Meaningful Use Stage 2: It’s Not too Early to Prepare for Attestation

By Michele Judge

With the first round of attestation for the Medicare and Medicaid EHR Incentive Program out of the way, healthcare providers are looking toward the next phase that commences in 2014. As expected, the second stage of MU will greet them with stricter documentation requirements. Rather than being dismayed, eligible professionals (EPs) and hospitals should utilize lessons learned in Stage 1 to prepare for a successful Stage 2 attestation.

To review, providers and hospitals will be required to report on more core objectives than in Stage 1. EPs will now attest to 20 total items, including 17 core objectives and three (of six) menu objectives. But as the industry found out from Stage 1, attestation is not straightforward. Reporting requirements are different for certain patient populations, which is the essence of numerators, denominators, thresholds and exclusions. This aspect proved to be among the most confusing for providers.

To help clarify, objectives requiring a numerator and denominator are divided into two groups:

In the first group, the denominator is based on patients seen or admitted during the 90-day EHR reporting period, regardless of whether their records are maintained using certified EMR technology.

The second group of objectives consists of those that are not relevant to all patients. In this case, the denominator is based on actions related to individuals whose records are maintained using certified EMR technology. More information can be found in guides such as this one provided by CMS.

But it’s not only the complex rules that promise to trip up providers in Stage 2. Meeting the increased documentation requirements for radiology and laboratory orders in particular have many wondering if they will attest successfully. The reason? Up until now, the focus for EMR developers has been on usability and meeting Stage 1 requirements. Radiology and lab order documentation has not previously been a priority.

Providers must use 2013 to become familiar with their EMR’s radiology and lab modules. If they determine that limitations in the software will jeopardize their MU compliance chances, they can suggest that their vendors deliver a more functional solution. Physicians can also consider implementing third-party stand-alone technology or a module that can be embedded within their current EMR. Many products, such as Emdeon’s lab orders and results software, are Web based, greatly easing implementation.

Perhaps the greatest bit of advice for the provider community, however, is not to procrastinate. Many physicians waited until the last three months of the year to collect their data, only to find that they failed to meet core and menu set objectives. Rather than risk missing out on MU’s economic windfall, providers should choose a 90-day period early in the year for attestation, leaving ample time to adjust their data if they do not initially meet the appropriate criteria. Providers should also consider using CMS’ calculator at, to test whether or not they would successfully demonstrate Meaningful Use.

With adequate foresight and planning, healthcare providers will greatly increase their chances for MU success. Companies like Emdeon are great resources, providing insights and continuously guiding physicians through the complex maze that is Meaningful Use.

Michele Judge is Senior Director of Clinical Services at Emdeon. She has over 20 years of experience in managing, deploying and developing computerized physician order entry solutions for laboratories, hospitals and pharmacies.

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Emdeon Awarded Exclusive Health and Human Services Contract to Define Process for Electronic Healthcare Transaction Standards

We are proud to announce that Emdeon has recently been awarded a contract to define the processes and tools needed to move electronic healthcare transaction standards to a new version. Under the contract, Emdeon will develop and execute an analytical methodology for the Centers for Medicare and Medicaid Services (CMS) to estimate the industry impact of moving to a new version of electronic transaction standards. The recommended process will be submitted prior to the standards development organization proposing adoption by the U.S. Department of Health and Human Services (HHS) to the National Committee on Vital and Health Statistics.

The purpose of the project is to define the activities when new HIPAA and ACA transaction standards are adopted to avoid the implementation issues that have been associated with revised transaction standards in the recent past. According to CMS, the intent of the project is to greatly reduce the likelihood of technical issues going undetected until after the standards are adopted and to eliminate the negative impacts such technical issues would have on the healthcare industry. Under the terms of the agreement, Emdeon will analyze the functionality, usability, interoperability and business usage of a sample of draft versions of HIPAA standards for the following healthcare transactions: claims, claim status, claim payment/remittance advice, eligibility and referral authorizations, as well as any new standard that HHS may consider for adoption during the term of the project.

"We are pleased to work with HHS on such a high-visibility project and lend our industry experience to help avoid costly implementation interruptions that could potentially save the healthcare industry millions of dollars," said Debbi Meisner, vice president of regulatory strategy for Emdeon. "As the single largest clinical, financial and administrative health information exchange in the U.S. healthcare system, Emdeon's extensive experience will enable us to identify and correct potential technical issues during all phases of the transition to a new version of the transaction standards."

For more information on this and other important industry news, check out the Emdeon Newsroom at

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So, what's all the fuss about ACOs?

Try as you might, it’s hard to ignore the buzz surrounding accountable care organizations (ACOs) these days. You’ll find articles about ACOs in nearly any publication you open and presentations on ACOs at nearly any conference you attend.

So—as Emily Litella of Saturday Night Live fame would say—what’s all this fuss about ACOs?

Shared savings, shared risk
When you sort through all of the rhetoric and regulation, an ACO is a network of doctors, hospitals and health plans that shares responsibility for providing care to patients. ACOs—both public and private networks—offer incentives for providers that cooperate and save money while meeting specific quality metrics. In other words, they get bonuses for keeping patients healthy and out of the hospital. On the other side of the coin, providers will be responsible for additional costs if they cannot effectively treat the patient.

While some experts debate whether or not ACOs will completely replace the current fee-for-service approach, they predict that some flavor of ACO will gain prominence in the marketplace.

PCPs and smaller practices will be critical to ACO success
Smaller practices find themselves in a challenging situation. It’s likely that large provider groups (such as independent physician associations), hospitals, health systems and payers will drive the development of most ACOs. But they will be highly dependent upon “family docs,” primary care providers (PCPs) and small specialty practices to deliver the well care, preventive services and disease management critical to meeting the access/quality/cost conundrum.

New model requires technology, communication
It’s to your advantage to explore whether or not it would be beneficial to participate in an ACO. You’ll be asked to enter into contractual relationships with other providers in your service area, of course, as well as implement health information technology (HIT) solutions like electronic health records (EHRs) to facilitate data sharing and collaboration if you have not done so already.

It also means you’ll need to communicate with patients about your involvement. The Medicare Shared Savings Program mandates that PCPs tell patients they are part of an ACO—and when they’re referring these patients to hospitals or specialists within the network. Patients, of course, can select other providers if they prefer.

Yet another option: the Comprehensive Primary Care Initiative
Here’s another twist: the Centers for Medicare and Medicaid Services (CMS) has created a model similar to ACOs specifically for PCPs—the Comprehensive Primary Care Initiative, also funded by healthcare reform. Through the program Medicare will coordinate with private and state health plans to pay bonuses to PCPs who improve care coordination for their patients. Even better, Medicare will offer PCPs additional resources to participate in the program. After two years, Medicare will give participants a chance to share in any savings they generate.

Consider all your options
Without a doubt, there will be no shortage of options for you to consider. And you’ll be able to respond in whichever way you feel most appropriate for your practice.

There’s only one reaction your partners at Emdeon advise against: Don’t take your cue from Emily Litella and simply say, “Never mind.” These changes are coming—and PCPs and small practices will be right in the middle of any new model. You’d be wise to keep abreast of what is occurring on the national scale, as well as right in your own backyard.

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