Stage 2 Meaningful Use Briefing Highlights Provider Challenges

If you thought the second stage of CMS’ “meaningful use” EHR incentive program for Medicare and Medicaid has already been analyzed enough, even though it’s still in its infancy stages, you might want to see what at least one physician flagged as top challenges providers attesting for Stage 2 will face. 

During the presentation “Meaningful Use Stage 2 NPRM: Overview for Eligible Professionals,” physician Michael Zoroukian, chief medical information officer with Sparrow Health System, highlighted several core objectives that physicians might want to consider more carefully. The hour-long presentation, part of the day-long HIMSS Virtual Briefing sponsored by the Healthcare Information and Management Systems Society, was loaded with information as well as warnings about the new stage.

Though there are many parts of the mammoth-size, 455-page proposal that will require a closer look, here are the core objectives physicians should pay closer attention to:

• Provide patients the ability to view online, download, and transmit health information within four business days of the health information being available to the eligible provider (EP): This measure suggests that patients should have a patient portal strategy, Zoroukian said, adding that using portal alternatives such as CDs and flash drives present “complicated work flows that pose their own set of risks.” For this measure, it’s expected that greater than 50 percent of all unique patients seen by the provider have available online access to this. “It’s definitely an increase from other requirements … and that will be a reason for us to increase efforts for patients to sign up for patient portals,” he said. This isn’t the first time this objective has been flagged as challenging. Robert Tennant, senior policy advisor for the Medical Group Management Association, recently toldPhysicians Practice this objectives may be difficult for practices who can’t afford a patient portal.“We’re not convinced a patient portal is the way to go for small practices at this point,” said Tennant. “There are additional costs.”
• Objectives related to “improving quality, safety, efficiency and reducing health disparities”: Though attesting for Stage 1 of CMS’ “meaningful use” rule officially meant physicians had to pay attention to everything from height and weight to blood pressure and smoking status for more than half its patients, the threshold is higher for Stage 2. For the three objectives related to smoking status (for anyone 13 and over), demographics, and vita signs, providers must now record information for more than 80 percent of patients.
• Use clinical decision support to improve performance on high-priority health conditions: CMS has upped the ante for Stage 2, now requiring providers to implement clinical decision support interventions related to five or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. In Stage 1, providers only had to implement one.
• Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach: Though this might have been something your practice bypassed during Stage 1, that’s not an option this time around. “The issue for the use of clinical reminders for patients who need followup care and preventative care, that has changed from [optional] to core,” said Zoroukian. “It will now become a core issue and it will need to be attended to.”
• Use secure e-messaging to communicate with patients on relevant health information: Note that providers will have to do this via a certified EHR (certified for both Stage 1 and Stage 2) for more than 10 percent of unique patients during the reporting period. “For some that won’t be much of a change, but for others that will be a significant change,” said Zoroukian.

If all of these requirements seem a bit daunting, it’s still better to deal with them now than in 2015. Zoroukian reminded attendees during the presentation that there will be a 1 percent decrease in payments to those who are not meaningful users 2015. Therefore, if you’re a first-time meaningful user, you’ll have to meet meaningful use for 90 days before end of 2014 (by October 1, 2014). Which means reporting will have to begin July 1, 2014, he said.