Meaningful Use

Meaningful Use and Your Practice

Read the FAQ

Get the answers to your MU questions with our FAQ.

Last update: October 16, 2015

In April 2015, the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) issued a proposed rule with meaningful use (MU) changes for 2015 through 2017. The proposal followed a CMS proposal for MU Stage 3, announced March 2015, that would govern MU in 2017 and after.

Those proposals were finalized October 6, 2015 with a single combined final rule. The rule effects the 2015 reporting year and eliminates Stage 1, incorporating it into the new Modified Stage 2 (also now called 2015-2017 Meaningful Use). The rule also finalizes the requirements for Stage 3 (also now called 2018 and beyond Meaningful Use). Criteria to meet MU modified Stage 2 thresholds will be easier to meet under the proposal, but penalties for MU will increase until 2018 when MU is rolled into the Merit Based Payment System (MIPS), along with the Physician Quality Reporting System, and the Electronic Prescribing (eRX) Incentive Program.

Critical Meangingful Use program changes due to this final rule for American Academy of Family Physician members to know include:

  • The reporting period for Medicare and Medicaid EHR Incentive Program for all eligible professionals (EPs) in 2015, and for new participants in 2015 and 2016 is any continuous 90-day period within the calendar year. Those who choose to volunterially attest to Stage 3 in 2017 will also have a 90-day reporting period.
  • The final rule reduced the number of MU stages to two (modified Stage 2 and Stage 3), with both stages sharing common objectives. Modified Stage 2 contains alternative measures and exclusions for some of the objectives, which are optional for EPs scheduled to do Stage 1 in 2015. The alternative measures and exclusion make Modified Stage 2 look almost identical to Stage 1 2014.

Modifications to individual objectives and measures for Stage 2 of MU include:

  • A change of the threshold for patient electronic access measure that requires patients to view, download, or transmit their health information from “5 percent” of patients to:
    • “Equal to or greater than 1” patient for 2015 and 2016.
    • 5% of patients for 2017.
    • Note: The measure to have 50% of patients to have available access is still in place.
  • A change of the threshold for secure electronic messaging from being a percentage-based measure, to:
    • “Equal to or greater than 1” patient for 2015 and 2016.
    • 5% of patients for 2017.
  • Consolidation of all public health reporting objectives into one objective with measure options following the structure of the Stage 3 public health reporting objective.
  • Elimination of the distinction between menu and core measures. Retained objectives and measures would be required for the program.
  • Reporting on nine objectives and one consolidated public health reporting objective for both Stage 1 and Stage 2.

See all the objectives and measures »

Stage 3

CMS released the final rule with a 60-day comment period with directions to comment on the finalization of Stage 3. They will review the comments and consider further rule-making in mid-2016 as part of the MACRA regulations currently planned for release.

AAFP is reviewing the finalized Stage 3 portion of the rule and will provide updates here, as well as crafting comments in regards to Stage 3 for CMS and ONC.

Year-by-Year Breakdown

In order to best explain the proposed MU changes, here is a year-by-year breakdown of the rule proposals.

2015

There are two potential cohorts, depending on the first year the physician attested to MU.

For those who first attested from 2011 thru 2013, your reporting period will be 90 days, and you will have to meet the modified Stage 2 measures. You are not allowed to use any of the alternative measures or exclusions.

For those who first attested from 2014 thru 2015, your reporting period will also be 90 days, and you will also have to meet the modified Stage 2 measures. However, since you were scheduled to attest to Stage 1, you can use any of the alternative measures or exclusions.

2016

Everyone is required to meet the modified Stage 2 measure, and you are not allowed to use any of the alternative measures and exclusions.

For those who first attested from 2011 to 2015, your reporting period is a full calendar year.

For those who are attesting for the first time in 2016, your reporting period is 90 days.

2017

Everyone has the option to either meet the Modified Stage 2 measures (without using any of the alternative measures or exclusions); or meet the Stage 3 measures. If you decide to continue with Modified Stage 2, you have a reporting period of a full calendar year. If you decide to attest to Stage 3, then your reporting period is 90 days.

2018

Everyone will be required to meet Stage 3 measures and report for a full calendar year.

Redundant, Duplicative, or Topped out Objectives and Measures

CMS has identified the following list of objectives and measures from MU Stage 1 and Stage 2 as redundant, duplicative, or topped out. Many of these objectives and measures may be valuable, and CMS encourages their continued use, but under the proposal, they will not require reporting.

Objectives and Measures for Eligible Professional

Objectives and Measures for Eligible Professional

:

Record Demographics

Objectives and Measures for Eligible Professional

:

Record Vital Signs

Objectives and Measures for Eligible Professional

:

Record Smoking Status

Objectives and Measures for Eligible Professional

:

Clinical Summaries

Objectives and Measures for Eligible Professional

:

Structured Lab Results

Objectives and Measures for Eligible Professional

:

Patient List

Objectives and Measures for Eligible Professional

:

Patient Reminders

Objectives and Measures for Eligible Professional

:
Summary of Care (Measure 1 – Any Method; Measure 3 – Test)

Objectives and Measures for Eligible Professional

:

Electronic Notes

Objectives and Measures for Eligible Professional

:

Imaging Results

Objectives and Measures for Eligible Professional

:

Family Health History

Background

CMS's EHR Medicare and Medicaid Incentive Program provides incentive payments to expedite and encourage EPs, eligible hospitals (EHs), and critical access hospitals (CAHs) to adopt, implement, or upgrade certified-EHR technology, and to demonstrate the "meaningful use" of certified-EHR technology.

EPs, EHs, and CAHs must demonstrate MU by meeting certain requirements. Those who fail to meet those requirements under the program will forfeit their incentive payment. However, starting in 2015, providers failing to meet criteria under the program face downward payment adjustments.

The program was designed to consist of three stages of MU, with each stage consisting of increasing requirements. Providers advance through each stage.

Stage 1 was intended to establish requirements for the electronic capture of clinical data, including providing patients with electronic copies of their health information.

Stage 2 focused on the data captured in Stage 1 being exchanged among health care providers and patients in order to improve coordination of care. Stage 2 also implemented a set of clinical quality measures (CQMs) for all providers to report in 2014, regardless of which stage they were in.

Stage 3 focuses on the advanced use of EHR technology to promote improved patient outcomes by increasing interoperability of health data and sharing among providers.

References

Acumen Physician Solutions. Meaningful use in 2015-2017: Only 9 objectives? http://www.acumenmd.com/blog/meaningful-use-in-2015-2017-only-9-objectives/(www.acumenmd.com). Accessed May 29, 2015.

Centers for Medicare and Medicaid Services. Federal register: Medicare and Medicaid programs; electronic health record incentive program—modifications to meaningful use in 2015 through 2017; proposed rule. Department of Health and Human Services. 2015. DHHS80(72)42CFR(495). http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Modifications_MU_Rule.pdf(www.cms.gov). Accessed May 29, 2015.

Healthcare Information and Management Systems Society (HIMSS). New CMS NPRM offers significant meaningful use flexibility in 2015 through 2017 program years. http://www.himss.org/News/NewsDetail.aspx?ItemNumber=41714(www.himss.org). Accessed May 26, 2015.

Hinshaw Health Law Alert. CMS issues proposed Stage 3 meaningful use standards. http://www.hinshawlaw.com/assets/htmldocuments/Articles/HealthLawAlert_LongBranded_04062015.pdf(www.hinshawlaw.com). Accessed May 27, 2015.