A Nephrologist’s Approach to Meaningful Use
The Meaningful Use Framework
At a high level, the meaningful use framework consists of 25 meaningful use objectives. These objectives come in two basic flavors; those with a target threshold and those without a threshold. I find it best to think of the objectives with a threshold in terms of a mathematical fraction. Each of these measures has a denominator which defines the eligible patient population or set of activities the objective is addressing. The numerator in each of these fractions is essentially the quality action taken for the patients or activities in the denominator (Did the patient have a problem on their problem list? Did I send the prescription electronically?). Sixteen of the Stage 1 meaningful use objectives contain a target threshold.
The second flavor the objectives come in is one in which the provider will attest to the fact that something has occurred during the reporting period. This is like answering a question “yes” or “no” (and by the way if the answer is “no” you do not pass go, you do not collect $44,000). Examples of this type of objective include; Yes during the reporting period the drug‐drug and drug‐allergy check on my e‐prescribing tool was turned on, or Yes, I have submitted six Clinical Quality Measures to CMS. There are nine Stage 1 meaningful use objectives without a threshold target.
The 25 Stage 1 meaningful use objectives are split into two categories; a core set of (table 1) 15 and a menu set of 10 objectives (table 2). As you can see from tables 1 & 2 each category contains both flavors of meaningful use objectives, some have a target threshold and some do not. In order to demonstrate meaningful use, each nephrologist must report the 15 core measures and they must select five from the menu to report. The only caveat here is that one of the public health objectives must be included in the five selected from the menu. During your first year of reporting, the reporting is defined as any continuous 90 day period within the calendar year. For years two and beyond the reporting period is the entire calendar year. Finally, although this is a CMS funded program, the meaningful use framework should be applied to all patient encounters regardless of payor source.