EPs sharing CEHRT across locations have some of the same considerations as individual EPs who work in multiple locations. Adopting, implementing, and upgrading (AIU) certified EHR technology (CEHRT) can be a complex financial and legal endeavor where CEHRT is often shared across multiple sites of a group or even across multiple practices to leverage various opportunities for efficiency, cost-sharing, and access to patient data. Sharing CEHRT is one mechanism through which an eligible professional (EP) can obtain CEHRT to ultimately achieve meaningful use. Sharing CEHRT among practices and providers that do not otherwise have a business affiliation is perfectly acceptable for EPs pursuing meaningful use (FAQ 10842).
Eligible professionals (EPs) who work at multiple sites have four general considerations while preparing for meaningful use, performing meaningful use, and attesting to meaningful use.
EPs attest to the program and earn incentives as individuals. EPs do have two choices associated with being part of a group or clinic practice, but neither one detracts from the overall program requirements applying to individuals: an EP may choose to assign his or her individual payments to an organizational NPI, and he may also choose to use a group patient volume calculation for his Medicaid encounters if such a calculation is an appropriate proxy for an individual's Medicaid patient volume. Ultimately, though, an EP earns a meaningful use incentive payment for his individual actions with certified EHR technology for his patient population. An EP does not attest for a site or a group-he attests for his achievement of the program requirements at his site(s) of practice.
During attestation, the question of whether one works at multiple sites is asked on the Provider Questions screen. If an EP worked at multiple sites during the patient volume reporting period or the EHR reporting period, the time during which meaningful use was performed, the attester must list the addresses of all the sites at which he worked, excluding Place of Service 21 and 23 sites. POS 21 and 23 locations are not applicable to this program, but POS 24 (ambulatory surgical centers) are applicable. If the EP worked full-time at one site and only part-time at another, the attester must list both sites. If two different physical locations were part of the same organization, the attester must list them as separate sites. Separate addresses=separate sites.
Part of the definition of meaningful user states, "To be considered a meaningful EHR user, at least 50 percent of an EP's patient encounters during the EHR reporting period during the payment year must occur at a practice/location or practices/locations equipped with certified EHR technology." (See FAQs 10146 and 10466.)
During attestation, the question of patient encounters is addressed at the beginning of the Core Measures screen. The addresses of multiple sites are pulled from the Provider Questions screen. For each site, the attester is directed to answer whether the EP has CEHRT at that site and list the number of patient encounters at each site. Note that the patient encounters are different from the number of unique patients used in other aspects of the meaningful use attestation.
If all of the sites have certified EHR technology, and one cannot easily determine the patient encounters by site, the attester may list the total patient encounters as the entry for each site. For example, if three sites have CEHRT, and the EP determines he had 1500 patient encounters total across those sites during the EHR reporting period, the attester may enter 1500 for each site.
Unique patients are all of an EP’s unique patients at non-POS_21 or 23 sites with CEHRT. (FAQs 10068 and 10466.) Numerators and denominators from different locations must be tallied. The directions are simple. Just add numerators and denominators from the different sites for the core measures, the menu measures, and the clinical quality measures. EPs are not required to cross reference in case the same patient was captured as a unique patient at multiple sites. Of course, as with each site, “Please keep in mind that patients whose records are not maintained in certified EHR technology will need to be added to denominators whenever applicable in order to provide accurate numbers.” If an EP does not have all patients in CEHRT, his EHR report will not provide the denominator of all unique patients required for several measures.
Alternatively, EPs may choose to include patients seen in locations without certified EHR technology if they enter information at a practice location with CEHRT, but there are limitations to this option. See FAQ 10475.
During attestation, the portal will require one numerator and denominator for each percentage-based measure and one yes/no attestation for implementing functions in CEHRT. None of the measures are listed by site; EPs attest with the totaled numbers for their patient population on CEHRT and affirm that yes/no functions were performed as specified. If multiple sites are using the same CEHRT on the same server, those totals may already be incorporated into the MU report or dashboard.
As above, meaningful use is performed across sites of practice for an EP’s entire patient population with CEHRT, and that includes the measures associated with testing. The Stage 2 Final Rule changed the way shared EHR technologies are handled for testing both Stage 1 and Stage 2 public health agencies. Under changes made in the Stage 2 Final Rule providers that use the same EHR technology and share a network for which their organization either has operational control of or license to use can conduct one test that covers all providers in the organization for stage 1 or a single effort to register and onboard for the Stage 2 public health measures.