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CMS may require meaningful use-certified EHRs for chronic care services

July 9, 2014
by Pamela Tabar, Editor-in-Chief
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Long-term care may have to start paying closer attention to the meaningful use program, especially if the Center for Medicare & Medicaid Services' (CMS') new proposed rule is approved. The federal agency is seeking to require the use of electronic health records (EHRs) that are certified to a minimum of meaningful use Stage 1 for physicians who provide chronic care management (CCM) services.  

The high acuity levels in skilled nursing bring the proposed mandate squarely to long-term care's front doorstep: Most adults aged more than 65 years (80 percent) have one chronic condition, and 50 percent have two or more, notes the Centers for Disease Control and Prevention.

The proposed requirement is a shift away from last year’s planned focus on requiring physicians to ensure billing capabilities and toward the collection and exchange of the data itself, according to the proposed mandate, buried in a 600-page proposed rule of Part B revisions slated to be published July 11 in the Federal Register (the pre-publication copy is available here).

"Given the standards and requirements already in place for healthcare practitioners and that will apply to those who furnish and bill for CCM services, we have decided not to propose an additional set of standards that must be met in order for practitioners to furnish and bill for CCM services," the proposed rule states. "Instead of proposing a new set of standards applicable only to CCM services, we have decided to emphasize that certain requirements are inherent in the elements of the existing scope of service for CCM services, and clarify that these must be met in order to bill for CCM services.

"In one area—that of [EHRs]—we are concerned that the existing elements of the CCM service could leave some gaps in assuring that beneficiaries consistently receive care management services that offer the benefits of advanced primary care as it was envisioned when this service was created," CMS explains in the rule. "It is clear that effective care management can be accomplished only through regular monitoring of the patient’s health status, needs and services, and through frequent communication and exchange of information with the beneficiary and among health care practitioners treating the beneficiary."

Valid EHR systems must be able to provide an electronic care plan, patient history notes, allergies and medication lists, care coordination capabilities and other data exchange functionality, according to the 2014 meaningful use Stage 1 standards.

As CMS explains in the proposed rule, "We believe that if care is to be coordinated effectively, all communication must be timely, and it must include the information that each team member needs to know to furnish care that is congruent with a patient’s needs and preferences."

To date, physician participation in the meaningful use program has been voluntary, although those who participate generally receive higher Medicare reimbursements.

The proposed rule [CMS-1612-P] is open for comment until Sept. 2.