CMS to Penalize Doctors $200M For Failing to Participate in Meaningful Use

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By Alex Ruoff

Feb. 10 — The federal government in 2015 will pay an estimated $200 million less in reimbursements to the 256,000 doctors who failed to participate in the Medicare Electronic Health Record Incentive program, according to Centers for Medicare & Medicaid Services data and officials' comments Feb. 10.

Provider participation in the meaningful use program was relatively low in 2014, according to the data, which were presented to the Health IT Policy Committee and the Health IT Standards Committee, the main advisory bodies to the Office of the National Coordinator for Health IT, during a special joint meeting.

As of Feb. 1, 127,815 providers had attested to meeting the requirements of the meaningful use program, which is about 25 percent of the more than 500,000 providers eligible to participate in the program. Providers have until Feb. 28 to attest to meeting the requirements of the meaningful use program in 2014 to obtain an incentive payment and avoid a Medicare reimbursement cut.

The meaningful use program’s penalty phase, which levies a 1 percent reduction in Medicare reimbursements each year a provider doesn’t successfully participate, began affecting Medicare claims Jan. 5, the CMS said earlier this year. Providers have until Feb. 28 to appeal the penalty.

About 200 hospitals will similarly face a reduction in Medicare reimbursements in 2015 for failing to participate in the meaningful use program, the CMS said in December 2014.

A spokeswoman for the American Hospital Association told Bloomberg BNA in December 2014 that an average hospital—with about $50 million per year in revenues from Medicare reimbursements—will see a $362,500 reduction in Medicare reimbursement for failing to participate in the meaningful use program.

Medicare penalties for failing to meet the meaningful use program's requirements are levied the year after a provider or hospital fails to participate. So providers and hospitals that fail to participate in the program in 2015 will face a Medicare penalty in 2016.

The CMS had paid more than $28.13 billion in incentive payments by the end of December 2014, according to the CMS data.

Penalty Amounts 

How much each provider will lose from the 1 percent reduction in Medicare reimbursements will depend on how many Medicare patients that doctor sees, according to the CMS. The Medicare agency's figures are based on providers' previous Medicare billing, Elisabeth Myers, in the Office of E-Health Standards and Services at the CMS, said during the meeting.

Myers said the combined estimated reduction in payments will be about $200 million for one year.

More than a third of the 256,000 providers subject to a Medicare cut this year, or 87,000 doctors, will lose between $1 and $250, according to CMS data. About 78,000 doctors, or 31 percent of the total, facing a Medicare cut will lose at least $2,000.

About 91,000 doctors facing a Medicare cut will lose between $250 and $2,000, according to the CMS.

Provider Participation 

More than 50,000 health-care providers attested to meeting the requirements of the meaningful use program in January alone, making it the busiest month for 2014 attestations, according to the CMS data. By Jan. 1, just 76,730 providers had attested to meeting the requirements of the meaningful use program, according to CMS data.

Of the 127,815 providers who have attested for 2014, 25,312 were first-time attesters and 36,782 attested to meeting the requirements of Stage 2 of the meaningful use program. More than 91,000 providers attested to meeting the requirements of Stage 1.

According to Myers, more than 71,000 providers who were supposed to meet the requirements of Stage 2 in 2014 have attested, either to meeting Stage 2 requirements or under the so-called flexibility rule (CMS-0046-F and CMS-0052-F; RINs 0938-AR71 and 0938-AS30) (79 Fed. Reg. 52,910, Sept. 4, 2014), which allowed providers to attest to meeting the program requirements using older certified EHRs..

The meaningful use program includes three phases, with increasing requirements for hospitals and physicians. Stage 1 focuses on data capture and sharing and Stage 2 focuses on capturing data for clinical processes. The CMS is expected to publish this spring criteria for Stage 3, which will focus on data capture for improving clinical outcomes.

To contact the reporter on this story: Alex Ruoff in Washington at aruoff@bna.com

To contact the editor responsible for this story: Kendra Casey Plank at kcasey@bna.com