CMS Stage 2 MU Proposed Rules Clarify Timing, Penalties, and more…

This summary of the CMS Stage 2 proposed rules for the EHR Incentive Program for Meaningful Use focuses on the Medicare version of the EHR program. Some encouraging news for specialists are new menu set measures focused on specialty concerns such as measures on diagnostic image accessibility and reporting to specialty society registries such as a cancer registry. There is also increased flexibility in the implementation of “Certified EHR technology” such that Eligible Professionals (EP) no longer have to implement technology for measures that they are excluded from.

Stages and Reporting Periods
The CMS proposal for Stage 2 continues to have an EP enter the program at Stage 1 and spend two years at each stage before moving on to the next. However, Stage 2 will not start until 2014 giving vendors and providers more time for implementation than the original schedule.

The proposal shows the stages progress with the EP’s years of participation as shown below.

Note that this requirement for the EP’s stage of participation based on the year of entry does not seem to be tied to the incentive compensation. To receive full incentive compensation of $44,000 per EP, the 90 day reporting period must start by October 3, 2012. EP’s participating in the program in 2011 will receive up to $38,000 while in Stage 1.

To receive any incentive payments, the Stage 1 reporting period must begin by July 3, 2014. EP’s entering the program after 2014, can avoid some of the penalties by meeting the criteria shown in the following chart.

Changes to Stage 1 Measures
The Stage 2 proposed rules take the opportunity to clarify some of the Stage 1 measures and in some cases, make changes to the Stage 1 measures. In most cases, these changes are optional in 2013 and mandatory in 2014.

Some of the changes increase the reporting denominator. For example, CPOE for medication orders was measured as “More than 30 percent of all unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE”. The proposed Stage 2 change is “ More than 30% of medication orders created by the EP during the EHR reporting period are recorded using CPOE.”

A few changes are more significant. For example, the Stage 1 measure to “Provide patients with timely electronic access to their health information …” is changed to “Provide patients the ability to view, download and transmit their health information…”

Stage 2 Measures
The Stage 2 proposal has 17 Core set measures and 5 Menu set measures as opposed to Stage 1 which has 15 Core set measures and 10 Menu set measures. However, CMS proposes that EP’s report on all 17 Core set measures (with some exclusions) and 3 of the 5 Menu set measures.

Most of the Stage 1 measures are carried over into Stage 2 with greater compliance measures as expected and some expansion of the Stage 1 measure. For example, the CPOE measure covers laboratory and radiology orders in addition to medication orders. The CPOE measure has increased from 30% of such orders needing to use CPOE to 60% needing to use CPOE.

The Menu set measures proposed in Stage 2 are making provision for the specialities. For example, “Imaging results and information are accessible through Certified EHR Technology” helps radiologists as has long been advocated by the ACR and others. Another Menu set measure reads “Capability to identify and report cancer cases to a State cancer registry..” and others encourage specialty society registry participation.

More Information
The proposed Stage 2 rule has been published in the Federal Register on March 7, 2012. There is a 60 day comment period and comments can be submitted at by searching on “Electronic Health Record Stage 2″.

The American College of Radiology has a detailed summary of the proposed Stage 2 rules for the Medicare program.