Endocrine Insider
July 28, 2010

(See full issue)

As reported in previous editions of Endocrine Insider, the American Recovery and Reinvestment Act (ARRA) allocated approximately $19 billion for Medicare and Medicaid Health Information Technology (HIT) incentives over a five year period, including direct incentive payments for the adoption and meaningful use of an HIT system. Beginning in 2011, eligible physicians could receive up to $15,000 in the first year, with reduced payments in subsequent years.  For more details see the February 19, 2009 issue of EI.

Earlier this year, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule on the criteria that eligible providers must meet in order to receive the bonus. The Society submitted comments to CMS in response to this proposed rule, raising concerns about the ability of physicians to comply with all of the proposed required criteria.  CMS released the final rule on July 13, 2010 in which it provides more flexibility and less stringent metrics for compliance in a number of areas.  In easing requirements, the final rule accommodates many of the Society’s concerns.
 
To be defined as a “meaningful user” of an electronic health record (EHR), eligible providers must meet a total of 20 required measures, down from 25 in the proposed rule.  The final rule also provides some flexibility in that providers must meet 15 required measures but may choose the remaining five from a set of 10 optional measures. Additionally, within these measures, the metrics for compliance have been scaled back from those set forth in the proposed rule. For a list of the core and optional measure choices, and the metrics for compliance, please see page 44370 of the Federal Register notice.

The final rule maintains a requirement from the proposed rule for completion of computerized physician order entry (CPOE) but lowers the participation threshold. For example, the proposed rule required that eligible providers run 80 percent of their orders through CPOE; the final rule requires that only medication orders be run through CPOE and that only 30 percent of these orders must be run through CPOE .The final rule also reduces from 50 to 40 the percentage of all lab tests with results in a positive/negative or numerical format to be incorporated into a certified EHR as structured data. The proposed rule required that 75 percent of non-controlled substance prescriptions be sent electronically; the final rule drops that requirement to 40 percent.