A CMS announcement that many doctors will see their 2015 Medicare payments cut by 1% for failing to meet federal electronic health-record incentive-payment program standards has provoked strong reactions from physician and hospital groups.
“The American Medical Association is appalled by the news,” said AMA President-Elect Dr. Steven Stack, who noted that “more than 50% of eligible professionals will face penalties … a number that is even worse than we anticipated.”
The cuts will target more than a quarter million physicians and other eligible professionals. The penalties will apply next year to providers who failed to meet the program's Stage 1 meaningful-use criteria in 2013.
Letters informing affected providers will be mailed in the coming weeks, a CMS official said. Instructions on how to appeal the CMS' penalty decision is available on the CMS website. Appeals must be filed by Feb. 28, 2015.
“This is a clear message to the administration that they've got to make significant changes to the program,” said Robert Tennant, senior policy advisor to the Medical Group Management Association, which has lobbied for several years to have the penalties applied to reimbursements at the end of the year in which the provider fails to make meaningful use, rather than two years later, as the program does now.
“It's only fair,” Tennant said. “Someone who struggled to meet meaningful use and did in 2014, why should they get a penalty in 2015?”
Tennant and Stack also argued that the program's scoring system, which requires providers to meet every requirement, is flawed.
“It's all or nothing,” Tennant said. “If you're 99% successful, you're 100% unsuccessful.”
The American Hospital Association also weighed in on behalf of affected physicians. “These widespread physician penalties reflect the many challenges providers face with the meaningful-use program,” said Chantal Worzala, the AHA's director of policy for health information technology. “Hospitals cannot be successful without their physician partners. It is time for CMS to address providers' concerns about the program.”
About 200 hospitals also face 1% Medicare penalties under the program.
According to a previous CMS estimate, about 527,200 physicians and other eligible professionals, and 5,011 hospitals can receive incentive payments through the program, which was created under the American Recovery and Reinvestment Act of 2009.
More than $25.7 billion in EHR incentive payments were made between early 2011 and Oct. 1 this year, including about $10.3 billion to physicians and other EPs, and $15.4 billion to hospitals, CMS data show. More than 414,000 physicians and other EPs, and 4,695 hospitals have been paid to date.
Related to the penalties, the timing on when meaningful use was achieved looms large. Although monetary carrots were included in the program when Congress created it, so too, were sticks—and timing—of potentially escalating Medicare penalties.
The penalties start at 1% of Medicare reimbursements beginning in 2015 for non-compliance in fiscal year 2013 for hospitals, and calendar year 2013 for physicians, dentists, optometrists, podiatrists and chiropractors.
A statement from Stack noted that the AMA has supported the EHR incentive-payment program from the inception of the legislation that created it, and has “provided extensive and constructive feedback” to the administration on how to fix its problems, “but few changes have been made.”
“In light of the dismal number of eligible professionals meeting meaningful use, we hope that the Administration will now move forward with the solutions we put forth in our blueprint to make the program more successful and better enable physicians to provide quality care for their patients,” Stack said.
Tennant noted that the CMS announced that an additional 28,000 physicians will receive notices that their Medicare reimbursements also will be cut by 1% for failing to comply with the Electronic Prescribing Incentive Program, adding, “I think the number of penalties in 2016 could go even higher,” since thousands of hospitals and physicians “have really struggled” with program requirements to step up to more stringent Stage 2 meaningful-use criteria.
An estimated 2,500 hospitals and 168,000 physicians and other EPs were deemed by the CMS to have met Stage 1 requirements in 2011 and 2012, the first two years of the program. They would have been required to meet Stage 2 requirements in 2014.
About 67% of those hospitals attested to meeting Stage 2 requirements as of Dec. 1 this year, a CMS official reported this month. Hospitals have until the end of the month to complete their attestation filings.
Only about 10% of physicians and other EPs scheduled to move up to Stage 2 this year have done so, but their payment period doesn't end until Dec. 31, and they have until the end of February to attest.
Stage 2 has been beset by woes since early 2014, as providers complained that their vendors had fallen behind schedule in delivering EHRs with the needed upgrades to meet Stage 2 functional requirements.
The feds have responded by tweaking the rules on filing dates and hardship exemptions to accommodate late delivery and installation of upgraded products.
Even so, Tennant said, “I'd be very surprised if, at the end of February, we see a number that we collectively agree is reasonable. Stage 2 had been very difficult to meet, not just for the EPs, but for the vendors. We've heard from a lot of our members that the installations have not gone very well. There are bugs because they (vendors) are rushing to get those products out to market.”
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