Feds publish final e-health 'meaningful use' rules

Just 20% of physicians, 10% of hospitals have basic EMRs today

The U.S. Department of Health and Human Services today issued the final guidelines that will determine how doctors, hospitals and other medical care facilities can qualify for reimbursements by rolling out electronic medical records (EMR) over the next four years.

Dr. David Blumenthal, national coordinator for health information technology, said the final "meaningful use" rules offer greater flexibility to physicians and hospitals than the initial guidelines first proposed earlier this year.

The new rules were finalized after a three-month public comment period during which more than 2,000 recommendations were received by HHS on its preliminary "notice of proposed rule making" effort. The final document is 864 pages long.

"We heard... it was too inflexible; that it was an all-or-nothing set of objectives. So we added some choice," Blumenthal said during a news conference today. "We want the objectives of meaningful use to be both ambitious but achievable."

For example, under the earlier proposed rules, physicians would have been required to write 75% of their prescriptions electronically. The final Phase 1 rule requires only that 40% of prescriptions be written electronically.

Last year, the American Recovery and Reinvestment Act set aside $36 billion to help hospitals and doctors purchase equipment to computerize patient medical records. But even the most sophisticated hospitals in the U.S. are still struggling to qualify for the payments, a recent study indicated.

HHS Secretary Kathleen Sebelius admitted during today's news conference that only 20% of physicians and 10% of hospitals now use even the most basic EMR systems -- which are also know as electronic health record (EHR) systems. "Our goal has never been to just use technology for the sake of technology -- to transfer everything on paper to a computer and call it quits," she said. "We're promoting electronic health records so that they can be used to deliver better care and give consumers more control over their own health care."

The Centers for Medicare and Medicaid Services (CMS), the federal agency tasked with writing the meaningful use rules, estimates that 66.4% to 92.6% of hospitals and between 21% and 53% of private physicians practices will have implemented EMRs by 2015.

Clinicians in private practices that deploy the technology and prove that their efforts are effective enough to meet the government's "meaningful use" standards can receive up to $44,000 per doctor in reimbursement funds through Medicare and $63,750 under Medicaid beginning next year. Hospitals could receive millions under the same program.

A 275-bed facility, for example, would be eligible for about $6 million to defray IT costs associated with deploying EMR technology. HHS estimates that as much as $27 billion could be spent on incentive payments.

The new rules state that reimbursement payments for Medicare providers may begin no sooner than October for eligible hospitals and no sooner than January 2011 for eligible health care professionals. In order to receive reimbursements and avoid penalties in the form of reduced Medicare payments, EMRs must meet the meaningful use standards by 2015. There are no Medicaid penalties.

One of the two regulations unveiled today defines the first phase of "meaningful use" objectives health care providers must meet to qualify for the bonus payments; the other identifies the technical capabilities required for certified EMR technology. The government expects to release the next two phases of the objectives over the next several years.

One change that has been made since last year is in the number of "core" requirements: There are now 15 for health care professionals and 14 for hospitals. The proposed rule would have mandated that professionals meet 25 core requirements and hospitals meet 23 in order to be eligible for incentive payments.

"This 'two-track' approach ensures that the most basic elements of meaningful EHR use will be met by all providers qualifying for incentive payments, while at the same time allowing latitude in other areas to reflect providers' needs and their individual path to full EHR use," the HHS said in a press release.

The number of clinical decision support rules has been reduced from five to one, Blumenthal said. HHS also set the number of clinical quality measures at 44, with six that must be met by physicians and 15 by hospitals.

HHS's Office of the National Coordinator (ONC) is also now establishing a nationwide network of "regional extension centers" staffed with IT professionals to help health care providers adopt EMRs that meet the new standards.

In addition to the final meaningful use rules, the ONC published a final rule in June establishing a temporary certification program for health information technology. The agency projects that certified EHR software will be available for purchase by hospitals and eligible professionals later this year.

Earlier this month, the U.S. Office for Civil Rights announced a proposed rule that would strengthen and expand privacy, security and enforcement protections under the Health Insurance Portability and Accountability Act of 1996.

Eligible health care providers and hospitals will be able to begin registering for the EHR incentive program in January 2011. Registration for both the Medicare and Medicaid incentive programs will occur at one virtual location, managed by the CMS.

For the Medicare program, physicians and eligible hospitals can begin registration starting in April 2011.

Lucas Mearian covers storage, disaster recovery and business continuity, financial services infrastructure and health care IT for Computerworld. Follow Lucas on Twitter at @lucasmearian, or subscribe to Lucas's RSS feed . His e-mail address is lmearian@computerworld.com.

Copyright © 2010 IDG Communications, Inc.

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