Robert Lowes
Medicare incentive programs have physicians sometimes feeling as if they are rolling down a rocky hillside inside a 50-gallon steel drum: Will they get hit with a penalty for not electronically prescribing? Or not using an electronic health record (EHR) system in a meaningful way? Or not reporting how they perform on measures of high-quality care?
Each incentive program has its own rules and deadlines, and organized medicine says its members are dazed and confused.
The Centers for Medicare and Medicaid Services (CMS) now has an app for that feeling — a downloadable, online tool that tells physicians whether they will experience a downward "payment adjustment" in Medicare reimbursement under each particular incentive program. All physicians have to do is answer "yes" or "no" to a series of branching questions. Depending on the answers, the automated decision tree leads to 3 different destinations. Physicians will owe the penalty, avoid the penalty, or possibly even qualify for a bonus.
By answering "no" to each of the following questions, for example, a physician would find out that he or she faces a 1% penalty in 2015 under the EHR meaningful use program:
Have you attested to meaningful use of certified EHR technology before 2013?
Do you plan to demonstrate meaningful use of certified EHR technology in 2013?
Do you plan to demonstrate meaningful use of certified EHR technology by October 1, 2014?
Do you qualify for a hardship exemption for the 2015 payment adjustment for (meaningful use) ?
Do you expect to be subject to 2014 (e-prescribing) payment adjustment?
If a physician comes to this last question and answers "yes," he or she discovers that the meaningful use penalty in 2015 increases to 2%.
The tool poses a similar set of questions for Medicare"s e-prescribing program and the Physician Quality Reporting System (PQRS). Participation in PQRS has a bearing on how physicians fare in the Value-Based Payment Modifier (VBM) incentive program. The online tool reveals whether they will incur VBM bonuses and penalties as well.
More information on all these incentive programs, and how to avoid their penalties, is available on the CMS Web site.
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