Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

EPs cannot receive EHR incentives from both Medicare and Medicaid in the same year—they must choose between the two, even if they are eligible under both programs. As discussed in a prior Meaningful Use Monday post, Medicaid is typically the EHR incentive program of choice for EPs who have a sufficiently large Medicaid volume. 

But providers must re-qualify annually, so what happens if the participating provider’s Medicaid volume drops below the 30% (or 20% peds.) threshold in a future year, making him/her no longer eligible for that program? What about an EP who initially participates as a Medicare provider, but subsequently becomes eligible for the more generous Medicaid program? As the first EHR Incentive Program participants approach year 2, they need to understand their options in this regard. 

The rule is as follows:  An EP may switch from one program to another, but only one time after receiving his/her first EHR incentive payment, and only for a payment year before 2015.  

Note: In case you are doing the math and calculating how you could game the system to increase your potential revenue, the rule goes on to say that under no circumstances can an EP’s total incentives exceed the total available under Medicaid, (i.e., $63,750).

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

A Meaningful Use Monday reader asked whether a provider who practices near the border of two states and treats patients under the two distinct Medicaid programs can participate in both EHR incentive programs. A similar question has been asked by physicians who have practice locations in two neighboring states. The answer is “No”, even if the EP meets or exceeds the 30% patient volume threshold in both states. 

EPs can receive only one incentive each year, and they must choose the state from which they wish to receive the payment. They can, however, change states on an annual basis when they re-attest—flexibility which is valuable in the event that their Medicaid volume falls below the required level in the first state and they lose eligibility for that program. 

CMS created a single registration system for both incentive programs to enable the States to check for—and make them responsible for preventing—duplicate payments, whether from two states or from Medicaid and Medicare simultaneously. My next Meaningful Use Monday post will discuss the rules for switching between the Medicaid and Medicare EHR incentive programs.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

At last week’s HIT Policy Committee meeting, Robert Tagalicod, (the new director of the Office of E-Health Standards & Services), presented an analysis of the attestation experience to-date [See John's previous Meaningful Use Details post for the slides and report]. The results lend themselves to some interesting observations—admittedly preliminary findings, but revealing nonetheless: 

• The average performance levels were quite high—on those measures that have thresholds to be met, providers attested to results considerably above the level required for successful accomplishment. This is a positive sign that once providers commit to an EHR and to meaningful use, they try to use the EHR on a routine basis, not just to satisfy the minimum requirements. True, these initial attesters represent early EHR adopters who have had time to become successful EHR users, but hopefully this trend will be sustained.
• Care coordination measures seem to present a challenge for many providers—the most commonly deferred (i.e., not selected) menu measures were medication reconciliation and summary of care at transitions.
• Very few providers were actually able to conduct a test of their ability to electronically submit syndromic surveillance information to public health agencies or submit immunization data to registries (5% and 28% of attesters, respectively). Not surprisingly, most EPs either excluded or deferred these public health measures. 

Of the 2,383 EPs that attested, 137 were unsuccessful. I’d be interested to know where they stumbled and if they will succeed in another reporting period.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Last week’s Meaningful Use Monday identified the two meaningful use public health measures—electronic reporting of immunizations and electronic reporting of syndromic surveillance data—at least one of which EPs must include among their 5 menu measures. So, what do you do if you can’t meet one or both of the public health measures? 

The requirement: EPs must accomplish at least one of these measures or they must exclude both. Another way to look at this is: If an EP attests to an exclusion for one of the measures, then the EP must attest to either accomplishing or excluding the other. What the EP cannot do is exclude one and then skip (“defer”) the other. (Examples of acceptable and unacceptable scenarios are described below.) 

There is a difference between “excluding” a measure and “deferring” a measure:

• To exclude a measure, the EP must meet the criteria for exclusion as spelled out in the definition of the measure. Example: an EP does not collect any reportable (i.e., syndromic surveillance) information, or there is no agency that can accept this information electronically. Excluding a measure counts as meeting the measure.
• Defer is the CMS term for electing to skip this measure, i.e., not count it as one of the EP’s 5 menu measures. (The term “defer” implies that the EP is postponing compliance to Stage 2.)

 Acceptable scenarios:

• Accomplish both public health measures.  This satisfies 2 of the 5 menu measures required for meaningful use.
• Accomplish one of the public health measures and defer (skip) the other measure. This satisfies 1 of the 5 menu measures.
• Accomplish one of the public health measures and exclude the other (assuming the EP meets the criteria for exclusion). This satisfies 2 of the 5 menu measures.  Note: Although CMS prefers that EPs not use up measures with exclusions if there are measures for which they have actual data or experience to report, the rules do not require EPs to do so.
• Exclude both public health measures (assuming the EP meets the criteria).

 Unacceptable scenario:

• Exclude one public health measure and defer the other. For example, an EP’s local public health agencies cannot accept syndromic surveillance information, but there are local registries that can accept immunization information. If this EP excludes syndromic surveillance, he/she would have to also report on immunizations—either by meeting the measure or by attesting to an exclusion.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

When selecting the 5 meaningful use menu measures on which to report—from the list of 10 possibilities—the only constraint is that the EP must include at least one of the two measures from the “public health” category:

• Perform a test of the EHR’s capacity to submit electronic data to immunization registries
• Perform a test of the EHR’s capacity to report electronic syndromic surveillance data to public health agencies.

 These two measures have a number of things in common:

• EPs report by attesting that “Yes” a test was performed. There is no numerator and denominator to report and consequently no thresholds to meet.
• One test is sufficient for a group of providers that share a certified EHR in the same setting – it is not necessary for each EP to conduct a test individually.
• The test does not have to be successful to meet the measure.
• If the test is successful, then the EPs should continue to report on a regular basis.

 Both measures allow EPs to claim an exclusion under specified circumstances:

• Immunizations Measure:  The EP does not perform immunizations OR none of the immunization registries to which he/she would submit the information are able to receive the information electronically.
• Syndromic Surveillance Measure: The EP does not collect any reportable information OR there is no public health agency that is able to receive the information electronically.

 The potential to exclude these measures has resulted in some confusion about which—and how many—of these measures to report. The next Meaningful Use Monday post will offer some guidance on this issue.