Jan. 1 brings 1% cut if erx requirements not met
Upfront carrots coupled with far-off sticks are part of the modus operandi of the federal government on several of its health information technology booster initiatives, and the CMS’ Electronic Prescribing Incentive Program is no exception.
The big difference is that with the CMS’ 3-year-old e-prescribing program, the sticks are no longer a distant threat. They’re almost here.
Barring some last-minute reprieve, come Jan. 1, the CMS will cut Medicare reimbursement payments by 1% for what could be thousands of physicians, group practices and other prescribing providers that have not met the CMS program’s arcane and shifting requirements. The erx program was created under the Medicare Improvements for Patients and Providers Act of 2008 and launched in 2009.
To say the erx program has been a fiasco would be an exaggeration, but it has come under broad and persistent criticism for its complexity, rule changes and lack of harmony with other federal information technology initiatives.
“I have to say it’s not one of their better-run incentive programs,” says Robert Tennant, senior policy adviser to the Medical Group Management Association.
In February, the Government Accountability Office produced a 75-page report criticizing the CMS for unduly burdening physicians and other prescribers by requiring duplicative reporting mechanisms between federal e-prescribing programs. It specifically dinged the CMS for not establishing common certification methods for the technologies those programs required.
Tennant estimates that as many as 80,000 physicians and other prescribers have filed requests with the CMS for exemptions from the looming penalties, but, with only weeks to go before those penalties kick in, Tennant says he’s heard of no physicians who have received a response from the CMS on whether their applications were accepted or denied. If the CMS grants waivers after Jan. 1, “Medicare will be forced to reprocess the claims,” he says. “I think the penalty will catch a lot of docs.”
The CMS erx program authorized e-prescribers bonuses of 2% of Medicare payments for 2009 and 2010; 1% for this year and 2012; and 0.5% for 2013, when the carrots stop.
In 2009, the program paid out $148 million to 47,500 qualified prescribers, according to the GAO. The average payment to e-prescribers under erx in 2009 was about $3,120 and the median payment was about $1,700.
The sticks—penalties with the erx program—as noted come out at 1% next year for noncompliance in 2011. They escalate to 1.5% in 2013 and peak at 2% in 2014, ending that year.
Meanwhile, the CMS’ Medicare electronic health record incentive program, which also has an e-prescribing component and which was created under the American Recovery and Reinvestment Act of 2009, began paying providers this year. Penalties for noncompliance under the EHR program also cut Medicare reimbursements, but they don’t start until 2015. So, penalties for the two programs don’t overlap, except that the statute for the EHR program