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CMS: 209K Docs to be Hit with MU Penalties in 2016

January 13, 2016
by Rajiv Leventhal
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Approximately 209,000 eligible professionals (EPs) will receive cuts in their Medicare payments in 2016 as a result of failing to meet standards set in the meaningful use program, according to recently released data from the Centers for Medicare & Medicaid Services (CMS).

As part of the American Recovery and Reinvestment Act of 2009 (ARRA), eligible professionals who do not successfully demonstrate meaningful use for an electronic health record (EHR) reporting period associated with a payment adjustment year will receive reduced Medicare payments for that year. The Medicare payment adjustments began on January 1, 2015 for EPs and sunset at the end of 2018 per the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

The 209,000 doctors getting hit with penalties is lower than the 257,000 EPs who were penalized last year. What’s more, the penalties aren’t that costly—nearly 117,000 of the EPs that will be penalized in 2016 will receive cuts of less than $1,000. Only 5,700 EPs will get hit with cuts of more than $10,000. As such, the cuts are presumably far lower than what it would cost providers to meet the meaningful use standards set forth by CMS. Penalties for hospitals have not yet been released publicly by the agency.

It remains to be seen how many physicians will receive cuts in 2017 after the recently passed Patient Access and Medicare Protection Act bill was signed into law late last month. The bill is designed to ensure eligible providers “flexibility in applying the hardship exception for meaningful use for 2015 EHR reporting period for 2017 payment adjustments.” Under the bill, physicians have until March 15, 2016 to apply for exemption, while the deadline for hospitals is April 1.

 According to a late December Washington Debrief report from  Leslie Kriegstein, interim vice president of public policy at the College of Healthcare Information Management Executives (CHIME), “The legislation would allow eligible hospitals and eligible physicians who find it impossible to comply with the modified Stage 2 rule released into the final 90-day reporting period of 2015 to apply under the 'unforeseen circumstances' category. The legislation enables the Centers for Medicare & Medicaid Services (CMS) to grant hardships not just on a case-by-case basis, but also to 'categories' with the deadline of March 15, 2016 for EPs and April 1, 2016 for EHs, after which time CMS would still have the case-by-case authority to grant hardship exemptions until July 1, 2016.” If more EPs are indeed granted these exemptions, in theory they would be not be penalized in the following year.

CMS also said that more than 70 percent of eligible physicians and other clinicians, and more than 95 percent of eligible hospitals have successfully used EHRs and received incentive payments from the federal government. Eligible professionals may receive meaningful use incentive payments under Medicare for up to five consecutive years throughout the duration of the program. However, Andy Slavitt, acting CMS Administrator, recently suggested that the meaningful use program might not be around even by the time 2017 rolls around, dropping the surprising news at the  the J.P. Morgan Healthcare Conference in San Francisco on Jan. 11, and then reinforcing his sentiments on his Twitter account.

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