What Meaningful Use Means for Pharmacy

Sammuel V. Anderegg, Pharm.D; Karl F. Gumpper, B.S.Pharm., BCPS, FASHP

Disclosures

Am J Health Syst Pharm. 2012;69(10):890-894. 

In This Article

Abstract and Introduction

Introduction

Pharmacists have been practicing as patient caregivers for decades but have failed to develop widespread acceptance of independent, accountable clinical practice.[1] Health care reform initiatives and investments in health information technology (HIT) offer new opportunities for pharmacists to achieve accountable clinical practice and become indispensable members of the patient care team.

Improving the U.S. health care system has long been a topic of debate. Lawmakers recently enacted legislation putting reform in motion and included measures to expand HIT in the bill.[2] As part of the American Recovery and Reinvestment Act of 2009, the Health Information Technology for Economic and Clinical Health Act mandates the universal adoption of the electronic health record (EHR) and provides resources to promote its "meaningful use."A total of $36 billion has been allocated to the Department of Health and Human Services for the meaningful-use initiative. This investment is expected to improve patient outcomes and reduce overall expenditures within the health care system.

Meaningful use is the terminology used by the federal government for the initiative to establish standards for EHRs and to optimize their use by hospitals, physicians, and other health care providers.[3] The meaningful-use initiative will be implemented in three stages and accomplished by incentivizing hospitals and providers to meet core objectives. These core objectives include the implementation of EHRs, documentation of patient-specific information, and reporting of clinical quality measures. Financial incentives, provided by the Centers for Medicare and Medicaid Services (CMS), for meeting these objectives became available in 2011.[4] Hospitals are initially eligible for $2 million in incentives and can qualify for more, depending on the number of patient discharges per fiscal year. Eligible professionals may earn up to $44,000 over five years through the Medicare incentive program or $63,750 over six years through the Medicaid incentive program (if at least 30% of their services are provided to Medicaid recipients). In 2010, CMS defined stage 1 requirements for meeting meaningful-use objectives (appendix).[3] Currently, data on clinical quality measures are required for reporting purposes only. Hospitals and eligible professionals must adopt "certified" vendor software meeting specifications outlined by the Office of the National Coordinator for HIT to complete these requirements.[5]

At the time of writing, stage 2 and stage 3 meaningful-use requirements were in development.

The adoption of meaningful-use criteria provides a framework to transform the payment system into a quality-based model. By requiring providers to report clinical quality measures, a transparent environment for patients and payers is created. These reports should detail the quality of services provided by health systems, ambulatory care clinics, and individual practitioners through clinical quality measures, such as those listed in the stage 1 objectives. It is then possible to set quality standards, or benchmarks, so that reimbursement reflects performance. For example, a physician may be asked to have immunization status on record for more than 95% of patients or initiate β-blocker therapy for more than 90% of patients with coronary artery disease, unless contraindicated. Hospitals may be required to have 100% of patients receive stroke education if the event is diagnosed during admission and ensure that platelet counts are monitored daily if heparin is prescribed. Payment reductions may occur if benchmarks are not achieved. A quality-based reimbursement system will halt efforts to increase patient turnover and minimize length of stay. The focus will shift toward patient-centered services and improving transitions of care.[6]

Patient-centered care requires all members of the health care team to work together. Physician–pharmacist partnerships are an example of how collaboration can improve patient outcomes.[7] By incorporating these partnerships into multidisciplinary care models, pharmacists can help eligible professionals and hospitals achieve quality-measure benchmarks and obtain increased levels of reimbursement.

Pharmacists have a unique opportunity to participate in meaningful-use initiatives and are appropriately trained to help accomplish many of the objectives outlined in the stage 1 requirements of meaningful use.[8,9]

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