EHR Meaningful Use - Beware Of The Show Stopper

Using your certified EHR in a meaningful way and successfully attesting that you've done just that online

By Brad Rourke, CPA

You can use your certified EHR (Electronic Health Record) and receive up to $18,000 for your first meaningful use reporting period. But first, you must meet the 15 core measures from Centers for Medicare & Medicaid Services (CMS) and the 10 menu set measures, from which you must satisfy five.

MEANINGFUL USE

If you are e-prescribing, maintaining patient problem lists, and providing at least 50 percent of your patients with a clinical summary, you may have everything covered to qualify for the incentive payment. But, when you are on CMS's website (cms.gov/EHRIncentivePrograms/) attesting to that, some questions might stop your progress.

The question posed for core measure number 10, “Report ambulatory clinical quality measures to CMS,” on the attestation form is simple: “I will submit Clinical Quality Measures?” You select ‘Yes' and move on to core measure 11 of 15 and breeze through and attest to all 15 core measures and five menu measures with relative ease.

At that moment, you think you have successfully qualified, select save and continue. But the next page is “Core Clinical Quality Measures [CQMs] Questionnaire 1 of 3.”

You've been confronted with the show stopper. This is where fatigue and frustration set in, because at this point you learn that you must report numerators and denominators for CQM instead of answering a simple Yes or No question with regard to implementing CQM.

Clinical Quality Measures is the most challenging of the Meaningful Use requirements, and if you do not successfully report this measure, you will not qualify for incentive dollars.

PART ONE OF THE SHOW STOPPER: THREE CORE QUALITY MEASURES

There are three core quality measures that physicians must report regardless of specialty:

1. NQF 0013 - Hypertension: Blood Pressure Measurement
2. NQF 0028 - Tobacco Use Assessment and Cessation Intervention
3. NQF 0421 - Adult Weight Screening and Follow-up

For each of these measures, you must track the number of unique patients you've seen during the reporting period that qualify within the definition of these core measures (the denominator) and the number of your performance instances (the numerator).

The performance instance is specific to the particular measure, for instance, in the case of Tobacco Use, cessation counseling. If you report zero in the denominator for any of the three core measures noted above, then you must substitute an ‘alternate core measure.'

A CMS EHR Meaningful Use Overview is provided on the CMS website that outlines the criteria for Meaningful Use and how to meet the requirements

PART TWO OF THE SHOW STOPPER: THREE ADDITIONAL QUALITY MEASURES

Once you've completed three core measures, save, and continue to the list of “Additional Clinical Quality Measures” to choose three. You'll be prompted to enter numerators and denominators. For eyecare practitioners, the most common additional reported measures are:

1. NQF 0086 - Primary Open Angle Glaucoma: Optic Nerve Evaluation
2. NQF 0088 - Diabetic Retinopathy: Documentation of Macular Edema and severity of Retinopathy
3. NQF 0055 - Diabetes: Eye Exam

For each of these measures, track the number of unique patients you've seen during the reporting period who qualify (the denominator) and the number of your qualifying performance instances.

THE SOLUTION

If you plan to “meaningfully use” a certified EHR, take the time to educate yourself on what qualifies for the numerators and denominators in the three core and the three additional measures you plan to report. If you do not do this, all of the time and effort you and your staff invest toward meaningful use may be for naught. EB

Brad Rourke, CPA, is vice president of Practice Director Software, headquartered in Lincoln, Neb.