CMS Proposed Changes for Meaningful Use in Mark Segal, Vice President, Government and Industry Affairs, GE Healthcare IT May 1, 2015

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Modifications to Meaningful Use in : Proposed Rule Aligns with Stage 3 proposed rule Removes redundant, duplicative and topped out measures Modifies patient-focused Stage 2 measures for patient engagement Single set of objectives & measures (with “stage” adjustments through 2017) No changes to certified EHR technology required or CQM reporting Aligns reporting period for all (including hospitals) to full calendar year Reporting period in 2015 (only) is any continuous 90-day period

Changes to Stages 1 and 2 Medicare and Medicaid All on single set of Stage 2 objectives and measures Some Stage 1 adjustments Core and Menu eliminated – all objectives required (with exceptions) Stage 1: three menu items now required – med reconciliation, patient education, public health (multiple options) Stage 2 hospitals: one menu now required (eRx) Public Health has multiple consolidated measures EP – 2/5 (1/5 if Stage 1) and Hospital 3/6 (2/6 if Stage 1) 4

Proposed Objectives 1.Protect Electronic Health Information – minor changes per Stage 3 2.Clinical Decision Support – retain with alternate specs. 3.Computerized Provider Order Entry (CPOE) – retain with alternate exclusions/specs. 4.Electronic Prescribing (eRx) - retain with alternate exclusions 5.Summary of Care – retain Measure 2 with alternate exclusion and with no transport specification; delete Measure 1 (any method) and 3 (Test) 6.Patient Specific Education – retain with alternate exclusion 7.Medication Reconciliation -retain with alternate exclusion 8.Patient Electronic Access (V,D,T) – retain measure 1 and revise measure 2 thresholds, with alternate exclusion 9.Secure Electronic Messaging – retain 10.Public Health and Clinical Data Registry (CDR) Reporting– replace with consolidated Stage 3 objective and “active engagement” 5

Eliminated Stage 2 objective and measures 6 Source: Federal Register / /Vol. 80, No. 72 /Wednesday, April 15, 2015 / Proposed Rules

2015 Modification Proposed Rule: Timeline

Timetable for revised meaningful use criteria 8 Source: Federal Register / /Vol. 80, No. 72 /Wednesday, April 15, 2015 / Proposed Rules

Alternate 2015 exclusions & specifications for Stage 1 providers Maintaining Stage 1 specifications for objectives and measures with lower threshold or other difference between Stages 1 and 2 (e.g., eRx). Exclusion for Stage 2 measures with no equivalent Stage 1 measure or where provider did not plan to attest to now-required menu objective (e.g., 10% TOC electronic transmission) Defined for each applicable objective and measure 9

Patient engagement changes V,D,T – from 5% to one (1) patient seen (EP) or discharged (hospital) Secure Messaging – from 5% to attestation that function enabled These proposals are controversial and especially subject to revision after comments evaluated 10

Public Health changes “Active engagement” vs. “ongoing submission” - Completed Registration to Submit Data:, Testing and Validation, or Production Modified consolidated objective & five/six measures per Stage 3 NPRM EPs: 2/5 measures (Stage 1 – 1/5) and EH: 3/6 measures (Stage 2 – 2/5) Bidirectional exchange required for immunization registries but not included in 2014 edition certification – will be an issue for comment/clarification Exclusions and one registry can meet multiple measures New measures – Case Reporting (2015 edition cert), Public Health Registry split from “Specialized Registry” and includes Cancer Registry, Clinical Data Registry split from “Specialized Registry”, Electronic Reportable Laboratory Result Reporting (Hospitals only) 11

Public Health measures 12 Source: Federal Register / /Vol. 80, No. 72 /Wednesday, April 15, 2015 / Proposed Rules

Attestation and payment adjustments Cannot attest before January 1, 2016 Deadline – February 29 (2015) and February 28 (2016) Hospitals – any 90 days between 10/1/2014 and 12/31/2015 EPs – any 90 days between 1/1/2015 and 12/31/2015 For 2015, 7/1 (hospital) & 10/1 (EP) Stage 1, Year 1 attestation deadlines to avoid 2015 penalties not feasible; penalties reversed retroactively 13

Medicaid No major changes Alternate attestation option using CMS portal for Medicaid providers seeking to demonstrate meaningful use to avoid Medicare payment adjustment and who are prohibited from switching between Medicare and Medicaid EHR incentive programs. 14

Questions? 15