Meaningful Use Stage 2 Rules Finalized

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Final regulations for the second stage of the Meaningful Use incentive program for electronic health records (EHRs), as expected, call on hospitals, physicians, and other "eligible providers" to increase interoperability of health information, adopt more standardized data formats, and generally make their EHR systems more capable than in the current Stage 1.

Federal officials on Thursday released the final Stage 2 rule for Meaningful Use and accompanying final rule on certification of EHR technology. The 2009 American Recovery and Reinvestment Act, which authorized the $27 billion program, requires providers to use certified EHRs in order to earn bonus payments from Medicare, Medicaid or both for Meaningful Use.

Stage 2 will begin in 2014, a year later than ARRA originally called for, or two years after a provider first achieves Stage 1 requirements. Providers can start earning Stage 1 incentive payments as late as 2017, although Medicare will impose penalties for not achieving Meaningful Use by 2015.

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The 672-page rule is similar to a proposal released in February in that it essentially makes the optional menu items from Stage 1 mandatory, adds a requirement for patient engagement, allows medical groups to attest to Meaningful Use for multiple providers at once, and raises some of the thresholds in meeting mandatory items. For example, Stage 2 requires providers to enter medication orders electronically for at least 60% of their patients, up from 30% in Stage 1.

However, the final rule does dial back some proposed thresholds. Notably, providers now only have to offer online access to health information and secure messaging for 5% of patients, not 10%, as had been proposed.

The final certification rule adds a requirement that all personally identifiable health data be encrypted while "at rest," in response to a recommendation from the Health IT Policy Committee, a federal advisory board, and public comments.

All told, physicians, chiropractors, dentists, physical therapists, and other individual providers have to meet 17 core measures for EHR usage, and also choose three from a menu of six additional measures. Hospitals must achieve 16 core measures plus three of six menu items.

In a Thursday conference call with journalists, national health IT coordinator Dr. Farzad Mostashari called the menu items "potentially more relevant to specialists" than those in Stage 1. Many people have criticized the current stage as being skewed toward primary care.

Eligible providers also must report on nine of a total of 64 specific clinical quality measures, while hospitals need to choose 16 of 29. Starting with the 2014 reporting period, providers will have to submit their Meaningful Use-related clinical quality measures electronically, Elizabeth Holland, director of health information technology initiatives for the Centers for Medicare and Medicaid Services (CMS), said during the teleconference.

According to Mostashari, Stage 1 was about "beginning the journey" to a nationwide network of interoperable EHRs that promote safety, quality, efficiency, and care coordination by asking providers to collect data electronically. Stage 2 builds on the current phase and starts to emphasize data sharing.

"The big message here is the push on standards-based interoperability of information," Mostashari said. "We are staying on course with the roadmap that we set in Stage 1."

A third and final stage of Meaningful Use is scheduled to begin in 2016. To date, CMS has paid out $6.6 billion in incentive money to about 3,600 hospitals and more than 128,000 individuals, Holland said.

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