Meaningful Use Overview
Federal EHR Incentives
Cost has always been a major barrier to the widespread use of electronic health records (EHR) systems. Recognizing this, Congress appropriated approximately $27 billion as part of the American Recovery and Reinvestment Act (ARRA) to help hospitals and physician practices acquire and use this technology to improve the quality of patient care over the next several years.
The federal EHR incentives are paid out to eligible health care providers after they have invested in EHR systems and demonstrated they’ve achieved a specific level of EHR use, which the government calls “meaningful use.” VITL and 60 other non-profit organizations around the country have been designated as "regional extension centers" and provided funding to help eligible professionals achieve meaningful use.
Participation in the federal EHR incentive program is voluntary. Eligible professionals can choose to participate under either Medicare or Medicaid. Professionals cannot participate in both at the same time.
The Medicare and Medicaid EHR incentive programs have different rules, which are explained in greater detail in this section of the VITL website.
What Is Meaningful Use of EHRs?
Meaningful use occurs when eligible practitioners use a certified EHR in a meaningful manner, and also use that technology for the electronic exchange of health information and to submit clinical quality and other measures to improve health care quality.
To achieve this goal, the criteria for meaningful use will be staged in three steps over the next several years. Stage 1 sets the baseline for electronic data capture and information sharing. Stage 2 and Stage 3 will continue to expand on this baseline.
The Stage 1 definition of meaningful use includes both a core set and a menu set of objectives that are specific for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs), in addition to reporting of clinical quality measures. This gives providers latitude to choose their own path to full EHR implementation and meaningful use. Objectives include basic entry of patient data such as vital signs, active medications, allergies, up-to-date problem lists of current and active diagnoses and smoking status.
| Eligible Professionals |
Must meet 15 core objectives that enable EHRs to support improved health care Must meet five additional objectives from a menu of 10 to implement in 2011-2012 Must report six total Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from alternate set) |
| Eligible Hospitals and CAHs |
Must meet 14 core objectives Must meet five additional objectives from a menu of 10 to implement in 2011-2012 Must report 15 Clinical Quality Measures |
EHR Incentive Payments from Medicare and Medicaid
The Centers for Medicare and Medicaid Services (CMS) is making up to $27 billion in EHR incentive payments, or as much as $44,000 (through Medicare) or $63,750 (through Medicaid) per eligible professional.
The table below explains the difference between the Medicare and Medicaid EHR incentive programs for EPs:
| Medicare EHR Incentive Program for EPs |
Must successfully demonstrate meaningful use in Year 1 and subsequent years Incentive amounts based on fee-for-service allowable charges Maximum incentives are $44,000 over five consecutive years Incentives decrease if EP starts participating after 2012 Must begin by 2014 to receive incentive payments; payments end in 2016 Fee schedule reductions begin in 2015 for EPs who do not demonstrate meaningful use Extra amount available for EPs practicing in predominately Health Professional Shortages Areas (HPSAs) |
| Medicaid EHR Incentive Program for EPs |
Can choose the Adopt, Implement or Upgrade option in Year 1, but must successfully demonstrate meaningful use in subsequent years Incentives are same regardless of start year Maximum incentives are $63,750 over six years (do not have to be consecutive) The first year payment is $21,250; next five payments are $8,500 Must begin by 2016 to receive incentive payments; payments end in 2021 No fee schedule reductions No extra amount for EPs practicing in predominantly HPSAs |
Who Is Eligible?
There are different rules and requirements for Medicare and Medicaid EPs, eligible hospitals, and CAHs. For example, EPs may not be hospital-based, and those who do not see Medicare or Medicaid patients are not eligible for the program's funds. Additional criteria apply.
The table below explains the differences for eligible professionals:
| Medicare Program |
Doctors of medicine or osteopathy Doctors of dental surgery or dental medicine Doctors of podiatric medicine Doctors of optometry Chiropractors |
| Medicaid Program |
Physicians Nurse practitioners Certified nurse-midwives Dentists Physician assistants in PA-led federally qualified health centers or rural health clinics |
In addition, Medicaid EPs must meet one of three patient volume thresholds over any continuous 90-day period within the most recent calendar year:
- Minimum of 30% patient volume
- Pediatricians Only: have a minimum of 20% Medicaid patient volume
- Practicing predominately (more than 50% of encounters over six months) in a FQHC or RHC only: have a minimum of 30% "needy individual" patient volume. Needy individuals are those whose care was covered by Medicaid, CHIP, sliding fee scale or was uncompensated care.
How Does VITL Fit In?
VITL is the only regional extension center (REC) serving Vermont. One of the primary tasks of a REC is to help eligible professionals in a geographic area understand the rules for the EHR incentives and assist them in achieving meaningful use of EHRs so that they qualify for incentive payments. For more information on how VITL can help, see the Why VITL section of this website.
Click here to sign up for VITL's regional extension center services.
If you have questions about meaningful use or require additional information, please contact Larry Gilbert at 802-839-1943 or email lgilbert@vitl.net.