Top 10 Things to Know about Meaningful Use Stage 2

1. The basic framework of the program has not changed. The dollars available through incentive programs remain unchanged for both Eligible Providers (EP) and Eligible Hospitals (EH). The eligibility parameters are (with very minor exceptions) unchanged as well, including which non-physician providers are able to participate in the EP program.
2. Eligible Providers will be required to report on 17 Core measures and 3 of 5 Menu measures; Eligible Hospitals will be required to report on 16 Core measures and 2 of 4 Menu measures. This is comparable to Stage 1 in the total number required, though the measures are not the same -- some have been consolidated and new options have been added.
3. The number of proposed Clinical Quality Measures (CQM) that providers will be able to choose from in reporting has increased dramatically. The number has moved from 44 to 125 for Eligible Providers and from 15 to 49 for Eligible Hospitals. Additionally, batch reporting – or reporting on the CQM as a group within the ambulatory environment – is proposed in an effort to simplify the process. The total number of available clinical quality measures will likely be decreased by the time of the Final Rule, but the current list significantly improves reporting options for specialists who felt that the Stage 1 CQM were too focused on primary care.
4. Allowances for exclusions in reporting the information included in the requirements will change. There really will be allowances only for providers who cannot meet a requirement because of the scope of their practice or issues specific to their geography that will have to be corroborated by the state or the FCC.
5. CMS has made changes in order to make broaden participation in the Medicaid side of the program. The means of counting patients towards the 30% threshold is now broader in allowing the inclusion of some CHIP patients, as well as all patients with Medicaid coverage, regardless of whether Medicaid is used to pay for the encounter. There are also now some children’s hospitals that are able to participate despite not having a CMS Certification Number.
6. Eligible providers will no longer be able to include in their attestation reports patient care provided in a location without an EHR by then recording it at another location that uses a certified EHR. The requirement to use a certified EHR for at least 50% of patient encounters in order to qualify for the program still stands, however.
7. Payment adjustments (otherwise known as penalties) will begin in 2015, as required by the statute. CMS will look at the providers’ behavior in 2013 to determine whether the 2015 fee schedule adjustments should occur. Program participants can attest to beginning their participation in 2014 through a 90-day EHR reporting period, but that must be completed and attestation finished at least 90 days prior to the end of the year for it be considered.
8. Interoperability is moving from the theoretical to the real. The exchange of information in the transmission of a care summary will no longer be just a test but rather require both making electronic information available to patients and the successful exchange of information between providers using different certified Electronic Health Records.
9. Patient engagement is an area of increasing focus. The goal is to help patients and their families feel that they are active participants in providing and accessing information related to their health so that they, in turn, increase the levels of successful self-management. CMS aims to get providers talking about health information technology and the patients’ ability to view, download and/or share that information by holding providers accountable for how many of their patients access their data and email their providers. Providing patients with access to their information by providing a patient portal or connecting to a Personal Health Record such as HealthVault will become a necessity.
10. The requirement to report to Public Health entities is expanding, with the addition of specialty registries and cancer registries. Syndromic surveillance reporting remains a Menu option, however, reflecting the ongoing challenges the states have in implementing their ability to accept the reported information.

ONC Proposed Rule:

• Read the ONC Proposed Rule [PDF - 2.3 M] [Word* - 807 K] >
• ONC fact sheet [PDF - 99 K] >