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Penalties for late EHR meaningful use reporting take effect in 2015
Practices that do not meet reporting requirements will be penalized 1% in 2015, 2% in 2016 and 3% in 2017 and beyond.
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Practices need to be aware of reporting requirements, incentive payments, penalties and costs before deciding to opt in or out of the federal government’s meaningful use program for electronic health records, according to a speaker.
The Centers for Medicare and Medicaid Services issued basic meaningful use criteria in 2010. The earliest EHR adopters qualified for incentive payments of up to $44,000.
“As carrots turn to sticks, as CMS moves more from an incentive system to a penalty phase, I think this is influencing a lot of your decisions about whether or not you should go on EHR, whether you should apply for meaningful use. But is it really worth the investment and hassle?” Candace S. Simerson, COE, CMPE, CAHCM, FASOA, administrator at Minnesota Eye Consultants, said at Kiawah Eye 2014.
Candace S. Simerson
Simerson said that more than 90% of eligible hospitals have adopted EHRs and 65% of Medicare and Medicaid providers have made a financial commitment to implement EHRs. To date, more than 355,000 Medicare and Medicaid providers have received EHR incentive payments, she said.
Simerson also noted that 14,000 providers, or 25% that started participating in meaningful use in 2011, did not attest to meaningful use in 2012. However, 57% of those early adopters returned to attest in 2013.
Overall, 85% of early adopters have successfully attested to meaningful use for 2011, 2012 and 2013, Simerson said.
“I think this is probably due to the penalties coming down the pike,” she said.
Meaningful use requirements
Providers had to begin participating in meaningful use by Oct. 1, 2012, and comply with all regulations to receive the maximum incentive payment of $44,000.
Providers that began participating in 2011 and 2012 can receive incentive payments of up to $44,000. Those that began in 2013 can receive up to $39,000, and those that begin in 2014 can get up to $24,000. Those that begin participating in 2015 and later will not receive incentive payments and will face penalties, Simerson said.
Medicare payment reductions for not meeting meaningful use requirements are 1% in 2015, 2% in 2016 and 3% in 2017 and beyond. To avoid a 1% payment reduction in 2015, providers must attest to meaningful use by Oct. 1.
“You have to continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years,” Simerson said. “Once you start, you really can’t discontinue. You can’t start and stop.”
Simerson said that on May 20, CMS proposed a new flexibility rule that would potentially allow providers to use 2011 CEHRT for this year’s quarterly reporting period or a combination of 2011 and 2014 to meet measures. The comment period has ended, but a final ruling has not been published to date. CMS is still pushing providers to implement 2014 CEHRT by the end of the year in order to meet reporting requirements in 2015.
There are hardship exceptions for meaningful use. Eligible providers located in areas that do not have sufficient Internet access, new providers and those facing unforeseen circumstances may receive exceptions.
The application deadline for exceptions is July 1, but CMS encourages earlier submission when possible, Simerson said.
Providers who receive incentive payments for EHR use may be subject to compliance audits.
“If you do choose to go on meaningful use, you just have to make sure you keep all of your paperwork and all relevant documentation, so that if you do get audited, you have this to produce because it’s going to be hard to go back and create it,” Simerson said. “Everything should be retained for 6 years post-attestation.”
PQRS and VBPM
In 2016, penalties also include 2% for noncompliance with the Physician Quality Reporting System (PQRS) and 2% resulting from the value-based payment modifier (VBPM), Simerson said.
Under PQRS, there is a 0.5% incentive for providers who report successfully in 2014. In 2015, eligible providers who do not participate in PQRS and reported successfully in 2013 will face a 1.5% penalty. In 2016, providers who do not participate in PQRS and reported for 2014 will face a 2% penalty, Simerson said.
“You can’t wait to start until that time frame because they’re going back 2 years,” she said.
The VBPM, based on cost and quality, applies to practices with 10 or more eligible providers. The modifier formerly applied to practices with 100 or more eligible providers and will apply to all eligible providers in 2017, Simerson said.
“I think this is another way that CMS is going to figure out how to adjust the payments going forward,” she said.
Cost-benefit analysis
Simerson estimated that the capital cost for a solo provider to adopt an EHR is $55,000 for software licensing, conversion and training, $55,000 for information technology infrastructure upgrades and $25,000 to set up rooms for EHR, totaling $135,000. The $44,000 maximum incentive payment for meaningful use “pales in comparison,” she said.
For a solo practice, annual maintenance, upgrades and dedicated personnel costs can total $107,500. Annual benefits such as incentive payments, coding support and transcription savings can total $106,000, Simerson said.
“I think these are somewhat equal on an ongoing basis, even though if you add the heartache, headache and the investment of time, from both a physician and an administrator perspective, the real costs are much greater,” she said. – by Matt Hasson
For more information:
Candace S. Simerson, COE, CMPE, CAHCM, FASOA, can be reached at Minnesota Eye Consultants, 9801 Dupont Ave. S., Bloomington, MN, 55431; 952-567-6100; email: cssimerson@mneye.com.
Disclosure: Simerson is president and COO of Minnesota Eye Consultants. She receives consulting fees from Alcon, Physician Recommended Nutraceuticals and Omega and is on Allergan’s speakers bureau.
Perspective
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William L. Rich III, MD
Because ophthalmology receives the highest percentage of its income from Medicare when compared with any other specialty, these new penalties starting in 2016 are not sustainable.To get a bonus in 2015, you must report on PQRS, but reporting nine measures across three domains is impossible if you are not employed by an academic center or large group that gets a pass using the primary care qualification in the group reporting option. A registry, IRIS, will allow you to do this; however, it is closed for 2014, so we hope physicians have reported 50% on three PQRS measures or the cataract measures group for 2014 to avoid the penalties in 2016.
Meaningful use criteria are pretty useless for specialists, but whoever controls the gold rules.
If you are going to retire in the next 3 years, don’t bother.
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