August 10th, 2015
By Dr. Jeff Brown -Meaningful Use Mentor
The big, bad word feared by many, “Meaningful Use,” simply means the performance of specific activities, known as Meaningful Use measures, with the aid of your certified EHR software. It’s not big and it’s not bad, and you definitely have nothing to fear.
To begin, there are 25 Meaningful Use measures and the EHR software you use must be certified in ALL 25, period! I emphasize this fact because there has been some confusion in the marketplace regarding this issue. Just know that your EHR product must be tested and certified in ALL measures if you are to get the coveted “CMS EHR Certification ID,” and ultimately a stimulus check. Look for the words “complete certification” on any software product you are considering, or already use, to know if it has passed every test set forth by the EHR Incentive Program.
For providers, the 25 Meaningful Use measures are divided into two groups, the first of which are called Core Measures, and there are 15 of them. These 15 core measures are non-negotiable, you must successfully report on them all. There is good news, however; the vast majority of chiropractors may report an exclusion for at least two of the 15 core measures – CPOE for medications and ePrescribing. Both have an exclusion for Eligible Professionals who write fewer than 100 prescriptions, which, of course, the vast majority of DCs will qualify for.
The 15 core measures are:
- CPOE for Medication Orders (Exclusion for non- prescribing DCs)
- Drug Interaction Checks
- Maintain Problem List
- ePrescribing (eRx) (Exclusion for non-prescribing DCs)
- Active Medication List
- Medication Allergy List
- Record Demographics
- Record Vital Signs
- Record Smoking Status
- Clinical Quality Measures (CQMs)
- Clinical Decision Support Rule
- Electronic Copy of Health Information
- Clinical Summaries
- Electronic Exchange of Clinical Information
- Protect Electronic Health Information
Second, there are ten Menu Measures, of which a chiropractor must choose five. You have some freedom here as you get to decide which five to report, hence the word “menu.” Keep in mind, numerous measures include exclusions that essentially exempt you from the measure as a whole, and reporting exclusions does not count against you. For instance, if you report the exclusion for one of the menu measures, you will only need to pick up four more from the remaining nine on the list. Or said another way, one excluded menu measure, plus four more menu measures, equals the five you need. The same holds true if you reported two exclusions: you would then only have three more to report, and so on. As long as you report five menu measures in total, it doesn’t matter how many are exclusions (2011 and 2012 only).
The 10 Menu Measures Are:
- Drug Formulary Checks (Exclusion for non-prescribing DCs)
- Clinical Lab Test Result
- Patient Lists
- Patient Reminders
- Patient Electronic Access
- Patient-specific Education Resources
- Medication Reconciliation
- Transition of Care Summary
- Immunization Registries Data Submission
- Syndromic Surveillance Data Submission (Exclusion likely for all DCs)
Menu measures #9 and #10 are considered “public health” measures and CMS wants one of these to be among the five you choose. Without going into great detail, choose #10 over #9 because #9 relates to immunizations, which Chiropractors do not administer.
Probably the most asked question I get from doctors is this: “Do I have to meet all of these Meaningful Use measures every time I see a patient?” Meet, yes; do something different than you do now, most likely not.
As an example, let’s examine core measure #8, Record Vital Signs. In order to meet this measure, you’ll need to have height, weight, and blood pressure recorded for more than 50 percent of patients age 2 and over. Sounds time consuming to take blood pressure on half of your 60 patients scheduled next Monday, doesn’t it? Not to worry, digging into the rule a little deeper is found this statement: “Height, weight, and blood pressure do not have to be updated by the EP at every patient encounter. The EP can make the determination based on the patient’s individual circumstances as to whether height, weight, and blood pressure need to be updated.” And better yet, the Final Rule also says this: “First, we do not believe that all three [height, weight, and blood pressure] must be updated by a provider at every patient encounter nor even once per patient seen during the EHR reporting period.” The above statements essentially say that the healthcare provider, not the government, gets to decide when it is clinically appropriate to reassess the vitals on any given patient. Clearly, no one in the government expects you to take vital signs on everyone, at every visit.
Furthermore, the Record Vital Signs measure even has a reportable exclusion for doctors who believe all three vital signs have no relevance to their scope of practice. Yes, the government is definitely not trying to tell you how to practice Chiropractic!
Also, keep in mind that none of the measures are so rigid as to expect 100% success. This means that each measure has benchmarks, or minimums, which take into consideration real life practice, and that it is impossible for offices to do everything all the time. For example, Menu #4, Patient Reminders, only asks you to send a reminder to 20 percent of your younger and older patients. Chiropractors should aspire to far exceed this 20 percent minimum because sending reminders is a fantastic way to boost patient retention.
There are yet other exclusions not mentioned here, and many of the measures listed above are extremely simple to meet. Bottom line: have no fear, Meaningful Use measures are merely sheep in wolves’ clothing.
By: Jeff Brown, DC, CPC, CCPC, www.meaningfulusementor.com