Stage 2 Meaningful Use NPRM Moves Toward Patient-Centered Care Through Wider Use of EHRs

Farzad Mostashari, MD, ScM, National Coordinator for Health Information Technology

Marilyn Tavenner, Acting Administrator for the Centers for Medicaid and Medicare Services

Substantial evidence shows that higher adoption of Electronic Health Records (EHR) can save our health care system money, save time for doctors and hospitals, and save lives.  Thanks to the Recovery Act and the Medicare and Medicaid EHR Incentive Program, we have seen great success and momentum as we’ve taken the first steps toward adoption of this critical technology: to date, over 43,000 providers have received $3.1 billion to help make the transition to electronic health records; the number of hospitals using EHRs has more than doubled in the last two years from 16 to 35 percent between 2009 and 2011; and 85 percent of hospitals now report that by 2015 they intend to take advantage of the incentive payments.

We have just announced the second stage of the three stage process.  This reflects our desire to create ambitious, but achievable, goals that enable eligible professionals and hospitals to make incremental progress in adopting and implementing electronic health records (EHRs).  The three stages are:

  • Stage 1 (which began in 2011 and remains the starting point for all providers): “meaningful use” consists of transferring data to EHRs and being able to share information, including electronic copies and visit summaries for patients.
  • Stage 2 (to be implemented in 2014 under the proposed rule): “meaningful use” includes standards such as online access for patients to their health information and electronic health information exchange between providers.
  • Stage 3 (expected to be implemented in 2016): “meaningful use” includes demonstrating that the quality of health care has been improved.

Today’s proposed rules focus on using EHRs to improve health and health care while reducing the burden on physicians and hospitals where possible. 

CMS’ proposed rule would specify the Stage 2 criteria that eligible providers must meet in order to qualify for Medicare and/or Medicaid EHR incentive payments.  It also would specify Medicare payment adjustments that, beginning in 2015, providers will face if they fail to demonstrate meaningful use of certified EHR technology and to meet other program participation requirements.  In addition, as we announced in a November 2011 “We Can’t Wait” announcement, Stage 1 has been extended an additional year for providers who attested in 2011 – meaning that these providers will have to attest to Stage 2 in 2014, instead of in 2013. 

The proposed rule announced by ONC identifies standards and criteria for the certification of EHR technology, so eligible professionals and hospitals can be sure that the systems they adopt are capable of performing the required functions to demonstrate either stage of meaningful use that would be in effect starting in 2014.

Together, these rules will encourage even more providers to participate and support more coordinated, patient-centered care. 

For details on today’s announcement, please visit;; and

Fighting Improper Payments And Fraud – Protecting Taxpayer Dollars

By Marilyn Tavenner, Acting Administrator of the Centers for Medicare & Medicaid Services (CMS)

Fighting fraud and waste in the health care system is a top priority for the Obama Administration.  We are committed to using all resources at our disposal in these efforts – and they are paying off.

Just last week, the Departments of Justice and Health and Human Services (HHS) released an updated annual report showing that in FY 2011 anti-fraud efforts have recovered more than $4.1 billion in fraudulent Medicare payments – the second year in a row recovery efforts reached this unprecedented level.  Compare this to just $2.14 billion recovered in FY 2008.  Prosecutions are way up too:  the number of individuals charged with fraud increased from 821 in fiscal year 2008 to 1,430 in fiscal year 2011 – nearly a 75 percent increase.

But we know we need keep doing more to end the “pay and chase” model of fighting fraud.  We need to stop fraud and waste from happening in the first place.  Today we’re taking an important step to protect taxpayer dollars by reducing improper payments to Medicare Advantage plans, an action that is estimated to save $370 million in the first audit year alone.  By improving the way we audit Medicare Advantage contracts, we will reduce the payment error rate for the Medicare Advantage program  and that saves money for Medicare.

We are also using new, advanced techniques to fight fraud.  Starting last year, we have been using “predictive modeling” technology – similar to technology used by credit card companies to identify and fight fraud nationwide.  This effort is just getting started but it’s already making a difference. Since the predictive modeling system was activated, CMS has stopped, prevented or identified $20 million in payments through November 2011 that should not have been made.

In addition, predictive modeling has identified 2,500 leads for further investigation, 600 preliminary law enforcement cases under review and resulted in 400 direct interviews with providers who would not have otherwise been contacted.

Predictive modeling won’t reach its full potential in overnight, but it’s already making an incredible difference and will do even more in the weeks, months and years ahead.

Better Coordination Leading to Swifter Medicare Coverage and Access

Marilyn Tavenner, Acting Administrator, Centers for Medicare and Medicaid Services 

Today, CMS is proposing that Medicare patients across the country have access to a new procedure, known as “transcatheter aortic valve replacement.” 

The result of an unprecedented level of collaboration between CMS, the Food and Drug Administration (FDA), the Agency for Healthcare Research and Quality (AHRQ), the American College of Cardiology, the Society of Thoracic Surgeons and Edwards Lifesciences, this proposed National Coverage Determination continues CMS’ commitment to cross-agency collaboration and ensuring patients have access to the latest and best medical technology.

Aortic valve replacements are used in patients whose aortic heart valves are damaged and cause the valve to narrow – a condition known as “aortic stenosis.” Once patients experience symptoms of aortic stenosis, treatment is critical to improve their chances of survival.  Until recently, aortic stenosis has been treatable only through surgical aortic valve replacement.  And as our population ages, the number of Americans with aortic stenosis progressively increases. 

Transcatheter aortic valve replacement allows doctors to replace a patient’s aortic valve through a small opening in the leg.  This less invasive procedure gives patients who cannot undergo open heart surgery a new way to repair their damaged heart valve.    

The first transcatheter aortic valve replacement system was approved by the FDA on November 2, 2011.  Since then, we have worked closely with the FDA, AHRQ, the American College of Cardiology, the Society of Thoracic Surgeons, and the device manufacturer, Edwards Lifesciences, to bring this new procedure to Medicare enrollees across the country.

Because this technology is still relatively new, it is important that these procedures are performed by highly trained professionals in optimally equipped facilities.  This decision proposes “coverage with evidence development” which, as a condition of coverage, would require certain provider, facility, and data collection criteria to be met.  Such requirements are important to ensure beneficiaries receive the safest and most appropriate care.

We are hopeful that this proposed decision will lead to increased access to less invasive treatment options for Medicare beneficiaries and save lives.

Today’s proposed decision will be open for 30 days of public comment before CMS issues a final decision later this year.  To read the proposal, visit the CMS website at:

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