Mainly, CMS (Centers for Medicare and Medicaid Services) is pulling away the carrot and will start using the stick on providers in order to get them to use - and prove their efficient use of - their EHRs.
For the last few years, providers who joined the program could earn upwards of $40,000 for purchasing and implementing an EHR system. Starting next year, those incentives are gone.
“If you sign up in 2014, you still get a lump sum. The most you can earn is $24,000 over the next three years,” Olson says. “However, if you wait to join in 2015 or after, you get nothing. But at least you won’t get penalized."
There are three reasons why a provider would start seeing a one percent penalty in their Medicare reimbursements next year. The first occurs if an eligible Medicare provider still does not have an EHR in place. The second is if they have an EHR but chose not to participate in the program. The third is if they signed up for the program but failed to prove meaningful use, which means they didn’t fulfill the criteria to prove they were using it.
“If you’re an eligible Medicare provider and you don’t want to participate, you’re going to suffer the penalties. If you want to participate, but have a reason for not doing it, then Medicare offers you options,” Olson says.
Hardship exemptions can run the gamut of a natural disaster to a doctor undergoing treatment to transferring the practice from paper to digital, which can take an entire year. “But you have to file a waiver to let them know your situation and get it approved,” Olson says.
The waiver forms can be found on the CMS website under meaningful use. Olson notes that the length of exemption granted will depend on the hardship circumstances. “And remember that hardship is not because you’re a small practice, it’s because something has gone wrong.”
Other reasons to file a waiver relate to problems with an existing EHR, such as a practice adopting an EHR but not being able to get it up and running in time to demonstrate the 90 days of meaningful use. Or some practices may have purchased an EHR but found that it was not certified for the meaningful use program or, even if it was certified, certain components, such as a working patient portal, were not in place in time to meet particular meaningful use criteria.
Practices may have also hit the obstacle of their EHR working fine for Stage 1, but then the software maker choosing not to undergo the rigors and expense of qualifying for Stage 2. “That’s a hardship,” Olson says, and stresses that those practices need to file a waiver. “Because if you don’t file, you get penalized on your Medicare and Medicaid reimbursements, and those penalties increase over the next three years.”
For eligible providers facing penalties, the one percent in 2015 grows to two percent in 2016 and maxes out at three percent in 2017 where it remains. “But there’s no deadline for signing up for the program,” Olson says, which would stop the penalties. “And they automatically get a hardship waiver once they sign up.”
For providers who passed Stage 1 criteria but no longer want to participate, the penalties are the same. “You get to keep the Stage 1 money,” Olson says. “But if you opt out of participating in Stage 2, you face penalties starting in 2016 at two percent.
The date for submitting a waiver to avoid 2015 penalties passed in July. “But no matter what, you should try. They make exemptions all the time. And it’s better than letting yourself get penalized,” Olson says. Especially since the waiver can be applied to 2016, so the effort will not be wasted.
To avoid the 2015 penalties, providers had to have signed up for the program no later than August. “So if you’ve not done it by now, it’s too late for 2015. You’re going to suffer the penalties,” Olson says. “But if you start today and demonstrate 90-days of meaningful use in the coming year, then you’re eligible to avoid penalties in future years. And you can still earn the $24,000 in incentives over the next three years.”
But everything could change. Olson says she’s seen four or five notable changes this year already. “They keep changing things because of complaints from providers. So what’s happening today can change tomorrow,” she says. “But don’t hold your breath and not act. Because eventually it will happen.”
