Meaningful Use

Meaningful Use and Your Practice

Read the FAQ

Get the answers to your MU questions with our FAQ.

On October 6, 2015, the Department of Health and Human Services and the Centers for Medicare and Medicaid Services (CMS) issued a final rule covering meaningful use (MU) changes for 2015 through 2017(www.federalregister.gov). That rule eliminated Stage 1, incorporating it into the new Modified Stage 2, and outlined what were intended to be the requirements for Stage 3. Criteria to meet MU Modified Stage 2 thresholds were made easier to meet under the proposal, but penalties for failure to achieve MU were slated to continue to increase.  

In November 2016, CMS released a final rule(www.federalregister.gov) that modified the reporting period for 2016. CMS also announced (via separate rulemaking) that as of January 1, 2017, under MACRA law, a new Quality Payment Program is being implemented and the EHR Incentive Payment Program previously known as Meaningful Use will be known as Advancing Care Information (ACI). The ACI performance category is one of four performance categories under the new Merit-based Incentive Payment System (MIPS). Details about ACI requirements for 2017 and beyond will soon be available here and among AAFP’s other MACRA resources.

2016 Reporting Period

A November 2016 final rule changed the reporting period for all eligible professionals (EPs) to any 90 continuous days in the 2016 calendar year. (Prior to that final rule, new attesters were able to report any 90 continuous days in 2016, whereas returning attesters were slated to be required to report for the full calendar year from January 1 to December 31, 2016).

Attestation Periods for 2016 Reporting

Medicare EHR Incentive Program Participants:

  • New attesters complete attestation between July 1 and October 1, 2016
  • Returning attesters complete attestation between January 3 and February 28, 2017

Medicaid EHR Incentive Program program participants should contact their state Medicaid program(www.cms.gov) for details about attestation deadlines and payment adjustments.

Reporting Requirements – Objectives, Measures, and Technology Required

In 2016, all eligible providers (EPs) must attest to a single set of ten objectives(www.cms.gov) and associated measures (Modified Stage 2 criteria) using EHR technology certified to the 2014 or 2015 Edition, or a combination of the two. Beginning in 2018, all EPs are required to use 2015 Edition Certified EHR Technology (CEHRT(www.cms.gov)).

Alternate Exclusions Available in 2016

The EHR Registration and Attestation system will automatically identify those who are eligible for alternate exclusions.

EPs eligible for alternate exclusions may choose to use alternate exclusions during attestation, but are not required to use them. Many of the alternate exclusions that were available in 2015 are not applicable in 2016. Two objectives offer alternate exclusions in 2016(www.cms.gov):

See the CMS Tipsheet for Objective 10 »(www.cms.gov)

Read the Guide for EPs Practicing in Multiple Locations »(www.cms.gov)
(Note: Useful for 2016, but because date last updated is prior to the MACRA final rule, do not rely on accuracy of data for 2017 despite the title of this resource being 2015-2017).

Read the EP Attestation User Guide »(www.cms.gov)

Read the EP Registration User Guide »(www.cms.gov)

Resources from Prior Years(www.cms.gov)

2016 Resources

2017 and Beyond

In 2017, the Medicare EHR Incentive Program is transitioning from meaningful use to the advancing care information (ACI) component of the Merit-based Incentive Payment System (MIPS). Links to basic ACI information for the 2017 performance year, as well as links to technical specifications sheets for each objective and measure are available below that detail numerators, denominators, and exclusions. Additional ACI resources will soon be added and available among our MACRA-related resources.

The ACI performance category is much like meaningful use. Eligible clinicians (ECs) must attest that 2014 or 2015 CEHRT is in place, and are now also expected to attest to good faith participation with CEHRT surveillance as requested, and support of information exchange and avoidance of information blocking.

The ACI score is broken down into a base and performance score (including any bonus points), each accounting for half of the total ACI score. To earn full credit for the base score (and to receive any credit for ACI), ECs must attest “yes” to yes/no questions, or submit a numerator of at least 1 and denominator, as required, for the four* required base score measures.

Failure to meet requirements for even one of the base score measures results in a score of zero for the base score and ultimately a zero for the entire ACI category.

If the base score is achieved, the performance score is based on how well you perform on nine ACI performance measures and whether or not any bonus points are achieved (for specified public health and syndromic surveillance reporting or for using CEHRT to perform a handful of practice improvement activities).

ECs can submit ACI data as an individual or as a group, through a Qualified Registry, QCDR, via attestation, EHR-Direct, EHR-Data Submission Vendor (EHR-DSV), or the CMS web interface.

There are hardship exclusions available for those with insufficient internet connectivity, extreme and uncontrollable circumstances, “lack of control” over the availability of CEHRT (as defined by CMS; including such things as natural disasters), and lack of face-to-face patient interaction. These hardship exclusion applications must be filed annually, and if approved result in reweighting of the ACI performance category to 0% with re-assignment of that 25% to the Quality Performance Category to maintain the potential for those participants to earn 100 points for the MIPS final score.

*In 2017, users of 2015 Edition CEHRT may choose to– though are not required to– report on “ACI Measures” which include five required base score measures, or alternatively may instead choose to report on the “2017 ACI Transition Measures” which 2014 Edition CEHRT users will report on in 2017 and include only 4 required base score measures.

ACI Resources

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 Professionals

Objectives and Measures for Eligible Professionals

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Record Demographics

Objectives and Measures for Eligible Professionals

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Record Vital Signs

Objectives and Measures for Eligible Professionals

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Record Smoking Status

Objectives and Measures for Eligible Professionals

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Clinical Summaries

Objectives and Measures for Eligible Professionals

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Structured Lab Results

Objectives and Measures for Eligible Professionals

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Patient List

Objectives and Measures for Eligible Professionals

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Patient Reminders

Objectives and Measures for Eligible Professionals

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

Objectives and Measures for Eligible Professionals

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Electronic Notes

Objectives and Measures for Eligible Professionals

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Imaging Results

Objectives and Measures for Eligible Professionals

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Family Health History

Background

CMS's Medicare and Medicaid EHR Incentive Program initially provided 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 failed to meet those requirements under the program in earlier years forfeited their incentive payment. However, starting in 2015, providers failing to meet criteria under the program have faced 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 of MU was intended to establish requirements for the electronic capture of clinical data, including providing patients with electronic copies of their health information.

Stage 2 of MU 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 on, regardless of which stage they were in.

Stage 3 of MU (and Advancing Care Information/ACI under MIPS) 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.

Last updated: January 2017