The thoughts and opinions of a 35 year board certified emergency medicine physician blogging about everyday life, the role technology has played in the emergency department business, and the art of practicing medicine. The times have changed: Health-care IT, EHRs and Meaningful Use!
For years we have talked about the carrot and stick approach to the CMS EHR incentive program. First came those lovely front loaded incentives that drove EHR adoption. Then, almost as an afterthought, we vaguely mentioned the penalties ("fee adjustments"). Well the carrots are getting smaller and the sticks are coming. For many Medicare providers who have delayed jumping in with both feet, it may already be too late to avoid the penalties. Let's look at the facts.
CMS states clearly: "If Medicare eligible professionals, or EPs, do not adopt and successfully demonstrate meaningful use of a certified electronic health record (EHR) technology by 2015, the EP's Medicare physician fee schedule amount for covered professional services will be adjusted down by 1% each year. The adjustment schedule is as follows:
2015-99% of Medicare physician fee schedule covered amount
2016-98 % of Medicare physician fee schedule covered amount
2017 and each subsequent year-97% of Medicare physician fee schedule covered amount
If less than 75% of EPs have become meaningful users of EHRs by 2018, the adjustment will change by 1% point each year to a maximum of 5% (95% of Medicare covered amount)."
That doesn't sound too bad, right? Just get you act together by 2015 and all will be well. However, that is not the case. The penalties are based on activity two years prior. That's right you pretty much have to have your act together in 2013 to duck those 2015 "fee adjustments". Permit me to quote directly from CMS scripture: "EPs who first demonstrated meaningful use in 2011 or 2012 must demonstrate meaningful use for a full year in 2013 to avoid payment adjustments in 2015. They must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years........EPs who first demonstrate meaningful use in 2013 must demonstrate meaningful use for a 90-day reporting period in 2013 to avoid payment adjustments in 2015. They must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years."
Now for you Medicaid EPs there is a bit of a twist. In the Medicaid EHR Incentive program there are no penalties against Medicaid reimbursements but you will be penalized for those Medicare charges if you don't reach meaningful use. Kind of a "damn if you do, damn if you don't" situation.
I can hear the wheels turning out there. What if I practice where there is no broadband Internet access? What if my town is hit by an tornado/hurricane/firestorm/tsunami? What if I never actually see a patient in person? What if there in no way on Gods's green earth I will ever achieve meaningful use? Funny you should ask. CMS has outline a process for hardship exceptions that should put your mind at ease for some of you. For the rest the stage is now being set for those who will begin receiving reduced payments in 15 months. A stitch in time save nine.
Jim Tate, President of EMRAdvocate, is a veteran of numerous EHR implementations in the United States and Asia. He consults with EHR vendors on interface and functional specifications, business strategy, documentation, and certification. The EMRAdvocate team has worked with over 200 EHR vendors in the development of certified EHR technology. Jim speaks frequently at national conferences on HIT adoption, EHR certification, Meaningful Use, EHR Incentive Audits and is a partner at HITECHAnswers, the foremost Meaningful Use education portal. Jim is committed to the proper use of technology to improve health care and may be reached at email@example.com