Doctors and organized medical associations are voicing their objections to proposed Stage 2 Medicare and Medicaid guidelines, saying the new standards are far too demanding for many smaller and less-sophisticated medical practices. Practitioners are asking that requirements be within a physician’s control and not rely on a third party’s use of technology; e.g., a patient or laboratory. The AMA, as well as 98 state and specialty societies, also argue that EHR penalties should not be backdated. These organizations also strongly oppose CMS (Centers for Medicare & Medicaid Services) plans to cut rates by 1% in 2015 and 2% in 2016 for not meeting ‘meaningful use standards’ by October 2014. It should be said that CMS has provided exemptions from penalties in certain practices.

Over 185,000 doctors have registered for the program but hundreds of thousands had not applied for the incentives as of March. Approximately 62,000 doctors have received incentives from either Medicare or Medicaid. CMS indicates that fewer than 200,000 physicians, out of the over 600,000 eligible, reported PQRS (Physician Quality Reporting System) measures in 2010. Over 125,000 doctors met enough of the criteria to share a total of some $400 million in incentives but hundreds of thousands did not even attempt to meet the pay-for-reporting criteria due to the burdensome process. Over 50,000 attempted to qualify for the bonuses but failed to report sufficient measures. PQRS participation increased when 35 academic practices, with 24,823 eligible professionals, chose to send physician quality data as group practices, receiving financial bonuses.

CMS is offering up to $44,000 over five years from Medicare or $63,750 over six years from Medicaid to eligible health care providers who adopt EHRs and implement them in a meaningful way, reports Charles Fiegl on www.amednews.com. Stage 1 rules, implemented in 2011, required physicians to meet 15 core measures and five optional measures; stage 2, which will begin in 2014, will require doctors to meet additional requirements.

Bonuses were allotted to 168,843 health care professionals and just over 19,000 medical practices in 2010, with the average payout $2,157/doctor and $20,364/practice. These incentive amounts are diminishing until 2014, the final year to receive higher pay before the first noncompliance penalty is levied to pay rates in 2015. A 1% penalty was applied this year to thousands of doctors who did not report enough eligible electronic prescribing situations with their patients last year.

The Government Accounting Office (GAO) is currently examining the process that CMS uses to validate if healthcare providers have met “meaningful use requirements”. Practitioners may be required to submit additional documentation to prove that they are, indeed, entitled to receive ‘meaningful bonuses’ since it seems apparent that the Medicare incentive program may be vulnerable to making improper payments. Currently, Medicaid requires additional reporting that Medicare does not require or does not verify until payment has been made; the GAO would like to see Medicare match those increased requirements. To test these conditions, some 10% of hospitals and 20% of professionals that are receiving incentive checks will be subject to random audits.

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Nearly 62,000 doctors have earned electronic health record bonuses from Medicare and Medicaid since May 2011, with nearly 40,000 getting bonuses from Medicare. Primary care practitioners have received the most from Medicare, with about 17,000 doctors sharing more than $300 million.

Specialty	Physicians	Bonus total
Family medicine	8,614	$155.1 million
Internal medicine	8,418	$151.5 million
Cardiology	3,214	$57.9 million
Gastroenterology	1,907	$34.3 million
Orthopedic surgery	1,721	$31.0 million
General surgery	1,501	$27.0 million
Urology	1,267	$22.8 million
Neurology	1,190	$21.4 million
Otolaryngology	1,085	$19.5 million
Pulmonary disease	1,027	$18.5 million
Nephrology	953	$17.2 million
Ophthalmology	902	$16.2 million
Obstetrics/gynecology	771	$13.9 million
Dermatology	747	$13.4 million
Endocrinology	594	$10.7 million
Other	5,628	$101.3 million
Total	39,539	$711.7 million

Source: “EHR Incentive Program,” Centers for Medicare & Medicaid Services