in Stage 1). In the final Stage 2 regulation, the metric has been reduced to 50%.
There was also a reduction in the final Stage 2 metrics for (j)(13) and (j)(14) requirements for patients that transition care. The interim Stage 2 regulations had a metric of 65% of patients with transitions of care have a medication reconciliation performed, and for outgoing transitions, the provider prepare a care summary for the receiving provider. The final regulations reduce this metric to 50% where it stood when these were Stage 1 Menu criterion.
The final regulations also reduced the target metric for the criterion for using electronic messaging to communicate with patients in (j)(17). The interim regulations had set the metric at 10%; the final regulations reduce this to 5%.
However, there are other changes that may pose some dilemmas for providers. The interim Stage 2 core criterion include one for patient electronic access to health information. This originally was a Stage 1 Menu criterion; it becomes a core criterion in Stage 2. The metric in the interim Stage 2 regulation was that 50% of patients receive timely access to information in their chart (up from 10% in Stage 1). However, in the final Stage 2 regulation, there is a second aspect to the metric – namely, that 5% of patients actually download information made available to them. It is not clear how this will be measured by the software, and it is also not clear how providers will cause patients to download the data made available to them.
An additional metric was added to (j)(14) between the interim and final Stage 2 regulations. Not only must 50% of patients have a care summary prepared by the provider as part of the transition of care, but 10% of these transitions must involve the electronic exchange of data between the two providers. This core requirement will tend to incentivize referral patterns between providers that are able to send and receive electronic data between them or through regional health information exchanges. As a result, those that are unable to participate in such exchanges will become increasingly isolated.
Menu Criteria Changes
There were also two changes in the Menu criteria between the interim and final Stage 2 regulations. First, the target metric for the first menu criterion, access to imaging results in the EHR, was reduced to 10% in the final regulations from 40% in the interim regulations. Second, a new menu criterion was added to encourage providers to actually document notes into structured data within the EHR system, and setting the metric to 30% of patients seen during the period.