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1. Meaningful Use Stage 2 : A View on
Penalties and Repercussions
The
Health Information Technology for Economic and Clinical Health Act (HITECH
Act), which was signed into law as part of the American Recovery and Reinvestment
Act of 2009 (ARRA), established a series of incentives and penalties to encourage
medical practitioners to adopt electronic health records (EHRs). The HITECH Act
established criteria for Meaningful Use (MU). The Centers for Medicare and Medicaid
Services (CMS) was tasked with validating MU to ensure that providers and hospitals
weren’t just installing EHRs, but using them in a way that actually improved patient
outcomes. Medicare and Medicaid eligible providers must meet a series of objectives
and then attest to MU by registering with CMS and providing the necessary data.
Meaningful Use Requirements and Attestation
The ARRA includes as much as $27 billion over ten years to support the adoption of
EHRs. EHRs can improve patient care and minimize costs by reducing the occurrence
of adverse drug events through clinical decision support rules, easier access to patient
records, increased patient outreach, and a greater percentage of generic prescribing.
Achieving these and other benefits requires that practitioners not simply move health
information from paper to electronic form but also utilize productivity- and safetyenhancing EHR functions such as entering prescriptions through the computer so
that the prescription can be automatically checked against the patient’s allergies and
for interactions with other drugs that patient is taking. Providers are required to meet
progressively more stringent MU requirements over the course of the program in order
to ensure that the full potential of EHRs is achieved.
Three Stages of Meaningful Use
CMS has divided MU into three stages.

Stage 1 began January 1, 2011, and places a focus on data collection. Eligible
providers will participate in no less than 2 years of Stage 1 regulations. In Stage
1, providers are expected to meet performance measures for 15 core and 5 of 10
menu objectives as well as a number of clinical quality measures.

Stage 2 is scheduled to begin January 1, 2014 for those providers that have
completed a minimum of two years of Stage 1 of Meaningful Use. Stage 2 places
a heavy emphasis on exchange of data.

Stage 3 is tentatively set to begin on January 1, 2015. No rules have been
proposed yet for Stage 3 of Meaningful Use.

2. EHR Incentive Programs
The HITECH Act established separate incentive programs for providers servicing
Medicaid and Medicare patients. The Medicaid program offers a maximum payout
of $63,750 over six years, while the Medicare program offers a maximum of $44,000
over five years. The last year to begin participation in the Medicaid program is 2016,
while the last year to participate in Medicare program is 2014. To qualify for the
Medicaid program, eligible providers must have a minimum of 30% Medicaid
population; pediatricians can qualify with a minimum of 20% Medicaid population.
Providers must demonstrate the Medicaid population over a 90 day period from the
previous calendar year. To qualify for the Medicare program, providers must bill for at
least one Medicare patient. Eligible providers also must have a minimum of $24,000 in
total Medicare allowables to receive the maximum incentive under the Medicare plan.
If the provider ends the year with less than $24,000, the provider will receive 75% of
their allowables as their incentive.
Disbursement schedule for Medicare MU Adopted Adopted Adopted Adopted
program
in 2011 in 2012 in 2013 in 2014
2011
$18,000
2012
$12,000
$18,000
2013
$8,000
$12,000
$15,000
2014
$4,000
$8,000
$12,000
$12,000
2015
$2,000
$4,000
$8,000
$8,000
$2,000
$4,000
$4,000
2016
Total
$44,000 $44,000 $39,000 $24,000

3. Disbursement schedule
Medicaid MU program
for Adopted
in 2011
Adopted
in 2012
Adopted
2014
Adopted
in 2015
Adopted
in 2016
2011
$21,250
2012
$8,500
$21,250
2013
$8,500
$8,500
2014
$8,500
$8,500
$21,250
2015
$8,500
$8,500
$8,500
$21,250
2016
$8,500
$8,500
$8,500
$8,500
$21,250
$8,500
$8,500
$8,500
$8,500
2018
$8,500
$8,500
$8,500
2019
$8,500
$8,500
$8,500
$8,500
$8,500
2017
2020
2021
Total
$8,500
$63,750 $63,750
$63,750
$63,750
$63,750
The Medicaid program allows the provider to receive the first year’s incentive by simply
adopting, upgrading or implementing a certified EHR solution. In the second year, the
provider only needs to prove MU for any consecutive 90 day period.
After the second year, the provide needs to prove MU for the entire year to receive the
incentive. Medicare providers must show MU for 90 continuous days to quality in their
first year and show MU for the full year in subsequent years. Medicare providers will
be subject to a 1% penalty if they do not successfully attest by October, 1, 2014,
while Medicaid providers will not be subject to penalties under current law. A provider
that qualifies for both programs should elect to participate in the Medicaid program
because of its higher payout and relaxed MU requirements in the first two years.

4. Providers attest to MU by entering numerators and denominators for each measure at
the CMS website for Medicaid providers. The website used for Medicaid registration
varies by state. Medicaid providers do not need to attest to MU during Year 1 but must
submit evidence they have purchased, implemented or upgraded to a certified EHR
solution.
Meaningful Use Stage 1
Stage 1 Meaningful Use objectives
To qualify for MU incentives, providers must use EHR technology that is certified by
Office of the National Coordinator (ONC) and Authorized Testing and Certification
Bodies (ATCBs). EHR products can be fully certified for all 25 MU objectives and a
minimum of 9 Clinical Quality Measures, or modular, which means they are certified
for a portion of the 25 objectives and 44 Clinical Quality Measures. Providers can
either purchase a fully certified solution or purchase modular solutions that together
meet the certification criteria.
Stage 1 Meaningful Use Core Objectives
1. Use computerized provider order entry (CPOE) for medication orders directly entered by any
licensed healthcare professional who can enter orders into the medical record per state, local
and professional guidelines.
2. Implement drug-drug and drug-allergy interaction checks.
3. Maintain an up-to-date problem list of current and active diagnoses.
4. Generate and transmit permissible prescriptions electronically (eRx).
5. Maintain active medication list
6. Maintain active medication allergy list

5. 7. Record all of the following demographics:
1. Preferred language
2. Gender
3. Race
4. Ethnicity
5. Date of birth
8. Record and chart changes in the following vital signs:
1. Height
2. Weight
3. Blood Pressure
4. Calculate and display body mass index (BMI)
5. Plot and display growth charts for children 2-20 years, including BMI.
9. Record smoking status for patients 13 years old or older.
10. Report ambulatory clinical quality measures to CMS or, in the case of Medicaid eligible providers
(EPs), the States.
11. Implement one clinical decision support rule relevant to specialty or high clinical priority along
with the ability to track compliance with that rule.
12. Provide patients with an electronic copy of their health information (including diagnostics test
results, problem list, medication lists, medication allergies) upon request.
13. Provide clinical summaries for patients.
14. Capability to exchange key clinical information (for example, problem list, medication list,
allergies, and diagnostic test results), among providers of care and patient authorized entities
electronically.

6. 15. Protect electronic health information created or maintained by the certified EHR technology
through the implementation of appropriate technical capabilities.
Stage 1 MU Menu Objectives
1. Implement drug formulary checks.
2. Incorporate clinical lab-test results into EHR as structured data.
3. Generate patient lists by specific conditions to use for quality improvement, reduction of
disparities, research, or outreach.
4. Send patient reminders per patient preference for preventive/follow-up care.
5. Provide patients with timely electronic access to their health information (including lab results,
problem list, medication lists, and allergies) within four business days of the information being
available to the EP.
6. Use certified EHR technology to identify patient-specific education resources and provide those
resources to the patient if appropriate.
7. The EP who receives a patient from another setting of care or provider of care or believes an
encounter is relevant should perform medication reconciliation.
8. The EP who transitions their patient to another setting of care or provider of care or refers their
patient to another provider of care should provide summary care record for each transition of
care or referral.
9. Capability to submit electronic data to immunization registries or immunization information
systems and actual submission according to applicable law and practice.
10. Capability to submit electronic syndromic surveillance data to public health agencies and actual
submission according to applicable law and practice.

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