Business Law Medicare and Medicaid Program

Question: Describe about the Business Law for Medicare and Medicaid Program. Answer: Introduction: Meaningful use is a Medicare and Medicaid program issued by CMS which gives incentives which is financial in nature for using Electronic health records technology (EHRs) which is certified to improve the health of patient. For getting the incentives related to EHR, providers need to show that certified EHR technology is meaningfully used by them, and they are also meeting the certain requirements such as recording the information of patients as data which is structured to exchanging summary care records. These requirements are set up by CMS for eligible hospitals, professionals and critical access hospitals. This EHR Medicare and Medicaid program is divided into three stages (HealthIT.gov, n.d.). In this paper, we discuss the background of meaningful use, and also state the requirements of meaningful use. The next topic contains effect on healthcare organizations if they are meeting or not meeting the requirements of meaningful use. We also discuss problems faced by healthcare organizations in fulfilling the requirements of meaningful use and also their possible solutions, and there is a brief discussion which includes why some organizations choosing not to meet the requirements and just bear the resultant penalties. Meaningful use: Background of meaningful use: Meaningful use defines as using the certified HER technology for the following purposes: For improving quality, safety, efficiency, and reducing disparities related to health. For increasing the engagement of patients and their families. For improving the public health, care coordination, and population. Maintain the confidentiality of health information of patient. It was assumed that this program will result in number of benefits such as better clinical outcomes; outcomes related to professional health will be improved; this will increase the efficiency and transparency of transaction, empower the individuals, and give access to the health system research data which is more accurate (HealthIT.gov, n.d.). If any eligible patients and hospitals adopt, upgrade, and demonstrate how to use certified EHR technology in a meaningful manner then financial incentives are awarded to that eligible patients and hospitals by Medicare and Medicaid EHR incentive program. Demonstration of meaningful use program requires time and resources, and this is the reason that CMS provide financial support to EPs and EHs for the demonstration of this program. EPs can qualify for this program up to $44000 from Medicare EHR Incentive Program and $63750 from Medicaid EHR Incentive Program, and eligible hospitals including CAHs can qualify up to $2 million or more (HealthIT.gov, n.d.). The three main components of meaningful use are stated and defined by Recovery Act: It is necessary that EP or hospitals use the certified EHR technology in manner which is meaningful. This technology is used to exchange the health information through electronic mode to improve the healthcare quality. This technology is used to submit the clinical quality measures and some other specified measures also, and these measures are selected by secretary (CMS, 2010). Following is the conceptual approach for meaningful use, and we also called the three stages of meaningful use: Capture and share the data Advanced clinical processes Improved outcome Requirements of meaningful use: This meaningful use program is conducted in three stages that are stage 1 which was initiated in 2010 and it main purpose is promoting the adoption of EHR technology, stage 2 was finalized in last of 2012 and this stage introduce more clinical decision support, care coordination requirements, and Stage 3 will focus on accurate exchange of information related to health and also other guidelines also which are introduced in earlier stages (Techtarget, n.d.). Following are the overview of three stages: Stage 1: following are the requirements of stage 1: 90 days is specified as reporting period for 1st year in this stage and also for 1 year subsequently. Reporting in this period must be done through attestation. EP and EH must achieve defined objectives and clinical quality measures. It is necessary to meet objectives and CQM that at least 80% patients have their records in certified EHR technology (HITEC/LA, n.d.). Stage 2: On 23rd August 2012, the Centers for Medicare Medicaid Services published a rule that is known as final rule, and that rule states the criteria for stage 2 that eligible professional and hospitals and CAHs must meet the objectives stated in stage 2 so that they can participate in the Medicare Medicaid Electronic Health Record Incentive Programs. Core objectives and also the menu structure for those core objectives are specified in Stage 1 and these objectives must be achieved by the providers for demonstrate meaningful use. Stage 2 keep these core objectives and menu structure specified by stage 1for use them in meaningful manner. There are number of stage 1 objectives which become core objectives for stage 2 (HRSA, n.d.). For demonstrating the meaningful use under stage 2 it is necessary that: In case of EPs it is necessary that they meet at least 17 objectives that are core objectives and they are selected from the list of 6 core objectives or from list of 20 core objectives. In case of EHs and CAHs, they must meet at least 16 core objectives and at least 3 menu objectives which are selected from the list of 6 core objectives or from list of 19 core objectives (CMS, 2012). Stage 3: Third level of stage of meaningful use mainly focus on following objectives: This part of the stage mainly focuses on improving the quality, safety and efficiency which result in good health outcomes. Support is provided by this level of stage to national high priority conditions. Patients can easily access to tools which help in promoting self management. It helps in improving the health of population. Access to data of patient which is comprehensive through the patient-centered HIE. Rule which is known as final rule is issued by CMS and ONC, and this rule is related to Medicare and Medicaid EHR Incentive Programs and the 2015 Edition Health IT Certification Criteria respectively on 6th October 2015 (Himms, 2015). Effect of meaningful use on health organizations: Research conducted by RAND shows strong evidence related to health IT improves patient outcomes. A large number of healthcare providers are using and adopting the information technology tools related to health such as certified EHRs which are mention in the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009. This act provides number of incentives if EPs and EHs meaningfully use certifies EHR technology which result in better care, health improvement, and lower costs. This program not only effect providers but to patients also such as: Many requirements of meaningful use program directly affect the patients by providing them easy access to the information related to their health, enhanced the engagement of patients and collaboration of patients with their providers. These requirements take care of many things such as whether patients get electronic reminder for their appointment, or they easily accessed the copy of information related to their health. Therefore now patients are experiencing positive changes in the health care system, and the reason behind this is health care technology. EPs send almost 190 million electronic prescriptions to their patients. Almost 13 million patients or more who aged up to 65 or more and under 5 years received reminders for their appointments. 33 million or more patients are now easily access the information through electronic mode related to their health (CMS, n.d.). Problems faced by health organizations: following are the problems faced by health organizations in meeting the requirement of meaningful use: There are large numbers of providers who have existing systems that are already performing functions related to HIE/EHR, and there are some other systems also which provide information related to lab results which are required to integrate into EHRs information to attain the requirements of meaningful use. It is the problem for providers to move data between these systems, and this will also bit expensive for providers especially for the medium size providers who do not have large IT stuff. The other problem for providers is that stage 3 criteria is not clearly defined till now, and those organizations which make investment in HER/HIE systems face uncertainty. Evaluating the current system against the standards issued by CMS will become the difficult challenge for the providers, especially for those providers who are looking to make new investment in this technology (Reich, n.d.; Backers, n.d.). Therefore, there are number of organizations which are ready to face penalty but did not meet the requirements of meaningful use. Conclusion: This report contains the background and definition of meaningful use, and also the three stages of meaning full use which are stage 1 Capture and share the data, stage 2 that is advanced clinical processes, and stage 3 improved outcomes. After this it contains the effect of meaningful use on providers and patients which state that both patients and providers get number of benefits from the meaningful use. Later we discuss the problems faced by providers in implementing the requirements of meaningful use such as problem for providers to move data between different systems, and stage 3 criteria is not clearly defined till now, and those organizations which make investment in HER/HIE systems face uncertainty. At last, we conclude the report with brief conclusion which state that meaningful use is beneficial for providers and patients but is also cause number of difficulties to providers in implementing the certified EHR program. References: HealthIT.gov. Meaningful Use Regulations. Retrieved on 8th December 2016 from: https://www.healthit.gov/policy-researchers-implementers/meaningful-use-regulations. HealthIT.gov. Meaningful Use Definition Objectives. Retrieved on 8th December 2016 from: https://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives. HealthIT.gov. EHR Incentive Programs. Retrieved on 8th December 2016 from: https://www.healthit.gov/providers-professionals/ehr-incentive-programs. Techtarget. meaningful use. Retrieved on 8th December 2016 from: https://searchhealthit.techtarget.com/definition/meaningful-use. CMS, (2010). Medicare Medicaid EHR Incentive Program. Retrieved on 8th December 2016 from: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/MU_Stage1_ReqOverview.pdf. HITCHLA. STAGE 1 MEANINGFUL USE CHECKLIST. Retrieved on 8th December 2016 from: https://www.hitecla.org/sites/default/files/HITEC-LA%20Stage%201%20MU%20Checklist_2011%200613.pdf. HRSA. Meaningful Use Stage 2. Retrieved on 8th December 2016 from: https://www.hrsa.gov/healthit/meaningfuluse/stage2/. CMS, (2012). Stage 2 Overview Tipsheet. Retrieved on 8th December 2016 from: https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/downloads/stage2overview_tipsheet.pdf. Himms, (2015). Meaningful Use 2015-2017 Modifications, Stage 3 Final Rules 2015 Certification Criteria. Retrieved on 8th December 2016 from: https://www.himss.org/library/meaningful-use/stage-3-final-rules. CMS. The Real World Impact of Meaningful Use. Retrieved on 8th December 2016 from: https://www.cms.gov/eHealth/ListServ_RealWorldImpact_MeaningfulUse.html. Reich, M. The technical challenges of attaining meaningful use. Retrieved on 8th December 2016 from: https://www.seabourneconsulting.com/the-technical-challenges-of-attaining-meaningful-use/index.html. Backers. 8 Problems Surrounding Meaningful Use. Retrieved on 8th December 2016 from: https://www.beckershospitalreview.com/healthcare-information-technology/8-problems-surrounding-meaningful-use.html.