The Centers for Medicare and Medicaid Services received some 2,000 comments after it published its proposed meaningful use rule in January, and they were key both to changes in the scope of the final rule published today and to the speed with which it was adopted.
"We have sought and received extensive input from the healthcare community, and we have drawn on their experience and wisdom to produce objectives that are both ambitious and achievable," Dr. David Blumenthal, the national health IT coordinator, said in announcing the final rule.
Flexibility in the number of objectives that healthcare providers must meet and when was perhaps the most important change, but public comments produced a number of other substantial changes, such as:
- Dividing the objectives into a "core" group of required objectives and a "menu set" of procedures from which providers can choose. This approach ensures that the most basic elements of meaningful EHR use will be met by all providers qualifying for incentive payments, while allowing latitude in other areas to reflect providers' varying needs and paths to EHR use.
- Including the objective for physicians and hospitals to provide patient-specific educational resources, a recommendation from the federal advisory Health IT Policy Committee. Hospitals now have the objective of recording advance directives.
- Modifying the definition of hospital-based physicians by following the Continuing Extension Act passed earlier this year by Congress to allow hospital-based providers in ambulatory settings to qualify for incentive payments. The final rule defines a hospital-based physician as performing substantially all his or her services in an inpatient hospital setting or emergency room only.
- Including critical access hospitals in the definition of acute care hospital for the purpose of incentive program eligibility under Medicaid.
- Estimates that incentive payments under Medicare and Medicaid EHR programs for 2011 through 2019 will range from $9.7 billion to $27.4 billion.
The final rule also simplifies the electronic reporting of data on the quality of care, requiring three core measures in 2011: blood-pressure level, tobacco status and adult weight screening and follow-up.
If the provider has no patients to which these measure scan be applied,, physicians must report results for three alternate measures: flu shots in patients older than 50 years, weight management for children and adolescents, and childhood immunization status.
More information is online at CMS and at ONC. The final rule is available at the public inspection page of the Federal Register.
