Over ten years ago the American Reinvestment & Recovery Act (ARRA) was implemented (CDC,
2019; Madison, 2018, p. 455). As a part of this act one measure was the HITECH (Health
Information Technology for Economic and Clinical Health) Act which “proposed the meaningful
use of interoperable electronic health records throughout the United States health care delivery
system as a critical national goal” (CDC, para. 1). The Medicare EHR Incentive Program is also
called meaningful use (healthIT.gov, n.d.). The term meaningful use pertains to meaningfully
using electronic health records (EHRs) in order to reduce errors, reduce medical mistakes, and
bring down costs (Madison, p. 455). Technically, meaningful use is one of four components
which make up the merit-based incentive payment system (MIPS): physicians quality reporting
program (PQRP), value based payment modifier (VBPM), and the aforementioned Medicare EHR
Incentive Program (meaningful use) (healthIT.gov, 2019).
Criterion
The criterion for meaningful use are outlined by the Secretary of Health and Human Services
(HHS). The Centers for Disease Control and Prevention (CDC) state that meaningful use is
defined by using certified HER technology in a manner consistent with the criterion for
meaningful use, making sure that the technology provides for the electronic exchange of health
information to improve the quality of care (CDC, 2019, para. 2). There are five pillars related to
health outcomes associated with the idea of meaningful use. These five pillars are 1) The
improvement of quality, safety, efficiency, and the reduction of health disparities, 2) Patient and
family health engagement, 3) Care coordination improvement, 4) Population and public health
improvement, and 5) Safeguard privacy and provide security protection for health information
(CDC, para. 2).
MIPS
One impact of the meaningful use criterion has been the shift towards the merit-based
incentive payment system (MIPS) on Medicare and Medicaid hospital and hospital provider
reimbursement. Incentives were used to reward physicians who actively engaged with
healthcare in a way which promoted “reform in the delivery, cost, and quality of healthcare in
the United States” (Madison, 2018, p. 459). Due to costs concerns by physicians regarding
implementing certified EHRs, incentives have been put into place. For example, Madison reports
that hospital providers who implement EHRs can be eligible for up to $18,000 in Medicare
incentives over a period of time (p. 460). The total cap for Medicaid incentives is over $63,000
per physician (Madison, p. 460). As of 2016 over $23 billion has been paid through the Medicare
program while nearly $11 billion has been paid through Medicaid (Madison, p. 461). However,
while healthcare providers can receive incentives if they do not adopt these incentives their
reimbursements can decrease from Medicare (Madison, p. 461; Ciocca, 2018).
Conclusion
For the health informatics nurse navigating the nuances of meaningful use and merit-based
incentives, a collaborative effort is important (Kaye, 2016). 1 Corinthians 10:31 (New
International Version, 2011) reminds us that “So whether you eat or drink or whatever you do,
do it all for the glory of God.” EHRs, the merit-based incentive payment system, and hospital
provider reimbursement are all simply tools. It is how and when we choose to apply them which
can have the greatest impact. The tools should always be utilized with the safety and wellbeing
of the patient at the forefront of the providers' mind, not simply the financial reimbursements
that they may represent.
Regards,
Georganna
References
Centers for Disease Control and Prevention. (2019). Meaningful use. Public Health and
Promoting Interoperability Programs.
https://www.cdc.gov/ehrmeaningfuluse/introduction.html
Ciocca, R. G., Johnson, B., Rathbun, J., & Woo, K. (2017). MIPS: Clinical practice
improvement activities. Journal of Vascular Surgery, 66(1), 326-326.
http://doi.org/10.1016/j.jvs.2017.04.020
HealthIT.gov. (n.d.). Meaningful use. The Office of the National Coordinator for Health
Information Technology (ONC). https://www.healthit.gov/topic/meaningful-use-and-
macra/meaningful-use
Holy Bible, New International Version. (1973/2011). 1 Corinthians. Biblica, Inc.
https://www.biblegateway.com/passage/?search=1+Corinthians+10%3A31&version=NI V
Kaye, S. P. (2016;2017;). Nurses’ attitudes toward meaningful use technologies: An integrative
review. CIN: Computers, Informatics, Nursing, 35(5), 237-247.
http://doi.org/10.1097/CIN.0000000000000310
Madison, M.P. (2018). The health information technology for education and clinical health act.
In R. Nelson & N. Staggers (Eds.), Health informatics: An interprofessional approach. (2nd ed.,
pp. 455-473.) Elsevier.
(Note: Reference section was correctly formatted with a 1/2 inch hanging indent for each
citation. This hanging indent did not correctly edit / copy / paste from Word document it was
drafted in. GMS.)
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