October 2012 
Overview of the Stage 2 Final Rule
On Aug. 23, 2012, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator (ONC) released the next round of rulemaking in the journey to Meaningful Use (MU). The official posting of these final rules appeared in the Federal Register on Sept. 4, 2012. The next phase of core and menu set measures are, on the whole, more aggressive than those of Stage 1.
Stage 2: Continuous Quality Improvement
With Stage 1 focused on the adoption and implementation of Certified EHR Technology and the capture of critical, structured data elements, CMS intends for Stage 2 to advance clinical processes for continuous quality improvement, and to pave the way for Stage 3 to advance quality outcomes.
Increase in Total Objectives, Changes in Stage 1 Measures  
The overall number of total objectives increased to 19 for Hospitals and 20 for Eligible Providers (EPs). Both hospitals and providers will need to select three of six menu items within these requirements. CMS has eliminated some Stage 1 measures, modified others, and added entirely new measures to achieve its goals. Core Quality Measures are no longer a Meaningful Use core requirement – but must be achieved to attest to Meaningful Use. All menu set requirements have been moved to core for Stage 2.
Key Changes within Stage 2  
Key changes within the Stage 2, the final rule, include:  
“The good news is that achievement and continuation of the Stage 1 requirements will automatically address several of the Stage 2 requirements for hospitals and providers. Any hospital or provider that has achieved Stage 1 will be about 60% done with Stage 2 requirements.”

Jim Deren
Strategic IT Planning
Specialist
CareTech Solutions

  • Stage 2 timing and program staging
  • – Early adopters (2012 and prior) will only need to measure 90 days for year one of Stage 2 in 2014
  • Certified EHR Technology updates – Attesters will need to purchase the base certified technology but only additional functionality that is relevant to their environment. A list of certified technology can be found at “http://onc-chpl.force.com/ehrcert
  • Core and menu set requirements – include new thresholds, increased functionality, new requirements, and the merging of some requirements
  • Clinical quality measures – have changed and the number of measures increased. Electronic transmission is required starting in 2014
  • Medicare payment adjustments – penalties will begin for those that have not attested by 2015 or those who do not continue to attest once achieved
  • Changes to the Medicaid EHR Incentive Program – expand the method for counting Medicaid patients
  • Appeals and audit process has been expanded to include new situations
  • The earliest that Stage 2 criteria will be effective is in federal fiscal year 2014 (Oct. 1, 2013) for eligible hospitals and calendar year 2014 (Jan. 2, 2014) for eligible providers
Certified Software Changes
In parallel to the CMS final rule defining Meaningful Use for 2014 and beyond, ONC has issued a final rule on standards, implementation specifications, and certification criteria for EHR technology to support the next round of Meaningful Use. The rule, referred to as the “2014 Edition,” represents an entirely new definition for Certified EHR Technology. CMS has eliminated the requirement regarding the need to “possess” EHR modules that are not going to be used to achieve Meaningful Use until a future stage.  
CareTech Solutions has compiled a more detailed summary of the Stage 2 specifications which can be provided upon request.  
Additional helpful public information links are:
The next newsletter will include a detailed look at Stage 2 requirements and specifications.


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