Two weeks ago we reviewed the four Stage 2 core objectives that do not require the provider to meet a target threshold. Remaining on our agenda are the 13 Stage 2 core objectives that establish a performance threshold the provider must clear in order to successfully participate in the meaningful use program. Our focus this week will be some familiar faces carried over from the Stage 1 core. Among these 13 Stage 2 core objectives are five measures for which very little has changed related to the mechanics of the actual measure. As we will see, in most of these measures the change from Stage 1 to Stage 2 is confined to an increase in the measure’s performance target.
Demographics
On the surface the most significant change for the demographics objective is the target increase from 50% in Stage 1 to 80% in Stage 2. The measure itself continues to require all five demographic values (gender, race, ethnicity, date of birth and preferred language) to be recorded in the patient’s record. If you have an interface between your billing system and your certified EHR that captures the appropriately coded demographic values for this objective, you will save a lot of time and effort. Remember, as with many of the objectives with a target, the denominator here is “unique patient encounters.” This means the patient can only appear once in the measure’s denominator regardless of how many encounters the patient has with the provider during the reporting period. If all five demographic fields are present within the certified EHR during one of these encounters, the patient will appear in the numerator for this measure.
Vital Signs
As with demographics, the big news here is the target increase from 50% in stage 1 to 80% in Stage 2. Stage 2 continues to look for the same three vitals: blood pressure, height and weight (the last two permitting the calculation of BMI). Of additional interest, you are now able to attest to the fact that either blood pressure measurement or BMI calculation are outside your scope of practice. In other words, your objective could measure performance for all three vital signs, only blood pressure or only BMI. This reporting nuance is unlikely to impact the typical nephrologist. As with demographics, the denominator for vital signs remains unique patient encounters.
Smoking Status
At the risk of sounding like a broken record, the change here from Stage 1 to Stage 2 is again a bump in the target from 50% to 80%. The measure continues to apply to all patients age 13 and older and as with the first two measures reviewed, the denominator is unique patient encounters.
eRx
The electronic prescribing objective remains on the Stage 2 core. Recall that this objective is asking what percentage of the provider’s permissible prescriptions are generated and transmitted electronically during the reporting period. The Stage 1 target of 40% increases to 50% in Stage 2. The phrase “permissible prescription” is unchanged and continues to exclude prescriptions for scheduled medications as well as those for durable medical equipment. ONC has added another exclusion if there are no pharmacies that accept electronic prescriptions within 10 miles of your practice location at the start of your reporting period, but this will not apply to the typical nephrologist. Finally, a common theme for Stage 2 is on display as ONC has combined the Stage 1 drug-drug, drug-allergy objective with the eRx objective. This should not present you with any challenges.
Clinical Summary
From the provider’s perspective the clinical summary is almost identical in Stage 2. Your EHR vendor is required to make a few more pieces of data available in the clinical summary and they must make it easy for you to redact specific pieces of data from the clinical summary if you wish to do so, but the mechanics largely remain the same. As in Stage 1, the Stage 2 objective is asking that a clinical summary be made available to the patient following at least 50% of the provider’s office encounters. The difference between Stage 1 and Stage 2 is the time frame in which the summary must be made available to the patient. That window narrows from three business days in Stage 1 to one business day in Stage 2. If you typically print the summary immediately following the encounter or make the summary available on a patient portal, this change will have little impact. On the other hand, if you have been mailing the clinical summary or printing it the following day, you may need to re-examine your workflow in order to remain compliant.
Beyond Old Friends
The 20 Stage 2 core objectives include 13 with a performance target. Today we have reviewed the five objectives for which little has changed from the Stage 1 core beyond the performance target. In the weeks ahead we will unpack the remaining eight Stage 2 core objectives and then move on to the Stage 2 menu. In the meantime, if you have questions or comments about the objectives reviewed to date, please post it here.
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