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CMS to levy Medicare penalties against physicians

As of Jan. 1, 2015, 257,000 physicians who didn't meet meaningful use measures will have their Medicare reimbursements cut.

If the views of Richard Porwancher, M.D., also represent even some of the quarter of a million physicians who face Medicare penalties from CMS in 2015, there are a lot of unhappy providers to whom EHRs feel more like a burden than a medical advancement.

CMS is set to begin levying 1% and 2% Medicare penalties against some 257,000 physicians who did not attest to meaningful use of EHRs in 2013 and 2014.

The reimbursement reductions will hit doctors starting Jan. 1, 2015, and are built into the provisions of the 2009 HITECH Act, which provided up to $30 billion in financial incentives for doctors and hospitals to adopt EHRs.

Doctors angry at the federal move

But while the penalties -- which can cumulatively total as much as 5% over several years -- were expected, CMS officials' pre-Christmas announcement triggered outrage from the American Medical Association (AMA) and consternation among many doctors who say meaningful use rules are often arbitrary and the penalties unfair. AMA officials said the numbers of doctors to be targeted by penalties were much higher than expected.

Porwancher said his five-doctor infectious disease practice had been unable to attest to meaningful use stage 2 in 2014 after successfully attesting to the less stringent stage 1 in 2013. Porwancher called the meaningful use program "coercive" and unfair, saying his practice has been unable to convince enough of its roughly 2,000 patients to meet the stage 2 measure requiring 10% of a practice's patients to use an electronic portal to communicate with doctors.

"It's neither realistic nor fair to expect 100% compliance with the patient portal. We're begging our patients to help, but we don't have control over our patients," Porwancher said.

Meanwhile, speaking to reporters on a not-for-attribution basis, a CMS official noted in a conference call that about 43,000 doctors who received hardship exceptions will not be subject to reimbursement reductions, but must reapply in 2015 to be exempt from meaningful use in 2016 and avoid future penalties.

Appeals possible

Also, doctors who receive letters in early 2015 notifying them about penalties have until the end of February to request a review of their situations by CMS, the official said.

The official said that the penalties should not be a surprise and that most physicians ought to be able to attest to meaningful use, receive incentives and avoid penalties.

Steven Stack, president-elect of the AMA, said in a statement that that AMA "is appalled by news from the Centers for Medicare and Medicaid Services … that more than 50% of eligible professionals will face penalties under the meaningful use program in 2015, a number that is even worse than we anticipated."

In the statement, Stack lumped in the meaningful use sanctions with other cutbacks and potential reductions in Medicare payments to doctors, including those in the Physician Quality Reporting System and the sustainable growth rate reimbursement formula.

"The penalties physicians are facing under the meaningful use program are part of a regulatory tsunami," Stack said.

Doc says his practice is trying, patients avoid portal

While his practice's EHR includes a portal as required under the meaningful use program, the specific nature of Porwancher's infectious disease practice -- which serves many patients with AIDS and other sexually transmitted diseases, as well as elderly patients -- is such that most patients shy from the portal, he said.

While the portal is secure, Porwancher said patients are still afraid to use it.

"We take care of patients who are rightfully concerned with confidentiality," he said. "We have people who are afraid about us even sending letters to their home."

Let us know what you think about the story; email Shaun Sutner, news and features writer, or contact @SSutner on Twitter.

Next Steps

CMS extends meaningful use hardship exception deadline

Rule proposes change to hardship-exception application process

Meaning use attestation figures by state

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