CMS and ONC Issue Regulations Proposing a Definition of "Meaningful Use" and Setting Standards for EHR Incentive Program

The Centers for Medicare & Medicare Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) encourage public comment on two regulations that lay a foundation for improving quality, efficiency and safety through meaningful use of certified electronic health record (EHR) technology. The regulations will help implement the EHR incentive programs enacted under the American Recovery and Reinvestment Act of 2009 (Recovery Act).

A proposed rule issued by CMS outlines proposed provisions governing the EHR incentive programs, including defining the central concept of “meaningful use” of EHR technology. The proposed rule would define the term "meaningful EHR user" as an eligible professional or eligible hospital that, during the specified reporting period, demonstrates meaningful use of certified EHR technology in a form and manner consistent with certain objectives and measures presented in the regulation. These objectives and measures would include use of certified EHR technology in a manner that improves quality, safety, and efficiency of health care delivery, reduces health care disparities, engages patients and families, improves care coordination, improves population and public health, and ensures adequate privacy and security protections for personal health information.

The proposed rule would define meaningful use for the Medicare EHR incentive programs. It proposes one definition that would apply to eligible professionals participating in the Medicare fee-for-service and the Medicare Advantage EHR incentive programs as well as a proposed definition that would apply to eligible hospitals and critical access hospitals. These definitions also would serve as the minimum standard for eligible professionals and eligible hospitals participating in the Medicaid EHR incentive program. The rule proposes that states could request CMS approval to implement additional meaningful use measures, as appropriate, but could not request approval of fewer or less rigorous meaningful use measures than required by the rule.

An interim final regulation (IFR) issued by ONC sets initial standards, implementation specifications, and certification criteria for EHR technology. Both regulations are open to public comment.

Read the CMS proposed rule and fact sheets   
Read ONC’s interim final rule

Medicare Wants Prescriptions Filled only with Drugs Properly Listed with FDA

The Centers for Medicare & Medicaid Services (CMS) have produced a fact sheet for Medicare Part D enrollees to help ensure that they receive safe and legally marketed prescription drugs. Effective January 1, 2010, CMS is no longer reimbursing Part D sponsors for prescription drugs that are not listed with the Food and Drug Administration (FDA).  This policy is part of a safety initiative to ensure that Medicare Part D enrollees receive prescription drugs that are properly registered with the FDA. View fact sheet  

40 Percent of U. S. Prescriptions Not Taken Properly; 12 Percent Not Even Picked Up

The Center for Technology and Aging has issued a position paper providing an overview of the medication-use process, and discusses three areas of opportunity for medication optimization in older adults: 1) medication reconciliation, 2) medication adherence, and 3) medication monitoring. Example technologies that support each area are also described. Among the research sources utilized are peer-reviewed journal articles, research and position papers from government and non-government sources, views expressed in expert panels and informant interviews, and research reports from the Health Technology Center and the New England Healthcare Institute. View full paper

Report Touts “Med-op” Technology for Older Adults

A new report supports information technology as key to improving medication-related errors and improving medication adherence among older adults. Produced by the Center for Technology and Aging in Oakland, Calif., the report says "widespread use" of technology aimed at this population could save thousands of lives and billions of dollars.

"More widespread use of technologies that reduce the cost and burden of medication-related illness among older adults is urgently needed," said David Lindeman, the center's director. Read more

Pharmacist-Physician Collaboration Improves Blood Pressure, Study Finds

Clinical pharmacists’ medication therapy recommendations for patients with uncontrolled hypertension to the patients’ community-based physicians resulted in controlled blood pressure for 63.9 percent of intervention group patients, compared to 29.9 percent of control group patients, according to a study published in the November 23, 2009, Archives of Internal Medicine. The study found that the intervention pharmacists made 771 recommendations, of which 742 (96.2%) were accepted by physicians. Of the 1,139 documented antihypertensive medication changes, 49.3 percent were for new medications, 29.2 percent were for increasing medication dosages, 17.1 percent were for stopping current medications, and 4.3 percent were for decreasing medication dosages. The study enrolled 402 patients at six Iowa medical offices and was conducted over six months. The pharmacists involved in the study held doctor of pharmacy (PharmD) degrees, and had completed pharmacy residencies in primary care. Read study abstract

MTM Project:
MTM faculty has established new requirements for assigning patients to pharmacists via the MTM Web portal and using the portal as a reimbursement vehicle from NMMRA. All pharmacists participating in the MTM project must use the MTM Web portal; anyone having problems signing in should contact Alex Vigil at (505) 998-9766.

E-Prescribing Project:
Evaluation of e-prescribing implementation is underway for phase 1 physicians. The Health Information Technology (HIT) Advisory Board has established requirements for free second-year vendor subscription fees, which will be due first quarter 2010 for phase 1 physicians. The HIT Advisory Board will evaluate each physician’s utilization of the technology to determine what portion of the subscription fee will be reimbursed. Initial data suggests that physicians will not meet the project’s original participation threshold for 100-percent coverage of the subscription fee, which requires that 80 percent of the physician’s prescriptions be transmitted electronically. The HIT Advisory Board has agreed to reduce the requirements to reach 100-percent reimbursement. Reimbursement of the second-year subscription fee will be determined based on the following program criteria:

• 100 percent reimbursement if 50 percent or more of eligible prescriptions are transmitted electronically
• Evaluation will be based on utilization during the last three months of the vendor’s contract year for each physician
• Subscription fee reimbursement will be prorated based on the percentage of eligible e-prescribed prescriptions below 50 percent 

Participating providers are responsible for meeting program requirements and payment of any portion of the subscription fee not reimbursed by NMPIC. Recruitment for phase 2 of the e-prescribing project continues - only 15 ore spots are available for phase 2. If you wish to participate, please contact Galina Priloutskaya.

PIMs

PIM guideline posters were distributed to 1,400 pharmacists, 250 osteopathic physicians, 70 nursing homes, 170 New Mexico Association for Home and Hospice Care members, 250 New Mexico Primary Care Association members and 5,000 medical providers licensed by the Board of Medical Examiners. Hospices and assisted living facilities have also expressed interest in implementing the PIM clinical guidelines. PIM posters will be made available for them per request. Please contact Susan Yelton at (505) 998-9753 to request PIM guidelines.

This material was prepared by the New Mexico Medical Review Association (NMMRA), the Medicare Quality Improvement Organization for New Mexico, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.
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